patho final study guide (1)

Hematopoiesis

  • Distributive means vessel issue

Clinical Manifestations of PCOS

  1. Prolonged menstrual periods
  2. Hirsutism (facial hair)
  3. Acne
  4. Male pattern baldness
  5. Acanthosis nigricans (darkened discoloration of skin)

Pathophysiology of Endometriosis

  1. Endometrial tissue is located outside the uterus
  2. Can result in:
    • Pelvic adhesions
    • Distortion of pelvic structures
  3. Dysmenorrhea

Etiology/Causative Agent of PID

  1. Result of sexually transmitted infection of the reproductive tract
    • Chlamydia trachomatis
    • Neisseria gonorrhoeae
  2. Microorganisms spread:
    • Into the cervix
    • Uterus
    • Uterine tubes
    • Ovaries
    • Into the peritoneal cavity

Causes of Stress Incontinence

  1. Childbirth
  2. Pregnancy
  3. Obesity
  4. Aging
  5. Pelvic surgeries (prostatectomy)

Clinical Manifestations of Addison’s Disease

  • Glucocorticoids:
  1. Low blood sugar
  2. Weakness
  3. Fatigue
  4. Anorexia
  5. Nausea, vomiting
  6. Weight loss
  • Mineralocorticoids:
  1. Dehydration
  2. Hyponatremia
  3. Hyperkalemia
  4. Hypotension

Clinical Manifestations of Diabetes Mellitus

Type 1

  1. Severe hyperglycemia and hyperketonemia
  2. Polydipsia (excessive thirst)
  3. Polyuria (excessive urination)
  4. Polyphagia (excessive hunger)

Type 2

  1. Related to long-term complications:
    • Visual changes
    • Changes in kidney function
    • Coronary artery disease
    • Recurrent infections

Clinical Manifestations of Grave’s Hyperthyroidism

  1. Enlargement of thyroid gland
  2. Excessive metabolic rate of the body
  3. Symptoms:
    • Weight loss
    • Agitation
    • Restlessness
    • Sweating
    • Heat intolerance
    • Diarrhea
    • Tachycardia
    • Heart palpitations
    • Tremors
    • Fine hair
    • Oily skin
    • Irregular menstrual cycle
  4. Goiter from follicular epithelial cell hyperplasia
  5. Exophthalmos: protrusion of the eyeball

Electrolyte Imbalance of Patients with SIADH

  1. Hyponatremia (serum sodium < 135)
  2. Hypotonicity (plasma osmolality < 280)
  3. Decreased urine volume
  4. Highly concentrated urine with high sodium content
  5. Absence of renal, adrenal, or thyroid abnormalities

Pathophysiology of DKA

  1. Lack of insulin causes mobilization of fatty acids for energy
  2. Increased production of ketones
  3. Kidneys unable to excrete ketones; cells cannot use byproducts
  4. Ketones accumulate in blood

Pathophysiology of Cushing’s Syndrome

  1. Hypersecretion of adrenal cortex hormones
    • Mainly increased cortisol
    • Glucocorticoids contribute to:
      • Metabolic function
      • Inflammatory/immune response
      • Stress response
    • Mnemonic: Remember CUSHing’s - there’s a CUSHION of steroids

Pathophysiology of DM1

  1. Autoimmune destruction
    • Multifactorial etiology involving genetic susceptibility and environmental triggers (viruses like mumps and rubella)
    • Cell-mediated immune mechanisms with cytotoxic T lymphocytes destroy pancreatic beta cells
    • Antibodies against glutamic acid decarboxylase (GAD) enzyme within beta cells
    • Chronic inflammatory response contributes to further destruction
  2. Insulin Deficiency
    • Clinical manifestations occur when 80-90% of beta cells are destroyed
    • Results in absolute insulin deficiency
    • Also affects alpha cell function, causing increased glucagon levels
    • Glucagon suppresses insulin production, worsening the condition
  3. Metabolic Consequences
    • Hyperglycemia from glucose accumulation without adequate insulin for cellular uptake
    • Hyperketonemia from unregulated fat mobilization
    • Fat oxidation produces ketone bodies, leading to metabolic ketoacidosis
    • Body utilizes fat stores and protein for energy (cellular starvation)

Possible Causes of Diabetes Insipidus (DI)

  1. Insufficient production of ADH by hypothalamus or ineffective secretion by posterior pituitary
  2. Inadequate kidney response to ADH (nephrogenic DI)
  3. Ingestion of large volumes of fluids/decreased ADH levels; sometimes due to psychiatric disturbances

Lab Test for Glucose Over the Past 3 Months

  • A1c: Shows amount of hemoglobin proteins in red blood cells that are coated with sugar

Clinical Manifestations of BPH

  1. Related to urethral obstruction from enlarged prostate, which impedes urine flow
  2. Symptoms:
    • Urinary frequency
    • Dribbling
    • Hesitancy
    • Incontinence
    • Urgency
    • Retention

Pathophysiology of Peptic Ulcer Disease

  1. Infection by H. pylori and chronic NSAIDs usage
  2. H. pylori damages protective mucus lining of stomach and duodenum
  3. NSAIDs produce prostaglandins that cause stomach acid erosion
  4. Alcohol use and smoking can contribute

Example of Passive Immunity

  • IgA provides passive immunity from mother to newborn through breast milk, ensuring essential immune defense prior to adequate infant immune response development

Differentiate RA vs OA

Osteoarthritis

  1. Overview: Progressive breakdown and loss of cartilage in joints due to wear and tear
  2. Degenerative disease affecting mostly weight-bearing joints
  3. Risk Factors:
    • Old age
    • Female
    • Obesity
    • Repetitive joint stress
  4. Symptoms:
    • Morning stiffness lasting less than 30 minutes
    • Hard and bony joints
    • No inflammation present
    • Nodes can be Bouchard’s or Heberden

Rheumatoid Arthritis

  1. Overview: Body's immune system attacks joints causing inflammation (autoimmune disease); systemic effects observed
  2. Risk Factors:
    • Age 20-50
    • Female
    • Family history
    • Smoking
  3. Symptoms:
    • Morning stiffness lasting greater than 30 minutes
    • Warm, soft, and swollen joints
    • Symmetrical and systemic effects
    • Nodes can be swan-neck, boutonniere, ulnar drift

ABCDE of Skin Cancer

  1. A - Asymmetry: A mole that is irregularly shaped
  2. B - Border: A mole with jagged edges without clear definition
  3. C - Color: A growth that is multicolored or changes color
  4. D - Diameter: A sudden increase in mole size, especially one greater than 6mm
  5. E - Elevation: A flat mole that becomes elevated

Primary Immunodeficiency

  • Group of inherited genetic disorders affecting normal immune system development or function
  • Present at birth leading to infections and potential autoimmune diseases

Examples of Active Immunity

  • Development of antibodies in response to an antigen from having a specific disease or vaccine

Examples of Type 2 Hypersensitivity

  • Antibody-mediated reactions such as blood transfusion, Graves’ disease, and hemolytic disease
  • When antibodies bind to antigens, cells are lysed and destroyed resulting in decreased red blood cells, decreased platelets, and leukopenia
  • Mediated by IgG or IgM

Possible Causes of Hypovolemia (Fluid Volume Deficit)

  1. Causes:
    • GI losses (vomiting, diarrhea)
    • Renal loss (diuretics, diabetes)
    • Third spacing (ascites, edema)
    • Swelling
  2. Pathophysiology:
    • Reduced intravascular volume leads to decreased venous return
    • Results in reduced cardiac output, hypotension, and poor organ perfusion
  3. Clinical Signs:
    • Tachycardia
    • Hypotension
    • Orthostatic changes
    • Decreased urine output
    • Altered mental status

Electrolytes: Intracellular vs Extracellular

Intracellular Fluid

  • Found inside cells, rich in potassium and proteins

Extracellular Fluid

  • Found outside cells, high in sodium and chloride

Differentiate Diffusion vs Osmosis

Simple Diffusion

  • Works for small, lipid-soluble molecules (e.g., O2, CO2) passed through the lipid bilayer
  • Movement follows concentration gradients until equilibrium is reached; particle size and membrane pore size affect rate

Facilitated Diffusion

  • Important for larger molecules (e.g., glucose) or ions that cannot cross on their own
  1. Transport proteins act as selective channels or carriers
  2. Types:
    • Leak Channels: Open without stimulation
    • Gated Channels: Open and close in response to stimuli
      • Voltage-gated: Stimulated by change in membrane potential
      • Ligand-gated: Stimulated by receptor-ligand binding
      • Mechanically gated: Stimulated by vibration, stretching and pressure

Osmosis

  • Water movement across a semipermeable membrane along concentration gradient; osmotic pressure is crucial for maintaining cell volume and turgor pressure

Active Transport: Electrolyte and Fluid Movement

  • Energy-requiring process moving substances against their concentration gradient
  1. Sodium Potassium Pump: Uses ATP to pump sodium out and potassium into cells, both against gradients
  2. Types:
    • Primary Active Transport: Directly uses ATP
    • Secondary Active Transport: Uses energy from one substance’s gradient to transport another
  3. Transport Diffusion:
    • Cotransport: Substances move in the same direction
    • Counter transport: Substances move in opposite directions

Clinical Manifestations of Meningitis

  1. Rapid and severe onset of symptoms
  2. Severe headache
  3. Photophobia (light sensitivity)
  4. Nuchal rigidity (hyperextended stiff neck)
  5. Increased ICP from brain edema and hypoxia leads to:
    • Decreased alertness
    • Loss of consciousness
    • Changes in mental status
    • Vomiting
    • Seizures

Differentiate Decorticate vs Decerebrate

  • Excitation injury may result from inability to meet metabolic demands of cells

Decorticate

  • Abnormal flexion; due to increased flexor muscle excitability

Decerebrate

  • Abnormal extension; due to increased extensor muscle excitability

Pathophysiology of Multiple Sclerosis

  • Axon injury and formation of demyelinated plaques

Pathophysiology of Cerebral Palsy

  • Altered central control of movement by the brain

Motor Dysfunction Classification

Spastic

  • Inability of muscle to relax
    • Hemiplegia: one arm and leg on the same side
    • Diplegia: both legs
    • Quadriplegia: all four extremities, trunk, and neck muscles

Athetoid or Dyskinetic

  • Inability to control muscle movement

Ataxic

  • Inability to control balance and coordination

Causes of Stroke

  • Results from pathological events (shock, cerebral hemorrhage, ischemia, infarction)
  • Leads to cerebral circulation impairment
  • Risk factors: hypertension, smoking, diabetes

Differentiate Hemorrhagic vs Thrombolytic Stroke

Hemorrhagic Stroke

  • Cerebral bleeding caused by trauma or defects in cerebral vessels
  • Persistent hypertension and neoplasia can lead to vessel weakness and rupture
  • Bleeding vessel compresses adjacent brain tissue and ventricles

Thrombolytic Stroke

  • Caused by occlusions of cerebral artery
  • Atherosclerosis forms most common site in the common carotid artery

Pathophysiology of Alzheimer’s Disease

  1. Accumulation of two abnormal proteins: amyloid beta and neurofibrillary tangles
    • Neurofibrillary tangles: tau binds to microtubules for stability but becomes sticky and forms tangles
    • Amyloid beta: fragment of amyloid precursor protein, forms plaques starting in small clusters then chains, finally organized as beta sheets
    • Senile plaques: dense deposits of amyloid beta found outside neurons

Types of Seizures

Complex Seizures

  • Involves both hemispheres; results in loss of consciousness; lack of memory during and after seizure

Simple Seizures

  • Limited to originating hemisphere; can involve motor or sensory

Generalized Seizures

  • Caused by generalized electrical transmission
    • Absence seizures: brief change in LOC, eye/mouth movement; can occur up to 100x a day
    • Myoclonic: involuntary movements, no LOC
    • Tonic-clonic: convulsive; associated with tonic (continuous contraction) and clonic (rapid contraction-relaxation) motions

Signs of Meningitis and Precaution

  • Symptoms include:
    • Severe headache
    • Photophobia
    • Nuchal rigidity
    • Increased ICP symptoms (decreased alertness, loss of consciousness, changes in mental status, vomiting, seizures)

Differentiate Para/Hemi/Quadriplegia

  • Hemiplegia: involves one arm and one leg on the same side
  • Diplegia: both legs
  • Quadriplegia: all extremities, trunk, neck muscles

Clinical Manifestations of Migraines

  1. Pain: Unilateral, pulsing and throbbing
  2. Aura: Visual disturbances preceding headache
  3. Prodromal Symptoms: Mood changes, food cravings, constipation

Pathophysiology and Clinical Manifestations of Parkinson’s Disease

Pathophysiology

  • Chronic, progressive neurologic condition
  • Degeneration of pigmented dopaminergic neurons of the basal ganglia
  • Impaired transport of dopamine
  • Presence of Lewy bodies (proteins)
  • Neuronal injury from oxidative damage suspected

Clinical Manifestations

  1. Tremor
    • Involuntary quivering primarily in hands, arms, legs, face at rest
    • Progressive onset
  2. Rigidity
    • Jerky movements due to resistance from flexors and extensors
  3. Bradykinesia
    • Associated with initiation of movement; may progress to akinesia (inability to move)
    • Sudden halting of movement is a cardinal sign
  4. Postural instability
    • Stiffness, decreased coordination, impaired balance

Early Signs of Increased ICP

  1. Change in mental status
  2. Headache
  3. Nausea/vomiting
  4. Visual disturbances
  5. Weakness

Generalized vs Tonic Clonic Seizure

Generalized Seizures

  • Caused by generalized electrical transmission
  • Absence seizures can occur up to 100x a day

Tonic-Clonic Seizures

  • Convulsive; associated with tonic and clonic motions

Clinical Manifestations of Multiple Sclerosis

  • Related to slowed nerve conduction
  • Clinical Course Variations:
    • Relapsing-remitting: periods of acute neurological symptoms with relief
    • Primary progressive: chronic deterioration without exacerbations
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