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Internal Medicine Final > unit 4 stuff > Flashcards

unit 4 stuff Flashcards

1
Q

how many layers does the skin have and what are they

A

3
epidermis, dermis, hypodermis

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2
Q

what are the 2 parts of the dermis

A

papillary dermis
reticular dermis

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3
Q

secondary lesion

A

a lesion becomes secondary when changes occur to primary lesion
(like scale, crust, thickening, ulcer, scar, ect)

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4
Q

what does the lab value of prealbumin indicate

A

nutritional status

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5
Q

what is the lab value hematocrit used for

A

monitoring wound healing

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6
Q

what are the 4 lab values measured with skin lesions/diseases

A

prealbumin
glucose
hemoglobin
hematocrit

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7
Q

melasma

A

hyperpigmentation of the cheeks and forehead

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8
Q

what happens to blood vessels with aging and what are the implications?

A

reduced numbers and get thinner

this compromises blood flow and impairs the individuals ability to thermoregulate

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9
Q

clinical implications of having fewer melanocytes in the skin

A

decreased protection against UV
increased skin cancer risk

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10
Q

the epidermis the body’s principal supplier of which vitamin

A

vitamin D

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11
Q

how does vitamin D deficiency impact the musculoskeletal system

A

increases osteoporosis because calcium needs vitamin D to maintain bones

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12
Q

oxidation damage impacts what 3 parts of the skin

A

lipids
proteins
DNA

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13
Q

2 bacterial skin infections

A

impetigo
cellulitis

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14
Q

2 viral skin infections

A

herpes zoster (chicken pox)
warts (verrucae)

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15
Q

3 fungal skin infections

A

ringworm (tinea corporis)
athletes foot (tinea pedis)
yeast (candidiasis)

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16
Q

psoriasis

A

Chronic skin condition with raised, inflamed, red plaques that look scaley

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17
Q

lupus erythematosus

A

Autoimmune disease
Impacts kidneys, skin, joints, heart, lungs, etc

Butterfly rash across the face

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18
Q

system sclerosis

A

autoimmune disease that causes fibrosis and vascular abnormalities in the skin/joints

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19
Q

polymyositis/dermatomyositis

A

autoimmune diseases that cause inflammation of the muscles and weakness

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20
Q

what is burn severity determined by

A

the depth and total body surface area

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21
Q

what are the percentages and areas of “Wallace rule of nines”

A

9% = arms + head
18% = legs + anterior trunk + posterior trunk

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22
Q

lund and browder method

A

a chart that estimates the total body surface area affected by a burn injury

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23
Q

____ burns account for 75% of all burn center admissions

A

thermal

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24
Q

what special population is most vulnerable to burns

A

children
(then older adults)

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25
Q

what 4 body systems are affected by burns

A

cardiovascular
renal
GI
immune

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26
Q

why is heart rate increased with a cutaneous burn

A

catecholamine release and hypovolemia

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27
Q

what happens to cardiac output with a cutaneous burn

A

decreased in the beginning
returns to normal
then INCREASES around 24 hours after injury

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28
Q

2 circulatory system symptoms of extensive burns

A
  • edema in both burned/non-burned tissue
  • decrease in circulating intravascular blood volume
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29
Q

how do the renal and GI systems respond to a burn

A

shunting blood from kidneys and intestines

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30
Q

oliguria

A

decreased urine output

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31
Q

paralytic ileus

A

intestinal dysfunction after burns

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32
Q

which burn type has a higher chance of being a multisystem injury

A

electrical burn

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33
Q

what are the physical characteristics of an electrical burn

A

smaller entrance wounds
explosive exit wounds

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34
Q

electrical burns impact which type of tissue the most

A

soft-tissue (muscle/ligament/etc)

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35
Q

which is more dangerous and why:
alternating current vs direct current

A

alternating current

it is associated with cardiopulmonary arrest, ventricular fibrillation, and tetanic muscle contractions

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36
Q

what is alternating current

A

electric current that periodically changes direction

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37
Q

why are chemical burns typically deep

A

they often continue burning until neutralized

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38
Q

which burns skin more: acids or alkalines?

A

alkalines

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39
Q

what is the danger of having a circumferential burn

A

they can make a tourniquet-like effect and lead to compartment syndrome or total loss of circulation

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40
Q

what is the clinical implication of having burns on the hands and joints

A

permanent physical and vocational disability

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41
Q

what is the most common and life-threatening complication of burn injuries

A

infection

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42
Q

hypertrophic scarring in burns is associated with

A

considerable morbidity and potential lifelong disfigurement

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43
Q

3 phases of medical management in burns

A
  1. emergent phase
  2. acute phase
  3. rehabilitative phase
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44
Q

what is done in the acute phase of medial management in burns

A

wound management
infection prevention
debridement and skin grafting
physical therapy

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45
Q

what is done in the emergent phase of medial management in burns

A

fluid resuscitation
ventilatory management
assessment of burn extent

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46
Q

xenographts

A

typically pig skin

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47
Q

allografts

A

typically cadaver skin

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48
Q

autografts

A

own skin

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49
Q

biosynthetic grafts

A

combination of collagen and synthetics

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50
Q

what type of graft is most often used in full-thickness burns

A

autograft
(this permanently closes the injury as well)

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51
Q

what are the bony prominences most susceptible to pressure ulcers (6)

A

heels
sacrum
ischial tuberosities
greater trochanters
elbows
scapula

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52
Q

what is used to classify neuropathic ulcers

A

wagner system

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53
Q

stage 1 pressure injury

A

nonblanchable erythema of intact skin

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54
Q

stage 2 pressure injury

A

partial-thickness skin loss with exposed dermis

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55
Q

stage 3 pressure injury

A

full-thickness skin loss

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56
Q

stage 4 pressure injury

A

full-thickness skin and tissue loss

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57
Q

unstageable pressure injury

A

obscured full-thickness skin and tissue loss

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58
Q

deep tissue pressure injury

A

persistent nonblanchable deep red, maroon, or purple discoloration

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59
Q

what causes superficial burns and what does it look like

A

sunburn (UV exposure) or brief exposure to flame/hot liquids

presents as mild-severe erythema, skin blanches with pressure, dry

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60
Q

what causes partial-thickness burns and what does it look like

A

scalding liquids/semiliquids/solids

targe thick-walled blister, edema, broken epidermis, wet, shiny

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61
Q

what causes full-thickness burns and what does it look like

A

prolonged exposure to chemical, electrical, flame, scalding liquids, steam

red/black/white, dry surface, edema, fat exposed

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62
Q

desquamation time for superficial burns

A

3-7 days

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63
Q

healing time for partial-thickness burns (deep and superficial)

A

deep = 21-28 days
superficial = 14-21 days

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64
Q

primordial prevention (and an example)

A

focused prevention on an entire population

ex: improving access to urban neighborhood to safe sidewalks to promote physical activity

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65
Q

how is primordial prevention promoted

A

through laws and national policy

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66
Q

what are ALL 8 symptoms of cardiac disease

A
  1. pain/discomfort in chest/neck/arm
  2. angina
  3. palpitations
  4. dyspnea
  5. syncope
  6. fatigue
  7. cough
  8. cyanosis
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67
Q

what are the 2 most common symptoms of the vascular component of cardiovascular conditions

A

edema
leg pain (claudication)

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68
Q

claudication

A

leg pain

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69
Q

biomarkers of cardiovascular disease

A

blood pressure
premature matricular contraction
LDL-C
CRP

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70
Q

what is the most common cause of death in the older population in the US

A

cardiovascular disease

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71
Q

cardiovascular disease accounts for over ___% of cardiovascular deaths in 65+

A

80%

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72
Q

what 2 things create stiff arterial walls and narrowed lumen

A

deterioration of arterial media
atherosclerotic plaque

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73
Q

why does BP increase as we age

A

the arteries are more stiff which means there is less “give” when blood passes through

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74
Q

what happens to the aorta with age

A

it becomes dilated (larger) and elongated

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75
Q

in comparison to men, women have higher incidences of (3 things) in their cardiovascular systems

A

mitral valve prolapse

fatal arrhythmias from cardiac/psychotropic meds (3x more)

bleeding episodes from thrombolytic agents

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76
Q

angina pectoris

A

chest pain/discomfort when the heart does not receive enough o2 rich blood

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77
Q

5 components of metabolic syndrome (how many of these components does a person have to get a diagnosis of metabolic syndrome)

A
  1. waist circumference (40in men 35in wom)
  2. reduced HDL (>40mg/dl men >50mg/dl wom)
  3. blood pressure (130/85)
  4. fasting blood glucose (<100)
  5. triglyceride (<150)

need 3/5 to be diagnosed

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78
Q

optimal cholesterol levels (total, LDL, HDL, triglycerides)

A

total = 150
LDL = 100
HDL = 40 men; 50 wom
triglycerides = under 150

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79
Q

normal BP vs elevated BP

A

normal BP = 120/80 or less
elevated BPP = 120-129/80

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80
Q

hypertension stage 1 + 2 levels

A

stage 1 = 130-139/80-89
stage 2 = 140/90 or higher

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81
Q

atherosclerosis

A

plaque buildup in the inner layer (intima) of the arteries

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82
Q

monckeberg arteriosclerosis

A

destruction of muscle and elastic fibers + formation of calcium deposits

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83
Q

what layer of the arteries is monckeberg arteriosclerosis involved with

A

the middle layer

(it deals with muscle + elastic fibers)

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84
Q

arteriolosclerosis

A

thickening of the walls of small arteries (arterioles)

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85
Q

percutaneous coronary intervention (PCI)

A

balloon is left in the coronary artery to keep it open

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86
Q

coronary artery bypass graft is taken from what structure in the body

A

the great saphenous vein

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87
Q

coronary stent is similar to which other coronary intervention

A

percutaneous coronary intervention

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88
Q

β-Adrenergic Receptor Antagonists (β Blockers) helps with

A

Angina, cardiac arrhythmias, hypertension, heart
failure, ventricular dysfunction post-MI

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89
Q

Angiotensin-Converting Enzyme (ACE) Inhibitors helps with

A

Heart failure, hypertension, ventricular
dysfunction post-MI

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90
Q

Antiarrhythmics help with

A

Cardiac arrhythmias, heart failure

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91
Q

Calcium Channel Blockers help with

A

Angina, hypertension, cardiac arrhythmias

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92
Q

Anticoagulants help with

A

Treatment and prevention of clot formation and emboli in the
deep veins, heart, lungs, and extremities

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93
Q

Antiplatelet medications help with

A

Prevention of clot formation and emboli in the deep veins, heart,
and brain

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94
Q

Hemostatics help with

A

Excessive bleeding, hemorrhage

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95
Q

Antidiuretics help with

A

Central diabetes insipidus

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96
Q

Diuretics help with

A

Heart failure, hypertension, edema

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97
Q

Vasodilators help with

A

Angina; hydralazine and minoxidil are used for hypertension

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98
Q

primary hypertension is also known as _____ and accounts for ___% to ___% of all hypertension cases

A

idiopathic hypertension
90-95%

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99
Q

secondary hypertension accounts for ___% to ___% of all hypertension cases

A

5-10%

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100
Q

malignant hypertension

A

diastolic blood pressure over 125mm Hg with target organ damage

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101
Q

which type of hypertension (primary or secondary) is due to an identifiable cause

A

secondary hypertension

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102
Q

ischemia

A

area of body is not getting enough blood, oxygen, and nutrients

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103
Q

MI type I

A

plaque rupture with thrombus

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104
Q

3 qualifications of MI type 2

A
  1. vasospasm/endothelial dysfunction
  2. fixed atherosclerosis with supply/demand imbalance
  3. supply/demand imbalance ALONE
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105
Q

MI type 2 develops due to

A

lack of oxygen supply vs the demand the heart is requiring

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106
Q

MI type 1 develops due to

A

Coronary artery disease (CAD)
triggered by plaque disruption (like a rupture)

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107
Q

heart failure

A

the heart is unable to pump sufficient blood to the body

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108
Q

orthostatic hypotension (give numbers too)

A

decrease in BP when standing from a seated or laying position

20mm SBP drop
10mm S + D BP drop
15 bpm increase

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109
Q

what is the main 2 dangers of older adults getting orthostatic hypotension

A

syncope (fainting)
falls

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110
Q

on an ECG, what is the indication of ischemia

A

t wave inversion

(line dips down instead of normal bump)

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111
Q

on an ECG, what is the indication of hypoxic injury

A

ST elevation

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112
Q

on an ECG, what is the indication of infarction/necrosis

A

abnormal Q

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113
Q

ventricular fibrillation

A

chaotic rhythm and rate of the heart

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114
Q

what is arrhythmia caused by (functionally)

A

abnormal rate of electrical impulse generation by the sinoatrial node (SA Node)

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115
Q

infective endocarditis (+ name 2 structures impacted)

A

infection of the endocardium
- lining inside heart
- heart valves

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116
Q

what disease of the heart is caused by streptococcal group A bacteria

A

infective endocarditis

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117
Q

what are the 2 pericardium layers

A

inner visceral layer
outer patietal layer

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118
Q

what is the pericardium’s job

A

stabilizes the heart in its anatomic position

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119
Q

aneurysm

A

abnormal stretching in the wall of an artery/vein/heart

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120
Q

what diameter of dilation of an artery/vein/heart is considered to be an aneurysm

A

50% dilation

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121
Q

what is the most common aneurysm in the body

A

abdominal aortic

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122
Q

thrombophlebitis

A

swelling of a vein from a thrombus (blood clot)

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123
Q

what are the 2 types of thrombophlebitis

A

deep vein thrombosis
superficial thrombophlebitis

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124
Q

4 risk factors of deep vein thrombosis and pulmonary embolism

A

immobility
trauma
lifestyle
hypercoagulation

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125
Q

pulmonary embolism

A

thrombus breaks loose (usually from the large deep veins of the pelvis and legs) and gets stuck in the lungs

126
Q

what is the most common reason for hospital readmission and death after total hip and knee arthroplasties?

A

venous thromboembolism

127
Q

2 types of venous thromboembolism

A

deep vein thrombosis
pulmonary embolism

128
Q

what could emboli be formed by (6 total)

A

blood clots
air bubbles
fat droplets
amniotic fluid
parasite clumps
tumor cells

129
Q

what happens when veinous valves become incompetent

A

dilation occurs from back flow creating VARICOSE VEINS

130
Q

the hematologic system is integrated with which 2 body systems

A

lymphatic
immune

131
Q

main functions of the hematologic system (3)

A

cellular metabolism
defense against injury/infection
balances body pH

132
Q

difference between thrombus vs embolus

A

thrombus = solid mass of clotted blood ONLY within a blood vessel or the heart

embolus = solid, liquid, or gas mass that lodges distally from place of origin

133
Q

infarction leads to

A

tissue necrosis

134
Q

when does shock occur

A

when the circulatory system is unable to maintain adequate pressure to supply the organs

135
Q

3 main causes of anemia

A

excessive blood loss (hemorrhage)
destruction of erythrocytes (hemolytic)
decreased production of erythrocytes

136
Q

2 ways to classify anemia

A

through shapes/sizes
through hemoglobin concentration levels

137
Q

how can NSAIDs cause anemia

A

GI blood loss from peptic/duodenal ulcers

138
Q

anisocytosis

A

various sizes of blood cells

139
Q

poikilocytosis

A

various shapes of blood cells

140
Q

erythropoietin
(what is it, where is it made and what is its function)

A

a hormone produced by the kidney that stimulates production and maturation of RBC

141
Q

what 3 nutrient deficiencies could cause a decrease production of erythrocytes

A

iron
vitamin B12
folate

142
Q

what 3 organs are most impacted by anemia

A

heart
liver
kidney

143
Q

anemia in the presence of coronary obstruction can lead to

A

cardiac ischemia (risk for heart attack)

144
Q

the 4 biomarkers checked in a complete blood count (CBC) lab

A

% of erythrocytes in total blood volume
concentration of hemoglobin
erythrocyte count
RBC size/shape

145
Q

reticulocyte count

A

amount of new RBCs

146
Q

primary hemostasis requires normal # and function of what 2 things

A

platelets
von willebrand factor

147
Q

what is the most important blood clotting factor in primary hemostasis

A

blood clotting factor 8 (VIII)

148
Q

what does von willebrand factor do

A

plasma protein that mediates the initial adhesion of platelets at sites of bleeding

149
Q

thrombocytopenia and what causes it

A

decrease in the number of platelets

caused by inadequate platelet production from bone marrow, destruction out of bone marrow, or splenic sequestration

150
Q

what is secondary hemostasis

A

Coagulation

151
Q

persons with abnormalities in secondary hemostasis tend to have deficiencies in _____.

list a disease example of this

A

clotting factors

hemophilia A or B

152
Q

what is hemophilia and how does a person get it

A

a bleeding disorder inherited as an X-linked autosomal recessive trait

153
Q

hemophilia A lacks which clotting factor? how about hemophilia B?

A

A: CF VIII
B: CF IX

154
Q

what is a normal concentration of coagulation factors

A

50-150%

155
Q

mild hemophilia symptoms

A

Random bleeding is rare

156
Q

moderate hemophilia symtoms

A

Random bleeding is not super common but can happen with minor traumas

157
Q

severe hemophilia symptoms

A

Random bleeding often occurs, particularly in the joints and deep muscles

158
Q

functions of the lymphatic system (4)

A

absorb macromolecules
help maintain fluid balance
fight infection
removes cell debris/waste

159
Q

lymphatic organs/tissues of the body (5)

A

thymus
bone marrow
spleen
tonsils
peyer patches in small intestine

160
Q

the _____ lymphatic drainage system is very symmetric while the ______ lymphatic drainage is very asymmetric

A

superficial
deep

161
Q

3/4ths of the total flow of the lymphatic system drains into what structure

A

the left subclavian vein

162
Q

what enhances the lymphatic flow in the trunks and ducts

A

respiratory effort

163
Q

right upper extremity and thoracic lymphotome drain where

A

the right lymphatic duct

164
Q

which lymph system vessels rely on muscle contraction and hydrostatic pressures to transport the lymph fluid

A

superficial vessels

165
Q

what type of muscle are lymph nodes made of

A

smooth

166
Q

lymphatic capillary functions

A

Transport/filter lymph from body cells and tissues

167
Q

lymphangion

A

each segment of collecting lymphatic vessels between valves

168
Q

lymphangion function

A

prevents backflow
enhances pumping action

169
Q

what nervous system controls the lymph vessel network

(bonus points: how many times do they contract per minute)

A

autonomic nervous system

5-10x/min

170
Q

lymphatic watersheds

A

separate territories of lymph flow regions in the body

171
Q

lymphadenitis

A

inflammation of one or more lymph nodes

172
Q

lymphangitis

A

inflammation of lymphatic vessel

173
Q

lymphadenopathy

A

enlargement of the lymph nodes

174
Q

2 types of lymphedema

A

idiopathic (primary)
acquired (secondary)

175
Q

what stage of lymphedema does lymphedema elephantiasis occur

A

state III

176
Q

most common cause of secondary lymphedema WORLD-WIDE

A

filariasis

177
Q

what is filariasis and how to you get it

A

parasitic worm
mosquito bite

178
Q

most common cause of secondary lymphedema IN THE USA

A

invasive procedures used to diagnose and treat cancer

179
Q

what is the Braden scale and what 6 components for patients are measured

A

determines likelihood of patient developing an ulcer

sensory perception
moisture
activity
mobility
nutrition
friction/shear

180
Q

____ tissue predisposes bacterial invasion and infection

A

necrotic

181
Q

what cell types dissolve necrotic tissues? What type of enzymes are used?

A

bacteria and macrophages
proteolytic enzymes

182
Q

what 2 patient populations are most susceptible to infections of pressure ulcers

A

immunosuppressed
diabetic

183
Q

lab values to look for in patients at risk for pressure ulcers

A

hemoglobin
hematocrit
prealbumin
total protein
lymphocytes

184
Q

how often does a patient need to be moved to avoid pressure ulcer development (independent vs dependent)

A

independent: every 15 mins

dependent: every 2 hours in bed and 1 hour while sitting

185
Q

the head of the bed should be lifted no more than _____ degrees to prevent pressure and shear forces on the skin

A

30 degrees

186
Q

5 causes of secondary lymphedema

A
  • any trauma/surgery that impairs the lymphatics
  • multiple abdominal surgeries
  • bacterial/viral infections
  • repeated pregnancies
  • crush injuries (including burns)
187
Q

infections elsewhere in the body can lead to ______

A

lymphadenitis (or lymphadenopathy)

188
Q

chronic vs acute lymphadenitis

A

chronic develops scarred lymph nodes with fibrous connective tissue

while acute is enlarges, tender, warm, and reddened

189
Q

lymphangitis/cellulitis

A

acute inflammation of the subcutaneous lymphatic channels

190
Q

The most common cause of secondary lymphedema in the US is…

A

Invasive procedures done for cancer diagnosis/treatment

191
Q

The most common cause of secondary lymphedema in the US is…

A

Invasive procedures done for cancer diagnosis/treatment

192
Q

renal neoplasms

A

tumor growth in the kidneys that can be benign or malignant

193
Q

renal calculi

A

urinary stone disease that causes urinary obstruction and severe pain

194
Q

eGFR lab numbers for normal kidney function, kidney disease, and kidney failure

A

normal: 60-120 (best to be over 90)
disease: 15-60
failure: 0-15

195
Q

prostatitis

A

inflammation of the prostate gland that can be acute/chronic and bacterial/nonbacterial

196
Q

benign prostatic hyperplasia

A

nonmalignant enlargement of the prostate gland

197
Q

organs in the upper urinary tract

A

kidney
ureter

198
Q

organs in the lower urinary tract

A

bladder
urethra

199
Q

3 functions of the kidneys

A

filter waste
control mineral/water balance
endocrine secretion

200
Q

why do females have higher incidence of UTI (2 reasons)

A

shorter urethra
urethra is closer to rectum

201
Q

UTI symptoms (just name a few)

A

urinary frequency, urgency, incontinence
nocturia
fever/chills
hematuria

202
Q

UTI pain referrals

A

shoulder
back
flank
pelvis
lower abdomen

203
Q

responses to vasoconstriction stimuli in the renal system are __(enhanced/impaired)___ while vasodilatory responses are ____(enhanced/impaired)____

A

enhanced
impaired

204
Q

what is the most common bacterial infection in the hospital and community

A

UTI

205
Q

what 2 structures are also involved in UTIs

A

bladder (cystitis)
urethra (urethritis)

206
Q

uncomplicated vs complicated UTI

A

complicated = UTI caused by medical condition (kidney stones, weak immune system, etc)

uncomplicated = typical bacterial infection of the bladder

207
Q

what type of bacteria makes up 80% of UTIs

A

E. coli

208
Q

main clinical manifestations of UTI

A

fever, nausea, vomiting
cloudy, bloody, smelly urine
burning/pain peeing

209
Q

3 reasons people can develop acute pyelonephritis

A
  1. ascending UTIs caused by E. coli
  2. bloodborne pathogens infecting other parts of the body
  3. being immunocompromised
210
Q

most common cause of chronic pyelonephritis

A

vesicoureteral reflex

211
Q

pyelo means

A

renal pelvis

212
Q

pyeloephritis

A

a type of urinary tract infection where one or both of the kidneys become infected

213
Q

vesicoureteral reflux

A

urine flows backward from the bladder into the ureters and kidneys

214
Q

murphy sign + what is this used to diagnose

A

tenderness over the costovertebral angle

ACUTE pyelonephritis

215
Q

what is the most common renal neoplasm diagnosis

A

renal cell carcinoma (90-95% of tumors)

216
Q

Male:Female ratio of renal cell carcinoma diagnosis

A

2:1
male:fem

217
Q

what are the 2 most common subtypes of renal cell carcinoma

A
  1. conventional/clear cell (75%)
  2. papillary (15-20%)
218
Q

long term use of diuretics and analgesic pain medications (aspirin, acetaminophen, ibuprofen) can increase risk of developing….

A

renal cell carcinoma

219
Q

what race is most susceptible to renal cell carcinoma

A

african americans

220
Q

what is the most common metastatic tumor to the sternum

A

renal cell carcinoma

221
Q

4 types of kidney stones and which is the most common

A

calcium (most common)
uric acid
stuvite
cysteine

222
Q

does an acidic or basic urine pH increase the risk of kidney stones

A

acidic

223
Q

kidney stone formation steps (5)

A
  1. supersaturation
  2. nucleation
  3. crystal growth
  4. aggregation
  5. stone formation
224
Q

size a stone must be to be considered renal calculi

A

> 20 um

225
Q

pain areas of renal calculi

A
  • severe “colicky” flank pain radiating to the groin/perineal areas
  • pain on the back where the kidney is
226
Q

renal calculi shares similar symptoms to _____

A

UTI

227
Q

HOW MANY MONTHS must go by with an eGFR over 60 and/or having the presence of kidney damage biomarkers to be diagnosed as chronic kidney disease (CKD)

A

3 months
(no matter what the underlying cause is)

228
Q

what are the 2 main conditions that increase risk for developing CKD

A

diabetes (30-50% of all CKD cases)
hypertension (>25% of all CKD cases)

229
Q

excessive nonprescription analgesic drug use can cause ______ which leads to CKD

A

analgesic nephropathy

230
Q

what are the 2 pathogenic signs of CKD

A

hyperglycemia
release of angiotensin II

231
Q

what is angiotensin II and what does it do

A

a hormone that constricts vessels to increase blood pressure (for filtration purposes) inside the kidneys

232
Q

BUN

A

blood urea nitrogen

233
Q

3 lab reports for assessing kidney disfunction

A

BUN
creatinine
protein in urine

234
Q

stage G1 kidney disease

A

Reversible for some people
may remain in stage 1 indefinitely

235
Q

stage G2 kidney disease

A

Damaged capillaries allow small amounts of albumin to be excreted in the urine

236
Q

stage G3 kidney disease

A

albumin levels increase in the urine and decrease in the blood

results in noticeable edema

237
Q

stage G4 kidney disease

A

Proteinuria (the kidneys are no longer able to excrete toxins)

hypertension due to increased production of renin

238
Q

stage G5 kidney disease

A

uremia (a cluster of symptoms)

239
Q

2 types of dialysis

A

hemodialysis (blood filtration, done in hospital or dialysis center)
peritoneal dialysis (cleansing fluid, can be done at home)

240
Q

2 treatment options for renal replacement

A

dialysis
kidney transplantation

241
Q

micturition

A

voiding or bladder emptying

242
Q

what is the smooth muscle of the bladder called

A

detrusor

243
Q

obstructive voiding or defecation, dyspareuia, and pelvic pain are all symptoms of

A

overactive pelvic floor

244
Q

urinary or fecal incontinence and pelvic organ prolapse are all symptoms of

A

underactive pelvic floor

245
Q

what is a significant contributory factor related to falls in older adults, pressure sores, skin breakdown, UTIs, institutionalization, depression, and isolation?

A

urinary incontinence

246
Q

2 most common types of urinary incontinence

A

Stress Urinary Incontinence (SUI)
Urgency Urinary Incontinence (UUI)

247
Q

Stress Urinary Incontinence (SUI)

A

Complaint of involuntary loss of urine on effort or physical exertion, or on sneezing or coughing

248
Q

Urgency Urinary Incontinence (UUI)

A

A sudden compelling desire to urinate that is difficult to defer resulting in a loss of urine

249
Q

what muscle can be blamed for Urgency Urinary Incontinence

A

detrusor

250
Q

prostatitis category I

A

bacterial infection of prostate from infection by bacteria or virus (STIs)

251
Q

prostatitis category II

A

chronic bacterial prostatitis that leads to sexual dysfunction like ED + ejaculatory pain

252
Q

prostatitis category IIIA vs IIIB

A

IIIA: pain and urinary dysfunction WITH inflammation
IIIB: pain and urinary dysfunction WITHOUT inflammation

BOTH DO NOT INVOLVE INFECTION

253
Q

prostatitis category IV

A

asymptomatic inflammatory prostatitis

254
Q

how do doctors know if someone has asymptomatic inflammatory prostatitis

A

WBCs and inflammatory markers are found in semen and/or prostate tissue

255
Q

prostate volume of ____mL defines having benign prostatic hyperplasia

A

30mL

256
Q

what direction/pattern do the prostate cells grow toward in BPH? what is the consequence?

A

inward which causes obstruction of the urethra

257
Q

what is PSA and what is the lab norm #

A

4 ng/mL

258
Q

what are the top 2 deadly cancers in men (in order)

A
  1. lung cancer
  2. prostate cancer
259
Q

1 in ___ men in america will develop prostate cancer

A

1 in 6!!!

260
Q

________ accounts for 98% of primary prostatic tumors

A

adenocarcinoma

261
Q

how do prostate cancer cells grow vs BPH cells

A

cancer: STARTS in the OUTER portion of the prostate then grows inwardly

BPH: new cells grow inward

262
Q

what causes the growth of prostate cancer cells vs BPH cells

A

cancer: decreased level of testosterone

BPH: new cells develop faster than old ones die

263
Q

where is prostate cancer likely to metastasize to (think bones, not organs)

A

axial skeleton

264
Q

upper airway structures

A

nasal cavities
sinuses
pharynx
tonsils
larynx

265
Q

lower airway structures

A

conducting airways (trachea, bronchi, bronchioles)

266
Q

ventilation

A

the ability to move the air in and out of the lungs via a pressure gradient

267
Q

respiration

A

the gas exchange that supplies O2 to the body and removes CO2

268
Q

symptoms of hypoxemia (7)

A

headache
shortness of breath
fast heartbeat
coughing
wheezing
confusion
blush of skin, fingernails, lips

269
Q

hypoxemia

A

deficient oxygenation of arterial blood

270
Q

what is the most common condition caused by pulmonary disease/injury

A

hypoxemia

271
Q

hypoxia

A

a broad term meaning diminished availability of oxygen to the body tissues

272
Q

-emia

A

blood or referring to the presence of a substance in the blood

273
Q

SaO2 levels are determined by…

A

arterial blood gas analysis

274
Q

Normal PaO2

A

80-100 mm Hg

275
Q

Normal SaO2 & SpO2

A

95-100%

276
Q

SpO2 determines (and what is it taken with)

A

% of hemoglobin molecules in the peripheral blood saturated with oxygen

taken with pulse oximeter

277
Q

2 ways of measuring arterial oxygenation levels
(name the direct measure then the indirect measure)

A

direct: saturation of arterial O2 (SaO2)
indirect: saturation of peripheral oxygen (SpO2)

278
Q

what is the clubbing sign

A

symptom of pulmonary disease that causes the tips of fingers to swell and nails to curve

279
Q

what is the normal angle of the finger/fingernail when measuring for clubbing

A

160*

280
Q

diminished gas exchange is primarily due to…

A

increased physiologic dead space

281
Q

what is the job of cilia

A

sweeps away mucus and debris

282
Q

3 ways pneumonia can occur

A
  1. infection
  2. inhalation of toxins
  3. aspiration of food/fluids
283
Q

lobar pneumonia

A

can involve one or both lungs at the level of the lobe

284
Q

bronchopneumonia

A

affecting the bronchioles and alveoli

285
Q

what are the most common infections in hospitalized patients

A

hospital-acquired pneumonia
ventilatory associated pneumonia

286
Q

what type of infectious agent (bacteria/virus) causes the most pneumonia

A

viral

287
Q

what 2 bacteria cause pneumonia and which is the most common?

A

streptococcus pneumoniae (most common)
mycoplasma

288
Q

dysphagia

A

difficulty swallowing

289
Q

what is the most common virus for pneumonia

A

respiratory syncytial virus (RSV)

290
Q

aspiration pneumonia

A

fluids or other materials are inhaled into the lower respiratory tract

291
Q

most cases of pneumonia preceded by an __(upper/lower)___ respiratory infection

A

UPPER

292
Q

airway clearance techniques and early mobility may aid in clearing WHAT

A

purulent sputum

293
Q

acute bronchitis is typically caused by

A

viral infection

294
Q

acute bronchitis

A

an inflammation of the trachea and bronchi that is of short duration (1 to 3 weeks)

295
Q

COPD
(what does it stand for and what is it)

A

Chronic Obstructive Pulmonary Disease

obstruction of the lungs that causes persistent respiratory symptoms and airflow limitation

296
Q

the 2 main diseases that cause COPD

A

chronic bronchitis
emphysema

297
Q

5 major COPD risk factors

A

smoking
low socioeconomic status
age (40+)
long-term exposure to lung irritants
rare genetic conditions (AAT deficiency)

298
Q

signs and symptoms of COPD (5)

A

constant cough
shortness of breath
can’t breathe deep
excess sputum
wheezing

299
Q

the spirometer measures (2 things)…

A
  1. how much air the lungs can hold
  2. how well the respiratory system can move air in/out
300
Q

chronic bronchitis clinical definition

A

productive cough lasting for at least 3 months per year for 2 consecutive years

301
Q

chronic bronchitis increased the production of _____

A

mucus

302
Q

hypersecretion of mucus, thick sputum, + impaired ciliary function are all signs of….

A

chronic bronchitis

303
Q

emphysema

A

enlargement of the alveolar ducts and alveoli that causes them loss of elasticity

304
Q

what is the biggest factor that contributes to emphysema development

A

cigarette smoking

305
Q

asthma

A
  • reversible
  • obstructive lung disease
  • inflammation and reactivity of smooth muscles causing bronchoconstriction/airflow restriction
306
Q

2 types of asthma

A
  1. extrinsic (allergic)
  2. intrinsic (nonallergic)
307
Q

4 main triggers of extrinsic asthma

A

foods
pollutants
pollen/dust/mold
animal dander/feathers

308
Q

which immunoglobulin is the main one present in asthma and what cell accompanies it

A

IgE is present on mast cells

309
Q

what is the leading cause of sleep apnea (70% of cases)

A

obesity

310
Q

what is the most common type of sleep apnea

A

obstructive

311
Q

overlap syndrome

A

co-occurrence of obstructive sleep apnea and COPD

Internal Medicine Final (6 decks)

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