Patho exam 2

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Patho exam 2
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2015-03-22 16:02:09
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pharmacology GI nephrology urology hepatic biliary oncology integumentary
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patho exam 2
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  1. What areas can urinary tract pathology manifest at?
    • back 
    • flank
    • abdomen
    • upper thigh pain
  2. what are some of the ways that PTA's play a role in treatment for urinary tract disorders?
    • rehab for dialysis and post transplant patients
    • conservative Tx with incontinence; pelvic floor
    • pt. education on s/s of disorders and infections
    • know that they are co-morbidities and how they affect the rehab process of other unrelated Dx
  3. effects of multiple medications
    BPH/benign prostatic hyperplasia
    pelvic floor disorders
    Hx of surgeries and catheterizations

    What do all of these have in common
    risk factors for the elderly and urinary tract disorders
  4. Where is kidney pain typically felt?
    posterior subcostal or costovertebral region T11-12
  5. How does kidney pain radiate?
    forward and around the flank ipsilateral lower abdominal quadrant along the pelvic crest and into the groin. ipsilateral shoulder pain if it presses on the diaphragm.
  6. A pt. came to you c/o these s/s: 

    flank pain that is dull aching & boring
    increased urination urgency
    pain unrelieved by change in position
    nausea & vomiting
    blood in urine
    fever & chills 

    what would you be suspicious of?
  7. what is an infectious inflammatory disease of renal parenchyma of kidney secondary to bacterial entering via urethra?
    pylonephritis
  8. What are the cells of the kidney called?
    parenchyma
  9. how does pylonephritis happen?
    • acute: associated with bacterial infections 
    • chronic: tublointerstitial disorder from progressive scar formation overlying the parenchyma
  10. A pt. came to you c/o these s/s: 
    sudden onset of fever and chills
    malaise
    HA
    dull pain over kidney and flank
    urinary urgency and frequency with dysuria

    what would you be suspicious of?
    pylonephritis
  11. What are some of the risk factors for pylonephritis?
    • ascending UTI's
    • cath
    • preggo
    • DM
  12. What are some of the things you want to monitor for when working with a pt. who you suspect has pylonephritis?
    • develops fever of 102+
    • c/o nausea and vomiting
    • mental changes
  13. what is infammation of glomeruli of both kidneys; acute or chronic?
    glomerulonephritis
  14. there are 2 different immunologic causes to glomerulonphritis, what are they?
    • 1: injury secondary to deposition of circulation antigen-antibody complexes in the glomeruli
    • 2: injury secondary to antibodies reacting with insoluble fixed lomerular antigens. the antigen can be endogenous as in SLE or exogenous such as with strptococci.
  15. what % of IDDM/type 1 pt.'s will develop glomerulonphritis?
    55%
  16. what % of NIDDM/type 2 pt.'s will develop glomerlonphritis?
    30%
  17. Other than diabetes, what other pathologys are associated with glomerular lesions?
    • SLE
    • hypertension
  18. changes in permeability secondary to glomerulonephritis leads to what?
    • pyuria
    • proteinuria
    • hematuria
    • edema
    • hypertension
  19. T/F: clinical manifestations with glomerulonphritis in early stages is typically few overt s/s
    true
  20. What are some of the things you would see that would make you suspect glomerulonphritis?
    • generalized edema
    • hematuria
    • pyuria
    • oliguria
    • hypertension
  21. T/F: due to symptoms being subtle, glomerulonphritis is typically found incidently on urninalysis or elevated BP readings.
    true
  22. What are some of the things you would do to treat glomerulonphritis?
    • increase protein intake
    • salt restrctions
    • diuretics to manage edema
    • low fat diet 
    • exercise
  23. immobilization, bone disease hyperparathyroidism, hypercalcemia vitamin d intoxication are risk factors for what type of kidney stone?
    calcium stones
  24. UTI's are risk factors for what type of kidney stone?
    magnesium ammonium phosphate stones
  25. Acidic urine at 5.5pH, gout and high purine diet puts you at risk for what type of kidney stone?
    uric acid
  26. what is an inherited disorder of amino acid metabolism that is a risk factor for kidney stones?
    cystine
  27. your pt. comes in with c/o of excruciating pain in the flank and upper outer quadrant of the abdomen, and nausea and vomiting. What would you suspect?
    kidney stones; colic pain
  28. your pt. come in with c/o of dull, deep ache in the flank or in the back. What would you suspect?
    kidney stones; noncolicky pain
  29. What are the classic triad s/s for kidney CA that only occurs with 10% of those diagnosed?
    • hematuria
    • abdominal or flank pain
    • palpable abdominal mass
  30. T/F: kidney CA is generally silent during the early stages with symptoms associated with mets usually the initial symptoms noted (cough, convulsions, back pain or pathologic Fx/
    true
  31. What is caused by hypoveloemic shock, infection or prostatitis and is reversible; function returns in 3-12 months?
    acute renal failure
  32. what type of renal failure is irreversible, progressive reduction of renal functioning  resulting in eventual permanent loss of kidney function?
    chronic renal failure
  33. What are some of the things renal failure pt.'s might have difficulty with?
    • concentrating
    • short term memory
    • independent living
    • fatigue and general weakness
    • immunosupressed
  34. What is cystitis?
    bladder infection
  35. how does cystitis develop?
    caused by usually ascending UTI, chronic or acute, bacterial
  36. where does the bacterial usually associated with UTI's come from?
    the bowel
  37. what is the most common predisposing factor for cystitis?
    catherterization or urinary instrmentation
  38. what populations are more at risk for bladder infections?
    • adult women
    • geriatric 
    • preggos
  39. What are the s/s for cystitis?
    • frequency
    • urgency
    • dysruia
    • pain that can be suprapubic
    • lower abdominal or flank pain
    • fever
    • chills 
    • malaise
  40. what is inflammation of the urethra
    urethritis
  41. what causes urethritis?
    • STD's
    • kidney stones
    • several other organisms
  42. where would a pt. c/o pain with urethritis?
    costovertebral angle either unilater or bilateral; can radiate to lower abdomen, upper thigh, testes or labia ipsilaterally
  43. what is a typical wave of pain like for a pt. with urethritis?
    crescendo wave of colic, excruciating and severe intensity.
  44. where is the most common site for urinary tract CA?
    bladder
  45. hematuria and back pain if it metastasizes is a major signs for what type of CA?
    bladder
  46. what is age related nonmalignant enlargement of prostate gland due to hyperplasia?
    benign prostatic hypertrophy
  47. what happens with BPH?
    urethra narrows due to hyperplasia and obstructs urination.
  48. 98% of all primary prostate tumors; third leading cause of death in US men, most common CA in men.
    adenocarcinoma
  49. what are the s/s for adenocarcinoma?
    • urinary obstruction
    • low back, hip, or leg pain from metatasizes
    • fatigue
    • weight loss
    • frequenct and/or painful urination
    • urgency
    • nocturia
    • incomplete baldder emptying
    • painful ejaculation
    • hematuria
  50. what can be the first signs for prostate cancer?
    LBP, pelvic or femur pain
  51. impairment of voluntary bladder control
    incontinence
  52. what are the three different types of incontinence?
    • stress
    • urge
    • neurogenic
  53. pressure applied to bladder from caughing sneexing laughing lifting exercising or any physical exertion that increased abdominal pressed and when the pelvic floor musculature cannont counteract the urethral/bladder pressure
    sress incontinence
  54. invoulntary loss of urine associated with strong desire to void
    urge incontinence
  55. lack of control or sensation of bladder activity resulting in incontinence due to CVA, or head injury.
    neurogenic incontinence
  56. what are the 3 types of neurogenic incontinence?
    • flaccid: LMN dysfunction
    • spastic: UMN dysfunction
    • uninhibited: neither flaccid or spastic
  57. symptoms associated with a multitude of different systemic conditons
    constitutional symptoms 
  58. nausea, vomiting, diarrhea, malaise, fatigue, fever, night sweats, pallor, diaphoresis and dizziness all have what in common?
    they are constititutional s/s 
  59. acute MI, diabetic acidosis, migraines, hepatobillary and pancreatic disorders, and inner ear issues are all systemic conditions associated with what?
    nausea 
  60. frequent watery stools resulting in poor absorption of water and nutrients?
    diarrhea 
  61. T/F: chronic diarrhea can lead to dehydration, electrolyte imbalance and weight loss
    true 
  62. T/F: diarrhea secondary to antibiotic use can occur 6-8 weeks after the inital dose is taken
    true 
  63. diminished appetitie or aversion to food. associated with cancer, heart disease and renal disease
    anorexia 
  64. fecal matter too hard to easily pass or bowel movements so infrequent that discomfort occur; low back pain may develop secondary t due to muscle guarding or pressure on sacral nerves from full lower intestine.
    constipation
  65. T/F: some of the causes for constipation include dehydration, diet, meds chronic diseases, lack of exercise, bed rest, emotional stress, and personality. 
    True! 
  66. A burning sensation in the esophagus usually felt in midline below the sternum in the region of the heart. 
    heartburn 
  67. How does heartburn happen?
    acidic contents of the stomach regurgitate into the esophagus 
  68. what are the different causes as to why someone would feel abdominal pain?
    • mechanical: due to stretching
    • inflammatory: release of prostaglandins histamine, seratonin or bradykinins that stimulate nerve endings
    • ischemic: lack of 02
    • refered
  69. what is often not detectable by the patient but rather need hemocrit test: bleeding caused by gastritis, peptic ulcers or lesions of the intestine often produce occult blood in the stool
    GI bleeding 
  70. vomiting bright red blood
    hematemesis 
  71. black tarry stools; typically indicates bleeding higher in the gi tract; but if the hi motility is increased upper gi blood in stool may be bright red
    melena 
  72. bleeding from the rectum or maroon colored stool 
    hematochezia 
  73. what are the major causes of upper GI bleeds?
    severly ill due to major trauma, burns, systemic ilness or head injury; pepetic ulcers; nsaids;chronic alcohol use. 
  74. has both psychological physiological contributing factors
    fecal incontinence 
  75. difficulity swallowing causes include neurological dysfunction local trauma or mechanical obstruction 
    dysphagia 
  76. pain during swallowing secondary to esophagitis or esophageal spasm, mimics coronary ischemia relieved by upright positioning and worsened by supine position
    odynophagia 
  77. kehr's sign, due to free air or blood in abdominal cavity such as when spleen ruptures causing distention 
    left shoulder pain 
  78. the lower esophageal sphincter becomes enlarged allowing stomach to pass through the diaphragm into the thoracic cavity
    diaphragmatic hernia 
  79. hiatal hernia due to failure of formation with the diaphragm 
    congenital 
  80. hiatal hernia due to blunt trauma or penetrating wounds
    acquired 
  81. What puts you at risk for hiatal hernia?
    anything that weakens the disphragmatic muscle or alters the hiatus and or increases intra-abdominal pressure
  82. lifting, straining, bending over, chronic or forceful cough, obesity, pregnancy, CHF, low fiber diet, constipation, and delayed bowel movements can all lead to what?
    increasing intra-abdominal pressure 
  83. reguritation and heartburn are common s/s for what?
    hiatal hernia 
  84. What are the 3 most common causes for GERD?
    • infections
    • chemical irritants
    • systemic diseases 
  85. scleroderma, smoking, caffeine, chocolate, alcohol, CNS depressants, fatty foods, cardiac meds and hiatal hernias are all common causes for what?
    GERD 
  86. heartburn, reflux, dysphagia, painful swallowing with pain described as "burning" that moves up and down and can also radiate to the jaw, neck and back are clinical manifestations for what?
    GERD 
  87. what are the typical over the counter remedies for GERD?
    • antacids or baking soda
    • upright position and walking
    • fluids
    • avoidance of predisposing factors
  88. T/F: there is an incidence of 3:1 men to women ratio of esphogeal CA that dues to heavy pipe and cigar smoking.
    true
  89. inflammation of the lining of the stomach that represents a group of the most common stomach disorders. usually self limiting and heals within several days.
    acute gastritis
  90. limited to the mucosa and do not extend beyond the musclaris mucosa. can be well localized or distributed diffusely throughout the muscosa.
    gastric erosions
  91. Who is most at risk for acute gastritis and why?
    >65yoa and use of NSAIDS >3 months along with corticosteriod use.
  92. the main symptom is epigastric pain along with the feeling of abdominal distention, loss of appetite, nausea, heartburn, low grade fever. What does this sound like?
    acute gastritis
  93. There are 3 types of chronic gastritis. What are they?
    • autoimmune
    • helicobacter pylori: non erosive CG
    • chemical gastropathy: chronic reflux
  94. age- primary factor
    vitamin deficiency
    abnormalities of gastric juices
    hiatal hernia
    alcohol use
    or combos of all of the above

    these are all risk factors for what?
    chronic gastritis
  95. loss of tissue lining the lower esophagus, stomach and most commonly the duodenum.
    peptic ulcer
  96. What is thought to be caused by aggressive action of hydrochloris acid and pepsion on the mucosa?
    peptic ulcer
  97. a bacteria that which inhibits the gastric mucosa of 95% of pple with DU and may either contribute or modify or be associated with the disease.
    heliobacter pylori
  98. How would someone with heartburn typically describe their pain?
    burning, gnawing, cramping, aching
  99. Where would someone with heartburn typically feel the pain?
    over the xiphoid process or referred to the back
  100. When do people with heartburn typically say the feel the most s/s?
    when stomach is empty and at 1-2 am
  101. T/F: aspirin and other nsaids can cause ulcerations, hemorrhage, perforation, stricture formation, exacerbation of inflammatory bowel disease.
    true
  102. T/F: nsaid theoretically break down the mucous membrane which protects the gi tract and thus can lead to local injury by allowing stomach acids to dissolve the intestine.
    true
  103. What is the most common for of gastric CA?
    adenocarcinoma
  104. What is the typical treatment for gastric CA?
    gastrecotmy bc chemo and radiation havent proven to be effective.
  105. Conditions that impair one or more steps in the digestive process
    malabsorption syndrome
  106. diarrhea, cramping, steatorrhea and flatulance together are all associated with what?
    malabsorption syndrome
  107. gluten sensitive enteropathy; genetically predisoposed immune mediated disorder
    celiac disease
  108. what leads to an intense inflammatory reaction resulting in loss of absorptive villi in small intestine; impairs absoroption of both macro and micronutrients.
    celiac disease
  109. Is celiac disease managable?
    yes. avoid foods with gluten and foods that may be processed around gluten containing products.
  110. inflammation of vermiform appendix
    appendicitis
  111. initially vague pain with episode of nausea that progresses over 2-12 hours to become localized in the right lower quadrant(mcBurneys point) with rebound tenderness and low grade fever.
    appendicitis
  112. severe, life threatening disorder that occurs when activated enzymes escape into the pancreas and surrounding tissue.
    acute pancreatitis
  113. onset typically abrupt and dramatic. may follow large meal or alcoholic binge. but can vary from mild pain to profound shock with coma and death. usualy initial pain is epigastric and abdominal presenting severely and radiates to back. worse with walking and lying supine and releived by sitting and leaning forward.
    acute pancreatitis
  114. what is characterized by progressive destruction of the pancreas mostly due to alcoholism?
    chronic pancreatitis
  115. what is the 4th most common cause of death from CA?
    pancreatic CA
  116. smoking is a mahor one with diet coming in second; high fat foods, preservatives, salts, refined sugar, and dehydrated foods. These are risk factors for what?
    pancreatic CA
  117. unknown etiology. involves genetic and immunologic influences on the GI tractsability to distinguish foreign from self antigens and to "down regulate" the mucosal response, allowing persistent increase of the tissue damaging process. both conditions are chronic , medically incurable
    inflammatory bowel diseases
  118. inflammation and uleration of the inner lining for the large intestine and rectum
    ulcerative colitits
  119. rectal bleeding, diarrhea, nausea and vomiting, anorexia, weight loss, anemia, accompanied by fever in acute disease. These are s/s for what?
    ulcerative colitits
  120. what is the prognosis for ulerative colitits
    no cure, remission and exacerbations; life expectancy is shortened due to malnutrition issues.
  121. what attacks terminal end of the small intestine and colon but can occur anywhere from the mouth to anus and usually in young adults and adolescents.
    crohns disease
  122. pain in periumbilical region and sometimes referred to low back and constant ache or tenderness in advanced disease. These are s/s of wht?
    crohns disease
  123. what is the common cold of the stomach?
    irritable bowel syndrome
  124. T/F:  irritable bowel syndrom may be a reaction to stress, but dont know cause; most common in women in early adult hood.
    True
  125. after how much % of liver function loss does it actually start to show s/s?
    80-90%
  126. what is located above the right kideny, stomach, pancreas, intestines and below diaphragm. has 2 lobes and the right is bigger than the left by 6X?
    liver
  127. Why is the liver a frequent site of metastasis?
    large blood and lymph supply.
  128. What are the 5 main functions of the liver?
    • detoxification of harmful substances
    • destruction of senesent RBC's/formation of bile
    • metabolizes hormones
    • stores vitamins
    • synthesizes protins, gluose and clotting factors
  129. What is pear shaped, under the liver, and holds up to 50ml of bile?
    gallbladder
  130. What gives skin, poop, and pee is color?
    bilirubin
  131. What is bile essential for?
    metabolism of fats and absorption of fat soluble vitamins.
  132. Where are some common sites for liver pain referral?
    • T-spine 7-10; midline to R side
    • R UT
    • R shoulder
  133. Where are some common sites for gallbladder referral pain?
    • R UT
    • R shoulder 
    • R interscap area T4/5-8 
    • R subscapular area
  134. yellowness of skin, sclerae, mucous membranes, and excretions (dark urine, light stools) due to bilirubin staining secondary to excess bilirubin not absorbed by liver that has accumlated in blood. Usually first noticed in the eyes
    jaundice
  135. What are the theraputic conditions for someone with liver disease?
    need rest/time and should not exercise them
  136. osteoporosis
    CNS S/S
    rhabdo
    spider angiomas
    palmar erythema
    bilateral CTS or tarsal tunnel syndrome
    nail changes

    these are all S/S of what type of disease?
    liver disease
  137. white bands across the nail plate
    leukonychia
  138. spoon nails
    koilonychia
  139. opaque nail beds
    nails of terry
  140. "shamroths window"
    clubbed nails
  141. Hepatitis
    cirrhosis
    portal HTN

    these are all diseases related to what organ?
    liver
  142. acute infectious inflammation of liver caused by viruses; major uncontrolled public health problem.
    viral hepatitis
  143. oral fecal contamination; often acquired in childhood and mimics the flu.
    hep a
  144. blood borne form of hep
    hep b
  145. exposure to blood or blood products; transfusions, needlesticks, IV drugs, no vaccine available.
    hep c
  146. inflammation of liver for 6 months or more after unresolved flare-up
    chronic hepatitis
  147. what represents the end stage of chronic liver disease?
    cirrhosis
  148. destruction of functional liver cells; replaced with fibrous connective tissue bands. as scarring gets worse, fibrous tissue restricts blood and lymph flow predisposing patient to portal HTN, obstruction of bile flow and cell death.
    cirrhosis
  149. alcoholism is the most common cause of what?
    cirrhosis
  150. What are the most common s/s of cirrhosis?
    weight loss, weakness, and anorexia.
  151. What are some of the late clinical manifestations of cirrhoisis?
    • splenomegaly
    • ascites
    • portosystemic shunts
    • bleeding
    • spide angiomas
    • encephaopathy
  152. How many drinks a week and a day would consider a man an alcoholic?
    • 14/wk
    • 4/ occasion
  153. how many drinks a week and occasion would consider  woman an alcoholic?
    • 7/wk
    • 1/ occasion
  154. what is the definition of a "drink"
    • 12-oz beer
    •  5-6-oz wine
    •  1-1.5-oz hard liquor
  155. HTN
    hepatitis
    chrrhosis
    hemorrhagic stroke
    pancreatitis
    gastritis
    sleep disorders
    major depression
    loss of libido
    cardiomyopathy 

    these are health risks related to what?
    chronic alcoholism
  156. failure to fulfill role at work, school or home. recurrent use in hazardous situations. legal problems related to overuse, and continued use despite related social or interpersonal problems are all related to what?
    alcoholic determining behaviors during the last 12 months.
  157. monitor for bilateral swelling of the feet
    monitoring for blood loss in the stools or hematemesis
    monitor for excessive bruising or nosebleeds
    prevent increases in intra-abdominal pressure
    rest to reduce metabolic needs on the liver. 

    these are all the things you want to monitor with what disease?
    cirrhosis
  158. primary tumors are rare, usually due to metastasis form colorectal, breast, lung or urogenital are what form of CA?
    liver
  159. T/F: liver CA is usually insidious in the onset and often masked by cirrhosis and chronic hepatitis.
    true
  160. T/F: the prognosis for liver CA is 7% 5-year survival rate.
    true
  161. what are cholelithiasis?
    gallstones
  162. what is cholecystitis?
    inflammation of the gallbladder due to gallstones impacted in cystic duct.
  163. who are more at risk for gallstones and why?
    women; elevated estrogen levels which cause more cholestrol to be secreated into the bile.
  164. T/F: most gallstones are asymptomatic but can become very painful with c/o pain in the RUQ and abdomin that can radiate to the mid-upper back, below right shoulder or btw scapulae.
    True
  165. what are the 3 most common ways to treat gallstones?
    • low fat diet for mild symptoms
    • laparoscopic cholecystectomy
    • lithotripsy: (shock waves)
  166. RUQ pain, nausea with vomiting, anorexia, fever, excessive belching and heartburn are common s/s for what?
    cholecystitis
  167. T/F: typically cholecystitis resolves in 1-7 days.
    true
  168. protects body from the enviroment
    interfaces btw internal and external environment
    prevents fluid from leaving the body
    synthesizes vitamin D
    area for heat exchange
    immune function
    touch, pressure, temperature, and pain sensation

    What are these a function of?
    skin
  169. New lesions
    unexplained lesions
    physician is unaware
    lesion is changing

    What do these have in common?
    they are general rules for MD referral for rash
  170. rapidly spreading rash
    accompanied by systemic c/o fever, fatigue, malaise
    accompanied by joint pain

    what do these have in common?
    urgent referral to MD for rash
  171. inadequate pulmonary gas exchange, notable in the mucous membranes, lips, tongue, and nails
    central cyanosis
  172. slowing of cutaneous blood flow; notable in the fingers, toes, nails and nailbeds, nose or outter surfaces of the lips.
    peripheral cyanosis
  173. what does it mean when someone starts to turn gray or brown (hyperpigmentation)?
    disturbance of adrenocortical hormone
  174. atopic dermatitis
    contact dermatitis
    eczema

    what do all of these have in common?
    common skin disorders
  175. common, chronic, relapsing, pruritic type of eczematous disorder.
    atopic dermatitis
  176. How does atopic dermatitis present in babies?
    red, oozing crusting rash
  177. how does atopic dermatitis present in adults?
    found in folds of extremities on flexor surfaces
  178. acute or chronic skin inflammation caused by exposure to chemical, mechanical, physical, or biologic agent
    contact dermatitis
  179. superficial inflammation of skin die to irritant exposure, allergic sensitization or genetics and is common in the elderly?
    eczema
  180. _____________ and  ______________ are common bacterial skin infections.
    • impetigo
    • cellulitis
  181. _________________, ____________________, and ________________ are viral skin infections.
    • herpes simplex 1 & 2
    • varcella zoster
    • warts
  182. ___________________ and _________________ are the most common forms of fungal skin infections.
    • tinea corpora
    • tinea pedia
  183. what form of bacterial skin infection is most common in infants, childern 2-5, elderly and is contagious and spreads easily?
    impetigo
  184. sm. macules develop into vesicles which become pustular, vesicles break and form thick yellow curst producing pain, erythema, cellulitis, itching, scratching, and causes autoinoculation.
    impetigo
  185. suppurative inflammation of the dermis and subcutaneous tissues.
    cellulitis
  186. skin is erythematous, edematous, tender sometimes nodular, commonly will develop lymphsangms as well and has a tendency for recurrence.
    cellulitis
  187. who is most at risk for cellulitis?
    • elderly
    • dm
    • malnutrition
    • steroid therapies
    • presence of wounds, ulcers, or burns.
  188. local disease secondary to reactivation of chicken pox virus.
    shingles/varicella zoster
  189. there are two types of the herpes. What are they?
    • type 1: cold sore, fever blister; contagious and incurable.
    • type 2: genital lesion; contagious and incurable.
  190. common, benign, viral infections of skin caused by human papilloma viruses (HPVS)
    warts
  191. what is tinea corpora more commonly known as?
    ring worm
  192. what is tinea pedis more commonly known as?
    athletes foot
  193. What are the 4 types of skin CA?
    • basal cell carcinoma
    • squamous cell carcinoma
    • malignant melanoma
    • karposi's sarcoma
  194. slow growing surface epithelial skin tumor originating from undifferentiated basal cells in epidermis.
    basal cell carcinoma
  195. T/F: basal cell carcinoma rarely metastasize beyond skin; occurs in men and women  age 30-40 and above and is the most common malignant tumor affecting white people due to the sun.
    true
  196. T/F: squamous cell carcinoma is the 2nd most common cancer among white people.
    true.
  197. usually occurs on rim of ear, face, lips, mouth, dorsum of hands where exposed to sun. More common in fair skinned people and peak incidence at age 60 men > women, caused by UV exposure.
    squamous cell carcinoma
  198. most serious, arises from pigmented cells in skin called melanocytes that synthesize melanin pigment.
    malignant melanoma.
  199. T/F: UV radiation damages DNA inside epidermal cells, tanning is bodys respone to uv exposure to block further UV rays attempts to destroy DNA. DNA lesions not repaired increase the risk for skin CA; the darker the tan the more UV damage there is to be repaired.
    true.
  200. Family Hx, blonde or red headed, marked freckling on the upper back, Hx of 3+ or more blistering sunburns prior to 20 yoa, Hx of 3+ outdoor summer jobs during adolescence

    what are these risk factors for?
    skin CA
  201. What is the ABCD method for early detection of melanoma?
    • A: asymmetry
    • B: border
    • C: color
    • D: diameter
  202. type of skin CA presenting as skin disorder, used to occur in jewish and italian men, now common in patients with AIDS (specifically homosexual males)
    kaposi's sarcoma
  203. What are some common immune dysfunctions of the skin?
    • psoriasis
    • SLE
    • scleroderma
  204. chronic, inherited, recurrent, inflammatory dermatosis characterized by well defined erythematous plaques covered with silvery scales.
    psoriasis
  205. appear on scalp, chest, nails, elbows, knees, buttocks, itching, pain due to dry cracked lesions that can recur and persist.
    psoriasis
  206. T/F: psoriasis lesions can develop into psoriatic arthritis
    true
  207. what term refers to a large group of diseases characterized by uncontrolled growth and spread of abnormal cells
    cancer
  208. abnormal growth of new tissues that serves no useful purpose, does not respond to normal body controls and may harm the host organism by competing for blood and nutrients
    neoplasia
  209. either an overgrowth or neoplasm; benign or malignant
    tumor
  210. the process of describing the extent  of disease at the time of diagnosis
    staging
  211. what is the purpose of staging cancer?
    • aids in Tx planning
    • prognosis
    • comparing outcomes
  212. what does cancer staging reflect?
    • rate of growth
    • extent of neoplasm
    • prognosis
  213. T/F: the most important predictors for recurrent CA are the stage at initial diagnosis and the histological findings.
    true
  214. What stage is carcinoma in situ?
    stage O
  215. what is the early stage of local CA?
    stage I
  216. What stage do yo have an increased risk of spread due to tumor size?
    stage II
  217. What stage has local cancer spread but may not have spread to distant sites
    stage III
  218. What stage has metastasis usually occurred?
    Stage IV
  219. What is the TNM staging system for CA?
    • T: primary tumor
    • N: lymph nodes
    • M: distant mets
  220. differ from normal cells in structure, size, function, rate of growth, and occurs due to a basic disturbance in cellular DNA
    cancer cells
  221. discrete stages that suggest a singler alteration can only partially push a cell to carcinogenisis.
    stages of tumor development
  222. What are some of the potential carcinogens that cause CA?
    • viruses: HPV, karposi's
    • chemical: smoking, asbestos 
    • drugs: steroids, chemo
    • hormones: ovarian and prostate CA
    • excessive alcohol consumption
  223. What do the impacts of carcinogens depend on?
    • individual susceptibility of resistance
    • potency of carcinogen
    • dose and duration of exposure
  224. what is the progression of carcinogenesis?
    • dysplasia: alteration and disorganization of adult cells
    • anaplasia: loss of cellular differentiation
    • neoplastic hyperplasia: results in formation of a tumor
    • Carcinoma in situ: localized area of cancer cells
    • invasive carcinoma
    • metastatic carcinoma: the process of spreading to the other parts of body
  225. What two ways  can metastasis occur?
    • travel through the blood or lymph to lodge OR
    • penetrate into adjacent structures
  226. once the primary tumor starts to move by local invasion, blood vessles from surrounding tissue grow into the solid tumor
    tumor angiogenesis
  227. T/F: the pattern of metastasis differs from CA to CA.
    True
  228. where are the 5 most common sites of mets?
    • lymph nodes
    • liver
    • lung
    • bone
    • brain
  229. what percent of newly Dx pt.'s have clinically detectable mets?
    30%
  230. what % of pt.'s have occult mets?
    30-40%
  231. causative agents are usually calssified as _______________ and _____________ and it is suspected that most cancers evolve as a result of the ____________________________________.
    • endogenous
    • exogenous
    • interplay of multiple causative agents
  232. what is the single most signifacnt risk factor for CA?
    AGE! 25 yoa and continues to increase at every 5 year mark.
  233. cancer gene that can contribute to development of cancer pathologic activation
    oncogene
  234. T/F: when immune system response is altered, blocked, or overpowered by a large number of malignant cells, it fails to function and cancer growth increases.
    true
  235. what enviromental factors lead to alterations in the cellular DNA causing uncontrolled cellular reproduction and growth of CA Cells
    food, drink, smoke, radiation, workplace exposures, drugs, sexual behavior, substances in air/water/soil.
  236. T/F: lifestyle plays a major role in CA development.
    true.
  237. strong link to CA; chronic emotional and physical_________causes both hormonal and immunological changes that faciliate the growth and proliferation of CA cells.
    stress
  238. What ethinic group is more commonly Dx and die from CA?
    blacks
  239. What are the most common CA's that show a familial pattern?
    • breast
    • ovarian
    • prostate
    • colon
  240. What 4 personal behaviors lead to CA?
    • tobacco use
    • diet
    • alcohol use
    • sexual and reproductive
  241. smoking
    alcohol
    obesity
    inactivity
    diet/nutrition
    unsafe sex
    urban air pollution
    indoor smoke from household fuels
    contaminated injections in healthcare

    what do these have in common?
    they are modifiable risk factors for CA deaths worldwide
  242. T/F: oncologic pain is not an early symptom of CA, but rather occurs when tumor is well advanced. occurs in 50-70% of clients in earlier stages and 60-90% in late stages.
    true
  243. bone destruction usually secondary to metastasis
    obstruction of hollow visceral organs and ducts
    infiltration or compression of peripheral nerves, arteries or veins
    infiltration or distention of skin or tissue
    inflammation, infection and necrosis of tissue. 

    what do all of these things have in common?
    mechanisms implicated in development of chronic CA pain.
  244. There are 2 main types of CA Tx, what are they?
    • curative
    • pallative
  245. surgery
    radiation
    chemo
    biotherapy or BRM
    hormonal therapy

    these are all what type of CA Tx?
    curative
  246. radiation
    chemo
    physical therapy
    medications
    acupuncture
    chiropractic
    alternative medicine
    hospice care

    these are all what type of CA Tx?
    pallative
  247. mucositis
    mouth sores
    nausea and vomiting
    fluid retention
    pulmonary edema
    cough
    HA
    Malaise
    fatigue
    dyspnea
    hair loss

    these all have what in common?
    they are side effects to CA Tx
  248. what type of effect does CA Tx have on the nutritiona status of a pt?
    • altered appetite, weight loss and malnutrition
    • adversely affect how the body digests, absorbs and uses foods
  249. if no recurrence of cancer in _________ after initial Dx, a pt. is considered cured.
    5 years
  250. What is the CAUTION acronym and what is it for?
    early warning signs for cancer 

    • C: changes in bowel/bladder
    • A: a sore that does not heal in 6 wks 
    • U: unusual bleeding/discharge
    • T: thickening or lumps
    • I: indegestion/difficulty swallowing
    • O: obvious change in wart/mole
    • N: nagging dry caugh or hoarseness
  251. what local and systemic S/S can a pt. present with?
    • weight loss
    • muscular weakness; proximal
    • anorexia
    • anemia
    • coagulation disorders
    • dyspnea, SOB
    • fever
    • pain
  252. T/F: CA pt's have an increased fall risk due to both the local effects of Ca and the systemic effect of CA Tx.
    true
  253. what blood levels would you not exercise a CA pt?
    • platelet: <50,000/ml
    • hemoglobin: <10g/dl 
    • WBC: <300/ml OR >10,000 with fever
    • absolute granulocytes (the phills):<50/ml
  254. What would you check before and after exercise with a CA pt?
    • 02 stats
    • HR
    • PR
    • breathing freqency
    • BP
  255. what target HR would you want to exercise a CA pt at?
    40-65%
  256. you would never want to exceed ____ on the borg perceived exertion scale and you do not allow the pt go ______________.
    • 12
    • anaerobic
  257. distended neck veins, facial and arm lymphadema with lung CA?
    superior vena cava syndrome
  258. back pain, muscle weakness or gait changes associated with mets from lung, breast, prostate, colon and multiple myeloma
    spinal cord compression
  259. chemo can cause acute renal failure most pronounced 6-72 hrs after chemo; muscle weakness and cramping, tachycardia, decreased BP or arrhythmias during activity
    tumor lysis syndrome
  260. what is the most common cause of death from CA in women and men since 1987 and sadly enough it is the most preventable form of CA?
    lung
  261. change in respiratory pattern
    recurrent pnemonia or bronchitis
    hemoptosis
    persistent caugh
    hoarseness
    SOB
    sharp pain increased during inspiration
    weight loss
    chest/shoulder/arm pain
    atrophy and weakness of arm and hand muscles
    S/S of lung cancer
  262. small cell or oat cell carcinoma
    squamous cell
    adenocarcinoma
    large cell carcinoma  

    what do these have in common?
    types of lung cancers
  263. T/F: metastases usually occur to regional lymph nodes, adrenal glands, brain, bone, and liver in lung cancer?
    true
  264. any chemical agent that affects living processes, used to prevent or alter disease processes, modifies biochemical or physiologic functioning capabilities of cells.
    drug
  265. defines the chemical structure, rarely used in medical practice
    chemical name
  266. common name given to a drug by the united states adopted name council; non-proprietary name
    generic name
  267. name given to a drug by a specific pharmacetical compay
    proprietary or trademark name
  268. the fate of drugs in the body; how the body acts upon a drug
    pharmacokinetics
  269. the actions and effects of the drug on tissues and organs of the body; how the drug accts on the body
    pharmacodynamics
  270. transport of the drug to its target site and removal of the drug and its metabolites from the body
    pharmacokinetics
  271. drugs must pass through lipid membranes to enter the  blood stream unless they are given intravenously.
    pharmocokinetics-absorption
  272. most common route, most convenient route, and the most economical route for drug delivery.
    oral administration
  273. How long does a drug take to take effect if given orally?
    30 min to an hour; depends on metabolism
  274. T/F: drugs that are effective after oral adminstration are absorbed through the intestinal epithelium and enter the blood vessels of the intestinal tract
    true
  275. T/F: oral administered drugs are carried directly to the live first.
    true
  276. what is the first pass effect?
    when a drug is rapidly metabolized by the liver and very little will enter into the blood stream.
  277. quickest onset of action; drug must be in solution form, difficult to self administer.
    intravenous injection
  278. absorption via mucous membranes of the oral cavity; fairly rapid absorption and onset of actions
    sublingual
  279. placed directly on the skin.
    topical
  280. drugs absorbed through the skin to treat systemic diseases
    transdermal
  281. tight junctions btw endothelial cells of the capillaries in the brain, presences of the basement membrane and the processes of astrocytes.
    blood brain barrier
  282. what does pharmcokinetic distribution depend on?
    blood flow so tissues with better perfusion will receive more exposure to the drug.
  283. T/F: the purpose of pharmacokinetics distribution are b/c of small fluctuation in pH, hormone levels, and amino acids secondary to routine daily activities are potentially damaging to the nervous system.
    True.
  284. the amount of drug that reaches its target of action
    bioavailability
  285. T/F: when a drug binds to protein in the blood stream and are considered inactive.
    true
  286. T/F: free or unbound drugs are the only ones available to interact with receptors or to be metabolized.
    true
  287. T/F: drugs that do not bind to plasma proteins generally have a quicker onset of action and a shorter duration of action that drugs that are heavily bound to plasma proteins.
    true
  288. enzymatic alteration of a drug; can lead to the formation of either a more active or less active metabolite or a toxic metabolie; usually occurs in the liver.
    biotransformation
  289. the time in which the concentration of the frug falls to one half of its original amount
    elimination half-life
  290. There's two ways biotransformation can happen on the liver. what are they?
    • chemical modification or inactivation
    • conversion of lipid soluble substances to water soluble derivatives
  291. when repeated doses of a drug are given at regular intervals, the blood concentration will increase until an _______________ is reached.
    equilibrium
  292. at equilibrium the dose administered equals the amount eliminated
    steady state or plateau level
  293. how many half-lives are required for steady state to be reached?
    4-5 half-lives
  294. if reaching a plateau in a shorter time is desired, a higher does or a _______________ can be admistered initially.
    loading dose
  295. T/F: steady state levels are important to achieve in chronic drug therapy so that a therapeutic range can be achieved and maintained
    true
  296. level below which the desired effect is usually not seen and above which toxic effects are seen.
    therapeutic range
  297. which drugs are harder to keep within the therapeutic range?
    short half-lives
  298. the duration of effect of the drug which can be more important than plasma concentration in the case when drugs continue to exert an influence without a presence.
    biological half-life
  299. where a drug produces its effect
    site of action
  300. may be on the cell membrane or inside the cell; triggers a reaction
    receptor
  301. reversible, and how much drug is bound to a receptor depends upon the affinity of the drug for the receptor and concentration of the drug
    drug binding
  302. a drug that binds to a receptor and produces and action
    agonist
  303. a drug that binds to the a receptor and does not produce an action but rather blocks another substance from binding
    antogonist
  304. how a drug produces its effect at the cellular level.
    mechanism of action
  305. what are the different mechanisms of action for a drug?
    • alter membrane properties
    • change ion permability
    • alter enzyme activity
    • alter synthesis of products
  306. the response to a drug depends on the dose of the drug. the higher the does the greather the response up to a ceiling.
    dose-response curve
  307. amount of drug needed to produce a certain effect of similarly acting drugs
    potency
  308. the maximum response to a drug. you adapt and have to increase the dose.
    efficacy
  309. the intended medicinal effect of a drug
    therapeutic effect
  310. predictable pharmacological effects that occur within therapeutic ranges that are not the intended medical affects and are undesireable.
    side effects
  311. affects that are harmful
    toxic effects
  312. include side effects and toxic effects; causes can either be dose related or non-dose related.
    adverse effects
  313. what are the 4 classifications for adverse effects of drugs?
    • mild
    • moderate
    • severe
    • lethal
  314. an adverse effect; the most common cause is an allergic reaction that develops after a few weeks of use and cannot be explained by the pharmcological effects of the drug.
    drug fever
  315. T/F: drug fever is important to recognize because if often occurs before more serious effects of drug reactions
  316. who is more susceptible to actions of a drug?
    elderly and children
  317. T/F: most investigational drug testing is done in young adult men so we dont know the effective dose toxicity and other factors for children infants elderly and women.
    true
  318. do men or women typically metabolize drugs faster and why?
    women; lower fat:lean ratio and hormones may play a role
  319. what may account for the decreased effectiveness of certain drugs in the obese?
    adipose tissue stores fat soluble drugs
  320. How does genetic variation have an effect on drug metabolism?
    • allergies: drug fever 
    • hypo-reactors: diminished response
    • hyper-reactors: exaggerated response
  321. when the same dose on repeated occasions produces a lower response or when a dose increase is required to maintain the same response?
    tolerance
  322. the improvement in medical status unrelated to an action of a drug but being given a "sugar" pill
    placebo effect
  323. requires cooperation of the MD prescribing the drug, the pt. and others involved in the care of the pt.
    compliance
  324. may occur when two or more drugs are administered together or close in time?
    drug interactions
  325. who is most likely at risk for drug interactions and how could you prevent it?
    elderly because they are typically on several medications. ASK THE PHARMACIST!
  326. often produce a unique form of analgesia- alter the perception of pain rather than eliminating the painful sensation entirely.
    opioids
  327. what would you expect to see a pt. being given if they are in moderate to severe pain that is fairly constant?
    opioids
  328. ______________ & __________________ are the main not so great effects of opioids.
    mental slowness and drowsiness.
  329. morphine
    codeine
    fentanyl 
    oxycodone
    hydrocodone
    demerol
    stadol 

    what type of drugs are these?
    opioids
  330. inhibit synthesis of prostaglandins and thromboxane by inhibiting cyclo-oxygenase enzyme.
    nsaids
  331. What are the different types of nsaids?
    • cox inhibitors
    • acetomenophen
    • ibuprofen
    • aspirin
  332. T/F: there is a limited delay of soft tissue healing particualrly during the first few days of the inflammatory process with nsaid use/
    true
  333. do nsaids  increase the rate of non-union and delay healing in those Fx that do unite?
    hell yea fucking right
  334. >65yoa
    Hx peptic ulcers
    smoking or alcohol use
    oral corticosterioid use
    anti-coagulants
    renal complicaction w/CHF or HTN
    use of acid supressents

    these are risk factors for using what?
    nsaids induced gastropathy
  335. stomach upset, indigestion, heart burn
    skin reactions
    increased BP
    new onset T spine or shoulder pain
    melena 
    tinnitus
    CNS changes
    Renal dysfunctions 

    these are all related to using what type of medication?
    nsaid
  336. what are these?
    aspirin
    advil
    motril
    naproxen/naprosyn
    oral nsaids

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