5500 final exam ( chapter 37,39,40)

provoked seizures

Seizures that can be predicted; caused by fever, metabolic imbalances, or brain injury.

Tx is the underlying cause and will resolve the seizure

unprovoked (epileptic) seizures

Seizure that has an unknown cause and cannot be predicted; can be focal, generalized, or unknown (epileptic spasms)

convulsion

motor secures that involve the entire body

focal unprovoked seizure

Seizure begins in a specific area of one hemisphere

Generalized unprovoked seizure

Seizure begins simultaneously in both hemispheres; unconsciousness and symmetric motor responses

focal seizures: without impairment of consciousness or Awareness

Focal seizure limited to one hemispheres may be preceded by an aura;

S/S include involuntary motor movement, visual, olfactory, o auditory disturbances

Focal seizure: with impairment of consciousness or awareness

seizures that start at the temporal lobe then proceed to rapid progression to both hemispheres

S/S include repetitive non purposeful activities, fear, flood of ideas, feeling of detachment/depersonalization- may be confused with psychiatric disorder.

Tonic-clinic seizure (generalized)

muscle contraction with extension of the consciousness; rhythmic bilateral contraction and relaxation of extremities.

Absence

blank stare; motionlessness, irresponsiveness or automatisms

myoclonic

involuntary muscle contractions; bilateral jerking of face, trunk, or extremities

Tonic

voluntary muscles of the legs and arms contact; Body stiffens with arms and legs extended

Clonic

repetitive bilateral symmetric, rhythmic muscle contraction; hyperventilation

Atonic

split-second loss of muscle tone; slackened jaw, drooping limbs, falling

This can be diagnosed with a physical exam, lab studies, MRI, or an EEG, which can tell where this is coming from?

seizures

Treatment for seizures

\-protect the from injury

\-prevent seizure activity

\- > 20 drugs FDA- approve such as monotherapy, if possible (antiepileptic drugs; anticonvulsants; benzodiazepines; biologics); neurostimulation (vagus or trigeminal nerve)

\- Surgical treatment: removal of epileptic lesion; amygdala and part of the hippocampus; or partial removal of corpus collosum

Dementias

Nonnormative cognitive decline with memory and cognition

S/S include short and/or long term memory loss, impaired judgement, personality changes, abnormalities of speech, impaired ability to perform activities of daily living (ADLs)

Alzheimer’s

most common form of dementia; a progressive disease that is the 6th cause of death; 60-80% have this; risk factors include age and genetics

what is the pathophysiology of Alzheimer?

Amyloid plaques(abnormal deposits of protein) damage/destroy brain cells; neurofibrillary tangles (threads of protein twist inside the neuron and cause damage/death)

what are the stages of Alzheimers?

initial: short-term memory loss

Moderate: global cognitive impairment

Severe: loss of ability to respond to environment; requires total care, bedridden.

what is the treatment for Alzheimers?

self-care; cholinesterase inhibitors

what does the testes make?

testosterone and immature sperm

where do sperm cell mature?

Epididymis

Androgens

Main testicular hormone and most abundant; produced by testes and adrenal cortex(less than 5%)

What are the three effects of testosterone?

\- Embryonic development of genitalia

\- development of primary sex characteristics

\- development of secondary sex characteristics

Testosterone also has _________________ effects and can help with _________________ and _______________ of sperm.

\- anabolic

\- generation

\- maturation

do male have 50% more muscle mass?

yes

Follicle-stimulating hormone (FSH)

stimulates production of ova and sperm as well as estrogen

Lutanizing hormone (LH)

Hormone that stimulates the production of testosterone and progesterone and helps with maturation of sperm

Erectile Dysfunction

Inability to achieve and maintain an erection

T/F 50% of males over 50 will have issue with Erectile Dysfunction

True

what are the three causes/risk factors of Erectile dysfunction?

\-vasoconstriction

\- vessel stenosis(plaque)

\- nerve damage

what is Erectile dysfunction a mater of?

cardiovascular disease

Treatment such as androgen replacement, penile implants, psychotherapy, oral meds to relax penile muscles, and vasodilators like viagra help what?

Erectile dysfunction

Balanitis

inflammation of the head(glans) of the penis

Balanoposthitis

Inflammation of the glans and prepuce(foreskin)

inflammation of the penis can be caused by?

poor genital hygiene and infection

S/S of inflammation of the penis

erythema and soreness

Treatment of inflammation of the penis

circumcision and antibiotics

What type of inflammation of the penis would be helped with a circumcision?

Balanoposthitis

peyronie disease

Fibrosis(scar tissue)that occurs in the penis; creates a bowed penis;

caused by repeated injuries to the area;

creates S/S of pain and difficulty getting an erection

how would you treat Peyronie disease?

\- Surgical excision

\- XIAFLEX—>breaks down scar tissue

\- hemorrheologic drugs that lower viscosity of blood

priapism

Involuntary, painful, prolonged erection for more than 4 hours;

can be caused by meds used to treat ED, alcohol, cocaine, antidepressants, or antipsychotic drugs;

Tx is alpha-adrenergic drugs and surgery

Why would someone with priapism want to take alpha-adrenergic drugs?

Vasoconstricts the vessels

Penile cancer

Cause: unknown, most are squamous epithelial cell; slow-growing

risk factors: immunodeficiency; HPV; poor genital hygiene; UV radiation and age

S/S: lumps/bumps

DX: biopsy

Tx: cryotherapy; laser removal; circumcision; radiation; chemotherapy

T/F: Penile cancer is common and has a bad prognosis if caught early.

False; really rare (

At what age should someone get the HPV vaccine? What is weird about this vaccine?

\- 9-12 years

\- only vaccine that has a rate of compliance worse than a third world country

Explain Embryonic Development of the testes

\- the testes develop in the abdominal cavity

\- descend through the inguinal canal into the scrotum

\- pulls blood vessels, lymphatics, nerves, ducts

\- all mediated by testosterone

\- the inguinal canal closes

what happens if the inguinal canal doesn’t close?

Part of the intestine can get through; causes an inguinal hernia; creates an enlarged scrotum and pain

Tx is surgery

Hydrocele

Fluid in the tunica vaginalis caused by an injury

Hematocele

Blood in the tunica vaginalis; caused by surgery/trauma

Spermatocele

a cyst at the end of the epididymis; asymptomatic, but will cause pain

varicocele

dilation of testicular veins

treatment is surgical ligation which is tying

What is the Tx for all testicular disorders that end in -cele?

drain/remove

Testicular torsion

twisting of the spermatic cord

can be treated by surgical detorsion and/or orchiectomy

Epididymitis

inflammation of the epididymis;

caused by STIs, UTI or prostate infection;

S/S is pain, swelling of testicle;

Tx is antibiotics

Orchitis

inflammation of the testes;

caused by bacterial or viral infection(MUMPS);

S/S is swelling, pain, fever, N/V;

Tx is antibiotics

what is the first cancer associated with a profession(chimney sweeps)

scrotal cancer

scrotal cancer( not common)

caused by exposure to tar, soot, oil; or poor hygiene and chronic inflammation;

more than half metastasizes to lymph nodes; starts with a small tumor that ulcerates(bleeds);

Tx is surgical excision ONLY;

prognosis correlates with lymph node involvement.

can scrotal cancer be treated by chemo and radiation?

NO

Testicular cancer

Etiology: is unknown

Risk factors: undescended testes; genetics

S/S: painful lump; swelling/fluid in scrotum (heaviness)

Tx: orchiectomy; chemo, radiation

Prognosis: excellent with early detection

Is testicular cancer common? What age group usually gets testicular cancer?

\-it is uncommon (1-2% of men)

\- men ages 20-35 old

What is the function of the prostate? Where is it located?

Makes fluid for sperm; surrounds the urethra

Prostate enlargement compresses the urethra. This causes alterations in urination. What are the four alterations?

\- weak stream

\- urgency

\- dysuria

\- discharge

prostatitis

inflammation of the prostate;

mostly caused by bacteria;

S/S is painful urination, malaise, nocturia, dysuria, hematuria, abdominal pain, mild fever;

Tx is antibiotics, alpha-blockers to relax bladder and prostate muscles

benign prostatic hyperplasia(BPH)

benign growth of cells within the prostate gland; creates enlargement of the prostate; age-related (>60 years old; 50%); nonmalignant; nodules can compress the urethra to a narrow slit;

S/S is same as prostatitis

Tx: alpha-blockers; meds to shrink the prostate; transurethral resection; prostatectomy

prostate cancer

cancer of the prostate gland;

etiology is unknown;

risk factors include age (>65), ethnicity(black>white>Asian), genetics, obesity; prevention helps with a PSA (prostate antigen test) and digital rectal exams;

S/S is same as BPH with blood in semen;

Tx is anti-androgens, chemo, radiation, and prostatectomy

A test that helps prevent prostate cancer; < 4 ng/mL is normal

Prostate Antigen Test (PSA)

Estrogens(female)

Female sex hormone that involves sexual maturation, skeletal growth, and fat distributions; also aids in ovulation, implantation, pregnancy, and parturition; helps develops and maintains the female secondary sex characteristics; helps with metabolic mechanisms as well

Why do females take their temperature when they ovulate?

Progesterone increases body temperature

Bartholin Gland Cyst

Cyst that blocks the gland that makes mucous for lubrication in the female reproductive system; caused by an obstruction from a bacterial infection or STI;

S/S include pain, tenderness and abscess if infected; can be treated with Analgesics, antibiotics, and draining

vulvuodynia

Pain in the external genitalia; cause is unknown but a vaginal infection is common;

S/S include localized, generalized pain;

Tx is with antibiotics and symptomatics

Are vulvar carcinomas more common in older women or younger women?

older

Vulvar Carcinomas in younger women

Cancer of the vulva often preceded by vulvar intraepithelial neoplasia; may be related to HPV(1/3 of the time)

Vulvar Carcinomas in older women

cancer of the vulva often preceded by nonneoplastic disorders; lesions causes itching and repeated injury or infection

Tx: surgery

What is considered the neck of the uterus?

cervix

Exocervix

stratified squamous epithelium

Endocervix

simple columnar epithelium

infections (HPV)

Can transform columnar epithelium too squamous epithelium of the cervix (metaplasia);

transformed cells are more likely to become cancerous

What is the most common cause of cervical cancer? What is the percentage?

HPV; 70%

cervical cancer

malignant tumor of the cervix; early stage is asymptomatic; late is vaginal bleeding after intercourse; abnormal discharge, pelvic pain;

Tx is hysterectomy, radiation, chemo

pelvic inflammatory disease

Infection (STI) ascends through the uterus to Fallopian tubes and ovary; transmitted through sexual contact; caused by gonorrhea and chlamydia(bacterial)

pelvic inflammatory disease

This uterine disorder creates inflammation, which causes pain in the lower abdomen and pelvis during intercourse, purulent discharge and abnormal bleeding, and increased WBC count.; can be treated with antibiotics

Endometriosis

Functional endometrial tissue outside the uterus; cause is unknown, but is related to previous c-sections, genetics, and immunocompromised;

S/S is premenstrual pain; pain during or after sex, and infertility;

Tx is analgesics/hormone pain, oophorectomy, and hysterectomy

What can happen if someone has endometriosis?

retrograde menstruation, which is when the blood goes into the Fallopian tubes

Endometrial cancer

malignant tumor of the endometrium; cause is unknown, but is related to a genetic mutation of endometrial cells;

risk factors include obesity and early menarche(early period);

S/S is bleeding between periods, pelvic pain, blood-tinged discharge;

Tx is hysterectomy, oophorectomy, radiation/chemo

What happens when someone has a disorder of pelvic support?

Muscles of the pelvic floor get weak; causes organs to move into vagina that should not be there; very rare

cystocele

Bladder herniates into vagina

Rectocele

Rectum herniates into vagina

Enterocele

Small intestine herniates into vagina

uterine prolapse

Uterus falls out of the body; can occur due to multiple pregnancies, obesity, age, genetics;

S/S is vaginal bleeding, discharge, in continence, constipation, sensation of heaviness in pelvis; has 3 stages; when ligaments are weak

What is the name of the final stage of uterine prolapse, which is the worst one?

procidentia

What is the least invasive Tx for uterine prolapse?

Kegel exercises for prevention

ovarian disorders

collections of fluid within a sac (cyst) in the ovary; caused by endometriosis, infection, or tissue formed during a normal menstrual cycle;

S/S is mostly asymptomatic; a large cyst will have abdominal pain and/or heaviness, pain during sex and during a cycle with fever;

Tx is cystectomy, oophorectomy, or hysterectomy

polycystic ovary syndrome (PCOS)

A syndrome characterized by a female not ovulating; can start out as a cyst; caused by heredity, excess androgen which can create amenorrhea or irregular menses

Amenorrhea

No period; can be primary(not having period when someone reaches 15, an endocrine problem) or secondary (no period after 6 months due to stress)

Dysmenorrhea

abnormal menstrual cycle

premenstural syndrome (PMS) (20-30% have this)

Caused by changing hormone levels,

S/S include mood swings, bloating, breast tenderness, tension/anxiety, headaches acne, increased appetite;

Tx is self-care and symptomatic

What medication says that having PMS creates 'pesky' symptoms and uses acetaminophen for pain, caffeine for bloating and fatigue, and antihistamines for water retention?

Midol

Menopause

No menstruation after 1 year; decreased ovary function causes low estrogen and progesterone levels; can be caused bu a hysterectomy and radiation/chemo;

S/S include irregular cycles, heavy bleeding, hot flashes, night sweats, vaginal dryness, mood swings, and weight gain;

Tx is self-care and short term hormone therapy