Pathology

Question 1

The indicators of a serious situation would be:

Answer 1

-severe symptom.
-life-threatening situation (the ultimate limitation in this life being death).
-moving into deeper levels – either physical or into the emotional/mental levels.
-acute – this indicates sudden change.
-progressive – more symptoms appearing indicating a worsening situation.

Question 2

symtoms of Pericarditis.
Is Pericarditis serious?

Answer 2

sharp pain in the centre of the chest, which may radiate to the neck and shoulders associated with palpitations.
It is better for sitting forward and worse for lying down, movement and breathing.

Pericarditis is the mostt acute/superficial cardiovascularr dissease.

Question 3

What symptoms would indicate that there is no serious condition underlying the loss of consciousness?

Answer 3

• Short duration of loss of consciousness.
• Not due to exercise.
• A specific trigger such as unpleasant event, emotional stress, sight of blood, standing in hot conditions, etc.
• No jerking of limbs whilst unconscious.
• No incontinence during the attack.
• No biting of tongue during the attack.

Question 4

Difference between superficial thrombosi and Deep Venous Thrombosis? and what are the complications of DVT?

Answer 4

DVT is much more serious. It affects the deep veins of the calf.
Complications are Pulmonary Embolism.
Which is most likely to brake from a fresh clot.

Superficial thrombophlebitis is never dangerous. The symptoms of the latter case are painful hardened superficial veins. They may be red and hot also.

Question 5

What is Pulmonary Embolism?

Answer 5

It is where a small area of the clot brakes off and becomes lodged in the lungs.
It can be a complication of DVT.
- Chest pain.
- Breathlessnesss.
- haemoptysis (coughing up blood from lungs).

It is fresh clot which is considered to be the most dangerous, as it is the easiest to break off to form an embolism.

Question 6

predisposing factors that may lead to clotting

Answer 6

• reduced blood flow
• post-operative states
• being elderly
• bed rest
• direct injury to the calf
• increased clotting tendency, e.g. post-operative, oral contraception/HRT, cancer, pregnancy.
• Smoking increases any risk.

Question 7

The predisposing factors involved in the development of heart disease

Answer 7

emotional states such as loneliness and separation.

This is why heart disease is more common in men. Women find it easier to be connected to others and share experiences. Men tend to be more isolated and out of touch with their feelings. Interestingly, as women strive to emulate men in business, the incidence of heart attacks in women is increasing.

Question 8

Does menopause increases the risk of heart attack?

Answer 8

No. The increase in frequency of heart attack in menopausal women reflects no more than increasing age. Menopause has no effect on the rate. It therefore makes no sense to give female hormone replacement treatment to women in an attempt to prevent heart attacks. Oestrogen and progesterone actually increase the likelihood of thrombosis and so obstruction to coronary artery blood flow.

Question 9

Angina pectoris

Answer 9

Hjartaöng: inadequate blood supply to the muscle of the heart.
due to ischaemia or severe anaemia.

Symptoms: pain in the chest (heavy, gripping - NOT sharp/stabbing). Felt in the centre of the chest and often radiates to the neck, back, lower jaw, epigastrium or inner aspect of the arms. The left arm is more often affected than the right.

Comes on with effort and emotional stress particularly in the cold or after a meal. Rest relieves the pain.
Llimit to the amount of exercise before symptoms appear.

There is associated sweating and pallor. Increasing severity of pain. Palpitations. tiredness, shortness of breath on exertion and flatulence.

pain lasting more than 30 minutes is almost certainly a heart attack.

Question 10

Heart Attack

Answer 10

Is the death of heart muscle due to an inadequate blood supply.
Cause is obstruction of the coronary artery due to atherosclerosis.
may occur suddenly or after a history of angina pectoris.
Nott an actual blockage, assumption is spasm of the coronary artery.
actual blockage and the assumption is that spasm of the coronary artery (squash court).

Symptoms:
-Severe and STABBING pain in the chest,
may come on at rest or wake the person at night. Rest does not relieve it.
Lasts for anything between 30 minutes and 2 days.
May be less severe in the elderly.
Palpitations are common.
There is great anxiety during the attack and fear of death.

associated signs of shock: pale, cold, and sweaty with a low blood pressure and rapid, thready pulse.
If there is associated cardiac insufficiency: cough and breathlessnes.
nausea and vomiting, diarrhoea and flatulence.

more extreme and serious form of ischaemia than angina pectoris.

Question 11

Difference between chest pain in Angina pectoris vs Heart attack

Answer 11

Angina pectoris: heavy, gripping. tight, burning.

Heart attack: more severe and stabbing.

Question 12

When is heart attack more likely to occur?

Answer 12

at night.

Question 13

Duration of Angina pectoris pain?

Answer 13

less then 15 minutess

Question 14

Duration of Heart attack pain?

Answer 14

between 30 minutes and 2 days.

Question 15

What triggers and/or makes Angina pectoris worse?

Answer 15

after meals, excersize, cold, emotions,

Question 16

What triggers and/or makes Angina pectoris better?

Answer 16

rests, keeping warm, nitrates

Question 17

What is the danger of sudden heart drug withdrawal?

Answer 17

The most serious risk is with betablockers and calcium antagonists. (calcium antagonistscalcium antagonists).
The heart is then exposed to the full force of adrenaline and a heart attack may follow sudden withdrawal.

Question 18

Lifestyle and diet advice for people with Ischaemic Heart Disease

Answer 18

• Lose excess weight
• Stop smoking
• Gentle graduated exercise
• Relaxation and visualisation exercises
• Discussion about the origin of the condition and how he has the ability, with help, to improve his situation.

Question 19

With heart attack, what is the process taking place in the heart?

Answer 19

There is an interruption in the blood supply of the heart muscle. Part of the heart muscle dies, the exact area affected depends upon the particular artery that is blocked.

Question 20

The 9 questions to ask about pain. And which 4 are most important?

Answer 20

1) Main site (most important)
2) Radiation (most important)
3) Character
4) Severity
5) Duration
6) Frequency
7) Time of occurrence
8) Modalities (most important)
9) Associated phenomena (most important)

Question 21

The 4 most important questions about pain:

Answer 21

Where is it?

Where does it radiate?

What makes it better or worse?

What other symptoms are there?

Question 22

Why does right ventricular insufficiency primarily affect the peripheries?

Answer 22

The heart cannot pump blood around the circulation adequately, and so it collects in the right side of the heart and backwards into the systemic circulation. This ‘excess’ of blood in the systemic circulation causes fluid to leak out into the periphery and the gastrointestinal system, and leads to the typical symptoms above.

Question 23

As the process of cardiac insufficiency is the same in case of left and right-sided types, there are some similarities. They are:

Answer 23

-palpitations
-tiredness
-breathlessness
-cyanosis and pallor

These symptoms have slightly different mechanisms in the two conditions.

Palpitations, tiredness, and pallor, are all directly the result of a weakness in the heart energy.

Breathlessness and cyanosis, however, have different causes.

In the case of left ventricular insufficiency they are due to ‘excess’ blood in the pulmonary circulation leading to oedema. This interferes with gaseous exchange and so levels of oxygen fall causing cyanosis.

In the case of right ventricular insufficiency, there is a decreased supply to the lungs, and so this is the reason for breathlessness and cyanosis.

These different mechanisms thus still lead to the same symptoms.

Question 24

When is chest pain serious? (7)

Answer 24

• If the chest pain is severe
• lasts longer then 20 minutes.
• at rest.
• with vomiting.
• with rapid pulse, low blood pressure, sweating & pallor.
• Increased frequency of attackes.
• Occuring at night.

Question 25

When is Breathlessness serious? (7)

Answer 25

• when breathlessness is severe
• acute
• Progressive
• with confusion
• with cyanosis
• pulse rate > 120 per minute
• paroxysmal attacks occurring at night
  (paroxysmal: sudden recurrence or intensification of symptoms)

Question 26

When are Palpitations serious? (5)

Answer 26

• pulse rate > 120 per minute
• pulse rate < 50 per minute
• with chest pain
• with oedema
• with loss of consciousness

Question 27

When in Oedema serious? (6)

Answer 27

• Acute
• Unilateral
• Severe
• Progressive
• With cardiac symptoms
• With renal symptoms

Question 28

When is Cyanosis serious? (2)

Answer 28

• Central - tongue
• Peripheral - lips and extremities (unless due to cold)

Question 29

When is loss of consciousness serious? (1)

Answer 29

On exercise

Question 30

When is cough serious? (1)

Answer 30

With pink frothy sputum

Question 31

When are distended veins serious? (1)

Answer 31

In abnormal site, e.g. neck when sitting up, over chest, or abdominal wall.

Question 32

Why is it important in people with epigastric and back pain to ask them whether the pain radiates through or round to the back?

Answer 32

The direction of radiation depends upon the organ involved. Pancreatic pain, classically, begins in the epigastrium and radiates through to the back whilst gall bladder pain radiates round to the back. Other sources of help in differentiation will be modalities and associated symptoms.

Question 33

epigastric pain that is worse before a meal and relieved by food suggests

Answer 33

excess acid is an issue. It also points to the duodenum.

Question 34

Name 6 cardinal symptoms of reflux oesophagitis

Answer 34

Burning pain in the epigastrium

Radiates to the chest

Worse for bending, stooping, lying

Worse at night

Better after food and antacids

Better for sitting

Question 35

There are several causes of gastritis. Which non-digestive symptoms may a person with gastritis have?

Answer 35

The main point of this question is that ‘indigestion’ or upper abdominal symptoms commonly arise from the intake of prescribed or over-the-counter drugs. You may see people with joint pains, chronic headaches or other long-term painful conditions for which they are taking aspirin or non-steroidal anti-inflammatory drugs. There are many other drugs that lead to abdominal disturbances such as nausea, vomiting and epigastric pain.

Question 36

is a gastric ulcer

Answer 36

Not due to too high acid levels in stomach. A gastric ulcer is characterised by the presence of low or normal acid levels. The problem, therefore, is primarily to do with the mucous membrane of the stomach.

characterised by epigastric pain, localised in area, worse for eating, better for vomiting and accompanied by a poor appetite and weight loss.

Question 37

A peptic ulcer developes because of

Answer 37

excess acid attacking the mucous membrane or because that mucous membrane cannot resist the effects of normal levels of acid.

Question 38

Duodenal ulcer

Answer 38

characterised by epigastric pain, localised in area, better for eating, better for vomiting, accompanied by a desire to eat regularly and perhaps with weight gain. It may wake the person at night.

Question 39

Reflux oesophagitis

Answer 39

characterised by a burning pain that radiates up into the chest. There may be dysphagia. It will be worse for bending or lying and better for sitting. (With peptic ulcer, the pain remains localised in the epigastrium and there is no effect by changes in posture.)

Question 40

Name four symptoms which may indicate the presence of a complication of a peptic ulcer

Answer 40

Copious vomiting, projectile vomiting, vomit containing food eaten more than 12 hours previously, vomiting blood, black tarry stools, severe abdominal pain with rigidity and shock.

Question 41

Diet and lifestyle factors when treating a person with peptic ulcer?

Answer 41

Diet
Regularity of meals
Emotional state
Drug use which includes tobacco and coffee

Question 42

symptoms of biliary colic

Answer 42

Pain in right hypochondrium or epigastrium

Severe

Radiates to right scapula (round to back)

Restlessness

Vomiting

Pain lasts for an hour or so to be left with an ache

Question 43

cholecystitis

Answer 43

inflammation of gall bladder. The pain of cholecystitis lasts for several days.
accompanied by a fever. Vague, recurrent upper abdominal symptoms of belching, nausea and intolerance for fatty food

Question 44

biliary colic

Answer 44

acute condition due to movement of a gallstone. As this settles back, the symptoms subside. for an hour or so

Question 45

what is the common long-term consequence of cholesystectomy? (surgical removal of the gall bladder)

Answer 45

Diarrhoea

Question 46

What is the main characteristic of pain arising from the pancreas?

Answer 46

Epigastric pain which radiates through to the back.

Question 47

The typical first symptom of cancer of the pancreas

Answer 47

painless jaundice. This is because the tumour can grow for some time without pressing on other structures.

Question 48

Name one modality and one associated symptom which will enable you to differentiate between the six major causes of upper abdominal pain you have studied. These are reflux oesophagitis, duodenal ulcer, gastric ulcer, biliary colic, cholecystitis and pancreatitis.

Answer 48

Reflux oesophagitis:
- Worse stooping (beygja fram)
- Worse lying
- Better sitting
- Better eating
- Better antacids
- Dysphagia
- Pallor and tiredness

Duodenal ulcer:
- Better eating
- Better antacids
- Worse night
- Nausea, vomiting
- Upper abdominal distension
- Belching
- Rumbling in abdomen

Gastric ulcer:
- Worse eating
- Better antacids
- Poor appetite
- Upper abdominal distension
- Belching
- Rumbling in abdomen

Biliary colic (krampar tengt gallsteinum):
- After food especially if fatty
- Vomiting
- Restlessness

Cholecystitis (inflammation of GB):
- After food especially if fatty
- Fever
- Toxaemia
- Rapid pulse rate
- Belching
- Abdominal distension

Pancreatitis:
- After eating
- After alcohol
- Better leaning forward
- Nausea, vomiting
- Rigidity of abdomen
- Symptoms of shock (cold, clammy, light-headedness)

Question 49

why is pancreatitis listed as the most severe of these six diseases of the upper abdomen?

Answer 49

The symptoms of pancreatitis are necessarily severe. Low blood pressure, rapid pulse rate and a rigid abdomen accompany them. It mimics a perforated peptic ulcer. It has a significant mortality in the acute phase. It is, therefore, the most severe of these six diseases.

Question 50

What is peritonitis?
What is the commonest cause of peritonitis?

Answer 50

This is inflammation (-itis) of the peritoneum (lífhimna).
It usually occurs secondarily to appendicitis (inflammation of the appendix - Botnlangabólga).

Question 51

The three main characteristics noted in the abdomen of someone with peritonitis?

Answer 51

Severe pain with immobility

Rebound tenderness (means more pain when pressure on the tender area is released)

Rigidity of the abdominal muscles

These are the classical appearances of peritonitis and indicate serious disease.

Question 52

What is considered to be the cause of the inflammation in Crohn’s disease and ulcerative colitis?

Answer 52

They are considered to be due to autoimmune mechanisms where the body’s immune system attacks its own organs.

Question 53

Which is more serious.. Crohn’s disease or ulcerative colitis?

Answer 53

Crohn’s disease.
- Affeectts all 3 layers of intestines.
- If surgery, it spreads to previously unaffectd areas.
- systemic symptoms
- fistulae

Question 54

Important issues which have to be considered when dealing with people who take powerful prescribed medication such as corticosteroids?

Answer 54

It is essential not to stop them suddenly or reduce them too quickly.

A degree of dependence will be inevitable - physical and psychological.

Long-term prescription will lead to weakening of people’s constitution.

Holistic treatment will necessarily be prolonged, as the person needs to be strengthened to the point where they can reduce the drugs.

It is helpful to support the person in many ways in order to maximise their health.

Question 55

The Cause of Diverticular Disease

Answer 55

due to inadequate fibre and roughage in the diet. This leads to increases in intra-colonic pressure as the faeces is not bulky enough to allow the intestines to function correctly. Long-term this will lead to the appearances of diverticuli.

Question 56

In terms of conventional medicine, what leads to the formation of jaundice?

Answer 56

Jaundice is caused by an increase in the level of bilirubin in the blood. Bilirubin is a breakdown product of haemoglobin which is the ‘red’ of red blood cells.

Question 57

What is the most common Hepatitis? and how do you get it?

Answer 57

Hepatitis C.
You get it from blood transfusions and through intravenous drug use.

Question 58

What are the commonest causes of cirrhosis?

Answer 58

The two main types are as a result of excessive alcohol intake or after hepatitis (particularly Types B and C). Of course, other chemicals and toxins affect the liver and can lead to cirrhosis but alcohol is the most usual.

Question 59

The key symptom for large intestine cancer

Answer 59

change in bowel habit of recent onset, with rectal bleeding

Question 60

Symptoms of cancer of Oesophagus

Answer 60

• Dysphagia first - sensation of swallowed food being stuck.
• Vomiting later as the obstruction developes and eventuallyy an inability to take anything orallyy other than fluid.

Question 61

Symptoms of cancer of the Stomach

Answer 61

• Vomiting of blood.
• Lump felt in the upper abdomen.
• Upper abdomen distension.
• Constipation develops later.

Question 62

Symptoms of cancer of the Large intestine

Answer 62

• Caecum (beginning of Large intestine): canges in bowel habit occur late as faeces are liquid.
• Rectum: constipation occurs early.
• Marked abdominal distension.
• Vomiting occurs late
• Bleeding - seen on the surface of the stool with rectal and anal cancers, mixed with faeces for others. the blood is redder the lower down in the bowel is the cancer.
• Lump felt in abdomen - tends to hard, fixed, irregular.

Question 63

Duodenal ulcers are associated with high or low acid levels?

Answer 63

High acid levels which lead to erosion of the mucosa

Question 64

Stomach ulcers are associated with high or low acid levels?

Answer 64

Low acid levels

Question 65

is it Duodenal or Stomach ulcers that are associated with losing weight?

Answer 65

Stomach ulcers, because people feel pain an hour or so after eating so they become afraid of eating.

Question 66

is it Duodenal or Stomach ulcers that are associated with gaining weight?

Answer 66

Duodenal ulcers, because the pain is relieved by eating.

Question 67

How would you know if sensory symtomps of the nervous system are serious?

Answer 67

if they are progressive. e.g. if they go from pins and needles to numbness, like in the case of a stroke.

Question 68

Cautions for treating nervous system

Answer 68

treat patiently and over a long period of time. Herbs are not sufficient alone to treat stress and nervous disorders so you must investigate the underlying cause. Lifestyle changes including rest and relaxation must be applied. You should never give herbs to a patient on medication for depression, stress, anxiety, epilepsy etc. without their doctor’s approval and supervision.

Question 69

Indications that a symptom or group of symptoms may be caused by cancer is

Answer 69

• Progressive nature
• Short history

Question 70

Brain Tumour Symptoms

Answer 70

Headache – especially if it feels worse than a normal headache or different. Usually caused by build
up of pressure in skull. Can be worse for bending, coughing, and straining. It is worse for walking and
when lying flat.
Seizures (fits)
Nausea and vomiting
Drowsiness and tiredness
Speech problems
Visual disturbances
Organ dysfunction dependent on the actual part of the brain involved
Tingling
Numbness
Weakness or Paralysis – generally on one side of the body
Personality changes

Brain tumours affect local brain tissue causing remote issues and the growing tumour also puts
increased pressure on the brain as it grows inside the rigid bony skull.

Stroke and epilepsy may result from pressure in the skull and pressure placed on nerve tracts.

Brain tumours can be non-cancerous (benign) low grade and slow growing or cancerous (malignant),
start in brain or spread there from other areas and are more likely to return.

Eventually consciousness is affected with drowsiness, sleepiness and then coma.

Symptoms generally develop in a progressive fashion over the course of several weeks or months with the
addition of new symptoms during that time.
History is generally shorter than chronic disease. Weeks or months rather than progression over months/ years.

Question 71

Circumstances where hoarseness is noticed.

Answer 71

• Laryngitis – swelling of the vocal cords caused by allergies, upper respiratory infection, or a cold.
• Shouting or Singing – Misuse of the voice.
• GERD – Gastroesophageal reflux disease. Caused by heartburn, acid entering the oesophagus mainly due to flap not closing properly and over production of acid in the stomach. The stomach acid irritates the tissue in the oesophagus and sometimes as high up as the larynx, causing severe inflammation.
• Vocal Polyps, cysts, and nodules. usually from overwork, common with singers or those who use their voice a lot. Like a callus on your hand, causing inflammation and restriction of the chords.
• Infection of the vocal cords – Thyroid cancer, Lyme disease, MS.
• Stroke or Parkinson’s affects the part of the brain that controls the voice.
• Laryngeal cancer – note if hoarse for longer than 3 weeks and other diagnosis don’t fit.
• Thyroid issues – inflammation or cancer can affect the voice box.

Question 72

The 2 key features indicating cancer are

Answer 72

short history and progression of symptoms.