Pathopharm Final Exam Diseases Flashcards
Edema
Palpable swelling produced by expansion of the interstitial fluid volume.
Causes = increased capillary filtration pressure, decreased capillary colloidal osmotic pressure. omcreased capillary permeability and obstruction of lymph flow.
Symptoms = may interfere with movement, swelling of the ankles and feet
Treatment = assess daily weight, visual assessment, measurement of the affected part and finger pressure. Elevate feet, Diuretic therapy, elastic support stockings and sleeves.
Diabetes Insipidus
Cause by a deficiency of or decreased response to ADH
Symptoms = Patient excretes large volumes of urine, excessive thirst
Treatment= pharmacologic preparations of ADH (Desmopressin), oral anti diabetic agent (Chlorpropamide) and thiazide diuretics
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Results from a failure of the negative feedback system that regulates the release and inhibition of ADH. May be due to stress or a chronic condition (brain and lung tumor)
Symptoms = marked water retention and dilutional hyponantremia
Treatment = fluid restriction (mild cases), diuretics such as mannitol and furosemide
Isotonic Fluid Volume Deficit (Dehydration)
A decrease in the ECF including the circulating blood volume
There are proportionate losses in sodium and water
A loss in body fluids and is accompanied by a decrease in fluid intake
Loss of body fluids due to loss of GI fluids, polyuria, or sweating due to fever and exercise
Symptoms = thirst, loss of body weigh, signs of water conservation by the kidney, impaired temperature regulation, signs of reduced interstitial vascular volume
Treatment = fluid replacement, usually isotonic electrolyte solutions are used for fluid replacement
Isotonic Fluid Volume Excess (Water intoxication)
An isotonic expansion of the EF compartment with increases in both interstitial and vascular volumes
Causes = inadequate sodium and water elimination, excessive sodium intake in relation to output, excessive fluid intake in relation to output.
Symptoms= acute weight gain, increased interstitial fluid volume, increased vascular volume
Treatment = providing a more favorable balance between sodium and water intake and output, sodium restricted diet, and diuretic therapy
Hyponatremia
A plasma sodium concentration below 135 mEq/L
Causes = administration of sodium free parenteral solution, GI losses, sweating, repeated irrigation of body cavities, diuretic use, increased ADH levels, hypothyroidism, heart failure, liver failure, kidney failure
Symptoms = muscle cramps, weakness, headache, depression, apprehension, personality changes, lethargy, stupor, coma, anorexia, nausea, cramps, diarrhea, vomiting, fingerprint edema (Increased ICF)
Treatment = when caused by water intoxication - limit water intake
Symptomatic Hyponatremia = treated with hypertonic saline solution and loop diuretic to increase water elimination
Hypernatremia
Plasma sodium level above 145 mEq/L
Causes =excessive water losses, decreased water intake, excessive sodium intake
Symptoms = thirst and signs of increased ADH levels
Intracellular dehydration
Signs and symptoms = headache, agitation and restlessness, decreased reflexes, seizures and coma, tachycardia, weak and thready pulse, decreased blood pressure, vascular collapse
Treatment = measures to treat the underlying cause of the disorder and fluid replacement therapy
Hypokalemia
A decrease in plasma potassium levels below 3.5 mEq/L
Causes = inadequate intake, excessive renal losses, excessive GI losses, transcompartmental shift
Symptoms = impaired ability to concentrate urine, anorexia, nausea, vomiting, constipation, abdominal distention, muscle flabbiness, weakness, and fatigue, muscle cramps and tenderness, paresthesias and paralysis, postural hypotension, confusion, depression and metabolic alkalosis
*Prominent U wave
Treatment = increasing the intake of food high in potassium, when needed rapidly = IV
Hyperkalemia
An increase plasma levels of potassium in excess of 5 mEq/L
Causes = excessive intake, release from intracellular compartment, inadequate elimination by the kidneys
Symptoms= nausea, vomiting, cramps, diarrhea, paresthsias, weakness, dizziness, muscle cramps, tall and tented T wave, risk of cardiac arrest
Treatment = decreased intake increase potassium output, hemodailysis or peritoneal dialysis (if have renal failure)
Metabolic Alkalosis
An increase in plasma pH due to primary excess in HC03-
Causes = excessive gain of bicarbonate or alkai, excessive loss of hydrogen ions, increased bicarbonate retention, volume contraction
Symptoms = confusion, hyperactive reflexes, tetany, convulsions, hypotension, arrhythmias, respiratory acidosis due to decreased respiratory rate, signs of compensation (decrease rate and depth of respiration, increased urine pH)
Treatment = potassium chloride (accompanying K+ deficit), fluid replacement with normal saline (volume contraction)
Metabolic Acidosis
Decreased plasm HC03- concentration along with a decrease in pH
The body compensates for the decrease in pH by increasing the respiratory rate in an effort to decrease PC02 and H2C03 levels
Causes= excess metabolic acids (increased anion gap), excessive bicarbonate loss (normal anion gap), increased chloride levels (normal anion gap)
Symptoms = anorexia, nausea and vomiting, abdominal pain, weakness, lethargy, general malaise, confusion, stupor, coma, depression of vital signs, peripheral vasodilation, decreased heart rate, arrhythmias, warm and flushed skin, increased rate and depth of respiration, hyperkalemia, acid urine
Treatment = correcting the underlying cause and restoring the fluids and electrolytes that have been lost. Supplement sodium bicarbonate
Respiratory Acidosis
Occurs in condition that impair alveolar ventilation and cause an increase in plasma PC02, along with a decrease in pH, result of decreased ventilation
Cause = depression of respiratory center, lung disease, airway obstruction, disorders of chest wall and respiratory muscles, breathing air with high C02 content
Symptoms = headache, weakness, confusion,depression, paranoia, hallucinations, tremors, paralysis, stupor, coma,skin warm and flushed, and acid urine
Treatment= improving ventilation, mechanical ventilation
Respiratory Alkalosis
Decrease in PC02, which produces can elevation in pH and decrease in HC03-
Causes =excessive ventilation - anxiety, hypoxia, lung disease, stimulation of respiratory center, mechanical ventilation
Symptoms= constriction of cerebral vessels and increased neuronal excitability, dizziness, panic, lightheadedness, tetany, numbness, tingling, seizures, arrhythmias
Treatment= administration of supplemental oxygen, changing ventilator settings, people with hyperventilation should rebreathe using a paper bag
Vitiligo
Pigmentary problem
Causes = precipitated by emotional stress or physical trauma, hypothyroidism, Grave’s, addison, pernicious anemia, Type 2 diabetes, and melanoma
Symptoms = sudden appearance of white patches on the skin, with definite smooth borders on the face, axillae neck or extremities
Treatment = self-tanning lotion, skin stains and cosmetic, irradiation, skin grafting, micropigmentation
Impetigo
Superficial bacterial infection caused by Staphylococci or group A
Causes= during warm summer months, or in warm moist climates, common among infants and young children
Symptoms = appears as small vesicle or pustule or as a large bulla on the face, pruritus often accompanies the lesion
Treatment = oral or intravenous antibiotics
Herpes Zoster (shingles)
An acute, localized vesicular eruption distributed over a dermatomal segment of the skin
Cause= by same herpesvirus, varicella zoster which causes chickenpox.
Symptoms = burning pain, a tingling sensation, extreme sensitivity of the skin to touch, and pruritus along the affected dermatoma
Treatment = antiviral agent, within 72 hours of rash development
Acne Vulgaris
Chronic inflammatory disease, a disorder of adolescents and young adults
Causes= increased sebum production, increased proliferation of the keratinizing epidermal cells that form the sebaceous cells, colonization and proliferation of P. Acnes and inflammation
Also due to poor hygiene, acne as an infectious process, diets high in fatty content and certain foods
Symptoms = acne vulgaris lesions on the back, chest, and shoulders
Treatment = topical agent and systemic antibiotics
Benzoyl peroxide= topical antibacterial, causes vasodilation and increased blood flow
Contact Dermatitis
Allergic Contact Dermatitis = result from cell-mediated, hypersensitivity to an allergen
Irritant Contact Dermatitis = chemicals that irritate the skin
cause irritant contact dermatitis
Cause = mechanical means
Symptoms= burning or stinging sensations, dryness,erythema, or edema, inflammation and vesicles
Treatment= washing affective area (minor case), applying antipruritic creams or lotions and bandaging the exposed areas. Topical corticosterioid may be helpful.
Urticaria (hives)
Pale, raised, itchy papules, that occur in the most superficial aspect of the dermis anywhere on the skin
Cause= immunologic reaction to an antigen in an IgE hypersensitivity response or nonimmunologic response to something unknown
Symptoms = small wheals blanched with pressure, Angioedema(when swelling occurs in the deeper dermis), may be swelling of the tongue and upper airways
Treatment = ice cube to the skin is used to differentiate physical urticaria from chronic urticaria due to other causes, most are treated with second- generation antihistamines that block H1 receptors and do not cause drowsiness (they inhibit vasodilatation, and relieve pruritus)
Psoriasis
Chronic inflammatory skin disease characterize by circumscribed, red, thickened plaques with an overlying silvery-white scale
Cause= uncertain, activate CD4 helper cells produce chemical messengers that stimulate abnormal growth of keratinocytes and dermal blood vessels, skin trauma, stress, infections, xerosis
Symptoms = itching and pain, loss of body fluids, disturbance in regulating temperature
Treatment= no cure, goal = to suppress the signs and symptoms, emollients (hydrate and soften), keratolytic agents (peel), Topical corticosteriods
Diabetes Ketoacidosis (DKA)
Most commonly occurs in a person with Type 1 diabetes, whom the lack of insulin leads to mobilization of fatty acids from adipose tissue because of the unsuppressed adipose cell lipase activity that breaks down triglycerides into fatty acids and glycerol.
The increase in fatty acids levels leads to ketone production by the liver
Causes= stress increases the release of gluconeogenic hormones, infection, pregnancy, or extreme anxiety , omission or inadequate use of insulin
Symptoms = polyuria, polydipsia, nausea, vomiting, and marked fatigue, abdominal pain, and tenderness, fruity smelling breath, hypotension and tachycardia, decreased blood volume
The heart rate increases as the body compensates for a decrease in blood volume and the rate and depth of respirations increase to prevent further decreases in pH
Treatment = to improve circulatory volume and tissue perfusion, decrease blood glucose, correct the acidosis, and correct electrolyte imbalances - administer insulin and intravenous fluid and electrolyte replacement solutions
Type 1 Diabetes Mellitus
Causes= Characterized by destruction of the pancreatic beta cells
Symptoms= an absolute lack of insulin, elevation in blood glucose, and a breakdown of body fats and protein, weight loss is common
Treatment =insulin injections
Type 2 Diabetes Mellitus
Heterogenous condition that describes the presence of hyperglycemia in association with relative insulin deficiency
Causes= insulin resistance, deranged secretion of insulin by the pancreatic beta cells, increased glucose production by the liver
Results from impaired ability of the tissues to use insulin (insulin resistance) accompanied by a relative lack of insulin or impaired release of insulin in relation to blood glucose levels(beta cell destruction)
Also genetic susceptibility and obesity
Symptoms= often asymptomatic, often overweight
Treatment = insulin usually not needed initially, insulin supplementation may be needed at later stages, weight loss typically improves the condition
Hypothyroidism
Congenital hypothyroidism = developed prenatally and is present at birth
Acquired hypothyroidism develops because of primary disease of the thyroid gland or secondary to disorders of hypothalamic or pituitary origin
Cause= result from destruction or dysfunction of the thyroid gland or it can be secondary disorder caused by impaired pituitary function or as a tertiary disorder caused by a hypothalamic dysfunction
Primary hypothyroidism can result from thyroidectomy, most commonly from Hashimoto thyroiditis, an autoimmune disorder in which the thyroid gland may be totally destroyed
Symptoms = goiter, hypo-metabolic state, myxedematous involvement of body tissues, gradual weakness and fatigue, gain weight, loss of appetite, and cold intolerance
As disease progresses= the skin becomes dry and rough and the hair becomes coarse and brittle, the face become puffy, constipation, flatulence, and abdominal distention
Treatment= replacement therapy with synthetic preparations of T3 or T4
Grave’s Disease
State of Hyperthyroidism, goiter, and ophthalmopathy
Causes= autoimmune disorder, characterized by abnormal stimulation of the thyroid gland by thyroid- stimulating antibodies that act on normal TSH receptors
Symptoms= opthalmopathy (from accumulation of T lymphocytes) causing diplopia, visual loss, exopthalmos (protruding eyeball), also presence of a goiter
Treatment = radioiodine treatment
Primary Adrenal Cortical Insufficinecy (Addison’s Disease)
Cause= primary adrenal insufficiency in which adrenal cortical hormones are deficient and ACTH levels are elevated because of lack of feedback inhibition
It is an autoimmune destruction of the adrenal cortex
Symptoms= hyper-pigmentation skin, cardiac insufficiency, hypotension, hypoglycemia, loss of weight (emaciation, anorexia, vomiting, and diarrhea), adrenal atrophy destruction, urinary losses (sodium and water), retention of potassium
Treatment= requires lifetime hormone replacement therapy = oral replacement therapy with higher doses being given during periods of stress , hydrocortisone is the drug of choice for primary adrenal insufficiency
Glucocorticoid Hormone Excess (Cushing Syndrome)
Causes= excess glucocorticoid production by the body
Pituitary form = results from excessive production of ACTH by a tumor of the pituitary gland
Second form = caused by a benign or malignant adrenal tumor
Third form= ectopic Cushing Syndrome = caused by a non-pituitary ACTH secreting tumor
Symptoms = fat pads (“buffalo hump”), emotional disturbances, moon face, cardiac hypertrophy (hypertension), think, wrinkled skin, poor wound healing, pendulous abdomen, abdominal striae, amenorrhea, osteoporosis, ecchymosis, purpura, muscle wasting and weakness
Treatment= to remove or correct the source of hypercortisolism without causing permanent pituitary or adrenal damage
After successful removal = person must receive cortisol replacement therapy for 6 to 12 months
Multiple Sclerosis (MS)
Cause =inflammation and destruction of mostly the white matter of the CNS myelin, immune -mediated
The demyelination of nerve fibers in the white matter of the brain, spinal cord and optic nerve = conduction abnormalities, ranging from decreased conduction velocity to conduction blocks
Symptoms = paresthesias (numbness, tingling, burning sensations or pressure on the face or involved extremities, abnormal gait, bladder and sexual dysfunction, vertigo, nystagmus, fatigue, and speech disturbances
Also, mood swings, depression, euphoria, inattentiveness, apathy, forgetfulness, and loss of memory may occur
Treatment = modifying the course and managing the primary symptoms of the disease, Corticosteriods are the mainstay of treatment for acute attacks = to reduce inflammation, improve nerve conduction
Myasthenia Gravis (MG)
Cause = a disorder of transmission at the neuromuscular junction due to antibody-mediated attack on nicotinic AChR or muscle specific tyrosine kinase that affects communication between the motor neuron and the innervate muscle
- Antibody mediated loss of acetylcholine receptors in the neuromuscular junction, by sensitized helper T cells and an antibody-directed attack on the acetylcholine receptor in the NMJ
Symptoms = muscle weakness and fatigability with sustained effort, most commonly affecting the eye and periorbital muscles with ptosis due to eyelid weakness.
This disease may progress from ocular muscle weakness (chewing and swallowing may be difficult)
Weakness in limb movement, the muscle of the lower face are affected as it progresses impairing speech
Treatment= immunosuppressive therapy, including corticosterioid drugs, reversible anticholinesterase drugs (pridostigmine and neostigmine)
Schizophrenia
Cause = a chronic psychotic illness characterized by disordered thinking and a reduced ability to comprehend reality
Symptoms = Positive symptoms (hallucinations, agitation, tension and paranoia) Negative symptoms (lack of motivation, poverty of speech, blunted affect, poor self-care and social withdrawal) Cognitive symptoms = disordered thinking, reduced ability to focus attention and prominent learning and memory difficulties
Treat = Antipsychotic drugs, these suppress symptoms during acute psychotic episodes and when taken chronically can reduce risk of relapse
Bipolar Disorder
Cause= recurrent fluctuations in mood, mood is abnormally elevated or abnormally depressed, separated by periods in which mood is relatively normal due to an imbalance in neurotransmitters
Symptoms=
Manic Episodes = persistently heightened, expansive, or irritable mood, with hyperactivity, excessive enthusiasm and flight of ideas
Hypomanic Episode = mood is persistently elevated, expansive or irritable
Major Depressive Episode = depressed mood and loss of pleasure or interest in all or nearly all of one’s usual activities and pastimes , including disruption of sleeping and eating patterns, difficulty concentrating, feelings of guilt, worthlessness, and helplessness
Mixed Episode = symptoms of mania and depression simultaneously (risk of suicide)
Treatment=
Mood stabilizers = relieve symptoms during manic and depressive episodes, prevent recurrence of manic and depressive episodes and do not worsen symptoms of mania or depression
Antipsychotic = help control symptoms during severe manic episodes
Antidepressants= always combined with a mood stabilizer
General Anxiety Disorder
Cause = chronic condition characterized by uncontrollable worrying
Symptoms = unrealistic or excessive anxiety about several events or activities (work, or school performance), that lasts 6 months or longer, also vigilance, tension, apprehension, poor concentration, and difficulty falling or staying asleep, trembling, muscle tension, restlessness, and signs of autonomic hyperactivity - palpations, tachycardia, sweating and cold clammy hands
Treatment =
Nondrug therapy = supportive therapy, cognitive behavioral therapy, biofeedback, and relaxation training
Drugs = benzodiazepines (first choice)
Attention- Deficit/ Hyperactivity Disorder (ADHD)
Cause = inattention, hyperactivity, and impulsivity, structural and functional in multiple brain areas
Symptoms = fidgety, unable to concentrate on school work, and unable to wait their turn, switch excessively from one activity to another call out excessively in class and never complete tasks
Treatment = CNS stimulants
Depression
Cause= functional deficiency of monoamine neurotransmitters (norepinephrine, serotonin or both)
Symptoms = depressed mood and loss of pleasure or interest in all or nearly all of one’s usual activities or pastimes , insomnia, anorexia and weight loss, mental slowness, and loss of concentration feelings of guilt and worthlessness, and helplessness (nearly everyday for 2 weeks)
Treatment =
Pharmacotherapy = SSRIs, SNRIs, TCAs, MAOIs, and Atypical antidepressants
Depression-specific pyschotherapy
Somatic therapies - electroconvulsive therapy and transcranial magnetic stimulation
Epilepsy
Cause= chronic neurologic disorders characterized by recurrent seizures, brought on by excessive excitability of neurons in the brain
Symptoms = brief periods of unconsciousness to violent convulsions, problems with learning, memory, and mood
Treatment = antiepileptic drugs
Alzheimer’s Disease
Cause= progressive memory loss, impaired thinking, neuropsychiatric symptoms (hallucinations, delusions), and inability to perform routine tasks of daily living due to cerebral atrophy, degeneration of cholinergic neurons and the presence of neuritic plaques and neurofibrillary tangle
Symptoms= confusion, memory loss, disorientation, getting lost in familiar, problems with routine tasks, changes in personality and judgement , difficulty with activities of daily living, anxiety, suspiciousness, agitation, sleep disturbances, wandering, paces, difficulty recognizes, loss of speech, loss appetite, weight loss, loss of bladder and bowel, total dependence
Treatment= Cholinesterase inhibitors
Parkinson’s Disease
Cause= slowly progressive neurodegenerative disorder, damage to the extrapyramidal system
Symptoms= tremor, rigidity, postural instability and slowed movement, also sleep disturbance, depression, psychosis, dementia
Treatment= Give drugs that can restore the functional balance between dopamine and ACh - dopaminergic agents (directly, or indirectly cause activation of dopamine receptors), and anticholinergic agents (drugs that block receptors ACh)
Asthma
Cause = chronic inflammatory disorder or the airways, airway inflammation results from an immune response to known allergens
Symptoms= inflammation and bronchoconstriction = difficulty breathing
Drugs = inflammatory agents (glucocorticoids) and bronchodilators (beta2 agonist)
Hyperaldosteronism
Caused= excessive secretion of aldosterone, aldosterone-producing adrenal adenoma
Causes= hypokalemia, metabolic alkalosis, and hypertension, and increase the risk of heart failure.
Symptoms= muscle weakness, changes in ECG
Treatment = when an adrenal adenoma is responsible= surgical resection of the adrenal gland, when bilateral adrenal hyperplasia is the cause = aldosterone antagonist (spironolactone)
Hypertension
Cause = elevated blood pressure (above 140/90) Primary = has no identifiable cause Secondary= Chronic renal disease, renovascular disease, oral contraceptive, coarctation of the aorta, primary aldosteronism, Cushing's, Pheochomocytoma, sleep apnea and thyroid or parathyroid disease Symptoms= left untreated can lead to heart disease, kidney disease, and stroke
Treatment = lifestyle modification (weight loss, sodium restriction, alcohol restriction, aerobic exercise, smoking cessation, maintenance of potassium and calcium intake and drug therapy = antihypertensive drugs
Malignant Hyperthermia
Cause= triggered by inhalation anesthetics and greatest when combined with Succinylcholine (a neuromuscular blocker), temperature becomes elevated owing to excessive and uncontrolled metabolic activity in muscle, secondary to increased release of calcium from the SR
Symptoms= muscle rigidity, and profound elevation of temperature
Treatment = immediate discontinuation of succinylcholine and the accompanying anesthetic, cooling the patient with external ice pack and IV infusion of cold saline, and administering intravenous Dantrolene, a drug that stops heat generation by acting directly on skeletal muscle to reduce its metabolic activity
Steven-Johnson’s Syndrome
Cause= hypersensitivity response to sulfonamides
Symptoms= widespread of lesions of the skin and mucous membranes, combined with fever, malaise, and toxemia
Treatment= Sulfonamides should be discontinued immediately if skin rash appears
Hyperglycemic Hypersmolar Nonketotic Syndrome (HHNS)
Cause= severe hyperglycemia brought on by insulin deficiency
Symptoms= a large amount of glucose is excreted in the urine, carrying a large volume of water with it = dehydration, and loss of blood volume, blood thickens, Untreated = severe dehydration, will eventually lead to coma, seizures, and death
Treatment= correcting hyperglycemia and dehydration by use of intravenous insulin, fluids, and electrolytes
HIV/AIDS
Cause= sexual contact, injection drug use, pregnancy, childbirth and breast feeding, occupational exposure, and blood transfusions/ organ transplants
AIDS= late stage of HIV
Symptoms= fever, swollen glands, sore throat, rash, fatigue, muscle and joint pains, headache, as it progresses = rapid weight loss, extreme tiredness, pneumonia, etc.
Treatment= no cure, treatment suppresses the virus (antiretroviral drugs)
Staphyloccus Aureus
Cause= group of bacteria, due to direct infection, or due to production of toxins by the bacteria (impetigo, toxic shock)
Symptoms= collection of pus, boil, furuncle, or abscess, area may be tender, painful, redness and swelling
Treatment= topical, oral, or intravenous, antibiotics
Clostridium Difficile
Cause - Bacteria that grows in the GI tract, that release toxics
Symptoms = watery diarrhea, severe abdominal pain, loss of appetite, fever, blood or pus in stool, and weight loss
Treatment = Oral antibiotics, probiotics, and drinking fluids
Mycoplasma Pneumoniae
Cause= Infection of the lungs by bacteria Symptoms= chest pain, chills, fever, dry cough, excessive sweating, headache, sore throat Treatment= Aspirin for fevers, drink plenty of water, rest and antibiotics
Pseudomona Aeruginosa
Caused by bacteria
Symptoms= endocarditis (fever, murmur), pneumonia (rales, rhonchi, fever, cyanosis, retraction, hypoxia, GI (abdominal distention), skeletal infections, skin infections (lesions, redness, blackness), eye infections
Treatment= antibiotics
Hypotension
Low blood pressure caused by dehydration, to serious medical disorders, blood loss,
Symptoms= dizziness, lightheadedness, lack of concentration, fainting, blurred vision, nausea, cold, clammy pale skin, rapid shallow breathing, fatigue, depression, thirst
Treatment= add more salt to your diet, drink more water, wear compression stockings, medications
