System interactions Flashcards
1
Q
What are risk factors that can contribute to obesity
A
Sedentary lifestyle
genetic predisposition
medications that increase appetite or food cravings high glycemic diet
environmental factors: smoking cessation stress abuse history
underlying illness
2
Q
What illness is predispose individuals to obesity
A
Polycystic ovarian syndrome
Cushing’s disease
hypothyroidism
Prader Willi syndrome
3
Q
What are cardiac physiologic changes that are commonly associated with obesity
A
Cardiomyopathy heart failure abnormal ventricular remodeling hypertrophy atrial fibrillation dysrhythmias
4
Q
What are pulmonary physiologic changes that are commonly associated with obesity
A
obstructive sleep apnea,
asthma,
hypoventilation syndrome
5
Q
What are kidney physiologic changes that are commonly associated with obesity
A
Decreased renal perfusion
6
Q
What are Genitourinary physiologic changes that are commonly associated with obesity
A
Urinary incontinence
infertility
7
Q
What are vascular physiologic changes that are commonly associated with obesity
A
Altered cardiac output and stroke volume hypertension varicosities increase total blood volume Venous insufficiency
8
Q
What are MSK physiologic changes that are commonly associated with obesity
A
Osteoarthritis
altered mobility patterns
9
Q
What are Adipose tissue, liver , pancreas physiologic changes that are commonly associated with obesity
A
increased adipokine production, fatty liver disease insulin resistance type two diabetes
10
Q
Is the best way to address a child’s Appearance of extra weight and the long-term health concerns
A
Conversation with child’s pediatrician is best way to determine if extra weight is truly a long-term concern
11
Q
When is a child considered overweight? Obese?
A
overweight 85-94 percentiles
Obese over 95 percentile
12
Q
Important factors when characterizing patients with obesity risks
A
BMI ]
hip to waist ratio
distribution of body fat
waist circumference
13
Q
What is lipedema
A
Undefined ideology affecting physical size and distribution of adipose cells in the body.
Appears in lower extremities of woman.
Sometimes appears as big legs and unsymmetrical body disproportions.
Patient should be educated and realistic outcome expectations and not assume weight loss or fix overall morphological proportion.
Exercise will help some
14
Q
Pear shape
A
Gluteal femoral obesity
peripheral fat distribution
common in women
associated with lower incidence of obesity related risk factors
15
Q
Apple shape
A
Central fat distribution
abdominal obesity
highly correlated with cardiovascular disease type 2DM
attributed to higher percentage of metabolically active visceral fat
16
Q
True or false waist circumference measures may be better predictors of diabetes and cardiovascular risk then BMI alone
A
true central obesity= > 40 males > 36 females hip to waist ratio >1 males >.85 females
17
Q
Carbohydrates
A
- Needed for high intensity exercise
- poor carbohydrate intake leads to protein consumption
- main source of feul for the CNS
- Simple carbs increase blood glucose
- complex carbs need to be broken down before they are used, increase BG levels slower
- glycemic index indicates how fast BG level will increase depending on carb breakdown
18
Q
Fats
A
- Primary fuel source for low intensity exercise
- Help protect organs, insulte body, help transport fat soluble vitamins
- Saturated fats- animal fat, bad cholesterol LDL
- non satureated fats: plant based fat, good cholesterol HDL
19
Q
Protein
A
- responsible for growth, and maintenance of body tissue
- skin ligaments and muscle
- .8 grams/ kilogram
- There are 20 amino acids, 9 of them are essential amino acids which cant be produced by the body
20
Q
can vitamins be prodiced by the body?
A
no
21
Q
fat soluble vitamins
A
A D E K
- absorbed by intestinal tract
- stored in liver and fatty tissues
- proteins carry vitamins thro body
- may reach toxic levels
22
Q
Vitamin a
A
Essential for eyes, epithelial tissue growth development and reproduction.
Deficiency: nights blindness rough dry skin growth failure
Toxicity: appetite loss hair loss and enlarged liver/spleen
23
Q
Vitamin D
A
Increases blood flow levels of calcium and phosphorus
Deficiency: faulty bone growth, rickets, osteomalacia.
Toxicity calcification of soft tissue, hypercalcemia
24
Q
Vitamin E
A
Antioxidant in cell membranes. Important for cell integrity for lungs and red blood cells
Toxicity: Breakdown of RBC
Deficiency: Decreased thyroid hormone increased triglycerides
25
Vitamin K
Necessary for at least two blood clotting proteins
Toxicity: Hemorrhage and defective blood clotting
Deficiency: cant happen
26
What are water soluble vitamins
```
Vitamin B2 riboflavin
vitamin B3 Niacin
vitamin B6 Pyridoxine
Vitamin B12 cobalamin
vitamin C
biotin
choline
folic acid
```
27
What is recommended intake for fruits a day ?
1.5 - 2 cups per day.
| One cup = cup of fruit, fruit juice or 1/2 of cup of dried fruit
28
What is recommended intake for veggies a day ?
2.5-3 cups/ day
| One cup = cup of veggies or juice or 2 cups a raw leafy greens
29
What is recommended intake for grains a day ?
5-8 ounces
1 ounce = 1 bread slice, cup of ceral, 1/2 cup of cooked pasta or rice
whole grains recommended
30
What is recommended intake for protein a day ?
5-6.5 ounces
| Ounce = cup of meat poultry fish, one egg. 1/2 ounce of nuts or seeds or 1/4 cup of cooked beans
31
What is recommended intake for dairy a day ?
3 cups/ day
32
what physiological changes occur with pregnancy
weight gain 25-35 lbs
uterus ascends into ab cavity and becomes ab organ
rib expansion to make room for uterus
diaphragm elevates 4 cm
- increased depth of respiration, tidal volume, min ventilation
- increased O2 consumption 15-20% blood volume 40-50% and CO 30-60%
33
what p postural changes occur with pregnancy
- hypotension in supine
- ab become overstretched
- ligs become lax
- joints are hypermobile
34
what is the recommended exercise during pregnancy
```
30 mins at 50-60 of max HR
loose clothing
NWB
avoid becoming overtired and stay hydrated
avoid supine p. 1st trimester
```
35
when is exercise not safe during pregnancy - relative contraindications
Relative:
- Severe anemia
- unevaluated cardiac disease disarrhythmia
- chronic bronchitis
- BMI < 12
- extreme sedentary lifestyle
- intrauterine growth restriction in current preg
- poor controlled HTN
- orthopedic limitation
- poorly controlled seizures, hypothyroidism, Diabetes 1, -HTN
- heavy smoker
36
when is exercise not safe during pregnancy - absolute contraindications
- Sig hemodynamic heart disease
- restrictive lung dx
- incopetent cervix
- premature labure risk
- bleeding
- placenta previa @ 26 weeks
- preclampsia, preg induced HTN
37
how many more calories are required a day in pregnancy
300
| if exercising, be aware
38
how should exercise be handed after dleivery
preg changes lst 4-6 weeks after delivery
39
how can you reduce pressure on the vena cava during preg?
left side lying
40
what types of exercises should be avoided in preg
- valsalva
| - ab exercises may induce contractions
41
What are the three methods for in enteral administration
Oral: absorption into the G.I. track via mouth allows for gradual increase of drug levels that are unpredictable. Outside must be non-lipid soluble so it may pass the intestinal track and be absorbed by the lining and degraded by the liver. Lipid soluble capsule for ingestion
Sub lingual: under the tongue or between the cheek and gums so drug may be introduced to the venous circulation directly to the heart. Fast introduction four cases of acute pain like angina. Drug bypass his liver and is not overly metabolized.
Rectal administration: is for patients who are of unconscious. drugs are not absorbed as well through the rectal cavity compared to sublingual and oral
42
Which route of administration allows for 100% bio availability
Intravenous administration. Inserted into peripheral vein to enter bloodstream.
43
What is a benefit of drug inhalation for drug administration
Lungs offer large surface area for absorption and can enter systemic circulation rapidly. May irritate respiratory tract. Often used for treating pulmonary pathology
44
What is the difference between topical and transdermal drug administration routes
Topical administration is applied directly on the skin or mucous membranes. Poorly absorbed through the skin therefore is reserved for treating look like skin ear or nose disorders. Mucous membranes are able to absorb drug better and can be used to treat systemic conditions.
Transdermal: Drug is applied directly to the skin with the intention to absorb through skin and enter systemic circulation. Slow and controlled release of drug over long period of time. Use of patch through Intophoresis and phonophoresis. Drug cannot penetrate the skin if degraded by dermal enzymes.
45
Factors affect pharmacokinetics
```
Age.
Weight.
Genetics.
Disease.
Exercise.
Medications.
Food- The stomach will speed absorption into bloodstream.Food with medication to avoid gastric irritation.
```
46
Is the intention of intra-arterial administration for drugs
Intended to be injected in an artery to travel directly to target tissues. Difficult because drug is intended to act at specific site without affecting other tissues, chemotherapy
47
What types of drug administration routes administered with injection
Intravenous
intra-arterial
subcutaneous-Injection directly under the skin can be useful when slow release into systemic circulation is required. Can be affected with Lynn mobility cold heat or massage.
intramuscular - Drug injected directly into muscle absorbed faster than subcutaneous injection.
intrathecal- Injected directly into the sheath like spinal meninges for drug to affect CNS without passing BBB
48
Bio availability
Percent of drug available in systemic circulation from site of original administration.
49
Pharmacodynamics
Drug affects on the body on a cellular level
| what to drug does to the body
50
Pharmacokinetics
How drugs are absorbed distributed metabolize and eliminated by the body
- what the body does to the drug
51
therapeutic index
Compares the therapeutic effect of the drug/effectiveness with lethal effects.
-Low TI indicates risky drug making patients taking his drugs being frequently monitored for adverse reactions.
52
Patient considerations for post surgical status with side effects of general anesthesia
Confusion and muscle weakness. Retention of pulmonary secretions; initiate breathing exercises or postural drainage with patient
53
What are considerations for a patient who has local anesthesia
- Spinal or local nerve block
- When using a transdermal patch, avoid using heat to avoid accelerated rate of absorption.
- Sensation and motor control may be diminished.
- Bracing may be needed, exercises should be performed cautiously.
54
What consideration should be made with anti-arthritic drugs and physical therapy
Glucocorticoid drugs can have catabolic affects that lead to break down a tendon bone in skin.
-Be cautious with stretching and strengthening exercises to reduce risk of fracture and soft tissue injury.
-
55
Antiepileptic drug systemic effects considerations
Cerbeller side effects; ataxia common.
Loss of coordination.
Cause skin to the conditions; dermatitis
56
Skeletal muscle relaxants systemic effects considerations
- Sedation and muscle weakness common side effects.
| - Avoid reducing spastic tone if it is functional.
57
Anti-Parkinson's drug systemic effects considerations
Roughly 1 hour after levodopa admin
- Closely monitor BP.
- May produce orthostatic hypotension and increased fall risk
58
Anti-hypertensive drug systemic effects considerations
-Increased risk for orthostatic hypotension.
59
anti- anginal drug systemic effects considerations
- Due to the limitation of angina episodes some patients may have increase of exercises tolerance
- pts taking beta blockers or Ca channel blockers will have reduced ability to tolerate higher loads
- Increased risk for orthostatic hypotension 2/2 vasodilation
60
Anti-arrhythmic drug systemic effects considerations
--Increased risk for orthostatic hypotension
61
CHF drug systemic effects considerations
-Fatigue and muscle weakness associated with decreased fluid and electrolyte levels
62
Anticoagulation drug systemic effects considerations
0Increased risk for bleeding.
| – Use caution with exercises that caused tissue trauma like massage or percussion
63
respiratory drug systemic effects considerations
-Cardiac arrhythmias
- confusion
- tremors.
– Signs of toxicity to be closely monitored.
-Mucolytic and expectorants should be taken 30 to 60 minutes prior to physical therapy
64
sedative drug systemic effects considerations
- pt will be calm at first, but will be drowsy at peak effectiveness.
- Schedule accordingly for physical therapy
65
antidepressants drug systemic effects considerations
Some drugs can negatively affect therapy with muscle weakness, sedation, increased risk for orthostatic hypotension, hypertension, monitor BP regularly
66
anti-psychotic drug systemic effects considerations
Dyskinesia or dystonia (extra pyramidal symptoms)
67
Gastrointestinal drug systemic effects considerations
Dizziness
fatigue
G.I. disturbances
68
Adrenocorticosteroid drug systemic effects considerations
Glucocorticoid drugs can have catabolic affects that lead to break down a tendon bone in skin.
- Be cautious with stretching and strengthening exercises
- Moderate strengthening and weight-bearing exercise can decrease catabolic affects.
- Glucocorticoids and mineral corticoid can lead to water retention and increase hypertension.
69
Sec Hormone replacement drug systemic effects considerations
hypertension 2/2 water retention
70
Thyroid drug systemic effects considerations
Produce side effects associated with symptoms of the opposite condition of hyper or hypo thyroidism
- Hypothyroidism: decreased cardiac function can't tolerate workloads.
71
Antibacterial drug systemic effects considerations
Increased sensitivity of skin and respiratory tract.
| -Use caution with UV light for adverse skin reactions
72
Bone regulating mineral agents
Action: enhance bone density, prevent bone loss and rate of reabsorption
Indication: Pagets, osteoporosis, hyper/hypo parathyroidism, rickets, osteomalacia
Side effects: GI distress dyspepsia, dysphagia, anorexia, bone pain cardiac arrhythmia
PT implication: High risk for bone FX, WB for bone formation stimulation
Examples: Estrogens(premarin), Ca+, vitamin D, (tums, calderol) biphospahtes (fosamax, boniva,) calcitonin anabolic agents (cibcalcin)
73
hormone replacement agents
Action: normal endocrine fxn when there is a deficiency
74
Antacids
Action: neutralize gastric acid, increase Ph in stoamch
Indication: GERD, indigestion, heart burn, peptic ulcer
Side effects: constipation diarrhea
75
anticholinergics
Action: block Ach effect on parietal cells and stop release of gastric acid
Indication: ulcers
Side effects: dry mouth, confusion, constipation, urinary retention
Examples: gastrozepin, muscarinic cholinergic antagonist
76
H2 receptor blcokers
Action: bind to histamine receptors to prevent histamine activated release of gastric acid release stimulated during food intake
Indication: dyspepsia, acute and long term mgmt of peptic ulcer
Side effects: headache, dizzy, mild GI distress, arthalfia,
Examples: zantac, pepcid, tagamet
77
proton pump inhibitor
Action: block secretions of acid from gastric cells
Indication: dyspepsia, GERD, prevention of esophagus erosion
Side effects: acid rebound after discontinues use
Examples: Prevacid, nexium, protonix, AcipHex, Prilosic
78
What are possible etiologies in the LUQ
```
Gastric ulcer
perforated colon
pneumonia
spleen injury/rupture
aortic aneurysm
```
79
What are possible etiologies in the RUQ
```
hepatomegaly
duodenal ulcer
cholecystitis
pneumonia
hepatitis
biliary stones
```
80
What are possible etiologies in the LLQ
```
perforated colon
illetis
sigmoid diverticulitis
kidney stone
ureteral stone
intestinal obstruction
```
81
What are possible etiologies in the RLQ
```
kidney stone
ureteral stone
meckel diverticulum
appendicitis
cholecystitis
intestinal obstruction
```
82
what are examples of overactive bladder meds?
ditropan, detrol
83
what are examples of urinary anti-infective meds?
used for nocturia, cystitis, burning with urination, UTI
| - cinobac, furadantin
84
alkylating agents
- oncology mgmt
- bind DNA strands together to prevent replication in order for cell death
- mustargen, Busuflex
85
what are neurosis disorder
- characterized by fear and maladaptive strategy with stressful or everyday activity
- not psychosis
- no delusions
- realize they have an issue
- anxiety
- ODC
- Phobia
86
what are disscociaive disorders
multiple personality
psychogenic amnesia
- pts dissacosites 1 part of mind from rest
87
personality disorders
Antisocial behavior
borderline behavior
narcissistic behavior
psychopathic personality
88
somatoform disorders
classified on physical symptoms without underlying causes
89
How can you diagnose lymphedema
Diagnose their history physical exam and imaging techniques
90
What is the difference between direct lymphography indirect lymphography and lymphoscintigraphy
direct lymphography - Contrast medium injected into lymph vessels to show entire lymph system through radiography. No commonly used 2/2 complications of contrast
indirect lymphography - Direction of contrast medium (water soluble) to show smaller superficial Lymph vessels
lymphoscintigraphy- More commonly used than direct lymphography to visualize lymphatic system through nuclear imaging (safer). Radioactive material is traced to to show how effective length is at being transported.
91
The primary sign is of lymphedema
Swelling in the extremities. Lymphatic system can no longer handle volume of fluid, fluid builds up in interstitium, leads to enlarged limbs.
Patient CC: Achiness fullness and heaviness. With progression valves expand become incompetent and lead to fluid accumulation.
-Proteins will degrade and lead to chronic inflammation
92
What is the progression of lymphedema
- Proteins will degrade and lead to chronic inflammation
- Fibrotic tissue changes to the surrounding tissue.
- fibrosis results in local hypoxia
- further chronic inflammation
- increased risk for infection
93
How do you classify lymphedema
Limb symmetry compared to opposite limb
-Measurements are made every 10 or 5 cm
- 7 circumference measurements are recommended for upper and lower extremities to make sure that fluid has been removed and not re-distributed
Mild <3
moderate 3–5
severe >5
94
Stage 0 lymphedema
Clinical stage.
No visible edema.
Transport capacity of lymph system is affected
95
Stage 1 lymphedema
Reversible lymphedema stage.
Pitting Edema.
Putting Edema increases with activity or heat and diminishes with elevation/rest
96
Stage 2 lymphedema
Spontaneously irreversible lymphedema stage.
Edema is now non-pitting.
Edema does not change with elevation or rest.
Skin changes: fibrotic changes and risk of infection increases
Stemmer sign is +
(Stemmer's Sign: thickened skin fold at base of the 2nd toe/finger is diagnostic sign for lymphedema. + when tissue cannot be lifted but can only be grasped as a lump of tissue; it is negative when it is possible to lift the tissue normally.)
97
Stage 3 lymphedema
```
Lymphostatic elephantiasis.
Extensive non-pitting edema
Significant fibrotic changes to skin.
Presence of papilloma, deep skinfold and hyper keratosis.
Infection is common.
Stemmer sign +
```
98
Contraindications to complete decongestive therapy
```
(for Manual lymphatic drainage, compression therapy, exercise and skin care)
- acute infection
diabetes
cardiac edema
hypertension
malignancy
DVT
renal insufficiency
```
99
What is the difference between lymphadenitis and lymphangitis
lymphadenitis- Infection/inflammation of a lymph node acute or chronic
lymphangitis- Infection/inflammation of lymphatic system pathways
100
What is the difference between lymphadenomegaly and lymphadenopathy
lymphadenomegaly- enlargement of lymph nodes occurs secondary to cancer infection or allergic reaction
lymphadenopathy- Disease that affects size number or consistency of lymph nodes
101
Risk factors for cancer
```
Older age
tobacco alcohol use
gender
virus exposure
environmental influence
poor diet
stress
occupational hazards
ethnic and genetic background
sexual/reproductive behavior
```
102
what does CAUTION stand for
General signs and symptoms of cancer
```
C: change in bowel and bladder
A: a sore that will not heal
U: unusual bleeding/discharge
T : Thickening lump develops
I: indigestion or difficulty swallowing
O: obvious change in wart/ mole
N: nagging cough hoarseness
```
103
Primary cancer prevention secondary cancer prevention tertiary cancer prevention
Primary: Elimination of modifiable risk factors, use of natural agents teas and vitamins, cancer vaccine
2nd: Detection selective preventative pharmacological agents; tamoxifen, multi factorial risk reduction
3rd: When disability from secondary cancer and treatment, manage symptoms, limit complications
104
Tumor classification for epithelium tissue
carcinoma
| adenocarcinoma for glandular tissue like prostate
105
Tumor classification for pigmented cells tissue
malignant melanoma
106
Tumor classification for connective tissues
```
Sarcoma
fibrosarcoma
liposarcoma
chondrosarcoma
osteosarcoma
hemangioma sarcoma
Leiomyosarcoma (smooth muscle)
rhabdomyosarcoma (soft tissue, hollow organs, bladder)
```
107
Tumor classification for nerve tissues
```
Astrocytoma
glioma
neurilemma
sarcoma
neuroblastoma
retinoblastoma
```
108
Tumor classification for lymphoid tissues
lymphoma
| Includes lymphatic tissues lymph nodes spleen can appear in stomach intestines skin CNS bone and tonsils
109
hematopoetic tissue
```
(Bone marrow plasma cells)
Leukemia
myelodysplasia
myeloproliferative syndromes
multiple myeloma
```
110
Stage 0 cancer
cancer is present only in the layer of cells it began
| - not all cancers hace stage 0
111
Stage 1 cancer
- limited to tissue of origin no lymph node involvement
112
Stage 2 cancer
- malignancy spreading to adj tissues
| - lymph nodes may show micro metastases
113
Stage 3 cancer
- spreads to deeper tissues
- signs of fixation to deeper tissue
- lymph involvement is high
114
Stage 4 cancer
- has metastasized beyond primary site
| - to other bone or organ
115
clinical vs pathologic staging
clinc: physical exam, labs, biopsy
pathologic: found during sx
116
What is the most prominent type of cancer with an extremely high mortality rate
Pancreatic cancer
117
What is the most common type of prostate cancer
Adenocarcinoma
118
Slow growing form of skin cancer rarely metastasize
Basal cell carcinoma
119
Accounts for approximately 15% of cancer deaths
Colorectal cancer
| -Adeno carcinoma and primary lymphoma account for majority of intestinal cancers
120
Counts for 50% of pediatric brain tumors
Astrocytoma
121
Leukemia
Blood cancer occurs with leukocytes that change into malignant cells. Proliferate into Brown Marrow sees production of normal cells
122
Most common malignant tumor seen in children primarily seen in adrenal glands and paraspinal ganglia
Neuroblastoma
123
Occurs in the epiphysis of long bones most common form of bone cancer in children peak incidence of 10 to 20
Osteogenic Osteogenic sarcoma
124
Wilms tumor
Neuroblastoma found in kidney. Diagnosed between 1-4 four years old
125
when is Surgery indicated as an oncology treatment option
- Indicated for prophylactic diagnostic or curative palliative goals.
- Adjunct therapies destroy a residual malignant cells
126
When is radiation most useful
-Localized malignancy.
May be used prior to surgical intervention palliatively to shrink malignant mass or postsurgically to ensure destruction of cells
127
What type of therapeutic agents are included in chemotherapy?
when is it indicated
```
Alkylating agents
anti-metabolite agents
steroid hormones
plant alkaloid agents
interferons
antitumor antibiotics.
-Widespread and metastatic malignancy
```
128
What is bio therapy (immunotherapy)
Strengthens patient's biological response to malignant cells.
Interferons, interleukin two, bone marrow transplant, stem cell transplant monoclonal antibodies, hormonal therapy, colony stimulating factors are used.
129
What is antiangiogenic therapy for cancer
- uses thalidomide to suppress blood supply formation
| - blocks process of growth not destruction
130
How long is heat and massage contraindicated over areas of chemotherapy and malignancy
12 months
131
What is an affective disorder?
```
mood/emotion disturbance
emotion are extreme and unrealistic
- bipolar
-depression
- mania
```
132
What is a dissociative disorder?
person unconsciously separates/ dissociates one part of the mind from the rest
- multiple personality
- psychogenic amnesia - forgets all spects of the past, no physical cause
133
What is a neuroses disorder?
Disorder with maladaptive strategy for dealing with stress and every day stimuli. Not psychosis no delusions patients realize they have a problem.
Anxiety disorder
OCD
phobia disorder
134
What is a personality disorder?
Dysfunctional view of society and level of sadness ongoing patterns of dysfunctional behavior.
- Antisocial behavior need for attention or gang involvement.
Has some concern for others, blames institutions seen before 16 y.o old lacks responsibility emotional stability
- Borderline behavior: Instability in all aspects of life recognizes self identity, uses projection, denial, defensiveness. Unpredictable mood, intense and uncontrolled anger
- Narcissistic behavior: cant love,self absorbed
- psychopathic personality low morality, little remorse, expert liar,
135
what are Schizophrenia disorders
Psychotic in nature, disorganized thoughts, hallucinations emotional dysfunction, anxiety and perceptual impairment.
-Catatonic schizophrenia: motor response and rigid posture. Uncontrolled movement, pt is aware
- Disorganized schizophrenia: progressive, mumbled talking and inappropriate emotional response
- Paranoid schizophrenia: delusions of persecution, special powers
136
what are somatoform disorders
Conversion disorder: physical complaints of neuro basis without underlying cause paralysis.
Hypochondriasis disorder. - minor illness are life threatening, excess fear of illness
Somatization disorder; woman, chronic and long lasting, symptom complaint without physiological basis, resembles hypochondriac disorder. Medications and medical visits alter patient's life
