Respiratory and Endocrine Flashcards
1
Q
Tuberculosis
A
- Infectious disorder caused by inhaled Mycobacterium tuberculosis bacteria (Rod-shaped aerobic bacterium requiring an acid fast stain to visualize)
- Spread by inhaled droplets
- The bacillus is intracellular, so antibodies are not created as a defense. Instead the bacterium elicits a delayed cell-mediated response
- Cell mediated response walls off the bacteria and prevents active tuberculosis
2
Q
Primary Infection (TB)
A
-Primary exposure: calcified, fibrotic caseous lesion called a tubercle may remain dormant for years(Latent tuberculosis)
3
Q
Secondary Infection (TB)
A
- Secondary infection leads to:Bloody cough,Cachexia (tissue wasting)
- TB was called consumption
- Symptoms:Fever, night sweats
- May spread to brain, kidney and bones
- Treatment: multi-antibiotic regimen over 12-18 months requiring strict compliance
4
Q
Screening for TB
A
- Mantoux skin test: type IV hypersensitivity reaction against injected antigen
- Must determine with infection in active or latent(May require X-ray, Sputum culture (acid fast stain) is required for diagnosis)
5
Q
Emphysema
A
- Breakdown of connective tissue in lungs causes confluence of alveoli and lack of recoil
- “inflation” – barrel chest due to confluence of alveoli and impaired ability to exhale (air trapping)
- Pink puffer: emphysema (dyspnea, hyperventilation, over inflation to maintain O2 levels)
- Manifestations: increased breath rate, barrel chest, right-sided heart failure, hyperventilation
6
Q
COPD
A
- A group of disorders characterized by progressive tissue degeneration and obstruction of the airways
- In the US, COPD = emphysema and chronic bronchitis
- Frequently leads to cor pulmonale: right sided heart failure due to respiratory disease
7
Q
Asthma
A
- Pathogenesis: constriction of bronchial smooth muscle,Increased mucous secretions
- Triggers: Extrinsic asthma: caused by something outside the body, like an allergen.(Type I hypersensitivity)Intrinsic asthma: caused by an internal trigger, like exercise, infection, etc.(Not a hypersensitivity)
- Manifestations: dyspnea,
- Treatment: Immediate: beta agonist. Long-acting: corticosteroids to prevent attacks. Status asthmatics: patient fails to respond to treatment-emergent treatment required
8
Q
Cystic Fibrosis
A
- Autosomal recessive disorder causing mutation in a chloride channel gene; Leads to production of thick, sticky mucous
- Mucous obstructs respiratory tract, pancreatic ducts, exocrine sweat glands, and reproductive ducts(Salt test)
- Respiratory symptoms
- Bacterial infections due to stagnant secretions; Secretions removed daily by percussion, positioning and coughing; Reduced gas exchange leading to fatigue and acidosis
- GI symptoms: malnutrition, steatorrhea
- Reproduction symptoms: reduced fertility
9
Q
Chronic Bronchitis
A
- Inflammation of the bronchi caused by irritants or infectious agents(Present for at least 3 months for 2 consecutive years)
- May be caused by long term exposure to pollutants or cigarette smoke
- Blue bloater: bronchitis (lower oxygen levels, cyanosis, edema)
- Symptoms: excessive secretion of mucous in bronchi, obstruction of air flow, hypoxia
10
Q
Pneumonia
A
- Acute lung inflammation characterized by inflammatory exudate and impaired gas exchange
- Fever, chest pain, productive cough
- Classified by causative organism (virus, bacteria, fungus) and by what area of the lung is infected
- Sign and symptoms: cough, fatigue, dyspnea, fever, increased WBC, crackles, altered mental status (older patients)
- Where acquired?:Hospital acquired,Community acquired, Secondary pneumonia may result in older and immunocompromised individuals
11
Q
Bronchopneumonia
A
- with localized pattern. (obstruction of small bronchi)
- Diffuse pattern of inflammation
- More common in bed-ridden patients
- “typical”
– bacterial (alveoli filled with fluid)
12
Q
Lobar pneumonia
A
- with a diffuse pattern within the lobe
- “typical”
–bacterial (alveoli filled with fluid)
-Usually caused by Streptococcus pneumoniae
13
Q
Interstitial pneumonia
A
-“atypical”
– viral or mycoplasma
- Diffuse and bilateral
- Fluid in the interstitial space
14
Q
Cushing’s Syndrome
A
- Excess of glucocorticoid hormones
- Signs and symptoms:trunk obesity, buffalo hump, but the arms and legs remain normal, moon shaped face, sdium and water, retention resulting in hypertension, atherosclerosis, muscular weakness and fatigue, easy bruisability, striae (stretch marks) on the abdomen, buttocks, and breasts,poor wound healing, increased susceptibility to infection, bones likely to fracture
- Diagnosis: blood tests for diabetes, electrolyte imbalances, infections, Imaging for tumors
- Treatment: reduce the amount of hormone, medications, surgical removal of the enlarged glands or tumor with hormonal replacement therapy
15
Q
Diabetes Mellitus
A
- Impaired glucose regulation resulting in hyperglycemia.
- Symptoms:glycosuria (glucose in urine),Polyuria(excessive urination),Polydipsia (thirsty), Polyphagia(due to cellular starvation from lack of glucose)
- Tests:Urine test for ketones, fasting blood glucose levels, glucose tolerance testing, glycosylated hemoglobin (Hemoglobin A1c)
- Treatment:regulation of diet, exercise, insulin, and hypoglycemic medications,regulation of the proper insulin dosage may vary
- Oral medications mostly used for type 2 diabetes
- Oral hypoglycemic agents: stimulate secretion of insulin from beta cells that still have some capacity, or make cells more responsive to insulin.
16
Q
Type 1 Diabetes
A
- Destruction of the islet cells; the person fails to produce an adequate amount of insulin
- Must take insulin injections to replace the insulin the pancreas is unable to produce
17
Q
Type 2 Diabetes
A
- The person makes a sufficient amount of insulin, but it has lost its ability to influence the cells of the body.
- Do not take insulin
- Treated by diet, exercise, and oral medications
18
Q
Chronic Complications of Diabetes Mellitus
A
- Macrovascular disorders: Atherosclerosis (increased lipid mobilization, serum cholesterol), thromboembolic strokes, gangrene
- Microvascular disorders: poor wound healing, poor circulation
- Retinopathy: a vascular disorder of the retina that can result in blindness; the minute retinal blood vessels become sclerotic and rupture
- Neuropathy: pain, tingling sensations, loss of feeling, and paralysis.
**Kidney failure
19
Q
Hypoglycemic Shock
A
- Too much insulin, not enough food, or excessive exercise
- Symptoms:light-headedness, faintness, trembles, and perspiration, shallow breathing
- Taking sugar in some form (candy or orange juice) is helpful
- If the glucose level is not raised, speech becomes thick and walking becomes unsteady. Double vision may be experienced, a loss of consciousness may follow.
- Treatment: IV injections of glucose or epinephrine
- Without treatment coma may result.
20
Q
Hyperosmolar hyperglycemic state (HHS)
A
- Hyperglycemic state (250 -400 mg/dL) without ketones
- Results from acute stress or illness, perhaps in Type II diabetes
- Causes severe dehydration due to glycosuria
- Treatment: rehydration in reduction in blood glucose levels, electrolyte replacement
21
Q
Pheochromocytoma
A
- A rare tumor of the adrenal medulla
- overproduction of epinephrine and norepinephrine
- Symptoms: heart palpitations, hypertension, rapid heart rate, chest pain, and weight loss may appear suddenly and sporadically
- Treatment: surgical removal the tumor; medications are also used before surgery to control symptoms caused by excessive epinephrine and norepinephrine -Medical concerns: stroke, assess BP
22
Q
Addison’s Disease
A
- All layers of the adrenal cortex are destroyed, usually due to autoimmune destruction
- Also caused by infectious diseases (TB), opportunistic disease from AIDS, cancers, hemorrhage of the adrenal gland
- Requires replacement therapy for life
- Diagnosis: 24 hour urine test for cortisol or serum cortisol; ACTH stimulation tests for ability of adrenal to respond
- Can result in a life-threatening condition during another acute illness/trauma
23
Q
Hypothyroidism
A
- Symptoms:bloated appearance, thick tongue, puffy eyelids, dry scaly skin, little perspiration, muscular weakness, excessive sleepiness, sluggish mental and physical processes, slurred speech, slow reflexes, decreased heart rate, increased risk of atherosclerosis, anorexia, hair loss, cold
- Causes: Primary disease of the thyroid gland or secondary to pituitary disease. Measure blood levels of T4 and TSH to assess function. May also be caused by iodine deficiency, or use of certain medications
- Autoimmune destruction of the thyroid gland: Hashimoto’s disease
- Treated with replacement therapy
- Severe complication: Myxedema coma; Hypothyroidism with acute illness or trauma; Severe hypotension, hypoglycemia, hypothermia, loss of consciousness
24
Q
Cretinism
A
- Thyroxine is essential to both physical and mental development.
- Congenital thyroid deficiency
- Etiology:error in fetal development
- Early detection is critical as replacement therapy improves prognosis
25
Q
Hyperthyroidism
A
- Hypermetabolic condition due to excess thyroid hormone
- Most common type: Graves’ disease
- Autoimmune disease in which antibodies to a thyroid antigen stimulate hyperactivity of the thyroid gland
- Treatment: destruction of thyroid with radioactive iodine or surgical removal and replacement therapy
- Symptoms:Tachypnea, Insomnia, Profuse perspiration, Hand tremors, Goiter, Weight loss
- Goiter: an enlargement of the thyroid gland
- Endemic goiter: due to lack of iodine
- Toxic goiter: due to excessive stimulation with TSH –
- Goitrogens: foods that contain elements that block T3/T4 production, increasing TSH production(Cabbage, turnips, lithium and fluoride)
26
Q
Pituitary Adenoma
A
- Effect on the skull: causes pressure:headaches, seizures, drowsiness, visual defects
- Effect on the hormone secretion:depends on which cells are involved, as to which hormone(s) are secreted
- Treatment: surgery, radiation, hormone replacement
- Diagnostic Procedures: Serum Assay for hormone levels or levels or chemicals being controlled, (Growth hormone levels (pituitary disorders), TSH, T3, T4 (thyroid disorders), Parathyroid hormone, calcium (parathyroid disorder), Cortisol (adrenal disorder), Glucose levels, tolerance test, hemoglobin A1c); Urine specimen (clearance, levels) and vasopressin test;Stimulation and suppression tests; CT scan or ultrasound; Fast blood glucose, oral glucose tolerance, hemoglobin A1c
- Treatment:Deficits may be treated with replacement therapy
- Excessive secretion may be treated with:Medications,Surgery,Radiation
27
Q
SIADH
A
- Excess ADH: syndrome of inappropriate ADH syndrome (SIADH)
- Fluid retention
- Severe hyponatremia leads to mental confusion and irritability
28
Q
Acromegaly (hyperpituitarism)
A
- Hypersecretion of growth hormone after puberty
- Etiology:adenoma
- Treatment:surgical removal, radiation, supportive treatments
29
Q
Giantism (hyperpituitarism)
A
- Gigantism:Hypersecretion of growth hormone prior to puberty
- Increased linear growth
- May affect hands and feet
- Etiology: adenoma
- Treatment: removal of adenoma or radiation to reduce the size of the tumor
30
Q
Pancreatic function
A
- Exocrine function: releases digestive enzymes through a duct into the duodenum of the small intestines
- Endocrine function:islets of Langerhans produce insulin and glucagon, which antagonize one another in regulation of blood glucose
