Patho-Exam 2

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Patho-Exam 2
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2013-07-08 03:16:17
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Exam 2
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  1. Syndrome of inappropriate antidiuretic hormone (SIADH) secretion
    • Posterior pituitary
    • secretion of ADH, pxytocin
    • water retention
    • hyponatremia
    • hyperoosmolarity
  2. Diabetes Insipidus
    • posterior pituitary
    • insufficient ADH
    • polyuria, polydipsia
  3. Hypopituitarism
    pituitary infarction (Sheehan syndrome, hemorrhage, shock)
  4. Premenstrual syndrome
    • cyclic physical/behavioral changes that impair interpersonal relationships or interfere with usual activities
    • luteal phase
    • abnormal nervous, immunologic, vascular, GI, etc.
  5. Dysfunctional uterine bleeding
    • heavy/irregular bleeding without disease
    • perimenopause
    • changes in hormonal levels
    • ovaries don't release egg
  6. polycystic ovary syndrome
    • oligo-ovulation/anovulation
    • elevated androgens
    • infertility
    • multifactorial (hyperinsulinism)
    • dysfunction of follicle development
  7. Primary Dysmenorrhea
    painful menstruation associated with prostaglandin release in ovulatory cycles
  8. Endometriosis
    • -functioning endometrial tissue or implants outside uterus
    • -In endometriosis, displaced endometrial tissue continues to act as it normally would — -it thickens, breaks down and bleeds with each menstrual cycle
    • responds to hormone fluctuations of menstrual cycle
    • -Causes: retrograde menstruation
  9. Infertility
    • inability to conceive after 1 yr
    • structural/hormonal
    • adhesions from pelvic inflammation cause obstruction
    • hormones disrupt ovulation.
  10. Benign prostatic Hyperplasia
    • enlargement of prostate gland
    • urethral compression
    • aging
  11. Follicular cysts
    This type can form when ovulation doesn't occur, and a follicle doesn't rupture or release its egg but instead grows until it becomes a cyst, or when a mature follicle involutes (collapses on itself
  12. corpus luteum cysts
    • low LH and pogesterone
    • inadequate development of corpus luteum
    • fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst
  13. corpus albican cyst
    • regressed form of the corpus luteum
    • As the corpus luteum is being broken down by macrophages, fibroblasts lay down type I collagen, forming the corpus albicans.
  14. Benign cysts
    • increase risk when hormonal imbalances are common (puberty or menopause)
    • common
    • causes: corpus luteum cysts and follicular cysts.
  15. Hypersecretion of growth hormone
    • acromegaly (during adulthood): cardiac hypertrophy, hypertension, atherosclerosis, type 2 diabetes, coronary heart disease. enlargement of facial bones and hands and feet, kyphosis
    • giagantism (children/adolescents)
  16. Panhypotituitarism
    • ACTH-cortisol
    • TSH-decreased metabolic rate
    • FSH/LH-amenorrhea, atrophic vagina, breast, uterus
    • GH-dwarfism
    • ...all deficiencies.
  17. hypersecretion of prolactin
    • female: amenorrhea, osteopenia
    • males: erectile dysfunction, impaired libido, hypogonadism
  18. Thyrotoxicosis
    • hyperthyroidism; increased TH
    • graves goiter, thyroid cancer, increased TSH
    • increased metabolic rate, increased tissue sensitivity to sympathetic stimulation, goiter, bruit over thyroid

    • primary: excess TH by thyroid gland
    • secondary: by TSH secreting pituitary (pathway)
  19. Graves Disease
    • hyperthyroidism
    • autoimmune
    • groiter, opthalmopathy, dermopathy
    • pretibial myxedema (subQ swelling on anterior of legs and indurated and erythemous skin.
  20. Hypothyroidism
    • not enough TRH and TSH
    • hashimoto disease
    • decreased metabolism, reduced heat production
    • myxedema (nonpitting, boggy edema)- pronounced around eyes, feed, hands, tongue thickens and pharynx=slurred speech

    iodine deficiency
  21. Hyperparathyroidism/hypo
    • hypercalciuria
    • alakaline urine
    • hyperphosphaturia-kidney stones

    secondary: renal failure

    • hypo: opposite- low calcium, high phosphate
    • low calcium leads to muscle spasms
  22. Diabetes type 1
    • pancreatic atrophy, loss beta cells
    • macrophages, T and B lymphocytes, NKC
    • autoimmune
    • genetic, environmental
    • hyperglycemia
    • polydipsia, polyuria, polyphagia, weight loss, fatigue
  23. Diabetes type 2
    • metabolic syndrome
    • reoccurring infections, vision, neuropathy
    • insulin resistance
    • decreased beta cell response with abnormal glucagon secretion
    • islet dysfunction due to decreased beta cell mass
    • hypoglycemia, diabetic ketoacidosis
  24. Diabetic ketoacidosis
    • absolute or relative deficiency of insuline
    • type 1 diaetes
    • decreased insulin=fat metabolism=release fatty acids (stimulate gluconeogenesis and ketogenesis)
    • by product of fat metabolism: ketones
    • vomit, dehydration, kussmal respiration, coma.
  25. Somogyi effect
    • hypoglycemia followed by hyperglycemia
    • type 1 diabetes
    • glucose high in morning due to stimulation of glucose conteregulation (epinephrine, GH, cortisol, glucagon release) gluconeogenesis from other sights at  night- peripheral glucose use is inhibited.
  26. Dawn Phenomenon
    • early morning rise in glucose
    • noncturnal elevations of GH=increase glucose
    • via fat and muscle metabolism
  27. Cushing disease/syndrome
    • excessive ACTH (disease), cortisol (syndrome)
    • adrenal cortex
    • rapid weight gain, moon face, glucose intolerant, bone, muscle wasting, immunosuppression, hyperpigmentation
  28. Addisons Disease
    • primary adrenal insufficiency
    • autoimmune
    • elevated ACTH, inadequate corticosteroid synthesis
  29. Hyperaldosteronism
    increased sodium retention, increased extracellular fluid=increased blood pressure=decreased renin, increased potassium
  30. Ferminization
    hypersecretion of estrogen=development of female sex characteristics
  31. Virilization
    • hypersecretion of androgens
    • male sex characteristics.
  32. Pituitary Gland: posterior and anterior
    • posterior: ADH and oxytocin
    • anterior: prolactin, LH, FSH, TSH,GH
  33. Benign vs malignant
    Benign: slow growth, well defined, encapsulated, not invasive, well differentiated, low mitotic index, not metastized

    malignant: fast growth, undefined, non ecapsulated, invasive, poorly differentiated, high mitotic index, metastize
  34. Carcinoma in situ (CIS)
    • epithelial malignant tumors
    • have not broken through basement layer
    • preinvasive
  35. Anaplasia
    absence of differentiation
  36. Stem cells characteristics
    • self renew
    • multipotent (differentiate into different cell types)
  37. Oncogenes
    • mutant genes
    • direct protein synthesis/cell growth
    • "gas"
  38. Tumor suppressor genes
    • encode genes proliferation
    • "breaks"

    if mutation=unregulated cell growth
  39. Mutations
    • stop tumor suppressor genes
    • loss of heterozygosity (unmask mutations)
    • gene silencing (shut off regions)
    • decrease apotosis

    in all...cause cancer
  40. caretaker genes
    • protein repair damaged DNA
    • if inhibit=increase cancer risk
  41. Angiogensis
    • growth of new vessels
    • feed cancer cells
  42. telomere
    • end of chromosome for protection (with each division gets shorter)
    • in cancer: production enzyme rebuild telomere
  43. epigenetics
    • heritable changes in gene expression
    • lifestyle modifications and pharm

    • methylation: silence tumor suppressing gene
    • histone modification: chromatin altered
    • micro RNA: stimulate gene expression
  44. Inflammation and cancer
    • cytokine stimulate enzyme cox-2= cancer
    • free radicals= mutations
    • decreased response to DNA damage
  45. Bacterial/virus-cancer
    • helicobacter pylori
    • peptic ulcer, stomach carcinoma, lyphomas

    virus: hep b and c, HPV
  46. Metastasis
    spread to distant site via lymph, blood
  47. cancer clinical manifestations
    • pain, fatigue, anemia, infection
    • cachexia: severe malnutrition (anorexia, early satiety, weight loss, anemia)
    • leukopenia: decresed WBC
    • thrombocytopenia: decreased platelets
  48. cachexia
    severe malnutrition (anorexia, early satiety, weight loss, anemia)
  49. xenobiotics
    • toxic, mutagenic, carinogenic
    • diet

    • phase I activation enzyme=stimulate
    • phase II detox enzyme= inhibit
  50. Obesity and Cancer
    • BMI
    • adipose tissue stimulates endocrine=release free fatty acids, increase insulin resistance=hyperinsulinemia
    • plus inflammatory factors
  51. childhood vs adult cancer
    child: <1% of cancers, nonepithelial/messendyrmal, short latency, ecogentic, few prevention, detect on accident, metastized at dx, responsive to tx, long term consequences of tx, >70% cure

    adult: >99% of cancers, organs, carcinomas, long latency, environmental/lifestyle, 80% preventable, screen (early detection), local at dx, not responsive to tx, few long term consequences to tx, <60% cure
  52. Mesodermal germ layer
    • origin of most childhood cancers
    • give rise to connective tissue, bone, cartilage, etc
  53. Etiology of cancer in children
    • genetic; oncogenes, tumor suppressor genes, chromosomal
    • environementa: prenatal, parental age incrased, childhood exposures.
  54. Gate control theory
    • complexities of pain. chronic
    • pain transmission to spinal cord via fibers
    • inhibit interneurons=stimulate CNS=close pain gate

    leads to diminished pain perception.
  55. Types of pain fibers
    • A-delta: fast, thick myelinated
    • Type C: small, unmyelinated throbbing, chronic pain
    • A-Beta: large, non-nociceptice (pain receptors)
    • inhibt a-delta and type c
  56. neurotransmitters
    • pain excitatory: aspartame, glutamate
    • pain inhibitory: serotonin, GABA, endorphin
  57. pain threshold
    point at which a stimulus is perceived as pain
  58. perceptual dominance
    pain in one location may decrease threshold in another location
  59. pain tolerance
    • duration of time and intensity of pain that person endures
    • cultural, physical/mental health
    • decreased with repeated pain, fatigue, anger, bored, sleep deprived
    • increased with alcohol, warmth, faith
  60. nociceptive pain
    • normal tissue
    • somatic(body)/visceral (organ)
  61. non nociceptive pain
    • neurpathic, pain receptors
    • chronic
  62. Chronic pain
    • can be nociceptive but long term (3 months)
    • decreased endorphins
    • c neuron stimulated
  63. Neuropathic pain
    • is pain caused by damage or disease that affects the somatosensory system
    • chronic
    • PNS: diabetes, cancer, HIV
    • CNS: spinal cord, MS, tumors
  64. Temperature regulation
    • via thermoregulators in hypothalamus
    • radiation, conduction, convection, vasodialation, decreased muscle tone, evaporation, incrased respirations

    infants: increased surface area, thin subQ layer
  65. Fever
    • adjust heat production, conservation, maintain core temperature
    • stimulate sweat, decreased muscle tone, flushed skin, peripheral vasodilation
    • benefits: kill microorganisms, lysosomal breakdown, phagocytosis, decrease zing, iron, copper, autodestructing, lymphocytes
  66. hyperthermia
    • 41 degrees: nerve damage
    • 43 degrees: death

    • heat cramps (loss sodium),
    • heat exhaustion (dehydrate, dec plasma vol., hypotension=weak, N&V, dizzy),
    • heat stroke (cardio and thermoreg. may cease=increased temperature=cerebral edema, degeneration of CNS, swollen dendrites)
  67. Malignant hypothermia
    • inherited muscle disorder
    • increased calcium release or decreased calcium uptake by muscles for contraction
    • increased oxygen consumption and lactic acid production
  68. hypothermia
    • 35 degrees
    • decreased viscosity of blood, decreased chemical reactions
    • accidental
    • therapeutic: ischemia is risk
  69. Sleep
    • multiphase process
    • restorative and memory consolidation
    • REM (20%) (rapid eye movement)
    • and NREM (majority 70%)

    peds 16-17 hs of sleep, most in REM

    with age: decreased total sleep, longer to fall asleep, aware more often, decrased stage 4
  70. sleep disorders breathing
    • upper airway resistance:
    • obstructive sleep apnea: obesity: blockage
    • obesity hypoventilation syndrome: obese short thick neck, impaired resp mechanism
    • leptin
  71. parasomnias
    awake from REM or arousal NREM
  72. somnambulism
    sleep walking
  73. oculocephalic test
    • dolls eyes
    • abnormal: don't turn in conjugate
    • absent: eyes don't turn as heat position changes
  74. arousal vs awareness
    arousal: awake, alteration. assess: LOC, pupil, motor, oculomotor

    awareness: cognitive functions, aware of self, environment, mood.
  75. oculovestibular test
    • caloric ice water test
    • abnormal: asymmetric eye movement
    • absent: no eye movement (brain dead)
  76. Brain death
    • brain stem death: irreversible
    • cant maintain homeostasis
    • criteria: unresponsive coma (motor/reflex), apnea, no cephalic reflexes, isoelectric EEG, completion of all app therapeutic procedures, signs present for 1 hr and 6 hrs after onset.
  77. Cerebral death
    • irreversible coma
    • no behavioral/environmental response
    • body continues with normal respirations, cardio, temp control, GI
  78. Vegetative state
    • wake from unconscious state
    • period of eye opening
    • potential response to physio stimulus
    • occasional eye movement with tracking
    • sleep/wake cycles
    • normal respirations/GI function
  79. generalized seizure
    • no local (focal) onset, form deep brain, neurons bilaterally
    • result from cellular, biochem, structural abnormalities
    • consciousness always impaired/ lost
  80. Partial seizure
    • focal
    • neurons unilaterally
    • consciousness may be maintained.

    may go into secondary generalized
  81. secondary genalized seizure
    • partial seizure become generalized
    • involves neurons from other hemisphere
    • consciousness lost
  82. static epilepticus
    state of continuous seizures lasting more than 5 minutes or rapidly reoccurring before person fully regain consciousness from previous
  83. seizure consequences on body
    • increase ATP
    • increased oxygen consumption
    • increased cerebral blood flow
    • glucose and oxygen depleted
  84. agnosia
    • cant recognize objects
    • pattern recognition
  85. aphasia
    • loss of total comprehension or production of language
    • stroke
  86. dysphasia
    • impaired comprehension or production of language
    • expressive: cant get words out
    • transcortical: cant understand
  87. dementia
    • progressive failure of cerebral functions, not caused by LOC
    • mental abilities impaired, decreased memory, language, altered behavior, orientation

    alzheimers
  88. Alzheimer's
    • form of dementia
    • genetic. early and late onset (non hereditary)
    • forgetfulness, emotional upset, disorientation, confused, lack of concentration
  89. increased intracranial pressure
    5-15 mmHg is normal
  90. suprotentoral hernia: uncal
    • most common
    • uncus from hippocampal gyrus shift from middle fossa through tentorial notch-posterior fossa
  91. suprotentoral hernia: central
    downward shift of diencephalon through tentorial notch
  92. suprotentoral hernia: cingulate
    gyrus shift under falx cerebri
  93. hypotonia/hypertonia
    decrease/increase muscle tone
  94. Huntington Disease
    • chorea
    • heridetary
    • severe degeneration of basal ganglia and frontal cortex (GABA reduced)
    • disrupt thought process
  95. Parkinsons Disease
    • hypokenesia
    • severe degeneration of basal ganglia
    • rigidity, bradykinesia, termor, posture abnormal, depression, disorientation, confusion, momroy loss
  96. hypokinesia
    • decreased movement
    • akinesia
    • bradykinesia
  97. Basilar skull fracture
    • base of skull (face)
    • temporal bone, occipital bone, sphenoid bone, ethmoid bone
    • raccoon eyes
    • battle sign (ecchymosis)
  98. Diffuse axonal injury (DAI) 1/3
    • shaking
    • rotation acceleration/deceleration
    • sheer, tear and stretch of nerve fibers
    • disabled
  99. Focal injury (2/3)
    • contusions
    • extra dural hematoma: in temperal fossa. artery bleeding
    • subdural hematoma: skull fractures, below dura
    • intracerebral hematoma: 3-10 days, increase ICP and compression leads to edema. decreaed LOC
  100. Mild concussion
    • temporary. increase in ICP
    • attention/memory deficits
    • 1(confusion/disorientation), 2 (momentary confusion with retrograde amnesia) 3 (with amenia retrograde/ anterograde)
  101. classical concussion
    • grade 4
    • physio/neuro dysfunction
    • LOC less than 6 hrs
    • retrograde and anterograde amensia
  102. Cerebral vascular accidents
    • thrombotic stoke: arterial occlusion by thromby (transient ischemic attacks)
    • embolic stroke: fragment breaks from thrombus formed outside braine
    • Hemorrhagic stoke: rupture in aneurysm
  103. Multiple sclerosis
    • autoimmune
    • progressive, inflammation, demylination

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