Pathophysiology midterm review

Exam Units

• Content areas:

  • Infection, inflammation, immunity 8 questions

  • Neural function 10 question

  • Sensory function 10 questions

  • Hematopoietic system 10 questions

  • Arterial Blood Gas (ABGs)

  • Lab Values

Factors Affecting Wound Healing

• Key Factors:

  • Malnutrition

  • Blood flow and oxygen delivery

  • Impaired inflammatory and immune response

  • Infection, wound separation, foreign bodies

  • Age

Antibiotics Overview

Penicillins

• Uses: Treats streptococcal and staphylococcal infections, syphilis, gonorrhea

• Naming: Ends in "-cillin" (e.g., piperacillin, amoxicillin)

• Side Effects: Gastrointestinal issues such as nausea, vomiting, diarrhea, and abdominal pain

Cephalosporins

• Uses: Varied, including urinary tract and respiratory infections

• Naming: Starts with "cef-" (e.g., ceftriaxone, cefepime)

• Caution: Contraindicated for those allergic to penicillin

Aminoglycosides

• Uses: Treat Gram-negative bacterial infections

• Examples: Gentamicin, tobramycin

• Adverse Effects: Ototoxicity, nephrotoxicity

Tetracyclines

• Uses: Treats various infections

• Naming: Ends in "-cycline" (e.g., doxycycline)

• Contraindications: Not for pregnant individuals or children under 8

Macrolides

• Uses: Mild to moderate respiratory infections

• Example: Azithromycin

• Contraindications: Lactating individuals or those with hepatic dysfunction

Fluoroquinolones

• Uses: Treats Gram-negative and Gram-positive infections of urinary/respiratory tracts

• Naming: Ends in "-floxacin" (e.g., levofloxacin, ciprofloxacin)

• Adverse Reactions: Tendon rupture, CNS effects

  • Contact Precautions: Wear gloves and gowns to prevent spreading infections through touch.

  • Droplet Precautions: Use masks to protect against germs from coughs and sneezes.

  • Airborne Precautions: Wear special masks to guard against germs that linger in the air.

Analgesics Overview

• Function: Decrease or eliminate pain without loss of consciousness

• Purpose: Allows mobility post-surgery for necessary exercises like coughing or deep breathing

Special Types of Pain

• Neuropathic Pain: Chronic pain due to nerve damage, often described as burning/stabbing/tingling

• Neuralgia: Sharp, sudden pain along a nerve path due to irritation or damage

• Phantom Limb Pain: Sensations or pain felt in an amputated limb

Spinal Cord Function

• Role: Transmits signals between brain and body; controls reflexes

• Structure: Long, cylindrical from brainstem to lower back

• Function in Neural: Basic motor control and sensation; damage leads to paralysis or sensation loss

Brain Stem Function

• Role: Regulates life functions (heart rate, breathing, swallowing)

• Structure: Comprises midbrain, pons, medulla oblongata

• Function in Neural: Communication pathway for brain and spinal cord; controls autonomic functions, reflexes

Motor Cortex Function

• Role: Voluntary movement control

• Structure: Located in frontal lobe, precentral gyrus

• Function in Neural: Signals to muscles for voluntary movements; damage can lead to motor issues or paralysis

Cerebellum Function

• Role: Coordinates movement and maintains balance

• Structure: Back of the brain, below occipital lobes

• Function in Neural: Fine-tunes movements; damage can cause ataxia

Skeletal Muscle Disorders

• Muscle Atrophy: Weakening/shrinking due to disuse/injury/disease

• Muscular Dystrophy: Genetic disorder causing progressive muscle weakness

• Carpal Tunnel Syndrome: Median nerve compression in wrist causing pain/numbness

• Guillain-Barré Syndrome: Immune system attacks peripheral nerves, causing weakness

• Herniated Disk: Ruptured/slipped spine disk causing pain and nerve compression

• Parkinson's Disease: Neurodegenerative disorder with tremors and rigidity due to dopamine loss

Spinal Cord Injury Effects

Injury Levels

• Cervical (C1-C7): Quadriplegia (all four limbs); impaired breathing

• Thoracic (T1-T12): Paraplegic (lower body, pelvic organs)

• Lumbar (L1-L5): Affects legs and urinary function

• Sacrum (S1-S5): Associated issues not specifically listed here

Autonomic Nervous System Dysfunction

• Vasovagal Response: Sudden heart rate and blood pressure drop; may cause fainting

  • triggers: stress, pain, standing too quickly

• Autonomic Dysreflexia: High blood pressure spike in individuals with spinal cord injuries

  • triggers: overstimulation of autonomic nervous system

• Postural Hypotension: Blood pressure drops upon standing; may lead to dizziness or fainting

Glasgow Coma Scale - assess level of consciousness

• Eye Response (4): Indicates alertness and awareness

• Verbal Response (5): Assesses brain function, memory, and awareness

• Motor Response (6): Evaluates muscle movement control; checks brain-body connections

• max points is 15

• 7 is comatose

• 

Posturing Types

• Flexed, Extended, Adducted, Plantar Flexed: Various postures that reflect neurological status

• decerebrate - arms flexed away from core

• decorticate - arms flexed into core

Stroke Types

• Ischemic Stroke: Result from a blockage (clot)

• Hemorrhagic Stroke: Involves bleeding in/around brain, often with increased intracranial pressure (ICP)

Eye Movements

• amblyopia

• nystagmus

• strabismus

• myopia

• astigmatism

• hyperopia

• 

Hearing Loss Types

Conductive Hearing Loss

• Definition: Problems in outer/middle ear preventing sound waves from reaching the inner ear

Sensorineural Hearing Loss

• Definition: Damage to cochlea or auditory nerve pathways

Hearing Loss Assessments

Diagnostic Tests

• Romberg Test: Assessing balance and proprioception

External Ear Disorders

Impacted Cerumen

• Definition: Blockage from accumulated cerumen in ear canal

• Causes: overproduction of cerumen, use of cotton swabs, narrow ear canal, hearing aids

• Symptoms: Hearing loss, ear fullness/pressure, pain, tinnitus (ringing in ear), dizziness, balance issues

• Management: Professional removal, ear drops, irrigation

Otitis Externa (Swimmer’s Ear)

• Definition: Infection/inflammation of the external auditory canal

• Causes: water exposure (swimming, bathing), mechanical injury (scratching, use of cotton swabs), allergies or skin condition (eczema, psoriasis)

• Symptoms: Itching, pain, redness, discharge (clear, yellow pus like)

• Management: Antibiotic/fungal ear drops, pain relief, avoidance of moisture

Barotrauma

• Causes: Rapid ascent/descent or Eustachian tube dysfunction

• Symptoms: Ear pain, hearing loss, pressure, possible bleeding or rupture of ear drum

• Management: prevention: yawning, swallowing, chewing gum, use nasal decongestants prior to flying/diving, if rupture occurs seek medical attention for possible ear drops or antibiotic treatment

Otosclerosis

• Causes: Genetic factors, more common in women

• Symptoms: Gradual hearing loss, tinnitus, difficulty in hearing in loud noisy environments

• Management: Hearing aids, possible stapedectomy (removal of affected bone), a prosthetic device can SOMETIMES replace the stapes

Disorders of inner ear: Tinnitus

causes, symptoms, diagnosis, management

Disordered Hearing in Children

• Even mild or unilateral hearing loss can affect a young child's language development, with 1 to 3 babies per 1,000 born with permanent hearing loss.

Causes of Hearing Impairment

• Hearing loss in children can be conductive or sensorineural. Genetic causes contribute to about 50% of sensorineural hearing loss.

Postnatal Causes

• After birth, sensorineural hearing loss can be caused by infections like bacterial meningitis or sepsis, toxins (e.g., ototoxic drugs), or trauma. Congenital cytomegalovirus is a leading cause of hearing loss in newborns.

Screening and Intervention

• The AAP recommends universal screening for all infants before 1 month of age, with intervention by 6 months. Children with risk factors for delayed hearing loss should receive ongoing monitoring, and a developmental and speech evaluation is needed once hearing loss is identified.

Hearing loss in Older Adults

• Presbycusis refers to age-related degenerative hearing loss, affecting approximately 45% of individuals aged 65 and older. It is a common social and health issue due to its high prevalence.

  Characteristics:

  • Gradual, bilateral hearing loss.

  • Typically involves high-frequency loss.

  • Leads to difficulty in understanding speech, especially in noisy environments, and challenges with sound localization.

  Causes and Symptoms:

  • Likely resulting from a combination of aging, auditory stress, trauma, and otologic diseases.

  • Common complaint: difficulty understanding speech rather than the inability to hear, particularly for high-frequency sounds like beepers or alarms.

  Screening and Treatment:

  • Annual screening recommended for older adults, often involving the question, "Do you have a hearing problem?"

  • Effective treatments include hearing aids, lipreading, and assistive devices.

  • Cochlear implants are recommended for severe hearing loss unresponsive to hearing aids.

Vestibular System Disorders

• peripheral vestibular apparatus

• vertigo

• motion sickness

• Meniere disease

Red Blood Cell Disorders

Normal CBC Levels

• WBC: 4,500–11,000

• Hemoglobin: 11–18 g/dL

• Hematocrit: Women 36-44%, Men 41-50%

• Platelets: 150,000–450,000

Lab Work Types

1. Complete blood count (CBC): red blood cells, white blood cells, hemoglobin, hematocrit, platelets

   • hemoglobin & hematocrit: H&H tests are performed to rule out anemia

2. Type & Screen: Identifies blood type and antibodies for transfusions

   • blood type: patient’s red blood cells are typed for their ABO and Rh (D) blood type

   • antibodies: the patient’s plasma is screened for the presence of antibodies that could cause a transfusion reaction

Blood Transfusion Reactions

• Monitoring: Start slow, watch for adverse reactions, and replace with normal saline if needed

• Start administration slowly (approximately 2–3 mL/min for the first 15 minutes).

• Stay with the patient for the first 15 minutes of transfusion.

• Assess the patient at least every 30 minutes for adverse reactions.

• Stop the blood transfusion if you suspect a reaction.

• Quickly replace the blood tubing with a new administration set primed with normal saline for IV infusion.

• Initiate an infusion of normal saline for IV at a keep open rate, usually 40 mL/hr.

• Obtain vital signs.

• Notify the health care team and the blood bank/transfusion service.

Blood Disorders

• Anemia: Deficiency in red blood cells, leads to fatigue & weakness

• Sickle Cell Disease: Genetic disorder causing abnormal blood cells [cause blockage in blood flow]

• Thalassemia: Reduced hemoglobin production, leads to anemia

• Polycythemia: Overproduction of red blood cells [can lead to blood clots]

• Neutropenia: Low neutrophil counts increasing infection risk

• Non-Hodgkin Lymphomas group of cancers originating from the lymphatic system, affecting white blood cells

• Leukemias: cancers of the bone marrow and blood, leads to overproduction of abnormal white blood cells

• Multiple Myeloma: Cancer of plasma cells in bone marrow affecting production of normal blood cells