Patho Exam 1

skin function

provide protection, serve as area for heat exchange, prevent fluids from leaving the body

epidermis

4-5 layers of avascular stratified squamous keratinized epithelium that migrate to the skin surface to replace cells lost during normal shedding

basement membrane

thin adhesive layer that cements epidermis to dermis (where blisters happen)

dermis

vascularized connective tissue that separates the epidermis from subcutaneous fat

keratinocyte

makes up 95% of all 5 layers of the epidermis; change as they are pushed out to the outer layer of the epidermis

epidermis cells

keratinocytes, melanocytes, merkel cells, langerhans cells

papillary dermis

thin layer of the dermis up against the epidermis; nourishes the epidermis

reticular dermis

thicker layer of the dermis

subcutaneous layer

vascularized layer of adipose tissue and connective tissue; energy, storage, and cushion

pressure ulcer (decubiti)

ischemic lesions of the skin caused by unrelieved pressure, shear forces, friction, and moisture that impairs the flow of lymph

stage 1 pressure ulcer

area of red, intact skin that is isolated to the epidermis; does not disappear when pressure is relieved

stage 2 pressure ulcer

partial thickness skin loss to the dermis; red or pink ruptured blister or shallow crater

stage 3 pressure ulcer

full thickness skin loss to subcutaneous fat; deep crater

stage 4 pressure ulcer

full thickness tissue loss to the bone and muscle; deep crater that may include necrotic tissue, slough, and eschar; tunneling often present

unstageable pressure injury

full thickness loss of tissue with base covered by slough or eschar; cannot be determined until either are removed

rule of nines

head & neck - 9%

right arm - 9%

left arm - 9%

trunk - 36%

groin - 1%

right leg - 18%

left leg - 18%

first degree burn

superficial partial thickness burns that only impact the outer layers of the epidermis; take 1-13 days to heal

ex. mild sunburn

mis

second degree burn

partial thickness burn that impacts the epidermis and some of the dermis or full thickness which impacts both; injury is painful, moist, red, and blistered; takes 1-3 weeks to heal

third degree burn

full thickness burn that extends into subcutaneous tissue and may involve muscle and bone; hardy, dry and leathery, after grafting take 1-2 weeks to heal

primary lesions

lesions arising from previously normal skin

ex. macules, papules, nodules, vesicles, wheals, pustules, cysts

secondary lesions

lesions arising from other disease conditions

ex. erosion, ulcer, fissure, scales, crust, scars, keloids, atrophy, lichenification

potassium hydroxide (KOH)

used to prepare slides of skin scrapings to test for fungal infections; KOH dissolves keratin but not fungal spores, leaving them visible on the slide

wood’s lamp

diagnostic tool that uses UV light to examine skin in a darkened room for fungal infections, bacterial infections, pigment disorders, and porphyria (useful for discerning conditions that look similar in normal light)

cranial nerve I

olfactory nerve; controls smell

cranial nerve II

optic nerve; controls vision

cranial nerve III

oculomotor nerve; controls eye movements, eyelid elevations, pupil constriction, and lens accommodation

cranial nerve IV

trochlear nerve; controls the superior oblique muscle which allows the eye to move downward and inward

cranial nerve V

trigeminal nerve; controls facial sensation (touch, pain, temperature) in the face and chewing

cranial nerve VI

abducens nerve; controls the lateral rectus muscle which allows the eye to move outward

cranial nerve VII

facial nerve; controls facial expression, taste from the anterior two thirds of the tongue, and salivation and tear production

cranial nerve VIII

vestibucochlear nerve; controls hearing and balance

cranial nerve IX

glossopharyngeal nerve; controls taste from posterior third of the tongue, sensation from the pharynx, swallowing, salivation, and gag reflex

cranial nerve X

vagus nerve; controls muscles of pharynx and larynx (swallowing and speaking), parasympathetic control of the heart, lungs, and digestive tract, and sensation from the throat and internal organs

cranial nerve XI

accessory nerve; controls sternocleidomastoid and trapezius muscles (head turning and shoulder shrugging)

cranial nerve XII

hypoglossal nerve; controls tongue movements (speech and swallowing)

communicating with pts with visual impairments

• announce yourself when entering the room

• orient pt to environment

• explain what you’re doing before you do it

• state when you’re leaving the room

• ensure adequate lighting

• address glasses

• ask if they want paperwork in braille

communicating with pts with hearing impairments

• face the pt directly and maintain eye contact

• ensure adequate lighting on your face

• speak clearly at a normal pace

• reduce background noise

• ask if pt wants ASL interpreter

• address hearing aids

• use written communication when appropriate

types of hearing loss

conductive (stimuli not adequately translated)

sensorineural (disorders that affect the inner ear, auditory nerve, or auditory pathways of the brain)

mixed (combo of both simultaneously)

eustachian tube

tube that extends from middle ear to the nasopharynx and allows air or secretions to enter or leave the middle ear cavity; opens with swallowing and yawning to allow for equalization of pressure between middle ear and outer environment

conjunctivitis

inflammation of the conjunctiva caused by bacterial or viral infection, allergens, chemical agents, physical irritants, or radiant energy

types of conjunctivitis

allergic: caused by itching due to allergens

bacterial: caused by hyperacute, acute, or chronic infections; purulent discharge and redness

viral: caused by adenoviruses, herpes, or enteroviruses; clear discharge and accompanied by upper respiratory tract infection

body water distribution

ICF: 2/3 total body water (40% body weight)

ECF: 1/3 total body water (20% body weight)

average adult male: 60% body water

average adult female: 50% body water

arterial blood gas (ABG)

normal pH (acid base status): 7.35-7.45

normal PaCO2 (respiratory status): 35-45 mmHg

normal HCO3 (metabolic status): 22-26 mEq/L

normal PaO2 (oxygenation): 80-100 mmHg

respiratory acidosis

high HCO2 + low pH

hypoventilation → CO2 retention

respiratory alkalosis

low HCO2 + high pH

hyperventilation → excess CO2 elimination

metabolic acidosis

low HCO3 + low pH

ketoacidosis, renal failure, severe diarrhea → acid gain/bicarbonate loss

metabolic alkalosis

high HCO3 + high pH

prolonged vomiting, NG suction, diuretic use, hypokalemia, cushing syndrome → acid loss/bicarbonate gain

hypertonic solution

solution causes water to move out of cell

hypotonic solution

solution causes water to move into the cell

isotonic solution

solution and cell have the same osmotic pressure (same size)

selye’s general adaptation syndrome (GAS)

stress response characterized by three stages:

alarm (generalized stimulation of the sympathetic nervous system)

resistance (body selects most effective and economic channels of defense)

exhaustion (resources are depleted and systemic damage appears)

negative feedback loop

sensor detects change → integrator sums and compares data with set point → effector returns system to within range of set point → again

positive feedback loop

sensor detects change → integrator receives signal → effector amplifies original stimulus → sensor detects amplification → effector continues to respond until event ends

stress

body’s physical and psychological response to a stressor

distress

negative stress; perceived as harmful

eustress

positive stress; perceived as manageable and rewarding

exocrine

substance released via body surface or cavity (ex. sweat glands or digestive enzymes enzymes into the GI tract)

endocrine

hormone released into bloodstream to target distant cells (ex. insulin to pancreas)

paracrine

cell releases a signal that acts on neighboring cells (ex. histamine to inflamed tissue)

autocrine

cell releases a signal that acts on itself (ex. cancer cells stimulating more growth)

heterocrine

gland with endocrine and exocrine function (ex. pancreas secrets insulin and glucagon into the blood and enzymes into the GI tract)

recessive genotype

requires two recessive alleles to express recessive phenotype

allele

alternate form of gene at the same locus (control trait expression)

homozygous

same two alleles

heterozygous

two different alleles

mutation

accidental errors in DNA replication (substitution of one base pair for another, loss or addition of one or more base pairs, or rearrangement of base pairs)

transcription

process in which RNA is synthesized from the DNA template

translation

the synthesis of a protein using the mRNA template

transduction

communication between cells through chemical messengers that bind to protein receptions on other cell surfaces or inside of cells

somatic cells

cells other than sperm and ovum

gametes

sperm and ovum

mitosis

the replication of DNA to duplicate somatic cells in the body

meiosis

the replication of germ cells to produce gametes

teratoid

related to teratoma (a tumor made from tissue not normally found at the site arising from germ cells)

chromosomes

stores genetic information in pairs

genome

total genetic content that is organized into chromsomes

genotype

genetic information stored in the sequence of base pairs

phenotype

recognizable traits associated with a specific genotype

x-linked recessive inheritance

traits are expressed phenotypically in male offspring while female offspring are strictly carriers

x-linked dominant inheritance

dominant trait linked to X chromosome are expressed phenotypically in both male and female offspring

carrier status

when a person carries a copy of a recessive allele but does not actively express the phenotype

congenital defects

structural or functional abnormalities at birth that develop during fetal development; caused by chromosomal abnormalities, single-gene mutations, teratogens, combos of genetic and environmental factors, etc.)

neural tube defects

congenital structural defects that occur when the neural tube fails to close completely during fetal development (ex. spina bifida, meningocele, anencephaly)

chemotherapy

systemic treatment that enables drugs to reach the site of the tumor as well as other distant sites; usually used in combo with radiation

radiation

uses high energy particles or waves to destroy or damage cancer cells; usually used in combo with chemo

surgery

oldest treatment for cancer that is used for diagnosis, staging of cancer, tumor removal, and palliation (relief of symptoms) when a cure cannot be achieved

stem cell therapy

treatment for blood cancer and certain blood/immune disorders; uses undifferentiated cells to repair, replace, or regenerate damaged tissue cells in the body

alopecia

hair loss caused by toxicities from vinca alkaloids involved in chemotherapy

weight loss due to cancer

cancer pts lose weight due to increased cytokines (increase resting energy expenditure, break down muscle and fat directly, and suppress appetite), cancer competing for nutrients, dysphagia, nausea, and pain

cachexia

weight loss and wasting of body fat and muscle tissue, accompanied by profound weakness, anorexia, and anemia; part of cancer anorexia-cachexia syndrome

pap smear

test to detect cancer in the cervix

mammography

x-ray technique used to detect breast cancer

rectal exam

physical exam of the rectum to assess for prostate, colorectal, or anal cancer

fecal occult blood test

positive test can be an indicator for colorectal cancer

colonoscopy

test that uses direct visualization of the colon via glass fiber bundle to assess for colon cancer; can also be used to remove polyps or biopsy

prostate-specific antigen (PSA)

blood test to assess for prostate cancer

transrectal ultrasonography

biopsy needle is guided to obtain sample tissue; can detect cancers that are too small to be detected through physical exam

ribosomes

site of protein synthesis

endoplasmic reticulum

rough: makes and stores proteins that become parts of organelles or cell membranes

smooth: smooth structure that synthesizes lipids (including steroid hormones)

golgi

four stacks of thin, flattened vesicles that receive substances from the ER via vesicles