Patho Exam 4

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  1. What is the difference between an open and closed fracture?
    • Open: the skin is broken
    • Closed: The skin is intact
  2. What is the difference between complete and incomplete fracture?
    • Complete: Bone is broke all the way through
    • Incomplete: Bone is fractured but not all the way
  3. What is a 45 degree fracture to long axis of a bone?
    Oblique fracture
  4. What two things cause an oblique fracture
    • Angulation
    • Compressive force
  5. What type of fracture is described as a break in 2 or more fragments
  6. A pt reports to the clinic and you suspect they have a fracture, what symptoms lead you to this conclusion?
    • Unnatural alignment
    • Swelling
    • Muscle spasm
    • Tenderness
    • Pain
    • Impaired sensation
  7. What is it called when there is a dislocation in which contact between the surfaces are only partially lost?
  8. Where are subluxations most common
    The spinal column
  9. What is the difference between a strain and a sprain
    • Strain is a tear in the tendon
    • Sprain is a tear in the ligament
  10. What is painful inflammation of the tendon
  11. What is painful inflammation of the bursae?
  12. At what age is Bursitis most common and what causes it?
    • Middle age
    • Repeated trauma (softball players)
  13. What is bursae?
    A fluid-like sac that acts as a cushion at joints
  14. What is a degradation of collagen fibers that results from trauma and repetitive stress?
  15. What is complete separation of a tendon or ligament from its attachment
  16. What is another name for Tennis elbow
  17. What is inflammation of tendon where it attaches to a bone (olecranon process - elbow)
  18. What is it when there is a sudden, forceful motion causing the muscle to become stretched beyond its normal capacity
    Muscle strain
  19. What is a complication of localized muscle injury caused by scar tissue calcification and subsequent ossification?
    Myositis Ossificans
  20. What is a life-threatening complication caused by severe muscle trauma manifested by excess myoglobin, and intracellular muscle protein in the urine?
  21. What is the most severe form of rhabdomyolosis
    Crush syndrome
  22. WHat can cause rhabdomyolosis
    Drug overdose and Long term immobility
  23. What disease what first seen in injuries after london air raids in WWII
  24. What is a less severe and more localized form of myoglobinuria which can lead to Volkmann ischemic contracture of forearm or leg
    Compartment syndrome
  25. What precipitating factors can lead to osetoporosis
    • Decreased estrogen/testosterone
    • Reduced physical activity
    • Inadequate Vit C and D
    • Insufficient dietary Ca+ and Mg+
  26. What diseases is characterized by reduced bone mass or density and imbalance of bone resorption and formation
  27. What disease is characterized by inadequate and delayed mineralization, causing radiolucent bands and bone fractures? Can cause Vertebral collapse?
  28. What is osteomalacia in children called
  29. What does deficiency in Vitamin D lead to in osteomalacia
    decreased calcium absorption from intestines and low serum phosphate
  30. What bacteria is the most common cause of osteomyelitis
  31. What 3 things cause Osteomyelitis
    • Staph
    • Contaminated open wound
    • Hematogenous Bone Infection
  32. What can osteomyelitis lead to and why?
    Necrosis due to impaired blood supply
  33. Name 5 places bone tumors may originate from
    • Bone cells
    • Cartilage
    • Fibrous Tissue
    • Marrow
    • Vascular tissue
  34. What type of tumors destroy small areas of bone, tend to be limited to anatomical confines, has a uniform and well defined border with a geographic pattern easily separated from normal bone
  35. What type of tumors have a moth eaten pattern with permeative pattern bone destruction that is not easily separated from normal bone and has the adjacent areas partially destroyed
  36. Name four common types of bone tumors
    • Osteosarcoma
    • Chondrosarcoma
    • Fibrosarcoma
    • Giant Cell
  37. Malignant bone-forming tumor found in the marrow that is large and destructive and has a moth-eaten pattern
  38. What type of bone tumor is common in middle-aged and older adults
  39. What malignant collagenic bone tumor is found in middle aged adults
  40. What type of bone tumor is from myelogenic tissue that occurs between ages 20 and 40?
    Giant Cell
  41. What is the pathology of shock
    Cells are not receiving adequate oxygenation or are unable to use the oxygen
  42. Name 3 compensatory mechanisms that happen when there is no glucose available for cells to use for energy
    • Glycogenolysis
    • Gluconeogenesis
    • Lypolysis
  43. What is the breakdown of glycogen to glucose
  44. What is glycogen formation from fatty acids and proteins rather than from glucose
  45. What is fat breakdown used for alternative for fuel generation?
  46. Describe the pathophysiology of cardiogenic shock
    An injury to the heart muscle causes decreased cardiac output which causes back-up in blood flow leading to pulmonary congestion. Because the blood is not being pumped out of the heart effectively, the cells are deprived of oxygen.
  47. What is the number one cause of cardiogenic shock?
  48. Describe the pathology of hypovolemic shock
    Due to a loss in blood or fluids, the heart has less oxygen to eject to the rest of the body leading to cell deprivation of oxygen
  49. What can cause blood loss that leads to hypovolemic shock
  50. What can cause fluid loss that leads to hypovolemic shock
    • Dehydration
    • Burns
    • Third spacing (Liver/Renal failure)
  51. What does someone with hypovolemic shocks skin feel like and why?
    cool and clammy, pale due to blood being shunted to the critical organs and subsequently away from the skin
  52. Pt comes into the clinic c/o chest pain and difficulty breathing. Upon assessment you note JVD, cool, clammy skin, and crackles in the lung fields. BP measures 90/47. HR is 112. What type of shock do u suspect the pt has and why?
    Cardiogenic shock, The tale tale sign is crackles and JVD as these indicate fluid overload which is consistent with this type of shock.
  53. What type of history would a man suspected of having cardiogenic shock most likely have?
    Hx of: MI, valve issues, arrhythmias, atherosclerosis, and heart infections
  54. Describe the pathophysiology of neurogenic shock
    Nervous system malfunction leads to decreased vascular tone which causes blood to pool.
  55. What things can lead to neurogenic shock
    Brain injury and SCI
  56. What is the NUMBER ONE symptom that differentiates neurogenic shock from all other types of shock and why
    Bradycardia because the nervous system is also responsible for stimulating the heart to beat effectively, with it being impaired, the heart rate slows dramatically
  57. What is the skin like for a person suffering from neurogenic shock and why
    warm and flushed. With neurogenic shock, all the vessels in the body are dilated causing blood rush to the skin
  58. Name two different mechanisms that can lead to shock and examples of each
    1. Cells are starved, so all available oxygen is taken by the tissues and very little is returned to the heart. (Cardiogenic/Hypovolemic)

    2. Oxygen has a hard time getting to the tissues due to inflammation or other barriers, so most of the oxygen returns to the heart (Distributive: Anaphylactic, septic)
  59. What cellular compensatory mechanisms occur to counteract decreased oxygenation?
    Aerobic switches to anaerobic leading to increased lactic acid production which decreases the pH and causes increased respiration
  60. What is progressive failure of 2 or more organ systems caused by SIRS after a severe illness or injury
  61. Name the four different parameters in which there needs to be at least 2 apparent to diagnose SIRS
    • Temp <96.8 or >100.5
    • HR >90
    • RR >20 or PaCo2 <32
    • WBC <4000 or >10,000, Bands >10%
  62. What criteria must be met for a pt to be diagnosed with Sepsis
    2 criteria of SIRS and confirmed infection
  63. What criteria must be met for severe sepsis to be diagnosed
    Sepsis + Sx of end stage organ damage + Hypotension <90 + Lactate >4 mmol
  64. What criteria is needed for a person to be in septic shock
    Sepsis + Hypotension that is unrelieved by fluids + Organ damage + Lactate >4 mmol
  65. When does a person transition from Septic shock to MODS
    When there is severe septic shock, organ FAILURE, and a build up of metabolic waste (due to liver failure)
  66. What type of burn affects only the epidermis?
    First degree
  67. What type of burn affects the epidermis and dermis but tactile and pain sensors stay intact
    Second Superficial Partial Thickness
  68. What type of burn affects the epidermis and dermis but the tactile and pain sensors are diminished
    Second Deep Partial Thickness
  69. What type of burn affects the epidermis, dermis, and subq tissue, tactile and pain sensors are absent
    3rd degree Full thickness
  70. What does a first degree burn look like? When does the symptom appear
    Blisters may be present within 24 hrs
  71. What does a second degree superficial partial thickness burn look like and when does the symptom appear
    Blisters present within minutes
  72. What does a second degree deep partial thickness burn look like
    • Blisters may or may not appear
    • Flat, dehydrated layer lifts off in sheets
  73. What does a third degree burn look like
    • Blisters are rare
    • A flat dehydrated layer lifts off easily
  74. Describe cellular and cardiovascular response to a major burn injury
    • Within minutes, capillary beds open
    • There's an increase in capillary permeability
    • There is an increase in hypermetabolic state
    • Hypercoagulable state develops
  75. What can Increased capillary permeability lead to for a burn patient
    Hypovolemic shock and massive edema
  76. Why does a burn patient have a persistent elevated body temperature?
    Due to the hypermetabolic state
  77. What will the labs look like for a burn patient
    • Elevated fibriniogen
    • Decreased PT and PTT
  78. Besides hypovolemic shock, what other type of shock is a burn patient at risk for and why
    Septic, due to the ability for microbes and endotoxins to translocate across intestinal wall, the complement system is deactivated which decreases opsonization and the body can no longer tell self from nonself allowing bacteria to multiply
  79. What is Small unmyelinated C polymodal nociceptors responsible for
    Transmission of diffuse burning or aching sensations (slow pain)
  80. What is Medium-sized A-delta fibers responsible for
    Carrying well-localized sharp pain important in initiating rapid reactions to stimuli (fast pain)
  81. What is responsible in the spinal cord for regulating transmission of pain impulses that proceeds cephalad for further processing and interpretation in the brain?
  82. What needs to be stimulated in order to close pain gates?
    Large, fast, heavy myelinated Alpha-Beta fibers
  83. Where are large, fast, heavy myelinated Alpha-Beta fibers located
    synapse at dorsal horn of spinal cord along with their nociceptive Alpha-Delta and C counterparts
  84. What two neurotransmitters located in the medulla and pons contribute to pain modulation
    Norepinephrine and Serotonin
  85. What are morphine-like neuropeptides that act as transmitters by binding to one or more opioid receptors?
    Endogenous Opioids
  86. What do endogenous opioids do??
    Inhibit transmission of pain impulses in brain and spinal cord
  87. Name 4 types of endogenous opioids
    • Enkephalins
    • Endorphins
    • Dynorphins
    • Endomorphins
  88. Name 3 types of acute pain
    • Somatic
    • Visceral
    • Referred
  89. What type of acute pain is near on on the surface of the skin that is sharp and localized
  90. What type of acute pain is located in the internal organs, abdomen, and skeleton
    Visceral Pain
  91. What type of acute pain is an area removed or distant from point of origin
  92. How does pain get referred in the body
    Cutaneous and visceral neurons converge on same ascending neuron and brain cannot distinguish between the two
  93. Describe the process of thermoregulation
    Hypothalamus > TSH-RH

    Anterior Pituitary > TSH

    Thyroid > Thyroxine

    Adrenal Medulla > Epinephrine

    = Vasconstriction, Glycolysis, Increased Metabolic Rate
  94. How does fever occur?
    Introduction of Exogenous pyrogens/endotoxins

    Phagocytes engulf bacteria

    IL-1, IL-6, interferons, and TNF released

    Raises Set point of hypothalamus
  95. What is a potential complication of fever?
    Heat stroke
  96. What occurs during a heat stroke
    • Regulatory center ceases to function
    • Sweating ceases causing rapid increase of body temp
    • Skin if dry and flushed due to vascular collapse
    • Altered LOC due to cerebral edema, degeneration of CNS, and Renal tubular necrosis
  97. At what temperature is someone at risk for heat stroke
    105 degrees
  98. What does hypothermia do to the body
    • Slows chemical reactions
    • Increases blood viscosity
    • Slows blood flow
    • Facilitates blood coagulation
    • Stimulates profound vasoconstriction
  99. At what temperature a person at risk for hypothermia?
    95 degrees
  100. What are sx of hypothermia
    • Shivering
    • Decreased HR, RR, CO
    • Decreased coordination
    • Moderate to severe acidosis
  101. What is consciousness
    Alertness with orientation to person, place, and time
  102. What is altered perception of stimuli (time, then place, then person)
  103. What is orientated X 3 but slow vocalization and decreased motor skills
  104. What LOC occurs when pt awakens in response to stimulation, continous stimulation is needed for arousal, and eyes are usually closed
  105. What LOC does a pt exhibit who only responds to painful stimuli
  106. What LOC is a pt who has no arousal to any stimulus but brainstem remains intact
  107. Name the components of the diencephalon
    thalamus and hypothalamus
  108. What occurs in the diencephalon as a person progresses into nonresponsiveness
    • agitated, dull, lethargic, obtundation
    • Pupils respond briskly
    • Dolls eyes
    • No Caloric posturing
  109. What is caloric posturing
    When there is no eye movement in direction on or after injection of hot/cold water in ear canal
  110. What three things take place in the midbrain as a person become unresponsive
    • Stupor/coma
    • Neurogenic hyperventilation
    • Midposition fixed pupils (MPF)
  111. What is the difference between brain death and cerebral death
    • Brain death is when cardiac and resp cannot be maintaned (death of brainstem/cerebellum)
    • Cerebral death is an irreversible coma but brain stem is not yet affected so brain can maintain cardiac and resp function
  112. What is caused by abnormal excessive hypersynchronous discharges of CNS neurons characterized by sudden transient alterations of brain functions
  113. Name and describe two types of partial seizures
    • simple: Motor, sensory, somatosensory sx (aura)
    • Complex: Loss of consciousness w/ automastisms
  114. What type of seizure has a partial onset and evolves into a generalized seizure
    Secondary generalized
  115. What type of seizure is bilaterally symmetric, without local onset, and loss of consciousness
  116. Define clonic phase in seizure
    Alternating contraction/relaxation of muscles
  117. Define tonic phase of seizure
    Muscle contraction with excessive muscle tone
  118. What is the occurrence of a second, third, of multiple seizures before the person has fully regained consciousness from preceding seizure causing cerebal hypoxia
    Status Epilepticus
  119. What phase of seizure follows tonic-clonic seizure usually involving sleeping
  120. What disease is charecterized by loss of neurotransmitter stimulation by choline acetyltransferinase
  121. What is late-onset FAD linked to?
    a defect on chromosome 19
  122. What is an accumulation of insoluble amyloid beta peptides that is also a protein found in AD
    Senile plaques
  123. What is neurofibrillary tangles?
    Twisted and distorted protein fibers in the neurons
  124. Where is neurofibrillary tangles more concentrated
    cerebral cortex and hippocampus
  125. What is the inability to perform coordinated acts in addition to cognitive
  126. What is the difference between blunt and open brain injuries
    • Blunt - closed - dura remains intact
    • Open - penetrating - Break in dura
  127. What can cause Blunt force trauma
    head strikes hard surface or rapidly moving object strikes head
  128. What does open brain injury result to
    Focal brain injury
  129. What involves specific, grossly observable brain lesions seen in cortical contusions, epidural hemorrhage, subdural hemorrhage, intracerebral hematoma, and open head trauma
    Focal Brain Injury
  130. What is a bruise on the brain from force of impact
  131. What is coup in regards to brain injury
    direct impact area
  132. What is an area that lies opposite of the line of force, lesions where brain strikes hard tissue on the opposite side
  133. What is the most common source of bleeding for an extradural hematoma
  134. What is the tearing of bridging veins major cause of rapid and subacute development
    Subdural hematoma
  135. What can subdural hematoma lead to
    Herniation due to blood filling subdural space
  136. What type of hematoma is caused from small blood vessels traumatized by shearing forces
    Intracerebral hematoma
  137. What results from inertial force to the head associated with high levels of acceleration and deceleration leading to memory loss, dizziness, HA, anxiety, and mood disorders
    Diffuse brain injury or diffuse Axonal injury (DAI)
  138. What type of DAI has decerebrate or decorticate posturing, prolonged stupor, or restlessness (concussion)
  139. What type of DAI has a prolonged coma that lasts days or weeks with incomplete recovery most often
  140. What type of DAI leads to immediate autonomic dysfunction (brainstem signs) that resolves in a few weeks. ICP appears 4-6 days after injury
  141. Where do most spinal cord injuries appear?
    • C1-C2
    • C4-C7
    • T12-L2
  142. What is caused by normal activity of SC cells at or below level of injury ceasing because of lack of continuous clonic discharges from brain or brainstem and impulses inhibited immediately after injury characterized by complete loss of reflex at or below level of lesion
    spinal shock
  143. How long does spinal shock usually last after onset symptoms?
    7-20 days
  144. What is associated with massive, uncompensated CV response to stimulation of the SNS usually occurring at T6 or above
    Autonomic hyperreflexia
  145. What is autonomic hyperreflexia usually in response to?
    bladder or rectum distention
  146. What is the biochemical and biomechanical alterations of the tissue that comprise the intervertebral disk
    Degenerative disk disease
  147. What is a structural defect that involves the lamina (neural arch of the veterbra
  148. Where is spondylolysis most common
    Lumbar spine
  149. What is caused when a vertebra slides forward in relation to an inferior vertebra
  150. Where is spondylolythesis most common?
  151. What is a protrusion of part of the nucleus pulposus through a tear in the fibrous capsule that encloses the gelatinous center of the disk
    Herniation of vertebral disk
  152. What causes pain in lumbosarcral area that radiates along the sciatic nerve over the buttocks and into the calf and ankle
    Herniated intervetebral disk
  153. Name some risk factors for CVA
    HTN, Cigarettes, elevated LDL, DM, hyperchromocysteinemia
  154. What type of stroke is caused by arteries supplying the brain and is most frequently attributed to atherosclerosis and inflammatory disease processes that damage arterial walls
    Thrombotic stroke
  155. What is thrombotic particles that cause an intermittent blockage of circulation?
  156. What causes neuro deficits in TIA
    focal disturbance of brain or retinal ischemic lasting less than an hour without an infarction
  157. What type of stroke involves fragments that break from a thrombus that was formed outside of the brain?
    Emoblic stroke
  158. What common sites are associated with embolic stroke
    heart: MI, Afib, Endocarditis, Rheumatic heart disease, aorta, common carotid artery
  159. What type of stroke is most commonly associated with HTN, ruptured aneurysms, arteriovenous malformation, and bleeding disorders
  160. What types of symptoms does hemorrhagic stroke cause
    HA, stiff neck, loss of consciousness, blood in CSF
  161. What is a lacunar stroke
    very small and only involves small arteries
  162. What is a cerebral infarction
    when an area of the brain loses blood
  163. What do nociceptors respond too
    mechanical, thermal, and chemical
  164. Describe the pathway of nociceptors to the brain
    Tissue injury > Substance P, Acetylcholine, Serotonin, and Prostaglandins > Nociceptor > Dorsal root ganglion > Spinothalamic Pathway > Thalamus > Somatosencory Cortex > pain
  165. Name two afferent fibers that transmit pain signals from free nerve endings into the CNS
    Myelinated A-delta fibers and Unmyeliated C fibers
  166. Describe how myelinated A-Delta fibers transmit pain.
    Myelinated A-Delta fibers is responsible for pain related to mechanical and thermal injury (fast pain), they respond to nociceptors and quickly relay the message to the dorsal root of ganglia where it travels through the neospinothalamic tract and onto the thalamus ending at the primary somesthetic cortex
  167. Describe how unmyelinated C fibers respond to pain?
    Unmyelinated C fibers respond to chemical stimuli or persistent mechanical or thermal injury and takes the paleospinothalamic tract to the brain stem (RAS) and onto the primary somesthetic cortex
  168. What is the PAG (Periaqueductal grey region) of the midbrain referred to?
    Endogenous Analgesic Center
  169. What pathway is fast pain (sharp, stabbing) associated with?
    Neospinothalamic tract
  170. What pathway is slow pain (dull, aching) associated with
    Paleospinothalamic tract
  171. What is the main biological difference between acute and chronic pain (besides the obvious)?
    • Acute involves Autonomic response
    • Chronic involves Psychological response
  172. What type of pain is a more diffuse and throbbing pain that originates in structures such as muscles, bones, tendons, and radiates to surrounding tissues
    Deep Somatic Pain
  173. What type of pain is diffuse and poorly defined pain that results from stretching, distention, or ischemia of tissues in a body organ
    Visceral Pain
  174. What pain originates at a visceral site but is perceived as originating in the part of the body wall that is innervated by neurons entering the same segment of the nervous system?
    Referred pain
  175. What gland is responsible for temperature regulation?
  176. Describe the 5 steps to fever
    • 1. Release of PGE2 or cytokines from inflammatory cells
    • 2. Resetting of thermostat set point
    • 3. Vasoconstriction, shivering, Piloerection, Increased metabolism
    • 4. Core body temperature reaches new set point
    • 5. Once temperature has been met, vasodilation, sweating, and increased ventilation occur to return temperature to normal set point
  177. Name and describe the four successive stages of fever
    • Prodromal: HA, fatigue, achy
    • Second (chill): Shaking, cold
    • Third: Flush, skin warm and red
    • Fourth: (devervescence): sweating
  178. What disease is pathologically characterized by cerebral cortex atrophy and enlargement of ventricles
  179. What are the hallmark symptoms of alzheimers
    • Short term memory loss
    • Denial
    • Disorientation
    • Impaired abstract thinking
    • Apraxias
    • Behavior changes
  180. What is the main difference between focal and diffuse brain injury
    • Focal: neuro deficit without loss of consciousness
    • Diffuse: Almost always includes loss of consciousness
  181. What is characterized by flaccid paralysis, loss of tendon reflexes below the sit of injury, absence of somatic and visceral sensations below the site of injury, and loss of bowel/bladder function?
    Spinal Shock
  182. What are two types of SCI and describe them
    • Primary neurological injury: occurs at time of mechanical injury and is irreversible
    • Secondary injuries: Progressive neuronal damage following a primary injury that promotes the spread of injury
  183. What is a temporary disturbance in cerebral bloodflow (lasting less than 1 hr)  which reverses before infarction occurs
  184. Name the steps that take place in MODS from Ischemic injury to Massive Systemic Immune/Inflammatory response
    • 1. Ischemic Injury
    • 2. <microcirculation, organ hypoperfusion
    • 3. Macrophages release inflammatory mediators which damage endothelium systemically
    • 4. Activation of complement, coagulation, fibrinolytic, kilkrein/kenin system
    • 5. Massive systemic immune/inflammatory response
  185. What causes hypoperfusion of tissue in MODS
    Vasodilation, Increased capillary permeability, selective vasoconstriction, and microvascular thrombi cause a maldistribution of systemic and organ blood flow
  186. What causes an increase in oxygen and substrate demand in MODS
    Due to the immune/inflammatory response, the body goes into a hypermetabolic state and hyperdynamic circulation which leads to increased oxygen and substrate demands
  187. What is the end result of increased oxygen and substrate demand as well as tissue hypoperfusion in MODS
    There is now an oxygen supply/demand imbalance which leads to tissue hypoxia and eventually organ dysfunction
  188. How does body fluids try to compensate for  decreased cardiac output in regards to shock?
    Due to intravascular deficits, there is vasodilation to allow fluids from the interstitial space to sequester into the vessels. Since there is now decreased interstitial fluid and oxygen, the body is forced to switch to anaerobic glycolysis which increases lactic acid, leading to acidosis
  189. How does the heart and vessels respond to decreased cardiac output and intravascular deficits in regards to shock? What clinical manifestations would appear as a result?
    • Heart: Pumps harder - weak, fast pulse
    • Peripheral Vessels: constrict - cool, clammy skin
    • Arterioles: dilate, Veins constrict: blood pools - increased clots
    • Blood is shunted to critical organs
    • Kidneys fail to eliminate H+ ions - oliguria
  190. Name 6 stages of fracture healing process
    • 1. Impact
    • 2. Induction: Clot and bruise (1st stage-heal)
    • 3. Inflammation: Cartilage formation
    • 4. Soft Callous: bridge two bones together
    • 5. Ossification: Callous turns to bone
    • 6. Remodeling
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Patho Exam 4
2014-11-30 01:40:41
Patho Exam 4
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