patho final- n version

CM Down Syndrome:

flat facial features, short stature, upwards slanting of the eye, small square head, small low set malformed ears, depressed nasal bridge

Ischemia:

blockage/diminished blood flow (no blood flow - no oxygen)

Primary Prevention

removing risk factors so disease does not occur

Secondary Prevention

detecting the disease when still curable

Tertiary Prevention

preventing further deterioration or reducing complications of disease

TNM Staging

(Tumor, Nodes, Metastasis), T \= Tumor size, N \= Lymph node involvement, M \= metastasis (absent/present)

Clinical Manifestations of cancer:

Pain, Fatigue & anorexia, Cachexia, Anemia, Leukopenia and thrombocytopenia, Infection, Paraneoplastic syndromes

Why do those with cancer have anorexia (loss of appetite)/cachexia (loss of skeletal muscle and fat)?

The cancer is attacking the normal body cells needed to function, hypermetabolic state

Cancer metastasizes by blood:

the second location is when it is metastasized - spread by blood

Potassium Lab Levels:

3.5 - 4.5/5 MEQ/L

Etiology of Hypokalemia:

Can arise from Cushing syndrome, inappropriate use of medications (not taking them)

Signs/Symptoms of Hypokalemia:

cardiac irritability (K is important in maintaining cardiac health), paralytic ileus (paralyzed gut), hyporeflexia, mental changes

Etiology of Hyperkalemia:

Potassium rich diet and medications, Whole blood or packed cells

Signs/Symptoms of Hyperkalemia:

depressed cardiac conduction (cardiac monitoring), prolonged PR interval, wide QRS

Magnesium Lab Levels:

1.5 - 2.5 MEQ/L

Etiology of Hypomagnesemia:

malnutrition, diarrhea

Signs/Symptoms of Hypomagnesemia:

hyperactive deep tendon reflexes, personality changes

Etiology of Hypermagnesemia:

increased intake with decreased renal excretion

Signs/Symptoms of Hypermagnesemia:

bradycardia, hypotension, lethargy

Calcium Lab levels:

8.5 - 10.0 MG/DL

Etiology of Hypocalcemia:

Thyroidectomy (parathyroid glands are responsible for calcium monitoring, usually gets injured in operation)

Signs/Symptoms of Hypocalcemia:

skeletal muscle cramps, seizures, laryngospasm, asphyxiation, death

Etiology of Hypercalcemia:

renal failure, hyperparathyroidism, immobility (buildup of Ca in blood)

Signs/Symptoms of Hypercalcemia:

decreased neuromuscular excitability, bone fracture risk, renal stones

Sodium Lab levels:

135 - 145 MEQ/L

Etiology of Hyponatremia:

Diaphoresis (profuse sweating), diuretics, drainage

Signs/Symptoms of Hyponatremia:

tachycardia, hypotension, coma, polyuria, decreased skin turgor

Etiology of Hypernatremia:

renal failure (can't dispose of waste via pee)

Signs/Symptoms of Hypernatremia:

CNS irritability (tingling, irritable), dry flushed skin

Arterial Blood Gas Levels:

pH: 7.35 - 7.45, PaCO2 (Carbon Dioxide): 45 - 35, HCO3 (Bicarbonate): 22 - 26, PAO2 (Oxygen): 80 - 100

Respiratory Acidosis:

pH < 7.35, Carbon Dioxide \> 45

Causes of Respiratory Acidosis:

damage to respiratory center in medulla from trauma or narcotics, airway obstruction chronic (Trauma -\> impaired ventilation -\> acidosis)

Manifestations of Respiratory Acidosis:

headache, irritability, blurred , psychological change

Treatment for Respiratory Acidosis:

improve ventilation

Metabolic Acidosis

pH < 7.35, Bicarbonate < 22

Causes of Metabolic Acidosis:

excess production of fixed acid from diabetic ketoacidosis or lactic acidosis, decreased renal function, increased bicarbonate losses from diarrhea

Compensatory Mechanisms for Metabolic Acidosis:

increase ventilation with the elimination of CO2 to increase pH (you blow off acid when you breathe)

Manifestations of Metabolic Acidosis:

stupor and coma

Treatment for Metabolic Acidosis:

controversial bicarbonate supplements

Respiratory Alkalosis:

pH \> 7.45m Carbon Dioxide < 35

Causes of Respiratory Alkalosis:

hyperventilation

Manifestations of Respiratory Alkalosis:

hyperexcitability of nervous system, light-headed, tingling of fingers and toes

Treatment for Respiratory Alkalosis:

treat underlying cause such as hypoxia by administering oxygen conserve carbon dioxide by rebreathing in paper bad

Metabolic Alkalosis:

pH \> 7.45, Bicarbonate \> 26

Causes of Metabolic Alkalosis:

excess base loading, loss of stomach acids, bulimia nervosa

Manifestations of Metabolic Alkalosis:

mental confusion, tetany, carpopedal spasm (hand spasm)

Treatment for Metabolic Alkalosis:

correct the cause

Intracranial pressure:

7 - 15 mmHg

Increased intracranial pressure, what happens?

Presses on Vital structures leading to brain herniation

S/S of Increased Intracranial Pressure:

headache, blurred vision, vomiting, behavioral changes, weakness/problems moving/talking, fatigue, sleepiness

Cushing's triad:

With signs of brain herniation (poking through a spot its not supposed to) -\> hypertension, bradycardia, and irregular respiration

Hemorrhagic Stroke:

An emergency condition in which a blood vessel BURSTS causing bleeding inside the brain.

Causes of Hemorrhagic Stroke:

risk w/ age, AV (arteriovenous) malformation

CM Hemorrhagic Stroke:

Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or lack of coordination.

Thrombotic Stroke:

a blood clot forms inside one of the brain's arteries - blocks blood flow to a part of the brain. This causes brain cells in that area to stop functioning and die quickly.

CM Spinal Cord Injuries:

Upper (Breathing issues) v Lower (bowel, bladder, immobility) neuron interruption; Primary (initial assault) v. Secondary (fallout from assault) injury, Complete v. Incomplete injury (how bad?)

Parkinson's:

Chronic, debilitating, progressive disorder of the basal ganglia and substantia nigra. Low dopamine

CM of Parkinson's:

tremors, rigidity, cogwheel, stooped posture with slow, shuffling, propulsive gait, drooling, dysphagia (difficulty swallowing), Mask face.

Hematoma:

A pool of mostly clotted blood that forms in an organ, tissue, or body space. A hematoma is usually caused by a broken blood vessel that was damaged by surgery or an injury.

Epidural Hematoma:

bleeding b/w skull and dura resulting from tear of artery (middle meningeal) - Usually occurs in younger indiv. - brief period of unconsciousness, consciousness regained, then rapid progression to unconsciousness

Subdermal:

bleeding between dura and arachnoid from venous tear - Usually develops slowly with signs/symptoms in 24 hours to weeks or can also develop rapidly. May progress to increased ICP, posturing, and seizures

Coup:

injury occurred at impact

Contrecoup:

injury occurs at the opposite end of the impact

Risk factors for someone to have a stroke:

obesity, high blood pressure, high cholesterol, diabetes, drinking too much alcohol, hypertension

Decorticate Position:

lesion of cerebral hemisphere - arms bent and hands turned inward, feet and legs extended out

TIA (Transient Ischemic Attack):

'warning stroke' w/ signs/symptoms resolved w/in 24hrs

Secondary brain injury:

damage from swelling, infection, cerebral hypoxia

Meningitis:

bacterial infection causing strep to release an endotoxin which causes swelling of the protective membranes covering the brain and spinal cord.

Signs/Symptoms of Meningitis:

nuchal rigidity (stiff neck) w/ nausea, photophobia, altered mental status, brudzinski (flexion of neck results in flexion of hip & knees involuntarily), vomiting, noncoherent

Pathogenesis of Multiple myeloma:

exposure to radiation, pesticide, autoimmune history

S/S of Multiple myeloma:

abnormal antibodies from bone marrow infiltrate organs -\> osteoclasts proliferate (break down) -\> bones break down -\> causing bone pain

Manifestations of Multiple myeloma:

pathological fractures, pain

Non-Hodgkin Lymphoma:

malignant transformation of t-cells or b-cells (more difficult to treat)

CM of Non-Hodgkin Lymphoma:

night sweats, weight loss, fever, painless lymph

Thrombocytopenia:

low platelets, propensity to bleed/bruise easily, increased Risk of hemorrhage

Lab-Shift to the Left:

High number of young immature WBC present - due to an infection/inflammation - bone marrow produces more WBCs and releases them into the blood before they mature.

Causes of Hypovolemic Shock:

decreased volume - can be from extracellular fluid/blood loss.

CM of Hypovolemic Shock:

thirst, cool/clammy skin, oliguria, decreased arterial blood pressure, tachycardia

What kind of shock with crush injuries?

Hypovolemic - HR increases to pump blood through the body, Pressure is going to go down

Cardiogenic Shock:

heart fails to pump enough blood to meet body's needs

CM of Cardiogenic Shock:

no blood flow, cyanotic heart (present in central, lips, mouth), pulmonary wedge pressure/central venous pressure will be elevated

Left Ventricular Dysfunction:

impairs movement of blood flow form low pressure pulmonary circulation to high pressure arterial side of systemic circulation.

Where does left-sided heart failure present:

respiratory

CM left-sided heart failure:

dyspnea, cheyne-stokes respirations, acute pulmonary edema/congestion, fatigue/weakness/mental confusion, fluid retention/edema

Right Ventricular Dysfunction:

when the right ventricle fails, reduced deoxygenated blood moving into pulmonary circulation causing a reduction in left ventricle cardiac output.

Where does Right-sided heart failure present:

systemic

CM Right-sided heart failure:

may result from left heart failure, COPD, as pulmonary circulation provides increased resistance to blood from the right ventricle, the right ventricle does not adapt as well as the left ventricle (hypertrophy) and results in dilation and failure of the right ventricle, Systemic edema and hepatosplenomegaly (enlarged liver and spleen), jugular vein distention, pitting edema

Normal ejection fraction:

50 - 70%

Heart Failure Ejection Fraction

Ejection Fraction:

The percentage of blood leaving the heart each time it squeezes

Receptive aphasia:

After one damages the Wernicke's area (usually after a stroke) the patient loses the ability to read and understanding speech.

Cardiac Pathology that causes a stroke

Atrial Fibrillation - an irregular heartbeat that occurs when the electrical signals in the atria (the two upper chambers of the heart) fire rapidly at the same time.

A STEMI (ST-Segment Elevation Myocardial Infarction)

is the most severe type of heart attack. Described as chest pain (sharp, severe, crushing), will not go away from sitting down, worst of the worst. Not relieved by rest/nitroglycerin

CM of STEMI:

epigastric distress, restless, impending doom, cough w/ pink frothy sputum; Irreversible myocardial cell death occurs after 20-40 minutes (needs to get blood pumpin to reprofuse)

non-ST-elevation myocardial infarction (NSTEMI)

is a type of heart attack that usually happens when your heart's need for oxygen can't be met. Unstable angina (no myocardial injury yet) - persistent and severe course of pain (ischemia causes chest pain), occurring at rest, lasts more than 20 minutes, severe and new onset, more frequent pain than usual

CM of cardiac tamponade:

Jugular vein distention, Elevation in central venous pressure, Decrease in systolic pressure, Signs of Shock

Imbalance between blood flow and cardiac demand:

myocardial ischemia is an imbalance between supply (of oxygen or of coronary blood flow) and demand (largely for contractile function).

Hypercoagulability:

clotting factors found in liver, peripheral clotting/central bleeding

Causes of Hypercoagulability:

can be genetic, also can be acquired as a result of surgery, trauma, side affects from medications

DIC (Disseminated Intravascular Coagulation):

a condition in which blood clots form throughout the body's peripheral blood vessels after shock, so central bleeding occurs while peripheral clots. These blood clots can reduce or block blood flow through the blood vessels, which can damage the body's organs.