BIOL 475 Exam 1

What are the major categories of disease?

• V - vascular

• I - infectious

• T - traumatic/mechanical

• A - autoimmune

• M - metabolic/toxic/nutritional

• I - idiopathic/iatrogenic

• N - neoplastic

• D - development/degenerative

vascular

caused by abnormalities of blood vessels

infectious

caused by the presence of a communicable pathogen

traumatic/mechanical

physical force damaging structures

autoimmune

the body’s immune system mistakenly identifies normal structures as foreign and attacks them

metabolic/toxic/nutritional

an abnormality in a biochemical pathway, presence of a toxin, or deficiency of a nutrient results in disease

idiopathic

not very satisfying, do not know exact cause of a disease

iatrogenic

disease caused by medical care or intervention

neoplastic

cancerous; caused by abnormal cell growth and division

developmental

caused by alteration or failure of a normal developmental pathway

degenerative

chronic, typically slow damage progressively interferes with a structure’s normal functioning

case studies

common method for presenting and learning elements of pathophysiology

complete H & P

asking detailed questions about a patient’s medical history and lifestyle in general

CC

• chief complaint

• patient’s main reason for seeking medical care, often stated in their own words

HPI

• history of present illness

• paragraph diving past the chief complaint, based on the history-taking experience of the practitioner

PMH

• past medical history

• a list of ongoing medical problems as well as major medical issues experienced in the past (major surgeries, procedures, and hospitalizations)

• current meds/drug allergies

SocHx

• social history

• personal info ab pt including gender, age, rac/ethnicity, diet, physical activity, habits

ROS

• review of systems

• comprehensive run-down of common symptoms affecting the body generally and all major organs

• pre-visit questionnaire

PE

• physical exam

• statement on patient’s overall appearance and presentation (Ex. pleasant 21 y/o female in no acute distress)

VS

• vital signs

T

• temperature

• 97.8-100.4 F

P

• pulse

• 60-100 bpm

R

• respiratory rate

• 10-18 bpm

BP

• blood pressure

• systolic: 90-120

• diastolic: 60-80

HEENT

• head

• ears

• eyes

• nose

• throat

CV

cardiovascular

Abd

abdomen

Ext.

extremities

progress note (SOAP)

typically written at least 1x day for inpatient

SOAP

• S - subjective

• O - objective

• A - assessment

• P - plan

S - subjective

information provided by patient and/or caregiver, including current symptoms and how they have progressed

O - objective

data that is not subject to pt’s memory or personal interpretation (VS, physical exam findings, lab results)

A - assessment

concise summary of what the provider thinks is going on

P - plan

plan of care, including changes to meds, additional tests, referral to other providers, follow-up visits

What are three reasons why lab tests are used as a first-line tool in making a diagnosis?

• cost - generally inexpensive

• noninvasiveness - typically venous blood sample or nasal swab

• speed - hours to day turnaround time

complete blood count (5)

tests for..

• RBC count

• RBC size

• hemoglobin and hematocrit

• WBC count and differential

• platelet count

chemistry panel (3)

aka Chem-7, BMP tests for…

• electrolytes (Nat+, K+, Cl-)

• renal function → BUN (blood urea nitrogen), creatine

• blood glucose

LFT (3)

liver function tests for …

• ALT/AST

• bilirubin

• total protein

cardiac enzymes (3)

tests for…

• troponin

• CK-MB

• CPK

What are the benefits of medical imaging? (2)

• basic chest x-ray and EKG cheap

• noninvasive

What are the risks of medical imaging? (4)

• MRI and CT scan are expensive

• claustrophobia

• exposure to radiation

• IV contrast

What are the 3 major planes the body is sectioned into?

• transverse

• sagittal

• frontal

transverse

horizontally oriented plane slicing the body into superior and inferior portions

sagittal plane

vertically oriented plane slicing the front of the body into left and right halves

frontal plane

aka coronal vertically-oriented plane slicing body into anterior and posterior portions

computed tomagraphy scanning

based on x-ray tech, except x-ray and detector can rotate around the body, taking images from all angles

Advantage of x -ray

high energy allows them to pass through the body and penetrate tissues

Risk of x -ray

high-ionizing radiation capable of disrupting biological molecules, including DNA

Advantage of CT

much higher resolution images and better w/ contrast dye

Risks of CT

higher radiation dose than normal x -ray

contrast agent

material introduced into body before/during imaging to improve quality of the image by enhancing the contrast of a body fluid or tissue

What is most commonly used to enhance contrast of GI tract?

barium

What is used to enhance contrast between blood vessels and surrounding tissue?

iodine

ultrasound

uses sound waves to image tissue instead of electromagnetic radiation

transducer

emits high-frequency sound waves that penetrate the skin and bounce off surface based on their density

Advantages of ultrasound (5)

cheap, simple, convenient, capture motion, and no radiation

Disadvantages of ultrasound (2)

• poorer resolution than CT

• deeper structure difficult to image due to poor penetration of sound waves

MRI

• magnetic resonance imaging

• Protons within water molecules align with the magnetic field which are detected to create an image

Advantages of MRI

superior resolution of tissues without any radiation exposure

Disadvantages

higher cost and claustrophobia possible

drug

substance that alters biologic activity in a person

What are the desired effects of a drug?

therapeutic effect: action that drug takes towards treating a specific condition

indications of a drug

when a drug has multiple therapeutic effects

contraindications

a drug that cannot be used in pregnancy

What is the difference between side effects and adverse/toxic effects?

• side effects - milder unwanted effects of drug that are typically anticipated and cause non permanent damage

• adverse/toxic effects - severe, less common, harder to anctipate effects

effective dose

dose that is expected to produce the desired effects in an average person

toxic dose

dose that tends to cause toxicity in most people

therapeutic index

ratio of toxic dose/effective dose

Is a higher or lower value for the therapeutic index more desirable?

higher - implies large diff b/w dose we might give to treat a condition vs. dose that causes damage

synergism

combination of multiple drugs enhances therapeutic effect

anatagonism

occurs when combination of two or more drugs decrease one or all of their therapeutic effects

pharmakinetics

what the body does to a drug (administered, absorbed, distributed, metabolized, excreted)

pharmacodynamics

what the drug actually does to the body (cells/tissues effects, interactions w/ target receptors)

What are the 7 routes of administration of drugs?

1. oral

2. sublingual

3. subcutaneous

4. intramuscular

5. intravenous

6. inhalation

7. topical

How are drugs metabolized?

via biotransformation, and metabolites are excreted in feces and/or urine

Why is a drug’s half-life important ?

determiens drug’s dose and dosing frequency

half-life of a drug

amount of time required for clearence of 50% of a dose of a drug

What are the two types of receptors that drugs interact with?

ionotropic and metabotropic

ionotropic receptor

opens ioin channel when ligand binds (most common in neurons)

metabotropic receptor

trigger some sort of change in intracellular signaling via 2nd messengers

Brand names are typically..

capitalized

pharmacist

doctor of pharmacy degree, manage retail stores

pharmacologist

trained researchers who study drug development, mechanisms, delivery, clinical trials, and toxicity

How are controlled substances organized?

schedules - based on therapeutic value, risk, potential for abuse/addiction (schedule I highest potential)

inflammation

body’s nonspecific response to injury

What are the four cardinal signs of inflammation?

• erythema → redness

• heat

• pain

• swelling → edema

positive chemotaxis

leukocytes attract chemical released by pathogens and damaged tissues

What are the normal proportions in a differential WBC count?

• Never Let Monkeys Eat Bananas (most→least)

• Neutrophils Lymphocytes Monocytes Esophils Basophils

lymphocytes elevated

viral infection

neutrophils elevated

bacterial infection

esonophil elevated

parasitic infection or allergy/asthma

basophil

release histamine and help in inflammation

What are the 5 steps of acute inflammation?

1. release of chemical mediators from injured cells

2. activation of pain receptors by bradykinin

3. mast cells and basophils release histamine

4. capillary dilation

5. bacteria enter tissue

What are the systemic effects of inflammation? (5)

• fever (pyrexia)

• malaise (flu)

• fatigue

• headache

• anorexia

How does chronic inflammation differ from acute inflammation? (5)

• less swelling

• more lymphocytes, macrophages, fibroblasts

• continued tissue destruciton

• fibrous scar tissue

• granuloma

What do aspirin, acetaminophen, and NSAIDs have in common?

block cyclooxygenase that decreases the synthesis of prostaglandins that mediate pain and inflammation

aspirin

irreversibly inhibits COX-1 and COX-2 reducing pain/inflammation, acts in CNS to reduce fever, and reduces blood clots

acetaminophen

acts in the CNS, decreases fever and perception of pain

NSAIDs

decrease pain and inflammation, but not as powerful of steroids

corticosteroids

most powerful inhibitors of inflammation with severe side effect