Exam 2 Free Response Review

Benign Prostatic Hyperplasia (BPH)

A noncancerous (benign) enlargement of the prostate gland that can make urination difficult.

History, physical exam (rectal exam), Prostate Specific Antigen (PSA) is done to rule out prostate cancer

Discuss how BPH is diagnosed

Drugs (to shrink prostate), Surgery (Transurethral Resection of the Prostate (TURP), Other methods to open up the urethra and improve flow (microwave heat, a needle, radiofrequency waves, electric vaporization, lasers, and more))

Discuss treatment of BPH

Grand Mal Seizures

Seizure in which the muscles contract (the tonic part), then rapidly alternate between contracting and relaxing (the clonic part). Consciousness is temporarily lost

Status Epilepticus

Seizure that lasts more than 5 minutes or the person does not wake up between seizures

Age, race, genetics, and family history

List 4 non-modifiable stroke risk factors

Blood pressure, diabetes, obesity, high cholesterol, smoking, and alcohol abuse

List at least 4 modifiable stroke risk factors

Herpes Simplex Virus (HSV)

A viral infection that causes a rash of small, painful blisters that turn into open sores (also known as cold sores). The sores go away, but the virus stays in your body for the rest of your life. The virus can become active again and cause more sores

Transmitted by sex or kissing

How is HSV transmitted?

Treated with antivirals (e.g. Valacyclovir) (Important to give at first “tingle”)

How is HSV treated?

Hypothyroidism

Thyroid does not produce enough hormone

Hashimoto’s thyroiditis

Most common cause of hypothyroidism

Hashimoto’s thyroiditis

An autoimmune disease in which your body makes antibodies that attack the cells in your thyroid

Symptoms may include an enlarged thyroid gland (goiter), tiredness, weight gain, and muscle weakness, treated with thyroid replacement (e.g. Synthroid)

Discuss symptoms of hypothyroidism and how it is treated

Hyperthyroidism

Overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions.

Graves’ Disease

An autoimmune disorder that causes the thyroid gland to produce excessive amounts of thyroid hormone

Graves’ Disease

Most common cause of hyperthyroidism

Symptoms include increased heart rate and BP; sweating excessively, nervousness and anxiousness, difficulty sleeping, and weight loss. Treatments include radioiodine (RAI) which is given as a pill to treat hyperthyroidism by gradually shrinking your thyroid—ultimately destroying the gland as well as a thyroidectomy which is the surgical removal of the thyroid

Discuss symptoms and treatments for hyperthyroidism

Type 1 Diabetes

Lack of insulin production. 90% of pancreas islet cells destroyed, so they produce little or no insulin. Occurs in only 10% of diabetics. Treatment is insulin

Type 2 Diabetes

Insulin Resistance. Most often due to obesity. The pancreas tries to increase insulin production, but there is not enough insulin to meet the body's needs. Treatment includes diet, exercise, oral and shot of hypoglycemic drugs, and if nothing else works, insulin. 90% or more of diabetics.

Gestational Diabetes

Insulin resistance due to pregnancy hormones. Usually resolves after delivery. Treatment includes diet, exercise, and if those do not work, insulin

Spinal anesthesia

Type of neuraxial anesthesia; local anesthetic is injected into cerebrospinal fluid in the subarachnoid space in the lumbar spine. Numb from waist down. Used for surgery in patients and most commonly used to planned C-sections. Single injection

Epidural anesthesia

Injection works by injecting an anesthetic into the epidural space around your spine. Numb from belly button to upper thighs. Used for back pain patients as a single injection. Use as an infusion for deliveries

Human Immunodeficiency Virus (HIV)

Destroys certain types of white blood cells and weakens the body’s ability to fight infection. Contracted by sexual contact, exposure to infected blood, and maternal transfer. Treated with antiretrovirals.

Viral load and CD4+ count

How do we follow patients with HIV?

Viral load

This test measures the amount of HIV in your blood. The goals of HIV treatment are to keep your viral load at undetectable levels and to keep your CD4 count high. A viral load test offers a good indicator of how well your treatment is working to achieve those goals.

CD4+ Count

Gives a general measure of the health of your immune system. A normal CD4 cell count is more than 500 cells per cubic millimeter (mm3) of blood. If you have a CD4 count of fewer than 200/mm3, you will be diagnosed as having AIDS.

Acquired Immunodeficiency Syndrome (AIDS)

The most severe form of HIV infection. HIV infection is considered to be AIDS when at least one serious complicating illness develops or the number (count) of CD4+ lymphocytes decreases substantially.

Natural Family Planning

A form of birth control without drugs, devices, or surgery. Symptomothermal method- Uses basal body temperature, mucus, and calendar methods together. Requires commitment- abstinence during the period of fertility. Is 99% effective

Amyotrophic Lateral Slcerosis (ALS)

The most common type of motor neuron disease. It’s often called Lou Gehrig disease. Involves the progressive degeneration of the motor neurons. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. (Ability to initiate and control muscle movement is lost. Lose the ability to speak, eat, move, and breathe). Caused by a combination of genetic, environmental, and biological factors, though the exact cause is unknown in most cases

Human Papilloma Virus (HPV)

A viral infection that causes skin warts, genital warts, and cancer of the cervix, penis, vagina, vulva, anus, or throat. Most common STI in the United States. It causes many cancers, is prevented with a vaccine, and there is no treatment.

Thrombolysis and mechanical thrombectomy

List the two ways to treat ischemic strokes

Thrombolysis

A medical treatment that dissolves blood clots to restore normal blood flow and prevent tissue damage

Mechanical thrombectomy

Going in and removing a blood clot using a special catheter that has a clot retriever on it

Ischemic strokes (embolic and thrombotic) and hemorrhagic strokes (intracerebral and subarachnoid)

List the two main categories of strokes and the subcategories of each one

Ischemic stroke

Death of an area of brain tissue (cerebral infarction) resulting from an inadequate supply of blood and oxygen to the brain due to blockage of an artery. It can be embolic or thrombotic (Treated with thrombolytics or thrombectomy)

Embolic stroke

Stroke caused by a clot within an artery, but in this case the clot (or emboli) forms somewhere other than in the brain itself, often from the heart.

Thrombotic stroke

Stroke that occurs when diseased or damaged cerebral arteries become blocked by the formation of a blood clot within the brain.

Hemorrhagic stroke

Strokes that include bleeding within the brain (intracerebral hemorrhage) and bleeding between the inner and outer layers of the tissue covering the brain from a leaking or rupture aneurysm (subarachnoid hemorrhage).

Intracerebral stroke

A type of stroke caused by the sudden rupture of an artery within the brain. Blood is then released into the brain compressing brain structures. Treatment includes lowering blood pressure, rarely operate if there’s too much pressure in the brain

Subarachnoid stroke

A type of stroke caused by the sudden rupture of an aneurysm. The location of the rupture leads to blood filling the space surrounding the brain rather than inside of it. Treatment includes endovascular coils or craniotomy with clipping.

Endovascular coiling

A procedure performed to block blood flow into an aneurysm (a weakened area in the wall of an artery). A catheter is passed through the groin up into the artery containing the aneurysm. Platinum coils are then released. The coils induce clotting (embolization) of the aneurysm and, in this way, prevent blood from getting into it.

Muscle weakness, paralysis, abnormal or lost sensation on one side of the body, difficulty speaking, sudden severe headache, confusion, problems with vision, dizziness and loss of balance and coordination.

List at least 5 symptoms of a stroke

Pressure sores

(aka bedsores, decubitus ulcers, pressure ulcers) Areas of skin damage resulting from a lack of blood flow due to pressure. Important to healthcare organizations because if they occur while in the hospital, the cost of care is not covered by insurance and the hospital loses money

Move patient frequently, specialized beds

Discuss prevention/treatment of pressure sores

Shingles

An infection that results from the reactivation of the Herpes Zoster (Chickenpox) virus. Reactivation cause unknown, but usually when the immune system is weakened

Painful eruption of blisters which can lead to chronic pain in the affected areas

Discuss symptoms of shingles

Prevented with a vaccine (new vaccine Shingrix is for people 50 and older), treated with antiviral medications (early treatment is critical to prevent long-term pain), pain relieving drugs are also often necessary

Discuss prevention and treatment of shingles

Subcutaneous insulin (SQ) and insulin pump

List the main two ways to give insulin

Subcutaneous insulin (SQ)

Insulin given via shots. Can be drawn up but now mostly in prefilled syringes. Have both rapid and long-acting forms.

Insulin pump

Continuous subcutaneous therapy. Continuous infusion of rapid acting insulin. Must dial in extra for meals. Some have a program to turn off if patient becomes hypoglycemic. An alternative to multiple daily injections of insulin by syringe or an insulin pen and allows for intensive insulin therapy when used in conjunction with blood glucose monitoring and carb counting.

Dialysis

An artificial process of removing waste products and excess fluid from the body in patients with renal failure.

Hemodialysis

A dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood. To get your blood into the dialyzer, the doctor needs to make an access, or entrance, into your blood vessels

Peritoneal dialysis

A way to remove waste products from your blood when your kidneys can no longer do the job adequately. A cleansing fluid flows through a tube (catheter) into the peritoneal cavity (abdomen) and filters waste products from your blood.

Physical therapy, drugs (NSAIDS and steroids, DMARDS, biologic DMARDS), and joint replacement

List treatment options for rheumatoid arthritis

Disease-modifying antirheumatic drugs (DMARDS)

Comprise a category of otherwise unrelated drugs defined by their use in rheumatoid arthritis to slow down disease progression.

Biologic (immunosuppressive) DMARDS

Drugs that suppress the immune system of patients with autoimmune arthritis, like RA. Biologic agents may suppress the inflammation so that corticosteroids can be avoided or given in lower doses. Thus, by interfering with the immune system, biologic agents may increase the risks of infection and certain cancers.

Laminectomy

Surgery that creates space by removing bone spurs and tissues associated with arthritis of the spine. Usually involves removing a small piece of the back part (lamina) of the small bones of the spine (vertebrae). Enlarges the spinal canal to relieve pressure on the spinal cord or nerves. Used for conditions such as spinal stenosis, herniated discs, and other spinal disorders that cause nerve compression.

Lumpectomy, partial mastectomy, simple mastectomy, modified radical mastectomy, radical mastectomy

List the 5 types of breast surgery

Lumpectomy

Surgery in which the tumor and a small amount of breast tissue are removed

Partial mastectomy

Surgery in which the tumor and a larger amount of breast tissue are removed

Simple mastectomy

Surgery in which all breast tissue but no muscle or lymph nodes are removed

Modified radical mastectomy

Surgery in which all breast tissue and lymph nodes are removed, but no muscle

Radical mastectomy

Surgery in which all breast tissue, lymph nodes, and muscle are removed

Female sterilization is a major abdominal surgery, and male sterilization is a minor outpatient procedure. Female sterilization is only 99% effective and male is 100%

Discuss why male sterilization is better than female sterilization

Multiple Sclerosis (MS)

A neurodegenerative potentially disabling disease of the brain and spinal cord (central nervous system). The immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Some newer treatments but not clear yet how valuable

Numbness or weakness in one or more limbs, tremor, lack of coordination or unsteady gait, vision problems

Discuss symptoms of MS

Dementia

Slow, progressive decline in mental function including memory, thinking, judgment, and the ability to learn.

Alzheimer disease (60-80%), Vascular dementia (from strokes), Dementia with Lewy bodies, Frontotemporal dementia, Human immunodeficiency virus, Parkinson’s disease

Discuss causes of dementia

Nothing proven to prevent., treatment includes PT and OT. Drug Treatment still not proven. Newest ones may decrease Amyloid Plaques (not clear that it helps)

Discuss prevention and treatment of dementia

Parkinson’s Disease

A slowly progressive degenerative disorder of the central nervous system. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone (rigidity), slowness of voluntary movements, and difficulty maintaining balance (postural instability)        

Occurs when 60-80% of dopamine cells die, Symptoms: Stiff muscles, Slow movements, Difficulty maintaining balance, Difficulty walking, Tremor, Treatment: Levodopa medication. Sometimes surgery. Physical Therapy. Maybe CBD

Discuss cause, symptoms, and treatment for Parkinson’s Disease

Rheumatoid arthritis

An inflammatory arthritis in which the joints, usually those in the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of the joints. The immune system attacks the joints and connective tissue

Osteoarthritis

Chronic disorder associated with damage to the cartilage and surrounding tissues and characterized by pain, stiffness, and loss of function. Usually from chronic use and aging. Treated with NSAIDS, PT, and joint replacement

Ophthalmologist

A medical doctor who specializes in treatment of diseases of the eye and performing eye surgery

Optometrist

Non-physicians that provide most primary vision care. They examine people’s eyes to diagnose vision problems and eye diseases, and they test patients’ visual acuity, depth and color perception, and ability to focus and coordinate the eyes.

Optician

A person qualified to make and supply eyeglasses and contact lenses for correction of vision