NSG 530 Advanced Pathophysiology Quiz 4 Questions and Verified Detailed Answers; for Guaranteed Success -Wilkes University

Anemia

A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume.

Anemia of chronic disease

Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.

Classic anemia symptoms

fatigue, weakness, dyspnea, pallor

hemolytic anemia

characterized by an inadequate number of circulating red blood cells due to the premature destruction of red blood cells by the spleen

pernicious anemia

lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream

hemolytic anemia

anemia caused by the destruction of red blood cells.

intrinsic factor

A substance produced by the mucosa of the stomach and intestines that is essential for the absorption of vitamin B12.

Folate deficiency anemia

lack of folate leading to premature RBC death... caused by dietary deficiency

Anemia of chronic disease

occurs in association with underlying inflammatory conditions, such as chronic infections (for example, HIV disease or hepatitis), rheumatologic diseases, and malignancies.

microcytic hypochromic anemia

anemia characterized by small, pale red blood cells that lack adequate hemoglobin to carry oxygen; can be caused by deficiency of iron or vitamin B6

iron deficiency anemia

anemia resulting when there is not enough iron to build hemoglobin for red blood cells

Sideroblastic anemia

Ringed Sideroblasts = Iron-laden/deficient RBCs. Presence of amino acid valine in hb S and not normal hb. Vaso occlusive crisis causes pain

Thalassemia

inherited defect in ability to produce hemoglobin, leading to hypochromia

Thalassemia major

-Homozygous

-Severe anemia

-Regular transfusions required autosomal recessive

Polycythemia Vera (PV)

chronic, clonal alteration characterized by overproduction (excessive proliferation) of red blood cells in marrow accompanied by splenomegaly; neoplastic condition involving abnormal proliferation of bone marrow stem cells and self-destructive expansion of red cells; cause remain unknown (erythropoietin remains normal); due to increased blood volume and viscosity, hyper-coagulable states result in clogging and occluding blood vessels; tissue injury (ischemia) and death (infarction) is the result; manifestations include plethora (ruddy, red color) and engorgement of retinal and cerebral veins

Thrombocytopenia

low platelet count

Thrombotic Thrombocytopenic Purpura (TTP)

aggregate, form microthrombi, causing occlusion of arterioles and capillaries

Idiopathic Thrombocytopenic Purpura (ITP)

disorder marked by platelet destruction by macrophages resulting in bruising and bleeding from mucous membranes

Immune thrombocytic purpura

Low platelets

Bruising

Petechia

Mucosal bleed

Menorrhagia

lymphocytopenia

an abnormally reduced number of lymphocytes

Lymphocytopenia causes

- Abnormal production due to immune deficiencies

- Destruction by drugs, viruses, or radiation. Bone marrow stimulating medications

Lymphocytosis

abnormal increase in lymphocytes

Eosinophilia

Increase in numbers of eosinophils in the bloodstream.

Hodgkin Lymphoma (HL)

Malignancy of B cells that occurs in lymph nodes of the neck or chest and may spread to nearby lymph nodes and the spleen and sometimes to the bone marrow; also called classical Hodgkin lymphoma, Hodgkin disease

Reed-Sternberg cells

Hodgkin's lymphoma

Non-Hodgkin's Lymphoma

a malignant cancer that starts in the lymphocytes; includes any type of lymphoma except Hodgkin's lymphoma

multiple myeloma

malignant tumor of bone marrow cells

Leukemia

cancer of white blood cells in bone marrow occurs at any age

Hyperthyroidsim

(*Grave's disease)

too much T3 and T4

-antibody stimulates TSH receptor and induces excess T3 and T4 in bloodstream --> enlarged thryoid

-TSH receptors in extrathyroidal tissues, including fat cells --> inflammation (bulging eyes)

-other symptoms: increased perspiration, increased appetite, nausea, vomiting, diarrhea

Hypothyroidism

A disorder caused by a thyroid gland that is slower and less productive than normal. High levels of circulating thyroid stimulating hormone. Low levels of thyroxine T4 stimulating anterior pituitary to increase TSH

Cushing syndrome

group of signs and symptoms produced by excess cortisol from the adrenal cortex

Addison disease symptoms

Hyponatremia, Hyperkalemia, Hypoglycemia, dark pigmentation, decreased resistance to stress, fractures, alopecia, Weight loss, GI distress. Adrenal insufficiency - producing high levels of ACTH, yet no cortisol.

Pheocromocytoma - symptoms?

Adrenal gland

palpitations, hypertension, diaphoresis, weight loss, hyperglycemia

surgical removal of adrenal gland

take steroid replacement after

Pheocromocytoma

Increased epinephrine production (catecholamine)

Will cause tachycardia, jitters, and EXTREME HYPERTENSION.

S/S similar to hyperthyroidism caused by a hormone secreting adrenal tumor

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect

diabetes insipidus signs and symptoms

Polyuria, polydipsia, dehydration-dry skin, weakness, fever, mental confusion, prostration

neurogenic diabetes insipidus

occurs due to interruption of the synthesis, transport or release of ADH due to hypophysectomy, tumors, inflammation, vascular lesions

Neurogenic Diabetes Insipidus assessment

-Very high urine output, very dilute

-Monitor sodium

*Monitor osmolarity and osmolality: abnormal means its dilute urine

-Mostly from trauma to hypothalamus

Nephrotic diabetes insipidus

Results from an impaired ability of the kidneys to respond to ADH- Can be acquired (due to renal damage), medication-induced (e.g. lithium can inhibit the kidney's ability to respond to ADH), or inherited (due to mutations in the ADH receptor at the kidneys)

ADH level is usually high

High serum osmolality

Low urine osmolality with a high urine volume output and thirst

--> Try to treat underlying cause when possible

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) etiology

Tumor can cause and produce antidiuretic hormone ADH. Iatrogenic includes surgery and medications. Leads to hyponatremia and hypoosmolality.

Symptoms of SIADH

- Weight gain without edema

- JVD, Crackles

- Tachypnea, ↑ HR

- Confusion, Lethargy, Seizures

- ↓ GI motility, Anorexia, Nausea

Treatment for SIADH

fluid restriction, diuretics, maintain sodium balance, treat the cause, hypertonic fluids.

diabetes mellitus

a group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.

diabetes mellitus causes

due to a genetic predisposition, obesity, hormonal imbalance, autoimmune disease

Type I Diabetes Mellitus

-insulin dependent

- caused by autoimmune destruction of the beta cells of the pancreas leading to little or no production of insulin

- require regular injections of insulin to permit entry of glucose into cells. Incurable.

type 2 diabetes

Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production.

type 2 diabetes causes

-overweight and sedentary people

-genetics

1) insulin resistance (cells lose sensitivity to insulin)

2) overproduction of glucose by liver

3) pancreas does not produce enough insulin

complications of diabetes

Atherosclerosis (CAD, PVD, MI, Stroke)

Retinopathy (Screen annually, rx-lasr photocoag)

Nephropathy - ACE inhibs prevent, 30% of ESRD

Neuropathy, Infections, Foot disease

hyperosmolar hyperglycemia nonketotic syndrome

A life-threatening condition resulting from high blood glucose that typically occurs in older adults, and which causes altered mental status, dehydration, and organ damage.

Kidney diseases causes

diabetes, requires dialysis. Earliest manifestation is microalbuminuria.

diabetic retinopathy

disease of the retina in diabetics characterized by capillary leakage, bleeding, and new vessel formation (neovascularization) leading to scarring and loss of vision or cataracts.

neuropathy

disease of the nerves

neuropathy symptoms

decreased sensation, pain, tingling, problems with balance (if in lower extremtiites), weakness in the extremities, dysfunction with other organ systems, *Inability to reach milestones as they are getting older

Neuropathy treatment

Low dose TCA's, anticonvulsants (gabapentin), cymbalta, pain meds

Neuropathy in diabetes

*60-70% of T2DM pts*

Pain: sharp, burning, aching, numb, can cause weakness, loss of reflexes

best *prevented with glycemic control*

Stable fracture

The broken ends of the bone line up and are barely out of place

compound fracture

bone breaks through the skin

Fatigue fracture

Abnormal stress or torque applied to bones that have the normal ability to deform and recover (joggers, dancers)

stress fracture

a small crack in the bone that often develops from chronic, excessive impact

pathologic fracture

occurs when a weakened bone breaks under normal strain

greenstick fracture

bending and incomplete break of a bone; most often seen in children

Transchondral fracture

Fragmentation and separation of the articular cartilage covering the end of a bone. High energy trauma

Dislocation

displacement of a bone from its joint

subluxation

partial dislocation of a joint

rheumatoid arthritis

a chronic autoimmune disorder in which the joints and some organs of other body systems are attacked

Rheumatoid Arthritis Treatment

-goal of tx: reduce inflammation and pain, promote joint function, and prevent joint destruction and deformity

-Pharmacological management includes NSAIDs to reduce inflammation and pain

-Corticosteroid meds may be desirable during severe flare-ups or when the patient's condition is not responding to NSAIDs

-Disease-modifying antirheumatic meds are slow-acting and take weeks or months to become effective, however, they have the ability to slow the progression of joint destruction and deformity

-PT interventions include passive and active ROM, heating and cooling agents, splinting, patient education, energy conservation, body mechanics, and joint protection techniques

ankylosing spondylitis

a form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae

Psoriatic arthritis

An inflammatory arthritis associated with psoriasis of the skin

Osteoarthritis

inflammation of the bone and joint. occurs with aging deterioration/ erosion of articular cartilage in synovial joints

osteoarthritis treatment

1. Acetaminophen 2 if not controlled, NSAIDs, like indomethacin, 3 celecoxib for GI bleeding 4 no glucocorticoids

arthroscopy surgery

a minimally invasive procedure for the treatment of the interior of a joint

Gout

a painful inflammation of the big toe and foot caused by defects in uric acid metabolism resulting in deposits of the acid and its salts in the blood and joints

Rhabdomylosis

is the breakdown of muscle cells contents that result in the release of muscle fiber contents into the bloodstream

Rhabdomylosis s/s

muscle pain, often extremely painful aching and throbbing.

muscle weakness.

muscle swelling or inflammation.

dark-, cola-, or tea-colored urine.

general exhaustion or fatigue.

irregular heartbeat.

dizziness, light-headed, or feeling faint.

confusion or disorientation. Creatinine kinase level diagnostic monitored

muscle strain

an injury that occurs when a muscle is stretched beyond the limits to which it is accustomed

Fibromyalgia

chronic condition with widespread aching and pain in the muscles and fibrous soft tissue

osteomalacia

disease marked by softening of the bone caused by calcium and vitamin D deficiency

Osteomalacia treatment

Vitamin D; recommended daily allowance: 400 IU; eat foods high in Vit D; sun exposure for at least 5 min/d

Paget's disease

a bone disease of unknown cause characterized by the excessive breakdown of bone tissue, followed by abnormal bone formation..

Epicondylopathy

a type of tendinopathy, where it attaches to a bony epicondyle such as those on the humerus, radius, and ulna

Epicondylopathy treatment

surgery

Osteomyelitis

inflammation of bone and bone marrow

Endogenous

produced from within; due to internal causes

exogenous infection

occurs if a pathogen breaches the host's external defense and enters sterile tissue

sarcoma of bone marrow

myelosarcoma

Osteosarcoma (osteogenic sarcoma)

the most common bone cancer in children and most commonly affects patients in the second decade of life during their growth spurt. Optimum treatment of osteosarcoma includes surgery and chemotherapy.

Ewing sarcoma

malignant tumor that develops from bone marrow, usually in long bones or the pelvis

Chondrosarcoma

malignant tumor of cartilage

Chondrosarcoma treatment

High grade; chemotherapy, wide excision 3cm with post chemotherapy,

Neck dissection is needed

20 % 5 year survival rate

Bacterial Skin Infections

impetigo, folliculitis, cellulitis

carbuncle

skin infection composed of a cluster of boils caused by staphylococcal bacteria

furuncle

boil; suppurative inflammatory skin lesion due to infected hair follicle

Pityriasis Rosea

Presents with a herald patch, Christmas-tree pattern.

herpes zoster

viral disease affecting the peripheral nerves, characterized by painful blisters that spread over the skin following the affected nerves, usually unilateral; also known as shingles

Candidiasis (Thrush)

infectious

fungus, d/t birthing process, abx, inhaled steroids s/s: white patches on tongue, gums, cheeks, itching. Rx: oral antifungals, mouth rinsing after steroid-KETOCONAZOLE: MONITOR LIVER FUNCTION, AVOID ALCOHOL, AVOID SUN

Ringworm

A highly contagious, fungal infection of the skin or scalp.

Ringworm signs and symptoms

circular reddish fungal rash

Fungal meningitis

Cryptococcus neoformans

viral meningitis

meningitis caused by a virus and not as severe as pyrogenic meningitis

Viral meningitis treatment

no specific treatment exists