Test 3 Flashcards
Basal cell carcinoma accounts for what % of skin cancers?
75%
What is the most common malignant tumor in Caucasians?
basal cell carcinoma
What usually causes basal cell carcinoma?
over exposure to the sun (radiation and chronic irritation)
Basal cell carcinoma usually appears how?
pearly white papule that develops a central ulceration, no pain or itching, very rarely metastasizes
Squamous cell carcinoma appears how?
slightly elevated lesion with irregular border
Squamous cell carcinoma often develops from what?
actinic keratosis
Treatment for both squamous and basal cell cancer?
surgery
Mohs Micrographic procedure is what?
a procedure where a sample will be taken from the effected tissue, frozen, cut, and examined under a microscope immediately to verify presence of cancer. Repeated till no cancer cells are left
Cryosurgery
applied liquid nitrogen to effected area then remove
Radiation therapy
high energy xrays are used to damage/kill the cancer cells and prevents the growth of new cancer cells
Electrodesiccation/curettage
removes tumor by scraping or curetting and then burning the base with an electric needle
Malignant melanoma is what?
tumor originating from melanocytes
What % of malignant melanomas develop on the skin?
90%
Approx 1/2 of malignant melanomas originate from where?
pre existing freckles or moles
Clinical features of skin cancer ABCDE
A=asymmetry of pigmented lesion (flat/elevated), B= borders (irregular margins with notching), C= color (varies, black dark brown red bleached), D= diameter or lesion (usually >6mm diamter), E=evolving (different from rest or changes in size, shape, and color)
Treatment of malignant tumors
surgery
Prognosis of malignant tumors
88%, 5% survival if treated early, at stage IV subcutaneous invasion 25% survival
Brain cancer has a relatively high mortality rate due to what?
due to the presence of malignancy and location in a closed craium this adds pressure to cerebral structures
What % of malignant brain cancer cases are in children?
20%
What % of brain cancers are primary neoplasms
50%
What % of brain cancers are tumors of glial cells?
75%
Cause of brain cancer
unknown for primary neoplasms, genetic factors seem to play a role
Death due to brain cancer occurs due to what?
compression of vital centers
What cancer is the leading cause of cancer deaths in the US?
lung cancer, more prevalent in women, kills approx 150,000 people/year
What % of patients with lung cancer smoke?
90%
Many lung cancers are metastases from other sites like what?
due to blood flow through the pulmonary capillary bed by way of the thoracic duct that empties into the superior vena cava
Squamous cell carcinoma
30% of lung cancers, tends to arise in central portion of lung (segmental bronchi), if caught early can resect that part and follow up with chemo/radiation
Adenocarcinoma
33% of lung cancers, tends to arise in periphery usually upper lobes, if caught early can also be resected and followed up with chemo/radiation, seen as thickened plaque white mucosa
Small cell carcinoma (Oat cell cancer)
20% of lung cancers, usually originates near hilum, metastasizes very early, best treated with chemo and has a high recurrence rate
Wilms tumor
one of the most common solid tumors in young children, diagnosed at ages 2-5 years
Wilms tumors is usually associated with deletions on what chromosome?
11
Colorectal cancer is detected how?
colonscopy
Colorectal cancer accounts from approx what % of cancer related deaths in the US?
15%
Colorectal cancer is associated with a diet low in what?
fiber, high in fat, sugar, and red meat
Signs and symptoms of colorectal cancer?
can be asymptomatic for years, change in bowel habits, occult blood in stool
Treatment for colorectal cancer
surgical removal, radiation, chemo
definition of neoplasm (tumor)
cellular growth not responding to normal body controls
Benign tumors
rarely kill yet can be fatal, dont penetrate adjacent tissue borders, dont spread to distant sites, grow slowly, usually encapsulated, do no usually recur when surgically removed
Malignant tumors
life threatening, invade nearby tissues, metastasize to distant sites via blood and lymphatic vessels, rapid growth, anaplastic, not encapsulated, usually distorted in size, shape, and structure
Classification of cancers
carcinomas, sarcomas, leukemia, lymphoma, myeloma, mixed
Carcinomas make up what % of cancer cases?
80-90%, largest group
Carcinomas is located where?
in epithelial tissue
Carcinomas tend to affect what?
organs/glands, breast, lung, colon, or prostate
Benign tumors or epithelial orgin usually are named using the suffix what?
-oma
Malignant tumors of epithelial origin are named with the term what?
carcinoma added to the type of tissue involved
Sarcomas refers to cancer that originates where?
supportive and connective tissues such as bones, tendons, cartilage, muscle, and fat
The most common sarcoma often develops as what?
painful mass on the bone
Benign tumors of connective tissue are named by appending the suffix what?
-oma to the type of tissue involved
Malignant tumors of connective tissue are named by adding what term to the type of tissue involved?
sarcoma
Leukemias
cancer of the bone marrow
Leukemias is often associated with the overproduction of what?
immature white blood cells
Leukemia also affects red blood cells and can cause what?
poor blood clotting and fatigue due to anemia
Lymphomas
develop in the glands or nodes of lymphatic systems, a network of vessles, nodes, and organs that purify bodily fluids and produce infection fighting white blood cells
Lymphomas are sometimes called what?
solid cancers
Lymphomas are subclassified into what two categories?
Hodgkin lymphomas, and Non hodgkin
What distinguishes Hodgkin lymphoma from non hodgkin lymphoma?
Reed stern berg cells
Local effects of tumors are what?
pain, obstruction, tissue necrosis and ulceration which may cause infection
Systemic effects of cancers
weight loss and cachexia (tissue wasting), anemia, infection
Risk factors to cancer
genetic predisposition, oncogenic viruses (HPV, AIDS), Radiation, chemicals, chronic irritation and inflammation, hormones
Grading based on degree of Anaplasia
Grade 1:well differentiated, Grade 2: moderately differentiated, Grade 3: poorly differentiated, Grade 4: anaplastic
Staging is based on what?
extent of spread (TNM)
TNM stands for what?
T=size of primary tumor, N= regional lymph node involvement, M= metastasis of primary tumor
Types of cancer treatment
surgery, chemotherapy and consists or a combo of 2-4 drugs
Adverse effects of chemotherapy
damage heart muscle, bone marrow depression, dec WBC, inc chance of infection, decr thrombocytes, and inc risk of hemorrhage, nausea and vomiting, hair loss and skin breakdown
Radiation therapy causes alteration in what?
tumor cell DNA
Radiation therapy may be applied how?
externally or internally
Adverse effects of radiation therapy
bone marrow depression, epithelial cell damage, sterility, and scarring
When youre cured of cancer it means what?
5 years cancer free post treatment
What youre in remission of cancer it means what?
period of time when there are no clinical signs
anemia definition
reduction in O2 transport ability leads to less energy produced in cell
General signs of anemia
fatigue, pallor, tachycardia
Severe anemia may cause angina during what/
stress
Cause of iron deficiency anemia
low dietary intake of iron, chronic blood loss, and malabsorption of iron
Iron deficiency anemia
insufficient iron impedes synthesis of hemogloblin
Diagnosis of iron deficiency anemia
low hemoglobin and hematocrit, RBC’s appear hypochromic and microcytic
Treatment of iron deficiency anemia
identify and resolve underlying cause, iron supplements
Transferrin
a beta one globulin of the plasma which acts as an iron transporting protein
Ferritin
an iron protein complex containing up to 23% iron, found in intestial mucosa, spleen and liver
Pernicious anemia
vitamin B12 deficiency, lack of intrinsic factor leading to inability to absorb B12 into the liver
Lack of intrinsic factor may be caused by what?
formation of autoantibodies against if in the stomach, chronic gastritis (common in ETOH abuse), gastrectomy or resection of ileum, dietary insufficiency is rare cause
Lack of B12 impairs maturation of what?
RBCs
Treatment of pernicious anemia
B12 injection, vitamin supplements
Aplastic anemia
impairment of bone marrow function leading to loss of stem cells
Decrease stem cells causes what?
pancytopenia
Possible causes of secondary aplastic anemia
radiation, chemotherapy, industrial chemicals, drugs, viruses
Signs and symptoms of aplastic anemia
general signs of anemia, multiple infections due to leukopenia, petechiae (tiny hemorrhage spots in skin)
treatment of secondary aplastic anemia
remove underlying cause
Treatment of primary aplastic anemia
bone marrow transplant, use chemo/radiation, infusion of donor stem cells
Sickle cell anemia
autosomal recessive disorder formation of HbS
Sickle cells obstruct what?
small vessels and form clots
Signs and symptoms of sickle cell anemia
begins about 1 year old, general signs of anemia, hyperbilirubinemia (jaundice, gallstone formation), vascular occlusion leading to periodic painful episodes, delayed growth and development, congestive heart failure
Treatment of sickle cell anemia
if symptomatic bone marrow transplant, analgesics, blood transfusion, avoid stenous activity, droxia
Polycythemia vera
neoplastic disorder of unknown orgin, inc. production of erythrocytes in bone marrow causes viscous or very thick blood
Polycythemia vera most commonly develops between what ages?
40-60
Signs and symptoms of polycythemia vera
bluish-red tone of skin and mucosa, hepatomegaly/splenomegaly, inc. BP, congestive heart failure, inc. risk of thromboses and infarction, hematocrit >55%
Treatment of polycythemia vera
periodic phlebotomy, drugs or radioactive phosphorus (32P) to suppress bone marrow
Prognosis of polycythemia vera
depends on age of patient and when diagnosis, treatment, and if there are complications, inc. risk for thrombosis, heart attack or stroke
General signs of blood clotting disorders
persistent bleeding from gums, repeated nosebleeds, petechiae, purpura and eccymoses, more bleeding than warraned by trauma, coughing or vomiting blood, blood in feces, general signs of anemia
Hemophilia A
classic hemophilia, x lined recessive trait, deficit or abnormality of clotting factor VIII
Hemarthrosis
bleeding into joints very painful
Hematuria
bleeding kidney, urinating blood
Treatment of Hemophilia A
Factor VIII replacement therapy
Disseminated intravascular coagulation (DIC)
involves excessive bleeding and excessive clotting,
DIC occurs as a complication of what?
a primary problem which activates clotting process in microcirculation
Primary problems that lead to tissue thromboplastin release include what?
obstetric complications (thromboplastin release from placenta), bacterial infections that release endotoxins, major trauma, some carcinomas
Signs and symptoms of DIC
depends on obstertric hemorrhage or thrombosis damage, depends on underlying causes, general signs of blood clotting disorders, vascular occlusion may cause infarcts, low BP or shock, respiratory and or renal failure possible
Treatment of DIC
heparin anticoagulation, replacement of platelets and clotting factors
Prognosis of DIC
depending on primary cause and severity
leukemia
neoplastic disorder involving white blood cells
many leukemias are associated with what?
chromosomal translocations
Acute lymphocytic leukemias is the most common what?
childhood cancer/ onset 2-6 years of age
Signs and symptoms of acute leukemia
infection, hemorrhage, signs of anemia, severe bone pain, weight loss, fatigue, enlarged lymph nodes/spleen/liver
Lymphoma
malignant neoplasm involving lymphocyte proliferation in lymph nodes
Cause of lymphoma?
unknown
Hodgkins lymphoma
occurs primarily in young adults, initally occurs in one lymph node and then spreads to other lymph nodes and then other organs
Stage 1 lymphoma
cancer affects a single node
Stage 2 lymphoma
2 or more lymph nodes on same side of diaphragm
Stage 3 lymphoma
involves nodes on both sides of the diaphragm
Stage 4 lymphoma
involves cancer spreading to the bone, lung or liver
Signs and symptoms of lymphoma
enlarged, nontender, painless lymph node (early sign), late sign is splenomegaly and other enlarged nodes
Treatment of lymphoma
radiation/chemo/surgery, excellent prognosis when found in the early stages
Non Hodgkins lymphoma
on the rise, more difficult to treat, widespread metastases often present at diagnosis
congestive heart failure
inadequate pumping ability of the heart and usually occurs as a complication secondary to another condition
ejection fraction
measurement of blood leaving your heart each time it contracts
general signs and symptoms of CHF
fatigue/weakness, tachycardia, pallor, oliguria
signs and symptoms of left sided heart failure
dyspnea/orthopnea, cough due to fluid in airways, paroxysmal nocturnal dyspnea, abnormal breath sounds (crackles/rales in bases)
signs and symptoms of right sided heart failure
heart receives blood back from the body, dependent edema, hepatomegaly/splenomegaly, ascites (abdominal distention), distended neck veins
Treatment of CHF
treat underlying cause (O2, surgery), drugs to reduce blood volume and vasoconstriction, low sodium diet
Primary Hypertension
Ateriosclerosis, (inc. BP) idiopathic, genetic factors and diet play a role
Secondary hypertension
results from renal disease, adrenal tumor, endocrine disease
Malignant hypertension
usually due to nephrosclerosis damage in renal blood vessels, severe when diastolic BP >120mm Hg
arteriosclerosis
general hardening of the arteries due to plaque, blood clots, anywhere in the body
Cause of arteriosclerosis
increased arteriolar vasoconstriction, dec. blood flow through kidneys causes them to further inc. BP,
Signs and symptoms of arteriosclerosis
defined as BP >140/90, usually asymptomatic in early stages, may be associated with fatigue, malaise, headache
Treatment of arteriosclerosis
dec sodium in diet, dec. weight, dec. stress, inc. exercise, drugs like diuretics/ACE inhibitors/alpha blocker/calcium channel blocker
Aortic aneurysms
localized dilation in arterial wall abdominal or thoracic
Cause of aortic aneurysms
damage to arterial wall, dilation may take different shapes like saccular (bulging wall on 1 side), fusiform (circumferential dilation), many anerurysms eventually rupture
Signs and symptoms or aortic aneurysms
usually asymptomatic, abdominal aneurysm may be palpable, thrombus may obstruct branches of aorta, pain, loss of pulses, dec BP, organ dysfunction
Treatment of aortic aneurysms
surgical resection and grafting, pending surgery need to prevent sudden inc. in BP (cough/bear down)
Insufficient blood supply to the myocardium can result in what?
myocardial ischemia, injury, infarction, or all 3
Ischemia definition
reduced or insufficient blood supply to an organ
Injury definition
occurs to organ/tissue when ischemia becomes more severe
Infarction definition
organ/tissue necrosis or death
Cause of Myocardial ischemia/infarction
usually caused by atherosclerosis or blockage of the coronary arteries that nourish the heart
What is the predominant site for infarction
left ventricle
What happens during myocardial infarction
central area of necrosis in generally surrounded by an area of injury, this in turn is surrounded by an area of ischemia
Cause of shock (severe hypertension)
BP is the function of the blood volume, heart contraction, and peripheral resistance
A drop in BP may be caused by what?
hypovolemic shock (loss of blood volume), cardiogenic shock ( dec. pumping capability of the heart), Septic shock, neurogenic shock (loss of signals to the sympathetic NS), Anaphylactic shock
Bodys compensation for dec. BP how?
inc. HR, Vasoconstriction, fluid retention (retains Na+), inc. RR
Signs and symptoms of shock
thirst, agitation, cool/pale skin, tachycardia, oliguria, dizziness
Complications of shock
acute renal failue, hepatic failure, DIC, cardiac ischemia and arrhythmias, multi system organ failure
Treatment of shock
supine position, treat underlying problem, give O2
Electrocardiogram (EKG/ECG)
noninvasive, compare basline results for any changes, useful for diagnosis and monitoring of arrhythmias/infarction
Holter monitor
records EKG while patient goes about daily activites
Echocardiography
cardiac ultrasound, used to record images of heart wall and valve movement, can estimate ejection fraction
Exercise stress test
check general function and stress induced problems
Chest xray
shape and size of heart, pulmonary congestion associated with left heart failure
Induced hypothermia
used to lessen the degree of permanent tissue damage to the brain and the heart, reduce the inflammatory response, slows the metabolic rate of consumption
Goal induced hypothermia
decrease core body temp to 32-34 degrees C within 2 hours of arrival for a max of 24 hours
Cardiac catheterization
pass catheter through blood vessel into ventricle and pulmonary artery, measures pressure, measures CO, monitor blood movement
Coronary angiography
thread catheter through aorta to coronary arteries, inject dye to locate coronary artery obstruction
Blood Tests
serum triglyceride and cholesterol levels, electrolyes, serum enzymes
Arterial blood gas
check o2, check acid base balance
Coronary artery bypass graft definition
common surgical intervention used to bypass obstructed or blocked coronary arteries by grafting in arteries/veins harvested from other areas of the patients body
general treatment measures for cardiac disorders
dietary modification, exercise, smoking cessation, drug therapy (vasodilators/beta blockers/digoxin/calcium channel blockers), antihypertensive drugs, anticoagulants
orientated times 3
person, place, time
vegetative state
loss of awareness and mental capabilities, unresponsive to verbal stimuli, make have sleep awake cycles
Brain death
cessation of brain function, absence of brain stem reflexes, absence of respiration
Contralateral paralysis or paresis is due to what?
brain damage on the opposite side, crossover or corticospinal tract
Decerebrate definition
adducted arms with extension, legs and head extended. body arched
Decerebrate position is usually due to what?
brain stem damage; GCS 2 motor
Decorticate definition
adducted with arms flexed, internal rotation of hands, legs extended and also rotated internally; GCS 3 motor
Optic nerve is divided where?
optic chiasm
Aphaisa definition
the inability to comprehend or to express language
Dysphasia definition
partial impairment
Expressive aphasia definition
inability to speak or write appropriately
Expressive aphasia occurs because of damage to what area in the brain?
Brocas area
Receptive aphasia definition
inability to read or understand spoken words
Receptive aphasia occurs because of damage to what area in the brain?
Wernicke’s area
Global aphasia
combination of expressive and receptive, likely major damage to brain
Seizures
uncontrolled excessive discharge of neurons in the brain
Petit mal seizure definition
absence seizure
Grand mal seizure definition
very physical
Any increased in the brain volume causes an increase in what?
ICP
Increased pressure limits arterial blood flow to brain leading to what?
ischemia and infarction
What causes cerebral arteries to dilate leading to more blood volume in brain?
hypoxia
What helps reduce brain swelling?
manitol
Decreased what causes cerebral vasoconstriction leading to decreasing ICP?
PaCO2
Transient ischemic attacks (TIA)
mini strokes;lasts few minutes to a few hours, temporary localized reduction in blood flow to brain
TIA is usually caused by partial occlusion of artery due to what?
arteriosclerosis, embolus, vascular spasm
Signs and symptoms of TIA
person remains conscious, short episodes of muscle weakness/numbness, transient aphasia or confusion
Cerebrovascular accident (CVA, stroke)
infarction of brain tissue due to lack of blood flow
CVA may be caused by what?
arteriosclerosis, embolus, intracerebral hemorrhage
Signs and symptoms of CVA
sudden weakness/numbness/tingling, loss of speech, confusion, sudden loss of vision, sudden severe headache, unusual dizziness
Treatment of CVA
thrombolytics, carotid endarterectomy if blocked, external vent. drain, control hypertension, rehab
Cerebral aneurysm usually occurs at points of bifurcation on what?
circle of Willis
Rupture causing bleeding into subarachnoid space and CSF causes what?
inc. ICP (the blood irritates tissue)
Signs and symptoms of cerebral aneurysm
headache, photophobia, nuchal rigidity due to irritation of spinal nerves
Treatment of cerebral aneurysm
surgery to clip or tie off aneurysm, ICP monitoring, external vent. drain
The two main reasons EVDs are inserted are what?
to divert infected CSF away from the brain and allow antibiotics to be given directly into the CSF to remove infection and to reduce pressure inside the brain
Meningitis
inflammation of the membranes surrounding the brain and spinal cord
Acute bacterial meningitis is when bacteria reaches the blood how?
blood (septicima), extension from nearby tissues, direct access through wounds
Most common bacteria in acute bacterial meningitis is what?
hemophilis influenzae, neisseria meningitides, streptococcus pneumoniae
Signs and symptoms of acute bacterial meningitis
sudden onset, severe headache, back pain, nuchal rigidity, vomiting,
Treatment of acute bacterial meningitis
fatal in 10-40% of cases, antibiotics, vaccines
head trauma definition
non congenital insult to the brain from an external mechanical force
Cerebral concussion
reversible interference with brain function, often associated with a brief loss of consciousness, usually resolves with 24 hrs
for males sports related TBIs were sustained most often by playing what sports?
football or bicycling
for females sports related TBIs were sustained most often by playing what sports?
soccer and bball
cause of cerebral concussion
blunt impact to the head causing the brain to strike and rebound from the skull
Signs and symptoms of cerebral concussion
loss of consciousness with shallow breathing, low pulse rate, flaccid muscle tone
Once consciousness is regained from a concussion what are the signs and symptoms?
amnesia, bradycardia, faintness, pallow, hypotension, photophobia
Delayed symptoms of a cerebral concussion
headache, nausea, vomiting, blurred vision
How do you diagnose a cerebral concussion?
cranial CT scan, MRI
Treatment of concussion
bed rest, close monitoring for progressive brain injury, behavioral changes, difficulty speaking, confusion
Subdural Hematoma (SDH)
when the head sustains a severe blow, blood will collect b/w the dura mater and the second membrane covering the brain known as the arachnoid membrane
Cause of SDH
caused by blood leaking from ruptured vessels below the dural membrane, almost always caused by a severe head injury
Signs and symptoms of SDH
difficulty walking, headache, confusion, slurred speech, visual problems, initial loss of consciousness,
Delayed symptoms of SDH
unilateral paralysis, severe headache, dilated pupils
How do you diagnose a SDH
CT/MRI, ICP monitoring
Treatment of SDH
craniotomy
Subarachnoid hematoma (SAH)
blood vessel rupturing resulting in release of blood into the subarachnoid space b/w the pial and arachnoid membranes
Cause of SAH
may be caused by head injury, spontaneous rupture of a cerebral aneurysm
Signs and symptoms of SAH
sudden onset of severe headache, nausea/vomiting, meningeal irritation, photophobia/visual changes, focal neurologic deficits, sudden loss of consciousness, seizures
How do you diagnose an SAH
CT scan, angiography, lumbar puncture
Treatment of SAH
surgical treatment to prevent rebleeding which involves clipping the ruptured aneurysm or endovascular treatment
Cerebral contusion
bruising of brain with rupture of small vessels located beneath or along the surface of the brain
Cause of cerebral contusion
blunt blow to head or by an impact that causes the brain to twist against the inner surface of the skull
Signs and symptoms of cerebral contusion
depends on loca and extent of injury, transient loss of consciousness, coma, lower BP and body temp, hemiparesis, severe headache, nausea/vomiting, lethary, apathy, drowsiness, hostility, combativeness
How do you diagnose a cerebral contusion
Cranial CT scan and MRI, ICP monitoring
Treatment of cerebral contusion
depends on severity , external vent drain, mech vent if needed, surgery
Closed head injury
skill isnt fractured but brain tissue is injured, inc ICP due to tissue swelling
Depressed skull fracture
displacement of a piece of bone below level of skull
Basilar skill fracture
occurs at base of skull, may leak CSF thru ears/nose, black eyes
Countrecoup
injury to area of brain contralateral to area of direct damage
most common spinal cord injury occurs where?
high mobility areas of the spine, C1-7 and T12-L2
Spinal cord nerves do not do what?
regenerate
What is the leading cause of spinal cord injuries?
motor vehicle accidents
What else causes spinal cord injuries
falls, acts of violence, sports, alcohol, diseases
Signs and symptoms of spinal cord injuries
depends on loca, spinal shock period, flaccid paralysis, post spinal shock period
Treatment of spinal cord injuries
surgery, glucocorticoids to reduce edema, aggressive PT and rehab
Guillain Barre Syndrome is seen in what?
post infections; polyneuritis, acute idiopathic polyneuropathy
Cause of GBS
exact cause may be unknown, may be abnormal immune response precipitated by viral infection
Where does GBS start?
process beings in legs; may rise to include respiratory muscles
GBS is what kind of paralysis?
ascending
Signs and symptoms of GBS
history of recent virus or immunization, progressive muscle weakness starting in legs, pain, vision and speech may be impaired, ANS impariment, cardiac arrhythmias, fluctuating BP
Treatment of GBS
may require vent and bronchial hygiene, supportive, PT
Multiple sclerosis
progressive demyelination of neurons of brain, spinal cord and cranial nerves, interferes with conduction of impulses
In MS what is usually not affected
intellectual function
MS may be considered to be what kind of disease?
autoimmune
signs and symptoms of MS
progressive degeneration with remissions and exacerbations, being age 20-40, blurred vision/double vision, muscle weakness, bladder and bowel disfunction
Treatment of MS
no specific treatment, glucocorticoids, interferon drugs
Parkinsons disease
progressive degenerative disease, dec number of neurons that secrete dopamine
A decrease in dopamine results in what?
excess stimulation which causes inc. muscle tone and activity
Primary idiopathic parkinsons usually develops after what age?
60, occurs in men and women
Secondary parkinsons may appear earlier due to what?
encephalitis, trauma, and vascular disease
Signs and symptoms of parkinsons
involuntary movement, repetitive motion of hands, inc. muscle rigidity, difficulty initiating movement, stooped/foward leaning posture, unblinking face
Signs and symptoms of parkinsons in the late stage?
urinary retention, constipation, orthostatic hypotension
Treatment of parkinsons
medications like L-dopa (replaces lost dopamine), Eledepryl (blocks breakdown of L-dopa), speech pathology, sugery (deep brain stimulation)
Complete fracture
extends through entire thickness
Incomplete fracture
extends only partway through the bone (partial)
Closed fracture
skin not broken at fracture site
Open (compound) fracture
skin broken at fracture site where a piece of bone protrudes
Simple fracture
single break in bone due to a direct blow
Comminuted fracture
multiple fracture lines/bone fragments embedded in tissue
Compression fracture
bone is crushed or collapses into small pieces
Impacted fracture
a break in which the bone is broken with one end forced into the interior of another
Pathologic fracture
usually a symptom not a cause, results from weakness in bone because of tumor, osteoporosis, ect
Spiral fracture
break angles around bone usually due to twisting injury
Greenstick fracture
bone bends but does not break (splits like a new twig), common in kids
Colles Fractures
extra articular fractures of the distal radius that occurs as a result of a fall onto an out stretched hand
Potts Fractures
fracture of the lower part of the fibula, with serious injury of the lower tibial articulation (rolled ankle or awkward landing)
Healing of fractures
may require open or closed reduction to align bone ends
Open reduction
surgical repair and external fixation (may require pins, plates, cast)
Closed reduction
bone manipulation and casting without surgery
Dislocations
separations of 2 bones at a joint
Subluxation
partial displacement with partial contact b/w surfaces of 2 bones
Treatment of dislocations
reduction to return bone to normal position, immobilization during healing, therapy
Spinal deformities
may be congenital or due to trauma/disease
Lordosis
anterior convexity of the spine, sway back, inward curvature of lumbar spine
Kyphosis
outward curvature of the spine, humpback
Scoliosis
lateral curvature of the spine
Treatment of spinal deformities
physical therapy, back braces, surgery (spinal fusion)
Osteoporosis
metabolic bone disorder characterized by decreased bone mass and density
Predisposing factors of osteoporosis
female, age >50 years, sedentary lifestyle, prolonged deficit of vitamin D or calcium, cigs smoking, small light bone structure, prolonged intake of glucocorticoids
Signs and symptoms of osteoporosis
early stages are asymptomatic, bone fracture, compression fractures of vertebrae
Treatment of osteoporosis
dietary supplements of calcium and vitamin D, fluoride supplements, biphosphonates, weight bearing exercise program
Rickets are seen in who?
children
Osteomalacia is seen in who?
adults
Rickets and osteomalacia is due to what?
lack of vitamin D and phosphates required for bone mineralization
Rickets and osteomalacia may be a result of what?
inadequate diet, not enough sunlight exposure, malabsorption syndromes, chronic renal failure
Signs and symptoms of rickets and osteomalacia
bone pain in larger bones, loss of height, muscle cramps, inc. bone fractures, skeletal deformity. Rickets bow legs and short stature
Treatment of rickets and osteomalacia
inc. exposure to sunlight, inc. dietary intake
Pagets Disease
progressive bone disease
What are the 3 stages of Pagets Disease
destructive stage, mixed, and osteosclerotic
Destructive stage
rapid bone resorption
mixed stage
bone resorption continues along with new formation of course bone
osteosclerotic stage
excess destruction ends deposition of abnormal bone continues
Signs and symptoms of Pagets disease
deformity of long bones, enlarged cranial bones, bone fractures, bone pain
Treatment of Pagets Disease if symptomatic
analgestics, biphosphonates to prvent bone resorption
Osteoarthritis
degenerative joint disease, most common joint disease
What are the 2 theories that may represent why it happens?
repeated injury to articular cartilage, autoimmune disorder
Disease process of osteoarthritis
articular cartilage shows surface defects and thinning, surface of cartilage becomes rough and fragments go into synovial fluid, bone develops cysts ans spurs, surrounding tissues may become inflamed
Signs and symptoms of osteoarthritis
most often affects weight bearing joints, frequently affects fingers and toes, pain in joint with weight bearing and movement, stiff joints, crepitus (grating)
Treatment of osteoarthritis
analgesics and anti inflammatories, ambulatory aids or weight reduction, surgery (joint replacement)
Rheumatoid arthritis
chronic systemic inflammatory disease, probably an autoimmune disease, more common in women
Course of rheumatoid arthritis
inflammation of synovial membrane, pannus formation on articular cartilage, cartilage erosion, pannus becomes fibrotic, ankylosis and deformity develop, osteoporosis on both sides of joint, muscle atrophy
Signs and symptoms of rheumatoid arthritis
exacerbations and remissions, insidious onset, symmetrical stiffness and aching joints, usually begins in fingers/wrists/toes, red/swollen joints, nodules, ulnar deviation of fingers
Treatment of rheumatoid arthritis
ASA and NSAIDS, COX-2 inhibitors (celebrex), balance b/w rest and moderate activity, PT, surgery
Hyperuricemia
deposit of uric acid crystals in joint
Cause of Gout
primary gout is idiopathic, secondary gout is related to another condition
Hyperuricemia may result from what?
overproduction of uric acid from the kidneys
Signs and symptoms of gout
sudden onset of severe joint pain, acute inflammation causes redness/swelling, fever, malaise, develop tophi (large hard urate crystal nodules around joints)
Treatment of gout
drugs to reduce serum uric acid levels, low purine diet, analgesics and anti imflammatory meds
ankylosing spondylitis
chronic progressive inflammation affecting sacroiliac joints, inververtebral spaces, and costovertebral joints
Ankylosing Spondylitis is an autoimmune disorder with genetic basis given with the presence of what in the serum of patients?
HLA-B27
Signs and symptoms of Ankylosing spondylitis
develops at 20-40 yrs of age, usually starts at sacroiliac joint then up the spine, low back pain/morning stiffness, dec lung expansion
Treatment of Ankylosing spondylitis
NSAIDS, COX-2 inhibitor
Myasthenia Gravis
acquired automimmune disease, the bodys own antibodies block/destroy acetylcholine receptors at the neuromuscular junction
Signs and symptoms of myasthenia gravis
periodic remissions and exacerbations, weak and fatigue muscles, eyelid dropping, impaired speech/chewing/swallowing, loss of facial expression
Myasthenia gravis is what type of paralysis?
descending
How do you diagnose myasthenia gravia?
tensilon test, electromyography, pulmonary function testing, CT scan
Treatment of Myasthenia gravis
thymectomy, corticosteroids, anti cholinesterase drugs, plasmapheresis, IV immunoglobulin therapy
