Pathology Final Exam

Normal sodium levels

135-145 mEq/L

Normal potassium levels

3.5-5.0 mEq/L

Normal chloride levels

97-107 mEq/L

Normal bicarbonate levels

22-26 mEq/L

Normal calcium levels

9.0-10.2 mg/dL

Normal phosphorus levels

3.0-4.5 mg/dL

Normal magnesium levels

1.3-2.1 mg/dL

Normal pH, PaCO2, HCO3 levels

pH 7.35-7.45

PaCO2 35-45

HCO3 22-26

Normal WBC levels

4,500 to 11,000

Normal hemoglobin levels

11 to 18 g/dL

Normal platelet levels

150,000 to 450,000

What is a cervical injury associated with?

paralysis below the neck; quadriplegia (4 limbs paralyzed); impaired breathing

What is a thoracic injury associated with?

legs and trunk paralysis; paraplegic (2 legs)

What is a lumbar injury associated with?

legs and leaky bladder

Premature atrial contractions (PACs)

early, extra heartbeats originating in the atria

EKG characteristics: early P wave, which may look different from a normal p wave

Atrial flutter

atrial electrical activity becomes rapid and regular (250-350 bpm), leading to a sawtooth pattern

EKG characteristics: F waves (sawtooth pattern) instead of normal P waves

Atrial fibrillation (AFib)

chaotic electrical activity in the atria, leading to an irregular and often rapid heart rate

EKG characteristics: irregularity irregular rhythm, absent P waves, fibrillatory waves

Ejection Fraction

a key measurement used to assess how well the heart is pumping blood; the percentage of blood that is pumped out of the left ventricle with each contraction, compared to the total amount of blood in the ventricle before the heart pumps

What is the Ejection Fraction formula? (EF)

EF = (stroke volume / end-diastolic volume) x 100

Normal ejection fraction values (EF)

55%-70% (the heart pumps out 55% to 70% of the blood in the left ventricle with each beat

What is Graves Disease (Enlarged Thyroid (Goiter))

Autoimmune disorder where the thyroid is abnormally stimulated by thyroid-stimulating antibodies; causes hyperthyroidism with goiter and ophthalmopathy

What is the Etiology (cause) of Graves Disease

other autoimmune disorders like myasthenia gravis; linked to MICA genotypes: MICA A5 (risk), MICA A6/A9 (protective)

What is the Ophthalmopathy (vision problems) of Graves Disease?

diplopia, visual loss, and corneal ulceration due to exophthalmos (protruding eyeball)

What are the treatments and considerations of Graves Disease?

Ophthalmopathy (vision) usually stabilizes after treating hyperthyroidism; can worsen after radioiodine treatment, so glucocorticoids may be prescribed

Cushing syndrome

hypercortisolism

What are the clinical manifestations (symptoms) of cushing syndrome?

fat redistribution, muscle weakness, skin changes, osteoporosis, metabolic changes, increased susceptibility to infections, emotional lability, gastric issues, androgen excess

How is cushing syndrome diagnosed?

Step 1: hypercortisolism diagnosis (urinary and plasma)

Step 2: determine cause (CRH test, dexamethasone suppression, imaging)

What are the treatments for cushing syndrome?

• Surgery (pituitary adenoma removal)

• Radiation or pharmacologic treatments;

• Goal (correct the cause of hypercortisolism without damage to glands)

Endometriosis

presence of endometrial tissue outside the uterine cavity; can cause pelvic pain, heavy or painful periods, infertility

Ectopic pregnancy

implantation of the fertilized ovum outside of the uterine cavity, most commonly in a fallopian tube; fetus is not viable and a salpingectomy is performed to remove the embryo and fallopian tube

Cryptochidism

partial or abnormal descent of one or both testicles into the scrotal sac; common in neonates; most cases resolve spontaneously

Hypospadias

urethral opening on the bottom of the penis

Epispadias

urethral opening on the top of the penis

Closed fracture

does not break the skin

*Open fracture

Compound fracture; skin surface is broken; higher risk of infection

Incomplete fracture

“Green stick” fracture; only goes partially through the bone

Complete fracture

bone is broken all the way through

*Spiral fracture

fracture from a twisting motion (common in child abuse)

Oblique fracture

fracture at an angle (diagonal break)

Compression fracture (impact)

bones are compressed after a high fall or jump

*Crush “compression” fracture

bones get crushed under a heavy object (high risk for a deadly fat embolism)

Hip fracture signs

• Shortening of leg on the affected area

• Muscle spasm around the affected area

• Ecchymosis on the thigh and hip

• Groin and hip pain with weight bearing

Compartment syndrome

extremely painful condition that happens when pressure within the muscles builds to dangerous levels, cutting off blood flow and oxygen, resulting in a dead limb

6Ps for compartment syndrome

Pain, Parathesia, Pallor, Poikilothermia, Paralysis, Pulse

What is Pain (6Ps)

extreme pain with passive movement (early sign); unrelieved with morphine; not resolving with medication

What is Parathesia (6Ps)

tingling, burning, numbness in the affected limb; problems moving or extending fingers; great difficulty

What is Pallor (6Ps)

paleness of the extremity

What is Poikilothermia (6Ps)

cold to the touch

What is Paralysis (6Ps)

inability to move the limb; loss of movement

What is pulse (6Ps)

absent of a pulse (late sign)

What to do for itching under a cast?

Use the hairdryer on a cool setting

How to assess circulation of a limb in a cast?

capillary refill, temperature, color, and pain or 6Ps

Complications of wearing a cast

hot spots (infection); compartment syndrome (decreased perfusion)

How to walk with a cane

stronger side holds the cane, move cane 1st, and weaker leg 2nd

How to go upstairs with a cane

up with the strong leg, cane moves next, weak leg last

How to go downstairs with a cane

descend with cane, weaker leg down, strong leg last

General cautions for crutches

put the weight on your hands and arms, not your armpits (can damage brachial plexus); don’t use others crutches

How to walk with crutches

both crutches forward with injured leg first, then move unaffected leg last

how to go upstairs with crutches

place body weight on the crutches, put the good leg first on the stairs, then bring the bad leg and crutches last (up with the good)

how to go downstairs with crutches

crutches and bad leg first, then the good leg (down with the bad)

Plaque (skin lesion)

fast growth of skin cells that appear in a few small spots looking similar to dandruff (psoriasis and eczema)

Urticaria (skin lesion)

superficial skin coloring or pale skin swelling, usually surrounded by erythema, that lasts anywhere from a few minutes to 24 hours (heat hives)

First degree burn

Superficial burn that presents as dry with blanchable redness; doesn’t require hospitalization

Second degree burn

Partial thickness burn that presents as painful blisters that are red, moist, and shiny fluid-filled vesicles; doesn’t require hospitalization

Third degree burn

Full thickness burn that presents with a dry, waxy, white leathery or charred black color, and is non-blanchable

Fourth degree burn

full thickness burn that goes through all layers of skin, down to muscles and bones (lacks pain)

Prehospital care 3C’s

• Cool water (primary intervention - briefly soak); no cream, ice, or ointment to open skin

• Cover the area with “clean dry cloth”

• Clothing and jewelry removal thats not adhered to burn

Top intervention for major burns in the first 24 hours

IV fluids: Lactated Ringers or Normal Saline Only

Which lab electrolyte is elevated after burns?

Potassium

What is the rule of 9s

used to quickly estimate the percentage of the body affected by a burn (total body surface area); and to calculate the necessary fluid resuscitation needed

What are the values for the rule of 9s?

9% total head (4.5% front, 4.5% back)

9% individual arm total (4.5% front, 4.5% back)

18% entire torso (9% chest, 9% abdomen)

18% entire back (9% upper back, 9% lower back)

18% individual leg total (9% front, 9% back)

1% perineum (groin)

When should you be worried about urine output in a burn patient?

when the patient is releasing less than 30 mL/hr

What is the best indicator of effective fluid resuscitation

urine output (30 mL/hr or more), then bP (90 systolic or higher), then heart rate (120 or lower)

Stage 1 | Pressure Injuries

1 layer of damage (epidermis); red skin that is non-blanchable and not broken

Stage 2 | Pressure Injuries

2 layers of damage; open wound (epidermis and dermis); wound bed is red/pink and shiny or dry

Stage 3 | Pressure Injuries

3 layers of damage (epidermis, dermis, subcutaneous); full thickness skin loss into subcutaneous fat; wound may tunnel under the edges of the wound bed

Stage 4 | Pressure Injuries

4 layers of damage; extends all the way down into muscle, bone, or tendon

Unstageable - Eschar | Pressure Injuries

black/brown; dead necrotic tissue; think EsCHARCOAL

Unstageable - Slough | Pressure Injuries

yellow and stringy; rubbery substance; needs to be debrided before a stage is made (think slough = skin of a chicken)

How soon after injury should a full head to toe skin assessment be documented?

within 24 hours

Why do we turn patients q1-2h (every 1-2 hrs)

to relieve pressure on the bony prominences (prevent pressure injuries)