Clinical Medicine Test 1 9/14/11

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Clinical Medicine Test 1 9/14/11
2011-09-07 00:03:56
Pathology language pathophysiology cellular adaptations cell damage classification functioning disability health promotion disease system effects pathology healing mechanisms injury celullular defense inflammation repair Terminology Wound Healing Process Inflammation Management Chapter 14 Substance Abuse

Test 1 for Clinical Medicine on Wednesday, September 14, 2011
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  1. Pathology
    branch of medicine that investigates the changes in body tissue caused by diesease
  2. Clinical Pathology
    Application of pathology (the investigation of changes in body tissue due to disease) in solving clinical problems
  3. 3 effects of disease processes looked at in physical therapy:
    • Impairments
    • Physical limitations
    • Ability to participate fully in one individual social structure
  4. Health
    spectrum from optimal level of function to death

    psychological, sociological, and spiritual well being-- along with indiviual physiology

    _(Traditionally thought of as absence of disease)_
  5. Disease
    biological process; a deviation from the normal physiological homeostasis
  6. Illness
    Individual's perception of being unwell
  7. Diagnosis
    Identification of a specific disease
  8. Etiology
    Cause of a disease

    "causative factors"
  9. Predisposing Factors
    Tendencies that promote development of a disease in an individual--makes them more susceptible

    • Examples:
    • -obesity
    • -diabetes
  10. Pathogenesis
    development of the disease
  11. Acute Disease
    develops quickly, marked signs, short term

    -- more predictable
  12. Chronic Disease
    Often milder, develops gradually, persists longer (maybe forever)
  13. Subclinical State
    Pathologic changes occur, no obvious manifestations

    --not enough to seek medical attention, feel differently, but nothing is present that can be identified--
  14. Latent State
    No symptoms or clinical signs are evident
  15. Prodromal Period
    • Early development of a disease
    • Signs are non-specific or absent
  16. Manifestations
    Signs & symptoms of disease
  17. Syndrome
    • Collection of signs & symptoms
    • Often affecting more than one organ
  18. Remissions
    Manifestions of the disease subside or are absent
  19. Precipitating Factor
    Condition that triggers an acute episode
  20. Complications
    New Secondary or additional problems

    --inability to swallow=secondary condition/complication of Parkinson's Disease--
  21. Therapy
    Treatment measures to promote recovery or slow the progress of a disease
  22. Sequelae
    Unwanted outcomes of primary condition
  23. Convalescence
    Period of recovery
  24. Prognosis
    • Probability for recovery or for other outcomes
    • --prediction--
  25. Rehabilitation
    Maximizing function of diseased tissues
  26. Epidemiology**
    Science of identifying the causative factors and tracking the pattern/occurrence of disease
  27. Morbidity
    Indicates the # of people w/ a disease wi/in a group

    (ex)--Native Americans have high morbidity rate for alcoholism
  28. Mortality
    Indicate the # of deaths resulting from a particular disease within a group

    --some cancers have and higher or lower mortality rate--
  29. Epidemics
    Occur when a higher than expected number of cases of an infectious disease occur within a given area

    --public health sense rise in a disease, creates vaccine
  30. Pandemics
    Involve a higher number of cases in many regions of the globe

    --moves geographically
  31. Occurence of Disease
    Tracked by incidence & prevalence
  32. Incidence
    Number of new cases in a given population within a specified time period
  33. Prevalence
    Number of new and old or existing cases in a specific population and within a specified time period
  34. cellular adaptions

    • Decrease in the size of cells
    • --Results in reduced tissue mass (creates less force & less strength)
  35. cellular adaptions

    • Increase in cell size
    • --Results in enlarged tissue mass
  36. cellular adaptions

    • Increased number of cells
    • --Results in enlarged tissue mass
  37. cellular adaptions

    Mature cell type is replaced by a different mature cell type (teeth)
  38. cellular adaptions

    Cells vary in size & shape within a tissue
  39. cellular adaptions

    Undifferentiated cells with variable nuclear & cell structures
  40. cellular adaptions

    "New Growth"--commonly called tumor
  41. cell damage

    Deficit of oxygen in the cells

    --vey common--
  42. cell damage

    Reduced oxygen in tissues
  43. cell damage

    Physical Damage
    • Excessive heat or cold
    • Radiation exposure
  44. cell damage

    Mechanical Damage
    Pressure or tearing of tissue

    lacerations, cuts, bruises
  45. cell damage

    Chemical Toxins
    • Exogenous-- from environment (ex) toxins you breath or touch; asbestus
    • Endogenous-- from inside the body (ex) bacterial infection releases toxins into the blood
  46. cell damage

    • Bacteria & Viruses
    • --Fungi--lethal (happens usually under imunosupression)
  47. cell damage

    Abnormal Metabolites
    • Genetic disorders
    • Inborn errors of metabolism
    • Altered metabolism
  48. cell damage

    Nutritional Deficits
    need supplements
  49. cell damage

    Imbalance of fluids or elecrolytes
    complecation of burns
  50. Disability
    • Biopsychosiocial models of disability are widely accepted
    • These models provide a framework for identifying the consequences of disease, disorder and injury
  51. Nagi Disablement Model
    • Pathology-disease process
    • Impairment-structural change
    • Functional Limitation-task oriented
    • Disability-social oriented

    --widely used by rehab professionals for many years--
  52. International Classification of Functioning Disabilty & Health
    • Developed by the World health Organization (WHO)
    • most important classification model
    • Aims to represent how individuals live with thier health conditions
    • Considers a number of factors that impact the behavior of an individual
    • has a global/ multi-cultural focus
  53. Cognitive/Disability/Mental Retardation
    • Difficult to diagnose in some
    • Impact patients & their families significantly
    • May impact PT treatment & goal setting
  54. Health Promotion & Disease
    • Public health concepts
    • Prevention and wellness
    • Role of the PT/PTA
  55. Multiple System Pathology
    • Many pathologies commonly treated in physical therapy impact multiple body sytems
    • Systemic effects of many diseases can have significant impact on function

    the more body systems involved, the more likely to impair function--
  56. System Effects of Disease

    Acute initial response to injury

    --more often demonstrates local response but may include systemic response
  57. system effects of disease

    Chronic Inflammation (most common causes)
    • has many causes but the most commonly seen in PT are:
    • --Persistant injury (carpal tunnel)
    • --Immune Response
  58. system effects of disease

    Factors That Influence Healing
    • Age
    • Nutrition
    • Multiple Co-Morbities (more illnesses, harder to recover)
    • Psycho-social status (poor, minority, "not educated"- all leads to difficult recovery)
  59. Immunodeficiency
    • Malnutrition
    • Age
    • Autoimmune Disease
    • Chemotherapy
    • Substance addiction
    • HIV/AIDS
  60. Neoplasm
    Cancers that have spread (metastisis) impact various body systems by encroaching on health/disturbing normal function
  61. Cellular Pathology & Healing
    • Cell injury & causes of injury
    • Inflammation as a response to injury
    • Tissue healing and repair
  62. Mechanisms of Cell Injury
    • Ischemia
    • Infection
    • Immune Reactions
    • Genetic Factors
    • Nutritional Factors
    • Physical Factors
    • Mechanical Factors
    • Chemical Factors
  63. Ischemia
    • Blood flow LESS than the minimum necessary to maintain cellular health
    • --Reduction in blood flow results in reduced oxygen to the tissues
    • --Frequently a result of arterial disease
  64. Infection
    • Most often caused by viral or bacterial invasion
    • --It is the job of the immune system to attack and destroy infected cells
  65. Immune Reactions
    • A spectrum of abnormal responses from mild allergy to life threatening responses
    • --Abnormal immune responses are the cause of many of the pathologies that we treat in physical therapy
  66. Genetic Factors
    A variety of conditions related to the number and structure of chromosomes
  67. Nutritional Factors
    • Malnutrition impacts the protein synthesis necessary for cellular growth and maintenance
    • --Excessive levels of certain nutrients can also have adverse effects on cells
  68. Physical Factors
    Trauma or the presence of physical agents can lead to cellular injury and death
  69. Mechanical Factors
    • Changes in size and shape of cells caused by increased or decreased load that fall outside of average for that particular tissue
    • --Repetitive strain disorders (carpal tunnel-median nerve compressed)
  70. Chemical Factors
    Substances that are toxic to cells lead to cellular death
  71. Reversible vs. Irreversible Injury
    • Injury to a cell causes a loss of its homeostasis
    • Cells become challenged to alter their mechanisms in order to regain homeostasis
    • Cell injury is considered reversible if it is small in magnitude or short in duration
    • This allows the cell to recover after removal of the injuring factor
  72. Cellular Defense
    • Mechanical Defenses
    • Cellular Defenses
    • Systemic Immune Defenses
  73. Inflammation & Repair
    • Inflammation is the body's response to tissue injury
    • A coordiniated series of physiological events
    • --eliminating the insult
    • --replacing damaged tissue
    • --promoting the restoration of normal structure and function
    • Three phases of inflammation and repair. They occur in sequence but with varying degrees of overlap and duration
    • --inflammation
    • --proliferation
    • --repair
  74. Inflammation and Repair

    Coordinated series of physilogical events with the goal of:
    • Eliminating the insult
    • Replacing damaged tissue
    • Promoting the restoration of normal structure and function
  75. Three phases of inflamation and repair. They occur in sequence but with varying degrees of overlap and duration
    • 1) Inflammation
    • 2) Proliferation
    • 3) Repair
  76. Phase 1: Inflammation
    • The body's immediate protective response that attempts to eliminate the cause of injury
    • Characterized by significant vascular response and the release of chemical mediators
    • --Transient vasoconstrictors (stop bleeding)
    • --Significant vasodilation (WBC's transported to injury sight)
    • --Increased capillary permeability
    • A significant increase in the presence of both red and white blood cells are noted in the area
    • White blood cells- remove debris and enhance the healing process (phagocytes)
    • Red blood cells assist in clotting
    • Local inflammation is characterized by the CARDINAL SIGNS of inflammation:
    • --Heat (warmth)
    • --Redness
    • --Swelling (edema)
    • --Pain
    • Leading to loss of function
    • Systemic signs of infection include:
    • --Fever (pyrexia)
    • --Changes in blood chemistry
    • Characterizes LOCAL inflammation
    • --HEAT
    • --REDNESS
    • --SWELLING
    • --PAIN
    • --FEVER (pyrexia)
  79. Changes in Blood with Inflammation
    • Leukocytosis-Increase in the number of white blood cells
    • Differential-altered proportion of various types of white blood cells
    • --Neutrophils: bind to microorganisms and control their growth
    • --Monocytes
    • --Phagocytes
    • C-reactive protein: a protein not normally seen in the blood but appears in response to tissue damage
    • Increased ESR: Elevated plasma proteins
    • Cell Enzymes: Released from damaged cells into the blood stream
  80. Leukocytosis
    Increase in the number of white blood cells
  81. Differential
    • Altered proportions of various types of white blood cells
    • --neutrophils: bind to microorganisms and control their growth
    • --Monocytes
    • --Phagocytes
  82. C-Reactive Protein
    Protein not normally seen in the blood but appears in response to tissue damage
  83. increased ESR= elevated PLASMA PROTEINS
    • Erythrocyte Sedimentation Rate
    • --Blood test used to measure time it takes for RBC's to separate from plasma and drop to the bottom of the tube (mm/hr)
  84. Cell Enzymes
    released from damaged cells into the blood stream
  85. Phase 2: Proliferative Phase
    • Rebuilding of damaged tissue covering and strengthening of injery site
    • --Epitheliazation: reestablishment of superficial tissue covering the injury sight
    • --Collagen Production: fibroblasts migrate to the area to produce new collagen
    • --Wound contracts: edges grow together
    • --Neovascularization: new blood supply forms to nourish newly formed tissue
  86. Epithelialization
    Reestablishment of superficial tissue covering the injury sight (thin covering)
  87. Collagen Production
    Fibroblasts migrate to the area to produce new collagen
  88. Wound Contracts
    Edges grow together
  89. Neovascularization
    New blood supply forms to nourish newly formed tissue
  90. Phase 3: Maturation
    • Longest Phase with durations varying according to size and severity of the wound
    • Collagen Synthesis and Lysis- primitive collagen is replaced by more permanent collagen
    • Collagen is aligned according to function
    • --Induction Theory: collagen mimics the tissue it is healing
    • --Tension Theory: collagen structure is determined by function
  91. Collagen Synthesis and Lysis
    Primitive Collagen is replaced by more permanent collagen
  92. Induction Theory of how Collagen is aligned according to function
    Collagen mimics the tissue it is healing
  93. Tension Theory of how collagen is aligned according to function
    Collagen structure is determined by function
  94. terminology of wound healing

    • Occurs with mild tissue damage. Damaged cells recover & return to normal structure and function within a short time
    • (ex) papercut
  95. Regeneration
    Damaged cells are replaced with identical new ones by the proliferation of nearby cells
  96. Replacement by Connective Tissue (scarring)
    Takes place when there is extensive tissue damage or when cells are incapable of regeneration
  97. Healing by First Intention
    Occurs when the edges of a wound are held close together (surgical wounds that are sutures)
  98. Healing by Second Intention
    Occurs when there is a large break in the skin with a greater inflammatory response and formation of significant scar tissue
  99. Chronic Inflammation
    • Active Inflammation that does not resolve and causes prolonged tissue destruction
    • May be caused by
    • --Failure to resolve causative factor
    • --Abnormal immune response to injury
  100. Factors Effecting Healing Process
    • Type, Size & Location of injury
    • Infection
    • Vascular supply
    • Physical Agents: electric stimulation
    • Co-morbitities: diseases
    • Movement
    • Age
    • Medications
    • Nutrition
  101. Treatment of Inflammation
    • Pharmacological Management
    • --Asprin
    • --Ibuprofen (advil/motrin)-musculoskeletal relief
    • --Naproxyn (sodium, alieve)
    • --Prednisone (corticosteroid)-acute inflammation, allergic reactions
    • --Cox-2 (enzymes secreted by iflammated tissue)
    • Celebrex (short term management of pain--10 days)
  102. Non-Pharmacological Management of Inflammation
    • Physical Therapy
    • --Physical Agents
  103. Musculoskeletal Tissue
    • Cartilage: heals poorly due to low vasular supply
    • Tendons: demonstrate regeneration if surgically repaired and immobilized. Functional outcomes implacted significantly by rehabilitation
    • ~~~Bone Healing~~~
    • Primary Intention: surgical fixation
    • Secondary Intention: Immobilization
    • Four Stages of Healing in Bone
    • --Inflammation
    • --Soft Callus
    • --Hard Callus
    • --Remodeling
  104. Primary Intention
    Surgical Fixation
  105. Secondary Intention
  106. Four Stages of Bone Healing
    • 1) Inflammation
    • 2) Soft Callus
    • 3) Hard Callus
    • 4) Remodeling
  107. Factors that Delay Healing
    • Advanced age
    • Poor nutrition
    • Anemia
    • Diabetes (#1 most commong problem w/ healing because of a compromised circulatory system)
    • Infection
    • Immunocompromise