Western Path 1 Midterm

Question 1

Type 1 Diabetes

Answer 1

• insulin dependent
• can occur at any age, but more common in children and young adults
• insulin deficiency resulting in autoimmune destruction of insulin secreting beta-cells within the pancreatic islets of langerhans
• 5-10% of all cases of DM

Question 2

Type 2 Diabetes

Answer 2

• previously known as non-insulin dependent, generally occurs in adulthood-but can happen at any age
• most patients have: a relative with dm and are overweight, generally with a central pattern of obesity
• insulin resistance- inadequate response of metabolic processes to physiologic insulin concentrations

Question 3

medications commonly used to treat diabetes

Answer 3

type 1- long lasting insulin injections ( typically insulin glargine); fast acting insulin (lispro or aspart),

type 2- sulfonylureas ( effective glucose-lowering agents); , thiazolidinediones(glitazones) reduce cardiac risk; long actin insulins primarily nph & glargine to decrease glucose level

Question 4

hypothyroidism

Answer 4

thyroid is unable to produce enough thyroid hormone to meet the body’s needs

• thyroid stimulating hormone (tsh or thyrotropin) stimulates the synthesis and secretion of thyroid hormones and stimulates every facet of thyroid iodine metabolism and promotes thyroid growth
• primary (most common cause of thyroid failure)- low serum thyroid hormone with elevated TSH, loss of fx thyroid tissue and interference of thyroid hormone production
• myxedema coma, cold intolerance, delayed deep tendon reflexes, decreased metabolic rates lead to cold and tendency to increased weight, failure to absorb fluids creates non pitting edema (myexdema)
• goiters develop with hashimoto’s, iodine def

Question 5

common drug used to treat hypothyroidism

Answer 5

Levothyroxine (L-T4) is the drug of choice, which will produce normal plasma levels of T4 & T3

Question 6

Hyperthyroidism (Thyrotoxicosis)

Answer 6

sustained increases in thyroid hormone synthesis and secretion

• most common causes are graves’ disease, autonomous single nodules and thyroiditis
• graves’ is most common TSH receptor autoantibodies that continuously stimulate the thyroid gland as TSH agonists
• autonomously fx’ing thyroid nodules- discrete and fx independently of pituitarty-thyroid negative feedback loop
• thyroiditis is inflammation with thyroidal damage leading to release of T4 & T3 w/o their active formation (transient hypothyroidism typically follows)
• symptoms: nervousness, emotional lability, fatigue, heat intolerance, weight change, increased appetite, myopathic symptoms, increase frequency of gm’s, sweating, irreg menstruation, cns disturbance, palpitations, staring eyes

Question 7

common drug used to treat hypothyroidism

Answer 7

Levothyroxine (L-T4) is the drug of choice, which will produce normal plasma levels of T4 & T3

Question 8

tension pneumothorax

Answer 8

Tension pneumothorax occurs when air accumulates between the chest wall and the lung and increases pressure in the chest, reducing the amount of blood returned to the heart.
-Symptoms include chest pain, shortness of breath, rapid breathing, and a racing heart, followed by shock.
-Doctors can usually diagnose the injury based on the person’s history, symptoms, and examination results.
-Doctors immediately insert a large needle into the chest to remove the air.
In an ordinary pneumothorax, injury to a lung allows a certain amount of air to enter the space between the lung and the chest wall (pleural space). Typically, the air stops accumulating. However, in tension pneumothorax, air continues to enter the pleural space as the person breathes and pressure rises inside the chest. The rise in pressure reduces the amount of blood returning from the body to the heart because the blood cannot force its way into the chest and back to the heart. As a result, the heart has less blood to pump to the body, resulting in shock.

Question 9

Asthma

Answer 9

main features: 1. reversible airflow obstruction

2. nonspecific airways hyper reactivity
3. airway inflammation
   - considered a disease of chronic fluctuating airways inflammation with a lethal potential
   - inflammation in lower airways
   - overtime structural changes in the airway (remodeling): muscle hypertrophy & thickening of the basement membrane decreasing oxygenation of body
   - acute causes: airway muscle contraction, edema & sloughing of mucus; this degrades airway fx causing respiratory symptoms and possible suffocation.

Question 10

pneumonia

Answer 10

When the germs that cause pneumonia reach your lungs, the lungs’ air sacs (alveoli) become inflamed and fill up with fluid. This causes the symptoms of pneumonia, such as a cough, fever, chills, and trouble breathing.

When you have pneumonia, oxygen may have trouble reaching your blood. If there is too little oxygen in your blood, your body cells can’t work properly. Because of this and the infection spreading through the body, pneumonia can cause death.

Pneumonia affects your lungs in two ways. It may be in only one part, or lobe, of your lung, which is called lobar pneumonia. Or, it may be widespread with patches throughout both lungs, which is called bronchial pneumonia (or bronchopneumonia).
Etiology: pulmonary parenchyma (functional tissues of organs vs. “soma” body of organ) assoc with symptoms of infection and accompanies, presence of a new infiltrate on a chest radiograph or auscultatory findings
Altered breath sounds or localized rales, crackles
From Strep or (Table 18-1)
Lower respiratory tract is constantly exposed to bacteria
Development of CAP indicates deft in defenses
Presentation: fevers, chills, elderly/immunocompromised (neutropenic: reduction of white blood cells) may not present with classic symptoms, instead: low grade fever, decreased appetite, lack of responsiveness , increased respiration/heart rates, hypoxia (lack of O2 in blood stream), use of accessory muscles trying to get O2 into the body, decreased breath sounds, rales, egophony (goat sound)
*Cough is the hallmark of pneumonia

Question 11

emphysema

Answer 11

lung condition in which tiny air sacs in the lungs - alveoli - fill up with air. As the air continues to build up in these sacs, they expand, and may break or become damaged and form scar tissue. The patient becomes progressively short of breath. Emphysema is a type of COPD (chronic obstructive pulmonary disease). The main cause of emphysema is long-term regular smoking.

The alveoli turn into large, irregular pockets with holes in them. The surface area of the lungs is gradually reduced, resulting in less oxygen entering the bloodstream.

The small elastic fibers that hold open the small airways leading to the alveoli also become destroyed. When the patient breathes out they collapse, i.e. the patient has problems exhaling air.

Emphysema is not curable, the condition cannot be reversed. However, treatment may slow down its rate of progression and alleviate symptoms.

Question 12

bronchitis

Answer 12

mucus membrane in the lungs’ bronchial passages becomes inflamed.

As the irritated membrane swells and grows thicker, it narrows or shuts off the tiny airways in the lungs, resulting in coughing spells that may be accompanied by phlegm and breathlessness.

The disease comes in two forms: acute (lasting from one to three weeks) and chronic (lasting at least 3 months of the year for two years in a row).

People with asthma may also have asthmatic bronchitis, inflammation of the lining of the bronchial tubes.

Question 13

syncope

Answer 13

temporary loss of consciousness or fainting

Question 14

5 major risks of hypertension

Answer 14

1. high blood pressure accelerates atherogenesis (forming of lesions on artery walls) increasing cardiac risk 2-3 times
2. level of systolic and diastolic bp is associated with cardiac risks in a continuous, graded and independent fashion, more so systolic than diastolic
3. risk for cardiovascular disease couple with each increase of 20/10 mm Hg starting at 115/75
4. often occurs with other atherogenic risk factors (dyslipidemia, glucose intolerance, hyperinsulinemeia & obesity)
5. association of with other risk factors increases risk in a multiplicative rater than additive fashion

Question 15

Causes of Secondary Hypertension

Answer 15

diabetes, renal disorders, pregnancy, drug or diet induced, adrenal disorders, neurologic disorders, parathyroid & thyroid disorders, coarctation of aorta, sleep apnea, obesity

Question 16

normal blood pressure

Question 17

prehypertension

Answer 17

120-139/80-89

Question 18

stage 1 hypertension

Answer 18

140-159/ 90-99

Question 19

stage 2 hypertension

Answer 19

> 160/>100

Question 20

pharyngitis

Answer 20

inflammation of the pharynx (the back of the throat

• causes sore throat, scratchiness of throat and difficulty swallowing
• resp viruses, mono, strep

Question 21

rhinosinusitis (sinusitis)

Answer 21

• inflammation of the maxillary and ethmoid sinuses
• “common cold” sneezing, rhinorrhea, congestion, facial pressure, postnasal drip, hyposmia or anosmia (deminished or lack of smell), sore throat, cough, ear fullness, fever myalgia

Question 22

allergic rhinitis

Answer 22

Nasal congestion, discharge, itching, sneezing, sinus pressure,
Etiology: nonallergic vs allergic rhinitis: releast of histamine, prostaglandins, leukotienes, cytokines
In allergic disease the release of mediators is associated with cross linking of immunoglocun E (IgE) on the mast cell by allergens

Question 23

laryngitis

Answer 23

An inflammation of the voice box from overuse, irritation, or infection
People may experience:
Cough: can be chronic, dry
Throat: soreness, lumps, frequent clearing, or dryness
Nasal: runny nose or congestion
Speech: hoarseness or impaired voice
Whole body: malaise or fever
Also common: discomfort, swollen lymph nodes, phlegm, or sleeping difficulty

Question 24

COPD (Chronic Obstructive Pulmonary Disease)

Answer 24

heterogenous disorder includes: emphysema, chronic bronchitis, obliterative bronchiolitis, asthmatic bronchitis

• air flow limitation that is not fully reversible*
• typically progressive and associated with abnormal inflammatory response of lungs to noxious particles or gasses
• cigarette smoking is major risk factor, others are occupational and environmental risk factors
• leads to pathologic changes to the airways and tissues in lungs, oxidative stress results in further damage, scar tissues forms and results in narrowing and fixed obstruction
• far advanced: lead to pulmonary hypertension and cor pumonale “blue bloaters”-cyanosis,edema, recurrent resp failure, etc
• when emphysema predominates are call “pink puffers” -think and barrel chested
• quit smoking, use bronchodilators and exercise training w/ nutritional counseling

Question 25

P wave

Answer 25

can reveal right or left atrial hypertrophy or atrial arrhythmias

abnormal: Elevation or depression of the PTa segment (the part between the p wave and the beginning of the QRS complex) can result from atrial infarction or pericarditis.
- If the p-wave is enlarged, the atria are enlarged.
- If the P wave is inverted, it is most likely an ectopic atrial rhythm not originating from the sinus node.

Question 26

poisoning

Answer 26

complete physical exam of all systems, followed by frequent repeated vital signs and exams for:

1. id of toxic syndromes & complications associated w/ toxin
2. detection of underlying disease or coexisting trauma
3. careful monitoring of the response to therapy

Question 27

metabolic consequences of increased visceral fat

Answer 27

hyperinsulinemia, insulin resistance, glucose intolerance, , adult onset diabetes, increase in VLDL’s, LDL’s and decrease in HDL; hypertension, gallstone and cholecysitis,

Question 28

obesity

Answer 28

increases the risk for morbidity and mortality and lessens life expectancy markedly.

Question 29

metastatic squamous cell carcinoma

Answer 29

In medicine, squamous cell carcinoma (SCC) is a form of cancer of the carcinoma type that may occur in many different organs, including the skin, lips, mouth, esophagus, urinary bladder, prostate, lungs, vagina, and cervix. It is a malignant tumor of squamous epithelium (epithelium that shows squamous cell differentiation).
-A carcinoma can be characterized as either ‘‘in situ’’ (confined to the original site) or ‘‘invasive’’, depending on whether the cancer invades underlying tissues; only invasive cancers are able to spread to other organs and cause metastasis

Question 30

symptoms and physiological changes that occur in heart that is associated with heart failure

Answer 30

1. systolic hf: inability of ventricle to empty normal with reduced ejection fraction accompanied by ventricular dilation
2. hf with preserved systolic fx: inability of the ventricle to relax or fill normally
   - salt and water retention occurs, pitting edema, exercise intolerance, paroxysmal dyspnea, cough, chest px, weakness, fatigue, nausea, abd px, nocturia, oliguria, confusion, insomnia, weight loss, depression
   - engorged neck veins, pales, displaced apex of ht, hepatomegaly (increased LV size), low volume pulses, s3 s4 murmurs, right ventricular heave

Question 31

gold standard method for diagnosing CAD

Answer 31

direct coronary angiography

Question 32

QRS Complex

Answer 32

useful in diagnosing cardiac arrhythmias, conduction abnormalities, ventricular hypertrophy, myocardial infarction, electrolyte derangements, and other disease states.

Question 33

causes of angina

Answer 33

1. obstruction of coronary arteries by atherosclerosis
   - others include: coronary artery abnormalities, coronary artery spasm, aortic stenosis, anemia, hyperthyroidism, carbon monoxide poisoning, cocaine use

Question 34

arrhythmia

Answer 34

irregular heartbeat

-Improper beating of the heart, whether irregular, too fast, or too slow

Question 35

tachycardia

Answer 35

faster than a normal heart rate at rest

Question 36

bradycardia

Answer 36

slow resting heart rate of under 60 bpm

Question 37

chronic fatigue syndrome

Answer 37

generalized muscle pain and weakness, poor concentration, irritability, post-exertional fatigue lasting longer than 24 hours

Question 38

most common cause of COPD

Answer 38

smoking

Question 39

complications of diabetes

Answer 39

premature vascular disease is the the eventual cause of death in more than 2/3 of diabetes patients

Question 40

oral lesions

Answer 40

Initial point of contact for pathogens and irritants entering the respiratory and digestive systems
-Recurrent Aphthous Ulcers (RAUs) (canker sores) more common in higher socioeconomic classes
(d/t stress? Diet high in red meat–>causing heat)

• Herpes Simplex (HSV): form ulcers, and trigeminal px, most immunocomptetent Pts don’t need meds
• Primary varicella-zoster virus (VZV) infection occurs during childhood when the human herpes virus 3 casues chickenpox
  
  • Remains dormant in sensory ganglia, can be reactivated causing shingles
• Fungal stomatitis (inflammation of mouth/lips)
• Cadidiasis (thrush) is present in oral cavity, iatrogenic infection (d/t physicians contact)
• Caused by broad spectrum antibiotic tx, dry mouth (xerostomia) (LI2: great point for dry mouth)
• Angular cheilitis presents as painful patch at mouth corners

-Fibromas are soft, tan, or pink lesion found repetive
Most commonly seens in older adults: chronic irritation such as cheek or lip biting, rubbing from tooth
-Hairy Tongue: buildup of dead skin cells
-Geographic tongue: migratory glossitis, is a benign condition characterized by smooth atrophy on the tongue

Question 41

otitis externa

Answer 41

swimmers ear
An infection of the outer ear canal
Pain: in the ear
Ears: inflammation or feeling of fullness in the ear
Also common: deafness, pus, redness, tenderness, itching, dry skin, or swelling

Question 42

otitis media

Answer 42

middle ear infection
An infection of the air-filled space behind the eardrum (the middle ear)
Pain: in the ear
Ears: inflammation or ringing
Whole body: vertigo, nausea, fever, or loss of appetite
Also common: headache, nasal congestion, or crying

Question 43

most common causes of chronic cough

Answer 43

postnasal drip, asthma, GERD, chronic bronchitis, post-infections bronchial hyper-responsiveness, bronchietctasis, ace inhibitors

Question 44

addison’s disease

Answer 44

chronic primary adrenal coritcal insufficiency
-mucus membrane pigmentation, skin pigmentation, darkening of hair, freckling, vitiligo, pigment accentuation at nipples and friction areas, pigment concentration at skin creases and scars, loss of weight, anorexia, vomiting, diarrhea, muscular weakness

Question 45

cushing’s syndrome

Answer 45

adreno-cortical hyper function
-red cheeks, moon face, fat pads, bruise easily, thin skin, thin arms and legs, red striae, pendulous abd, poor wound healing, high blood pressure

Question 46

breast mammogram recommendation

Answer 46

Routine screening of average-risk women should begin at age 50, instead of age 40.
Routine screening should end at age 74.
Women should get screening mammograms every two years instead of every year.
Breast self-exams have little value, based on findings from several large studies.