Term
| Head injuries can be classified as _____ trauma and ______ trauma. |
|
Definition
| Closed (blunt); open (penetrating) |
|
|
Term
|
Definition
| Head injury occurring directly beneath the point of impact. |
|
|
Term
| Define contrecoup injury. |
|
Definition
| Head injury occurring at the pole opposite the point of impact. |
|
|
Term
| Are blows to front, back and side of head likely to produce coup or contrecoup injuries? |
|
Definition
Front = coup
Back and side = coup and/or contrecoup |
|
|
Term
| Two types of primary brain injury. |
|
Definition
|
|
Term
| Three high-level categories of cranial hematomas. Define each. |
|
Definition
Epidural = between skull and dura mater
Subdural = between dura and arachnoid mater
Intracranial = within brain |
|
|
Term
| Epidural hematoma most commonly caused by tearing of what artery? |
|
Definition
|
|
Term
| Which type of hematoma is associated with rapid neurological deterioration, and why? |
|
Definition
| Epidural hematoma, because they are usually arterial bleeds |
|
|
Term
| Three kinds of subdural hematomas. |
|
Definition
| Acute, subacute and chronic |
|
|
Term
| Define acute subdural hematoma. |
|
Definition
| Develops within 48 hours of injury as a result of tearing of bridging veins |
|
|
Term
| Define subacute subdural hematoma. |
|
Definition
| Develops within 48 hours to 2 weeks of injury as a result of tearing of bridging veins |
|
|
Term
| What condition does an individual have before developing a chronic subdural hematoma? |
|
Definition
| Some prior brain atrophy that has enlarged the subdural space. |
|
|
Term
| How long does it take for a chronic subdural hematoma to develop? |
|
Definition
| Months or years before being discovered. |
|
|
Term
| What usually causes an intracranial hematoma? (2) |
|
Definition
| Shearing of small blood vessels from blunt trauma but can occur because of direct vessel injury from a penetrating injury. |
|
|
Term
| Define diffuse brain injury. |
|
Definition
| Generalized disturbance of brain tissue involving shearing force damage associated with rotational movement of the brain within the skull |
|
|
Term
| What are the two categories of diffuse brain injury? |
|
Definition
| Concussion and diffuse axonal injury |
|
|
Term
| Criteria for mild concussion. |
|
Definition
| Affects attentional and memory systems; consciousness not lost |
|
|
Term
| Criteria for Grade I concussion. |
|
Definition
| Confusion and disorientation with momentary amnesia |
|
|
Term
| Criteria for Grade II concussion. |
|
Definition
| Momentary confusion and retrograde amnesia after 5-10 minutes |
|
|
Term
| Criteria for Grade III concussion. |
|
Definition
| Confusion and retrograde amnesia from impact; also anterograde amnesia (inability to form new memories after amnesia-causing event) |
|
|
Term
| Define diffuse axonal injury. |
|
Definition
| Widespread tearing of axons and hemorrhage of small blood vessels in the brain characterized by coma lasting longer than 6 hours. |
|
|
Term
| List five common systemic complications arising from head trauma. |
|
Definition
1) Acute respiratory distress syndrome (ARDS)
2) Cardiac dysrhythmias
3) Hemodynamic instability (hypertension and hypotension)
4) Gastrointestinal dysfunction and bleeding
5) Electrolyte disturbances (especially hyponatremia and hyperglycemia) |
|
|
Term
| List 6 components of general medical support provided to people with head trauma. |
|
Definition
1) Ventilation and oxygenation assessment
2) Cardiac telemetry
3) Continuous BP monitoring
4) Gastric pH monitoring
5) Serum electrolyte monitoring
6) Nutritional support |
|
|
Term
|
Definition
| Spinal cord trauma resulting in initial loss of somatic and autonomic nerve function |
|
|
Term
| How soon does the spinal shock stage usually resolve? |
|
Definition
|
|
Term
| What stage follows the spinal shock stage? |
|
Definition
| Heightened reflex activity stage |
|
|
Term
| Spinal shock leads to what three symptoms below the level of injury? What two other systemic symptoms does the person experience? |
|
Definition
Flaccid paralysis
Loss of sensation
Hypothermia
Loss of bladder and rectal control
Hypotension |
|
|
Term
| What three symptoms characterize the heightened reflex activity stage? |
|
Definition
Return of bladder-emptying reflex
Hypertonic paralysis
Hyperreflexia |
|
|
Term
| What is autonomic hyperreflexia (dysreflexia)? |
|
Definition
| A complication of the heightened reflex activity stage of spinal cord injury; a massive, uncompensated cardiovascular response |
|
|
Term
| What three symptoms are common in autonomic hyperreflexia? What stimulates this reaction? |
|
Definition
| Hypertension, sweating, and flushing. Brought on by pain, touch, or a full bladder or bowel. |
|
|
Term
| What drugs are used to reduce spinal cord swelling? |
|
Definition
|
|
Term
| Define degenerative disk disease |
|
Definition
| Disk or annulus protrusion, or narrowing of the spinal canal or intervertebral foramen |
|
|
Term
| What 3 symptoms does the person with degenerative disk disease of the cervical region have? |
|
Definition
| Neck, shoulder, and scapula pain; sensory alterations; difficulty in walking |
|
|
Term
| What symptoms does the person with degenerative disk disease of the thoracic region have? |
|
Definition
|
|
Term
| What 2 symptoms does the person with degenerative disk disease of the lumbrosacral region have? |
|
Definition
| Pain and weakness in lower extremities, and possibly sphincter weakness |
|
|
Term
|
Definition
| Structural defect of the spinal column that may be inherited or acquired. Torsional and rotational stress causes small fractures that lead to dissolution of the lamina. |
|
|
Term
|
Definition
| Vertebra slides forward in relation to the vertebra below |
|
|
Term
|
Definition
| Congenitally narrow spinal canal, or spinal canal narrowed by bulging annulus |
|
|
Term
| Herniated intervertebral disk |
|
Definition
| Trauma to the lumbar spine (and occasionally the cervical spine) results in a tear in the fibrous covering that surrounds the gelatinous vertebral core, which extrudes and compress the nearby nerve root. |
|
|
Term
| What are the symptoms of a herniated disk? (2) |
|
Definition
| Back pain and sensory and motor dysfunction in the distribution of the affected nerve root (e.g., weakness and decreased reflexes) |
|
|
Term
| What are the two broad categories of CVAs? |
|
Definition
|
|
Term
| What is the most common cause of acute brain infarction? |
|
Definition
|
|
Term
| Eight risk factors for acute brain infarction. |
|
Definition
1) Age
2) Smoking
3) Hypertension
4) Diabetes
5) Dyslipidemia
6) Increased lipoprotein A and C-reactive protein.
7) Hormone replacement therapy and
8) Syndromes that can increase blood viscosity, such as polycythemia vera |
|
|
Term
| What happens in a transient ischemic attack? |
|
Definition
| Thrombus breaks up quickly, individuals will experience a brief episode of neurologic dysfunction (lasting less than 24 hours) |
|
|
Term
| What happens in a stroke-in-evolution? |
|
Definition
| Thrombus builds up over several hours and individual may experience slowly progressive neurologic dysfunction |
|
|
Term
|
Definition
| Persistent vessel obstruction will result in cerebral infarction unless perfusion is restored rapidly |
|
|
Term
| Cardioembolic stroke, artery most affected, and recurrence rate. |
|
Definition
| Thrombus forms in heart then travels into one of the cerebral vessels, most commonly the middle cerebral artery. Frequently, a second stroke follows because the underlying cause of the embolus remains. |
|
|
Term
| What three heart diseases most commonly lead to cardioembolic stroke? |
|
Definition
| Atrial fibrillation, myocardial infarction, and valvular heart disease |
|
|
Term
|
Definition
| Small infarcts (less than 1 cm) that occur deep in the brain because of obstruction of very small intracerebral vessels. Small areas of infarcted brain tissue surrounded by normal brain. Very localized and unpredictable neurologic deficits. |
|
|
Term
| People with what two diseases are most at risk for lacunar stroke? |
|
Definition
| Individuals with diabetes and hypertension |
|
|
Term
| Global Hypotension Stroke (watershed strokes) |
|
Definition
| Total brain perfusion falls because of cardiovascular collapse |
|
|
Term
| Five risk factors for hemorrhagic stroke |
|
Definition
1) Hypertension (weakening of the walls of intracerebral vessels)
2) Congenital aneurysms
3) Vascular malformations
4) Condition associated with increased risk for bleeding (thrombocytopenia)
5) Coagulopathies such as liver disease, hemophilia, and iatrogenic anticoagulation |
|
|
Term
| What does penumbra refer to regarding cerebral infarction? How long can it survive? |
|
Definition
| It's the ischemic area surrounding the infarction that can survive up to 90 minutes due to collateral arterial flow. |
|
|
Term
| What characterizes acute brain infarction? |
|
Definition
| Abrupt painless loss of neurologic function |
|
|
Term
| Because the middle cerebral artery is most commonly affected by atherothrombotic and embolic disease, what are three common manifestations of acute brain infarction? |
|
Definition
Hemiparesis—Decreased motor ability on the affected side
Hemisensory loss—Decreased sensation on the affected side
Aphasia—Loss of speech ability |
|
|
Term
| Intracerebral hemorrhage is most often associated with the sudden onset of ____ and ____. |
|
Definition
| Severe headache; loss of consciousness |
|
|
Term
| Are hemorrhagic or ischemic strokes more serious? |
|
Definition
|
|
Term
|
Definition
| Percutaneous transluminal cerebrovascular intervention to re-establish blood flow in the obstructed artery |
|
|
Term
| Where are most aneurysms located? |
|
Definition
| In or near the Circle of Willis |
|
|
Term
| Most common age and gender for aneurysms? |
|
Definition
| 50-60 years old, slightly more common in females |
|
|
Term
| Saccular (berry) aneurysms |
|
Definition
| Localized, progressively growing sac that affects only a portion of the artery's circumference, may be result of congenital abnormalities or degeneration |
|
|
Term
| Fusiform (giant) aneurysms, most common in which arteries? |
|
Definition
| Large aneurysm (>25 mm) that stretches to affect entire circumference of arterial wall. Most commonly in basilar or carotid arteries |
|
|
Term
|
Definition
| Localized dilation or ballooning of a blood vessel |
|
|
Term
|
Definition
| Irreversible arterial dilatation due to destruction of the vessel wall by infection |
|
|
Term
|
Definition
| Arterial wall weakened by fracture, penetrating missile, neurosurgery, or imaging |
|
|
Term
| Aneurysms are frequently asymptomatic and usually appear as _____, _____, or a combination. |
|
Definition
| Subarachnoid hemorrhage, intracerebral hemorrhage |
|
|
Term
| Cavernous angioma vascular malformation |
|
Definition
| Collections of blood vessels in the sinuses |
|
|
Term
| Capillary telangiectasis vascular malformation. Associated with what disease? |
|
Definition
Dilated capillaries with interspersed normal brain tissue
Occurs in deep brain regions
Associated with Rendu-Oster-Weber disease |
|
|
Term
| Venous angioma vascular malformation |
|
Definition
Most common vascular malformation
Development of veins in radial pattern feeding a central vein |
|
|
Term
| Arteriovenous malformation (AVM) |
|
Definition
Tangle of malformed vessels where arteries feed directly into veins
Malformation that is most likely to hemorrhage |
|
|
Term
| Subarachnoid hemorrhage (SAH) occurs primarily in individuals with _______ (85% of cases). |
|
Definition
|
|
Term
| Describe a subarachnoid hemorrhage. |
|
Definition
| An aneurysm located in the subarachnoid space can leak blood from thin areas in the aneurysm wall. This blood is then pumped into the subarachnoid space. |
|
|
Term
| What is the body's response to a subarachnoid hemorrhage? |
|
Definition
| An intense inflammatory response, with the release of inflammatory cytokines and an influx of leukocytes. This hemorrhagic and inflammatory "soup" can spread through the CSF and involve the entire surface of the brain and spinal cord. |
|
|
Term
| List two phenomena associated with subarachnoid hemorrhage. |
|
Definition
1) Impairment of CSF reabsorption, leading to accumulation of CSF (hydrocephalus).
2) Delayed vasospasm—Inflammatory cytokines and neurohumoral agents in the CSF can result in intense spasm of cerebral vessels between three days and two weeks after the hemorrhage, resulting in severe cerebral ischemia. |
|
|
Term
| The individual presenting with a subarachnoid hemorrhage is often healthy but with a history of severe headaches. They present with what five common symptoms? |
|
Definition
Severe headache
Stiff neck
Photophobia
Irritability
Loss of consciousness |
|
|
Term
| What are the three main goals for treating someone with a subarachnoid hemorrhage? |
|
Definition
1) Monitoring and immediate intervention for increased intracranial pressure and many other systemic complications
2) Prevention of rebleeding from the aneurysm, most often through catheter-guided or surgical blocking of the aneurysm inflow
3) Prevention and management of delayed vasospasm through the use of hydration techniques and calcium channel blocker administration |
|
|
Term
| Which bacterial cause of meningitis is of special concern for people living in close quarters (dorms, military barracks) |
|
Definition
|
|
Term
| Three classic symptoms of meningitis? |
|
Definition
| Severe headache, fever, nuchal rigidity |
|
|
Term
| Eight meningitis symptoms aside from the classic three. |
|
Definition
1) Photophobia
2) Rash (may be petechial)
3) Vomiting
4) Cranial nerve palsies
5) Papilledema
6) Focal neurologic deficits
7) Irritability
8) Decreased consciousness |
|
|
Term
| Five causes of brain abscesses. |
|
Definition
1) Trauma
2) Neurosurgery
3) Spread of infection from nearby source (ear, sinuses)
4) Bacteremia
5) Septic emboli |
|
|
Term
| Immunocompromised patients are at risk for brain abscess from what two additional sources? |
|
Definition
| Parasites and fungi (Toxoplasma gondii) |
|
|
Term
| The symptoms of brain abscess are very similar to that of _____. |
|
Definition
|
|
Term
| Three viruses that commonly cause encephalitis. |
|
Definition
1) West Nile
2) Eastern equine virus
3) Herpes simplex |
|
|
Term
| Symptoms of encephalitis. |
|
Definition
Range from mild to life- threatening.
Fever, delirium, or confusion that progresses to unconsciousness, seizure activity, cranial nerve palsies, paresis and paralysis, involuntary movement, and abnormal reflexes. |
|
|
Term
| Define HIV myelopathy and give four symptoms |
|
Definition
Degeneration of the spinal cord in the lumbar spine
Leg weakness, upper motor neuron signs, incontinence, and sensory loss |
|
|
Term
| Definition of multiple sclerosis |
|
Definition
| T-cell autoimmunity to CNS myelin with subsequent inflammation and formation of demyelination plaques and axonal degeneration |
|
|
Term
| What is the early clinical manifestation of multiple sclerosis. |
|
Definition
| Inflammation and symptoms wax and wane in the beginning. |
|
|
Term
| Mixed or general multiple sclerosis. |
|
Definition
| Visual, but can include brain stem and cognitive dysfunction |
|
|
Term
| Spinal multiple sclerosis (2) |
|
Definition
| Causes weakness and/or numbness, and bladder and bowel problems. |
|
|
Term
| Cerebellar multiple sclerosis. |
|
Definition
| Causes disorders in gait and motor movements. |
|
|
Term
| What age and gender is likely to be affected by ALS? |
|
Definition
| Equal to men and women in 50s. |
|
|
Term
| The origin of ALS is a defect on chromosome __ that leads to defective _______ metabolism. |
|
Definition
|
|
Term
| Symptoms and prognosis of ALS. |
|
Definition
| Both flaccid and spastic paralysis progressing to respiratory muscles. Usually live 2-3 years. |
|
|
Term
| Generalized symmetric polyneuropathies |
|
Definition
| Symmetric involvement of sensory, motor, or autonomic fibers |
|
|
Term
| Distal axonal polyneuropathy. Two most common causes. |
|
Definition
| Affects the peripheral axons, causing sensory impairment. It is caused most commonly by diabetes mellitus or alcohol abuse. |
|
|
Term
| Demyelinating polyneuropathy. Most common type. |
|
Definition
| Affects Schwann cells, causing weakness. Guillain-Barré syndrome is the most common type. |
|
|
Term
|
Definition
| Affect the cell body of only one type of peripheral neuron, usually dorsal root ganglion |
|
|
Term
| Focal or multifocal neuropathies |
|
Definition
| Affect the sensory and motor fibers in one or more nerves |
|
|
Term
| Guillain-Barré syndrome. List four causes. |
|
Definition
Demyelination of the peripheral nerves causing motor paralysis
1) Respiratory or gastrointestinal viral or bacterial infection
2) Surgical procedures
3) Viral immunizations
4) Lymphoma |
|
|
Term
| Radiculopathies. Symptoms. |
|
Definition
Spinal roots are injured or damaged by compression, inflammation, or stretching and tearing.
Decreased muscle strength, tone and bulk, impaired deep tendon reflexes, and pain |
|
|
Term
| Plexus injuries. Three symptoms. |
|
Definition
Traumatic injury to the nerve plexus distal to the spinal roots but proximal to the formation of the peripheral nerves.
Motor weakness, muscle atrophy, and sensory loss in affected areas |
|
|
Term
| Myasthenia gravis. Onset of symptoms? Common in what kind of individual? |
|
Definition
| Autoimmune disease (antibodies to ACH receptors) affecting any age. Weakness and fatigue. Can be triggered by anesthesia, but onset is usually very gradual. Most common in individuals with other autoimmune disorders. |
|
|
Term
| Which muscles are usually affected first in myasthenia gravis? |
|
Definition
|
|
Term
|
Definition
| Weakness of the respiratory muscles with decreased ventilation and hypercapnia (elevated blood CO2) |
|
|
Term
| How do brain tumors cause their symptoms? |
|
Definition
| Invading or compressing surrounding tissues and by increasing intracranial pressure |
|
|
Term
| What is the most common type of brain tumor? |
|
Definition
|
|
Term
| What are the three most common locations of an astrocytoma? |
|
Definition
| Cerebrum, hypothalamus, or pons |
|
|
Term
| Two most common locations for an oligodendroglioma |
|
Definition
| Frontal and temporal lobes |
|
|
Term
| What is the most common location of an ependymoma? |
|
Definition
|
|
Term
|
Definition
| Encapsulated tumors that originate from the dura mater or arachnoid membranes |
|
|
Term
|
Definition
Nerve sheath tumor from Schwann cells or due to the inherited disorder, neurofibromatosis
Tumor causes brain stem displacement that obstructs CSF |
|
|
Term
| Two most common types of spinal cord tumors. |
|
Definition
| Neurofibromas and meningiomas |
|
|
Term
| Three types of spinal cord tumors. |
|
Definition
| Intramedullary tumors (within neural tissue), intradural and extradural tumors. |
|
|
Term
| ______ spinal tumors cause symptoms by both invasion and compression of neural tissue, whereas ______ tumors cause only compression. |
|
Definition
| Intramedullary; extramedullary |
|
|
Term
| List 6 risk factors/causes for Alzheimer's disease. |
|
Definition
1) Family history
2) History of head trauma
3) Alcohol abuse
4) Toxins
5) Viruses
6) Prions (submicroscopic proteinaceous infectious particles) |
|
|
Term
| Three components of the pathophysiology of Huntington disease. |
|
Definition
1) Profound degeneration of the basal ganglia
2) Frontal cortex atrophy
3) Development of plaques in the central nervous system |
|
|
Term
| Parkinson disease is a common movement disorder that occurs because of degeneration of the ______. |
|
Definition
|
|
Term
| The hypertonia and akinesia of Parkinson's is due to what imbalance? |
|
Definition
| Decrease in dopamine and increase in acetylcholine. |
|
|
Term
| What three types of cellular dysfunction cause tissues to fail to respond correctly to hormones? |
|
Definition
1) Receptor-associated disorders
2) Intracellular disorders (secondary messengers)
3) Circulating inhibitors (antibodies or proteins binding to hormones) |
|
|
Term
| List three different ways hormone receptors can malfunction. |
|
Definition
Decrease (sometimes increase) in # of receptors
Change in molecular structure of receptors
Antibodies to receptors |
|
|
Term
|
Definition
| Syndrome of inappropriate antidiuretic homrone secretion |
|
|
Term
| Two principal consequences of SIADH. |
|
Definition
| Increased intravascular volume and hyponatremia (hypoosmolality) |
|
|
Term
| Three categories of diabetes insipidus. |
|
Definition
Neurogenic (central) = inadequate ADH secretion
Nephrogenic = inadequate kidney response to ADH
Psychogenic = primary polydipsia (ingesting large amounts of fluids) |
|
|
Term
| What symptom to diabetes mellitus and insipidus have in common? |
|
Definition
|
|
Term
| Principal health concern for diabetes insipidus. |
|
Definition
| Dehydration from large amounts of dilute urine. Restricting fluid intake can lead to severe hypernatremia. |
|
|
Term
|
Definition
| May be the result of primary dysfunction of the anterior pituitary or secondary to hypothalamic dysfunction and can affect all pituitary hormones or just selected ones. |
|
|
Term
|
Definition
| Absence of all pituitary hormones. |
|
|
Term
| What is the consequence of a TSH (thyroid-stimulating hormone) deficiency? |
|
Definition
| Secondary hypothyroidism with cold intolerance, dry skin, lethargy, tissue edema (myxedema), and decreased metabolic rate. |
|
|
Term
|
Definition
| Benign tumors that press on surrounding tissues and can decrease (or sometimes increase) hormone secretion. |
|
|
Term
| Increased secretion of growth hormone and insulin-like growth factor is most commonly the result of a ______ arising from growth hormone-secreting cells. Leads to _____ in children and ______ in adults. |
|
Definition
| Pituitary adenoma; gigantism; acromegaly |
|
|
Term
| What is the most common hormone-secreting pituitary adenoma? |
|
Definition
|
|
Term
| Four symptoms of increased prolactin production. |
|
Definition
| Amenorrhea, galactorrhea, hirsutism, and gonadal dysfunction |
|
|
Term
| What is another name for hyperthyroidism? |
|
Definition
|
|
Term
| Most common causes of hyper- and hypothyroidism? |
|
Definition
Hyper = Graves disease
Hypo = inflammatory disease of thyroid |
|
|
Term
| What endocrine symptoms are present with hyper- and hypothyroidism? |
|
Definition
Hyperthyroidism: Goiter, decreased TSH
Hypothyroidism: Goiter, increased TSH |
|
|
Term
| What reproductive symptoms are present with hyper- and hypothyroidism? |
|
Definition
Hyperthyroidism: Amenorrhea, impotence
Hypothyroidism: Galactorrhea, anovulation |
|
|
Term
| What neurologic symptoms are present with hyper- and hypothyroidism? |
|
Definition
Hyperthyroidism: Restlessness, tremor, fatigue, insomnia, hyperreflexia
Hypothyroidism: Lethargy, confusion, slow movements, ataxia, decreased reflexes, coma |
|
|
Term
| What cardiovascular symptoms are present with hyper- and hypothyroidism? |
|
Definition
Hyperthyroidism: Increased cardiac output, tachycardia, dysrhythmias
Hypothyroidism: Decreased cardiac output, bradycardia, cardiomyopathy |
|
|
Term
| What respiratory symptoms are present with hyper- and hypothyroidism? |
|
Definition
Hyperthyroidism: Dyspnea, decreased vital capacity
Hypothyroidism: Dyspnea, hypoventilation and hypercapnia, laryngeal edema with hoarseness |
|
|
Term
| What GI symptoms are present with hyper- and hypothyroidism? |
|
Definition
Hyperthyroidism: Weight loss, diarrhea, hypolipidemia
Hypothyroidism: Weight gain, constipation, hyperlipidemia |
|
|
Term
| What integumentary symptoms are present with hyper- and hypothyroidism? |
|
Definition
Hyperthyroidism: Sweating, flushing, warm skin, soft fine hair, heat intolerance
Hypothyroidism: Coarse dry skin and hair; cold intolerance |
|
|
Term
| What special symptoms are present with hyper- and hypothyroidism? |
|
Definition
Hyperthyroidism: Exophthalmus with Graves disease, pretibial myxedema
Hypothyroidism: Myxedema |
|
|
Term
| Why are goiters present in both hyper- and hypothyroidism? |
|
Definition
| Goiters result from either abnormal stimulation of the thyroid or by compensatory hypersecretion of TSH in hypothyroidism. |
|
|
Term
| Thyroid-stimulating immunoglobulins |
|
Definition
| The antibodies that stimulate TSH receptors in Graves disease. |
|
|
Term
| Individuals treated for Graves disease often experience what subsequent complication? |
|
Definition
| Iatrogenic hypothyroidism and need hormone replacement |
|
|
Term
| What are two causes of hyperthyroidism aside from Graves disease? |
|
Definition
| Toxic Multinodular Goiter and Toxic Adenoma. One or more thyroid follicles hypersecreting thyroid hormone. |
|
|
Term
| What symptoms are present in Graves disease that are absent in toxic multinodular goiter and toxic adenoma? |
|
Definition
| Exophthalmos and myxedema |
|
|
Term
| Factitious hyperthyroidism |
|
Definition
| Results from excessive intake of pharmaceutical thyroid hormone. |
|
|
Term
| What causes a thyroid storm? |
|
Definition
| Individuals with unrecognized thyrotoxicosis are subjected to some physiologic stress. The effects of high levels of thyroid hormone are made much worse by the concomitant increase in catecholamine levels in response to stress. |
|
|
Term
| Five symptoms of thyroid storm. How would death occur in this instance? |
|
Definition
| Hyperthermia, tachycardia, agitation, gastrointestinal distress, and dehydration. May lead to high-output heart failure. |
|
|
Term
| Three common causes of primary hypothyroidism? |
|
Definition
Autoimmune thyroiditis
Iodine deficiency
Iatrogenic hypothyroidism |
|
|
Term
| What is another name for autoimmune thyroiditis? What is the pathophysiology? |
|
Definition
| Hashimoto disease. Auto-antibodies destroy the thyroid gland. |
|
|
Term
| Myxedema coma. Population most at risk? |
|
Definition
| Untreated hypothyroidism, especially in the elderly. Severe hypothyroidism can lead to significant depression of the central nervous system and even coma. |
|
|
Term
| Another name for primary hypothyroidism? What occurs? |
|
Definition
| Congenital hypothyroidism. Child is born without a fully formed thyroid gland. |
|
|
Term
| What is the most common type of endocrine gland cancer? |
|
Definition
|
|
Term
| What is the most important risk factor for thyroid carcinoma? What does this mean as far as people most likely to get it? |
|
Definition
| Ionizing radiation, so cancer patients who have received radiation treatment often get thyroid carcinoma. |
|
|
Term
| Because benign diseases of the thyroid gland are much more common in ___ than in ___, the finding of a thyroid nodule is very worrisome in ___. |
|
Definition
|
|
Term
| Hyperparathyroidism can result from disease of the parathyroid glands themselves (primary) or as a compensatory response to ______ like that seen in ____ disease and ____ malabsorption (secondary). |
|
Definition
| Chronic hypocalcemia, renal, calcium |
|
|
Term
| What is the typical cause of primary hyperparathyroidism? One other cause? |
|
Definition
Adenoma of the chief cells
Hyperplasia of the gland |
|
|
Term
| The hypercalcemia and hypercalciuria of hyperparathyroidism can contribute to the formation of _____. |
|
Definition
|
|
Term
| Two principal consequences of primary hyperparathyroidism. |
|
Definition
| Hypercalcemia and osteopenia / bone fragility |
|
|
Term
| Difference in symptoms between primary and secondary hyperparathyroidism? |
|
Definition
| Bone fragility in both, but hypercalcemia only in primary hyperparathyroidism. |
|
|
Term
| Primary cause of secondary hyperparathyroidism. |
|
Definition
| Renal failure, inability to activate vitamin D and therefore malabsorption of calcium. Parathyroid gland tries to compensate for hypocalcemia. |
|
|
Term
| Most common cause of primary hypoparathyroidism? |
|
Definition
| Injury or removal of the parathyroid gland. |
|
|
Term
| Consequence of hypoparathyroidism? Treated with? |
|
Definition
| Hypocalcemia, treated with high doses of calcium and vitamin D. |
|
|
Term
| What % of all diabetes mellitus cases are Type I? |
|
Definition
|
|
Term
| In diabetes mellitus type I, what happens to the alpha and beta cells of the pancreas? |
|
Definition
| Autoantibodies destroy beta cells (no insulin production), and alpha cells are abnormal and produce excess glucagon |
|
|
Term
| What are the three P's of type I diabetes? |
|
Definition
| Polydipsia (constant thirst), polyphagia (constant hunger), polyuria |
|
|
Term
| Type II diabetes is more common in which four ethnicities? |
|
Definition
| Native Americans, blacks, Hispanics, and Asians/Pacific Islanders |
|
|
Term
| What is the most powerful risk factor for Type II diabetes? |
|
Definition
|
|
Term
| How do the pancreatic islet cells function in type II diabetes? |
|
Definition
| Initial compensatory hyperinsulinemia; disease progression results in decreased insulin production and an increase in glucagon synthesis |
|
|
Term
| Why is obesity a risk factor for type II diabetes? |
|
Definition
| In obesity, insulin is less able to facilitate the movement of glucose into tissues, contributing to insulin resistance. |
|
|
Term
| Five theories explaining the link between obesity and insulin resistance. |
|
Definition
1) Decreased insulin receptors
2) Impaired postreceptor insulin signaling
3) Release of free fatty acids that interferes with insulin signaling
4) Increased inflammatory cytokines that disrupt insulin signaling
5) Decreased insulin sensitivity due to hyperinsulinemia |
|
|
Term
| How is the metabolic syndrome diagnosed? |
|
Definition
3 out of the following 5 criteria:
1) Abdominal obesity
2) Increased serum triglycerides
3) Decreased HDL
4) Increased blood pressure
5) Prediabetes or diabetes |
|
|
Term
| Six common symptoms of type II diabetes. |
|
Definition
1) Gradual increase in visual difficulties
2) Genitourinary infections
3) Paresthesias (especially in the feet)
4) Fatigue
5) Weight gain
6) Polyuria with polydipsia |
|
|
Term
| Which ethnicity is at greatest risk for type I diabetes? |
|
Definition
|
|
Term
| Which genders most at risk for type I and type II diabetes? |
|
Definition
Type I: Male = female
Type II: Female > male |
|
|
Term
| Which complication occurs in type I diabetes but is rare in type II. |
|
Definition
|
|
Term
| Describe what happens in diabetic ketoacidosis. |
|
Definition
| Fatty acids are released as an alternate fuel source. Fatty acids cause ketone formation, leading to severe metabolic acidosis. |
|
|
Term
| Seven symptoms of diabetic ketoacidosis. |
|
Definition
1) Severe dehydration and hypotension
2) Nausea and vomiting
3) Lethargy and decreased consciousness
4) Kussmaul respirations
5) Acetone (fruity) breath
6) Serum glucose levels of 300-750 mg/dL
7) Metabolic acidosis with decreased bicarbonate levels |
|
|
Term
| Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) |
|
Definition
| Only in type II diabetes, more serious than diabetic ketoacidosis. Hyperglycemia is more severe (600 - 4800 mg/dL), causing extremely high diuresis. May lead to death from hypovolemic shock. |
|
|
Term
| In what three ways does the hyperglycemia in type I and type II diabetes adversely affect tissues? |
|
Definition
1) Glycosylation of proteins, lipids, and nucleic acids stimulates cellular injury
2) Induction of the polyol pathway results in conversion of glucose to sorbitol and then fructose, which increases intracellular osmotic pressure, causing cellular edema and tissue dysfunction.
3) Activation of protein kinase C by hyperglycemia contributes to insulin resistance, tissue inflammation and edema |
|
|
Term
| What causes the neurologic effects of diabetes mellitus? (4) |
|
Definition
| Cerebrovascular disease (atherosclerosis), nerve degeneration, conduction defects, autonomic dysfunction |
|
|
Term
| What two factors cause renal disease in diabetes mellitus? |
|
Definition
| Glomerular injury, renovascular obstruction |
|
|
Term
| What are two common cardiovascular effects of diabetes mellitus? |
|
Definition
| Coronary artery disease (atherosclerosis), peripheral vascular disease |
|
|
Term
| What three factors cause the ophthalmologic effects of diabetes mellitus? |
|
Definition
| Microvascular disease, sorbitol accumulation, and glycosylation of lens proteins |
|
|
Term
| What is cushing syndrome/disease? |
|
Definition
| AKA hypercortisolism. Hormonal disorder caused by prolonged exposure of the body's tissues to high levels of cortisol due to hyperfunctioning of the adrenal cortex. |
|
|
Term
| Differentiate cushing disease and cushing syndrome. |
|
Definition
Cushing disease = secondary to excess production of ACTH from a pituitary adenoma
Cushing syndrome = primary disease of the adrenal cortex (such as adenoma) or ectopic production of cortisol (from lung tumor) |
|
|
Term
| 6 consequences of cushing disease/syndrome? |
|
Definition
1) Hyperglycemaia
2) Abnormalities in fat deposition (moon face, truncal obesity)
3) Protein wasting
4) Cardiovascular: atherosclerosis, salt + water retention
5) Immunosuppression
6) Irritability, depression, other psychological illnesses |
|
|
Term
| 4 symptoms seen in Cushing disease but not in Cushing syndrome. |
|
Definition
1) Hyperpigmentation
2) Acne
3) Changes in hair distribution
4) Gynecomastia (male breasts) |
|
|
Term
| Differentiate primary and secondary hyperaldosteronism. |
|
Definition
Primary hyperaldosteronism = excessive production of aldosterone from the adrenal cortex caused by an adrenal adenoma.
Secondary hyperaldosteronism = activation of the renin-angiotensin-aldosterone system in conditions such as heart failure, renal failure, hypertension, and hepatic cirrhosis. |
|
|
Term
|
Definition
| Primary adrenal insufficiency with inadequate production of cortisol and aldosterone caused by autoimmune destruction of the adrenal cortex |
|
|
Term
| Secondary hypocortisolism |
|
Definition
| Caused by withdrawal of corticosteroid therapy. Also sometimes (incorrectly) called Addison disease |
|
|
Term
| Five clinical manifestations of Addison disease. |
|
Definition
1) Metabolic abnormalities (e.g., hypoglycemia, hyponatremia, and hyperkalemia)
2) Hypovolemia and hypotension (can be life-threatening)
3) Orthostatic dizziness, weakness, fatigue
4) Anorexia, nausea, abdominal pain
5) Confusion, apathy |
|
|
Term
|
Definition
| Tumor of the adrenal medulla that secrete large amounts of catecholamines. Complications exacerbated when in combination with stressful events (extreme hypertension, tachycardia) |
|
|
Term
| Which blood counts are decreased in all types of anemias? |
|
Definition
| Hematocrit and hemoglobin |
|
|
Term
| What types of blood disorders would show a decreased or increased reticulocyte count? |
|
Definition
| Decreased in disorders that decrease erythropoiesis; increased in hemorrhage and hemolytic anemias |
|
|
Term
| What is the mean corpuscular volume test? |
|
Definition
| Indicates the size of the erythrocytes. Used to differentiate macrocytic, microcytic and normocytic anemias. |
|
|
Term
| What is the mean corpuscular hemoglobin test? |
|
Definition
Indicates the amount of hemoglobin in the red blood cells
Used to differentiate hypochromic from normochromic anemias |
|
|
Term
| What are the three primary causes of anemia? |
|
Definition
Decreased production of erythrocytes (decreased erythropoiesis)
Increased loss of erythrocytes (hemorrhage)
Increased destruction of erythrocytes (hemolysis) |
|
|
Term
| What are the two macrocytic-normochromic anemias? |
|
Definition
| Pernicious anemia and folate deficiency anemia |
|
|
Term
| What are macrocytic anemias? |
|
Definition
| Unusually large stem cells (megaloblasts) in the bone marrow that mature into larger than normal erythrocytes (macrocytes) |
|
|
Term
|
Definition
| Vitamin B12 deficiency, causing abnormal erythrocyte DNA synthesis |
|
|
Term
| Chronic atrophic gastritis |
|
Definition
| Inability to produce intrinsic factor, which is essential for the absorption of dietary B12 from the ileum |
|
|
Term
| The blood count when diagnosing pernicious anemia would show what? (hematocrit, hemoglobin, reticulocyte, MCV, MCH, serum B12) |
|
Definition
Hematocrit (Hct) and hemoglobin: Decreased
Reticulocyte count: Decreased
MCV: Increased
MCH and MCHC: Normal
Serum B12: Low |
|
|
Term
| What three types of individual typically has a folate deficiency anemia? |
|
Definition
| Malnourished, history of alcohol abuse, pregnant/lactating (b/c of folate demands) |
|
|
Term
| The blood count when diagnosing folate deficiency anemia would show what? (hematocrit, hemoglobin, reticulocyte, MCV, MCH, serum folate) |
|
Definition
Hct and hemoglobin: Decreased
Reticulocyte count: Decreased
MCV: Increased
MCH and MCHC: Normal
Serum folate: Low |
|
|
Term
| What are the two types of microcytic-hypochromic anemias. |
|
Definition
1) Iron-deficiency anemia
2) Sideroblastic anemia |
|
|
Term
| What is the most common type of anemia in the world? |
|
Definition
|
|
Term
| What three populations are most at risk for iron-deficiency anemia? |
|
Definition
1) Individuals living in chronic poverty
2) Women of childbearing age
3) Children |
|
|
Term
| Women may develop iron loss (iron-deficiency anemia) due to ______. |
|
Definition
|
|
Term
| Bleeding that results in iron loss is usually ______ and ______. |
|
Definition
|
|
Term
| 6 symptoms of iron-deficiency anemia in addition to normal anemia symptoms. |
|
Definition
1) Brittle and malformed nails
2) Angular stomatitis
3) Dysphagia
4) Gastritis
5) Neurologic symptoms
6) Pica |
|
|
Term
| The blood count when diagnosing iron-deficiency anemia would show what? (hematocrit, hemoglobin, reticulocyte, MCV, MCH, serum iron and ferritin) |
|
Definition
Hct and hemoglobin: Decreased
Reticulocyte count: Decreased
MCV: Decreased
MCH and MCHC: Decreased
Serum iron and ferritin: Decreased |
|
|
Term
| Define sideroblastic anemia |
|
Definition
| Inadequate cellular iron uptake in the bone marrow and disordered DNA synthesis with resultant microcytic-hypochromic erythrocyte formation. Leads to production of small, pale, ineffective erythrocytes |
|
|
Term
| Two symptoms of sideroblastic anemia in addition to normal anemia symptoms |
|
Definition
Hepatomegaly and splenomegaly
Bronze-tinted skin |
|
|
Term
| The blood count and bone marrow biopsy when diagnosing sideroblastic anemia would show what? (hematocrit, hemoglobin, reticulocyte, MCV, MCH, serum iron and ferritin, bone marrow biopsy) |
|
Definition
Hct and hemoglobin: Decreased
Reticulocyte count: Normal
MCV: Decreased
MCH and MCHC: Decreased
Serum iron and ferritin: Increased (cellular uptake is impaired, not absorption or loss of iron from the body)
Bone marrow biopsy: Confirms the presence of sideroblasts |
|
|
Term
| What are the 3 normocytic-normochromic anemias? |
|
Definition
1) Aplastic
2) Post-hemorrhagic
3) Hemolytic |
|
|
Term
|
Definition
| Failure of bone marrow and therefore a reduction in all blood cell types (pancytopenia) |
|
|
Term
| What are the four common causes of aplastic anemia? |
|
Definition
Infiltration
Autoimmunity
Infections
Toxic insults to the marrow |
|
|
Term
| People with aplastic anemia suffer from what three general categories of symptoms? |
|
Definition
Generalized anemia
Recurrent infections
Bleeding |
|
|
Term
| What happens to hematocrit levels with posthemorrhagic anemia? |
|
Definition
| Stay the same when whole blood is lost, but hemodilution occurs after body compensates (via salt/water retention) or IV replacement therapy. Usually requires eventual blood transfusion or packed red blood cells. |
|
|
Term
| Acquired hemolytic anemia |
|
Definition
| Auto-antibodies to erythrocytes result in degradation of the cell membranes and destruction of the erythrocytes by the spleen |
|
|
Term
| What are the four diagnostic findings for acquired hemolytic anemia? |
|
Definition
1) Low hematocrit and hemoglobin
2) Increased reticulocyte count
3) Presence of schistocytes (abnormal cell shapes) on blood smear
4) Positive Coombs test (detects red blood cell autoantibodies) |
|
|
Term
|
Definition
| Autosomal recessive disorder that causes an abnormality in hemoglobin synthesis. Formation of hemoglobin S (instead of normal A). When hemoglobin S is exposed to dehydration, it takes the sickle form and is therefore destroyed by the spleen |
|
|
Term
| Sickle-cell anemia is believed to have evolved as a protective mechanism against what? |
|
Definition
|
|
Term
| Complication of sickle-cell anemia aside from low blood O2? |
|
Definition
| Sickle-shaped cells cannot readily pass through the microvasculature of many tissues, causing obstruction. Ischemia and infarction may result. |
|
|
Term
| Differentiate sickle-cell trait and sickle-cell anemia. |
|
Definition
Trait = individual is heterozygous for the gene; may be asymptomatic or experience periodic episodes
Anemia = homozygous for gene, leading to life-threatening disease |
|
|
Term
|
Definition
| Due to reduced erythropoietin release |
|
|
Term
| In anemia of chronic disease, chronic inflammatory conditions lead to what three anemic traits? |
|
Definition
1) Decreased erythrocyte survival
2) Decreased erythropoiesis
3) Disordered iron utilization by red blood cells |
|
|
Term
|
Definition
| Compensatory response to hypoxemia (high-altitude exposure, chronic lung disease, or chronic heart disease) |
|
|
Term
| What problem can arise from polycythemia? |
|
Definition
| Very high hematocrit and increased viscosity of the blood can lead to tissue infarction |
|
|
Term
|
Definition
| Hypercellularity of the bone marrow and increased production of erythrocytes |
|
|
Term
| Five consequences of polycythemia vera. |
|
Definition
Hyperviscosity of blood
Hypercoagulability
Poor tissue perfusion
Tissue ischemia
Possible organ infarction |
|
|
Term
|
Definition
| Increase in leukocytes, most often a physiologic response to infection or physical stress |
|
|
Term
|
Definition
| Decrease in number of leukocytes, never normal or beneficial |
|
|
Term
|
Definition
Increased numbers of circulating granulocytes (neutrophils, eosinophils, and basophils) which are usually released in response to infection.
Often used to refer to just neutrophilia. |
|
|
Term
| What causes granulocytopenia? (2) |
|
Definition
| 1) Infection overwhelms the number of granulocytes and monocytes in circulation. 2) Disorders that suppress bone marrow function |
|
|
Term
| Neutrophilia is often referred to as “_____” and is most commonly associated with ______. |
|
Definition
| Left shift; bacterial infection |
|
|
Term
| Neutropenia is usually the result of what? |
|
Definition
|
|
Term
| Neutropenia is marked by a count of less than ____. |
|
Definition
|
|
Term
| Agranulocytosis (granulocytopenia) |
|
Definition
| Decrease in all granulocytes |
|
|
Term
| What usually causes eosinophilia? Other causes? (3) |
|
Definition
Allergies
Infection with parasite, malignancies, some medications |
|
|
Term
| Eosinopenia is associated with what syndrome and what event? |
|
Definition
Decrease in eosinophils
Cushing syndrome or major stressor (surgery, shock, burn) |
|
|
Term
| What usually causes basophilia? |
|
Definition
| Inflammation secondary to infections such as measles or chickenpox and immediate hypersensitivity reactions |
|
|
Term
| Three causes of basopenia? |
|
Definition
| Pregnancy, stress, and hyperthyroidism |
|
|
Term
| _____ is often transient and is not a good indicator of disease state. |
|
Definition
|
|
Term
| _____ is rare and usually indicates hairy cell leukemia or glucocorticoid therapy. |
|
Definition
|
|
Term
| What usually causes lymphocytosis? |
|
Definition
| Viral infections, particularly Epstein-Barr |
|
|
Term
| Four causes of lymphocytopenia |
|
Definition
1) Immune disorders like AIDS
2) Steroids
3) Radiation
4) Chemotherapy |
|
|
Term
| Two types of acute leukemias and two types of chronic leukemias |
|
Definition
Acute myelogenous leukemia
Acute lymphocytic leukemia
Chronic myelogenous leukemia
Chronic lymphocytic leukemia |
|
|
Term
| Acute myelogenous leukemia is more common in which population? |
|
Definition
|
|
Term
| The leukemia process starts with a single malignant cell called a ______. What two outcomes does this result in? |
|
Definition
Clonal cell
Dysfunction of the neoplastic leukocyte progeny cells and interference with the production of other blood cells in the marrow |
|
|
Term
| What makes leukemia unique as a malignancy? |
|
Definition
| There is not an increase in the rate of cell division but rather a blockage of the normal differentiation of the cell so that it continues to divide (“immortal cell”) |
|
|
Term
| What are the three common symptoms of leukemia, and why? |
|
Definition
| Infection, anemia, and bleeding because the over-production of non-functioning leukocytes crowds out erythrocytes and thrombocytes. |
|
|
Term
| How is acute leukemia diagnosed? |
|
Definition
| Detection of undifferentiated leukocytes in circulation. |
|
|
Term
| Philadelphia chromosome. Which type of leukemia does it lead to? |
|
Definition
| Exchange of chromosomal materials between chromosomes 9 and 22, leading to chronic myelogenous leukemia. |
|
|
Term
| Age groups that the two chronic leukemias occur in? |
|
Definition
CML = middle-aged to older adults
CLL = elderly |
|
|
Term
| How is chronic leukemia diagnosed? |
|
Definition
| Presence of partially differentiated leukocytes in the blood and marrow |
|
|
Term
|
Definition
| Manifestation of a normal immunologic response to infection, with proliferation of T and B lymphocytes and resultant enlargement of lymph nodes. Also associated with malignancy. |
|
|
Term
| Define malignant lymphomas and state two types. |
|
Definition
Malignant transformation of a lymphocyte and continue to grow uncontrollably in a lymph node or other lymphatic tissue.
Hodgkin lymphomas
Non-Hodgkin lymphomas |
|
|
Term
|
Definition
| Hodgkin lymphoma = malignancy of lymphocytes that reside in the lymph nodes |
|
|
Term
|
Definition
| Malignant cells in Hodgkin lymphoma with characteristic appearance |
|
|
Term
| Two main types of Hodgkin lymphomas |
|
Definition
Classic Hodgkin
Nodular lymphocyte predominant Hodgkin |
|
|
Term
| Four categorizations of classic Hodgkin lymphoma. |
|
Definition
1) Lymphocyte predominance
2) Nodular sclerosing
3) Mixed cellularity
4) Lymphocyte depletion |
|
|
Term
|
Definition
| Classification of clinical stage of Hodgkin lymphoma based on nodal involvement, symptoms and tumor pathology |
|
|
Term
| Normal first symptoms of Hodgkin lymphoma |
|
Definition
| Lymphadenopathy of the neck, leading to night sweats, low-grade fevers, weight loss, and itching |
|
|
Term
|
Definition
| Wide spectrum of lymphoid malignancies other than Hodgkin disease, tends to involve many peripheral nodes and extends into extranodal tissues |
|
|
Term
| Clinical presentation of non-Hodgkin lymphoma. |
|
Definition
| Similar to Hodgkin lymphoma except also involves nasopharynx, gastrointestinal tract, bone, testes, and other soft tissues. |
|
|
Term
|
Definition
| Associated with infection by the Epstein-Barr virus, presents with a facial mass around the jaw |
|
|
Term
| Myeloma and multiple myeloma |
|
Definition
Neoplastic proliferation of malignant plasma cells
Multiple myeloma = multi-focal tumors |
|
|
Term
| Common age and ethnicity for multiple myeloma. |
|
Definition
|
|
Term
|
Definition
| In myeloma, immunoglobulin fragments excreted in the urine and damage renal tubular cells |
|
|
Term
| Five common clinical manifestations of myeloma. |
|
Definition
1) Bone pain
2) Pathologic fractures
3) Hypercalcemia (lethargy and confusion)
4) Renal disease
5) Recurrent and overwhelming infection |
|
|
Term
| One major or three minor criteria must be present to diagnose multiple myeloma. What are the three major criteria? |
|
Definition
1) Positive biopsy results
2) Over 30% plasma cells in bone marrow sample
3) Monoclonal antibody in blood/urine |
|
|
Term
| One major or three minor criteria must be present to diagnose multiple myeloma. What are the four minor criteria? |
|
Definition
1) 10% to 30% plasma cells in bone marrow sample
2) Monoclonal antibody present, but not enough to be a major criteria
3) Holes in bones from tumors seen on imaging studies
4) Normal antibody in blood abnormally low |
|
|
Term
|
Definition
| Form of non-Hodgkin lymphoma most commonly seen in children and adolescents. Often, the tumor arises from malignant immature T cells in the thymus. Very aggressive cancer that usually presents as stage 4 |
|
|
Term
| What is the usual first symptom of lymphoblastic lymphoma? |
|
Definition
| A painless lymphadenopathy in the neck |
|
|
Term
|
Definition
| Overactive spleen results in anemia, leukopenia, and thrombocytopenia caused by sequestration of blood components in the spleen |
|
|
Term
| Two causes of thrombocytopenia |
|
Definition
| Decreased platelet production or increased platelet aggregation or destruction |
|
|
Term
| Thrombocytopenia has many causes. List viral, nutritional, bone marrow, cancer, and pharmacological causes. |
|
Definition
1) Epstein-Barr Virus
2) HIV
3) B12 deficiency
4) Folate deficiency
5) Bone marrow diseases like aplastic anemia
6) Leukemia
7) Drugs that reduce platelet production (heparin, chemo, alcohol) |
|
|
Term
| One paradoxical cause of thrombocytopenia |
|
Definition
| Autoimmune disease that aggregates platelets, causing thrombosis and ischemia |
|
|
Term
| Immune thrombocytopenic purpura |
|
Definition
| Idiopathic IgG autoantibody-mediated condition common in both children and adults. Type II hypersensitivity to altered platelet antigens and subsequent platelet destruction in the spleen |
|
|
Term
| Thrombotic thrombocytopenic purpura |
|
Definition
| Found most often in women in their thirties. Characterized by platelet aggregation without activation of the coagulation cascade, probably from autoimmune stimulation of platelets. Microcirculation occlusion and ischemia. |
|
|
Term
| Essential thrombocythemia |
|
Definition
| Platelets produced resulting in counts of over 600,000 |
|
|
Term
| Symptoms of essential thrombocythemia (3) |
|
Definition
| 1) Asymptomatic 2) Thrombosis 3) Mild hemorrhaging (esp into GI tract) |
|
|
Term
| Inadequate platelet function is most commonly the result of what? |
|
Definition
| Drugs such as nonsteroidal antiinflammatory drugs (NSAIDs), antibiotics, cardiovascular drugs, psychotropic drugs, anesthetics, and some foods |
|
|
Term
| Five systemic disorders that can cause inadequate platelet function |
|
Definition
Uremia (renal failure)
Autoimmunity disorders
Leukemias
Myelodysplastic syndromes
Cardiopulmonary bypass |
|
|
Term
| Disorders of coagulation are the result of defective or deficient _______. |
|
Definition
|
|
Term
|
Definition
| Sex-linked recessive disorders that cause insufficient production of clotting factors (factor VIII) |
|
|
Term
|
Definition
| Also is caused by a factor VIII deficiency (like hemophilia) and is inherited as an autosomal dominant disorder |
|
|
Term
| Acquired causes of impaired hemostasis include _____ deficiency and ____ disease |
|
Definition
|
|
Term
| Why does a vitamin K deficiency cause impaired hemostasis? |
|
Definition
| Interferes with the synthesis of prothrombin, coagulant factors, and anticoagulant factors |
|
|
Term
| Why does liver disease cause impaired hemostasis? |
|
Definition
| Prevents the normal synthesis of clotting factors and increases fibrinolytic activity. May cause thrombocytopenia and alterations in platelet function |
|
|
Term
| Disseminated intravascular coagulation |
|
Definition
| Systemic thrombohemorrhagic disorder. Systemic clotting in the presence of bleeding |
|
|
Term
| Explain how the paradox of systemic clotting and bleeding in DIC is possible. |
|
Definition
| Systemic coagulation consumes clotting factors and platelets. At the same time, the clots are being broken down (clot lysis) due to fibrinogen degradation products (FDPs), which can lead to oozing of blood or, in severe cases, hemorrhage. |
|
|
Term
| Four clinical manifestations of someone with disseminated intravascular coagulation. |
|
Definition
1) Bleeding from skin puncture sites
2) Hemorrhage into the central nervous, gastrointestinal, and pulmonary systems
3) Multiple organ dysfunction
4) Poor peripheral tissue perfusion |
|
|
Term
| Management of DIC has been revolutionized by the use of ______. |
|
Definition
|
|
Term
| What is the Virchow Triad? |
|
Definition
Steps leading to thrombus formation:
1) Endothelial injury
2) Stasis of blood flow
3) Hypercoagulability |
|
|
Term
|
Definition
| Distended veins, usually in the lower extremities |
|
|
Term
| Because clinical recognition of DVT is difficult, _____ is the most effective means of management. |
|
Definition
|
|
Term
| Superior vena cava syndrome (patients likely to develop) |
|
Definition
| Patients with bronchogenic (lung) cancer or lymphomas will develop compression and progressive occlusion of the superior vena cava, leading to venous distension in the upper extremities and head. |
|
|
Term
| State the normal systolic and diastolic values, as well as prehypertension, stage I and stage II hypertension |
|
Definition
Normal < 120 AND < 80
Prehypertension 120-139 OR 80-89
Stage 1 Hypertension 140-159 OR 90-99
Stage 2 Hypertension > 160 OR > 100 |
|
|
Term
| Approximately __% of Americans older than age __ have hypertension. |
|
Definition
|
|
Term
__ - __% of hypertension is idiopathic and called ________.
__ - __% of hypertension is the result of an identifiable etiologic cause and is called ______. |
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Definition
| 90-95; primary hypertension; 5-10; secondary hypertension |
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Term
| Role of gender in risk for hypertension. |
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Definition
Men > women before age 55
Women > men after 55 |
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Term
| What are 4 genetic influencers of hypertension? |
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Definition
Genes that determine:
1) Body's response to sympathetic nervous system
2) Body's response to renin-angiotensin-aldosterone system
3) Glucose tolerance
4) Renal excretion of sodium |
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Term
| Three ways the sympathetic nervous system ensures adequate blood pressure. |
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Definition
1) Increasing cardiac contractility
2) Increasing heart rate
3) Inducing arteriolar vasoconstricion
Thus, SNS overactivity can cause hypertension |
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Term
| Dysfunction of the RAA system in the hypertensive individual can lead to persistent increases in _____ and _____. |
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Definition
| Peripheral resistance (from angiotensin); renal salt retention (from aldosterone) |
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Term
| In addition to vasoconstriction, what can angiotensin II do to contribute to hypertension? |
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Definition
| Promote vascular remodeling and permanent increased peripheral resistance |
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Term
| Three of the natriuretic peptides have the word "natriuretic" in them. What's the fourth? |
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Definition
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Term
| How does disruption of natriuretic hormones lead to hypertension? |
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Definition
| Keeps excess salt from being excreted in the urine. |
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Term
| Because insulin has several important roles in ______, insulin resistance can lead to hypertension. |
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Definition
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Term
| Role of acute vs chronic inflammation in hypertension. |
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Definition
| Cytokines (histamine, prostaglandin) in acute inflammation lead to vasodilation, but chronic inflammation contributes to vascular remodeling and smooth muscle contraction |
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Term
| Five primary causes of secondary hypertension. |
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Definition
1) Renal vascular disease: increases in RAA activity
2) Renal parenchymal disease: increased RAA activity
3) Adrenocortical tumors: Increased production of cortisol and aldosterone
4) Adrenomedullary tumors (pheochromocytoma): Increased production of catecholamines
5) Drugs (e.g., oral contraceptives, corticosteroids, antihistamines) |
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Term
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Definition
| Occurs when hypertension is severe or sustained and begins to affect many other organs in the body |
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Term
| Nine effects of complicated hypertension. |
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Definition
1) Hypertensive retinopathy
2) Renal nephrosclerosis
3) Coronary artery disease
4) Hypertrophic cardiomyopathy from increased myocardial afterload
5) Ischemic heart disease
6) Stroke: Acute brain infarction
7) Stroke: Intracerebral hemorrhage
8) Dementia
9) Hypertensive encephalopathy: Acute cerebral edema |
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Term
| Official definition of orthostatic hypotension. (How much change in BP?) |
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Definition
| Systolic blood pressure decrease of 20 mm Hg (or greater) or diastolic blood pressure decrease of 10 mm Hg (or greater) within the first 3 minutes of standing. |
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Term
| What causes orthostatic hypotension? |
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Definition
| Failure of sympathetic nervous system vasomotor compensatory mechanisms |
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Term
| Most common cause of aneurysm. |
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Definition
| Atherosclerotic degeneration of the arterial wall |
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Term
| What is LaPlace's Law when applied to blood vessels? |
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Definition
| The tension (T) on the wall of a vessel is the product of the pressure (P) times the radius (R) of the vessel. T = P x R |
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Term
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Definition
| Involves entire vessel (all tunicae) or heart wall; most commonly due to atherosclerosis and hypertension |
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Term
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Definition
| At least one tunica left unaffected; usually due to trauma |
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Term
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Definition
| A localized dilation of a small area of an artery forming a saclike protrusion; usually results from trauma |
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Term
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Definition
| A localized dilation of an artery involving the entire circumference, which gives it a spindle appearance |
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Term
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Definition
| A type of saccular aneurysm, located in a cerebral artery, usually in the circle of Willis |
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Term
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Definition
| Most commonly involves the thoracic aorta, partial tear in vessel wall such that blood enters into the wall of the aorta and forms a second lumen. Acute ischemia and infarction of vital organs. Very high mortality, surgical emergency. |
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Term
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Definition
| Blood enters the arterial wall, channeling blood through a false passage that separates the artery layers |
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Term
| Thromboangiitis obliterans (Buerger disease) |
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Definition
| Idiopathic inflammatory and immune vasculitis involving the peripheral arteries, most common in young male smokers. Vasospasm and arterial remodeling lead to vessel narrowing and chronic ischemia of tissues, especially in the hands and feet. |
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Term
| Raynaud phenomenon and Raynaud disease |
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Definition
Phenomenon = vasospasm associated with systemic diseases, especially scleroderma and lupus
Disease = idiopathic vasospasm related to an imbalance of vasodilators and vasoconstrictors |
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Term
| Why does endothelial injury start the atherosclerotic process? |
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Definition
| Causes inflammation with adhesion of macrophages to endothelium via adhesion molecules. Macrophages then release cytokines and oxidize LDL |
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Term
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Definition
| Macrophages that have phagocytosed oxidized LDL. They accumulate on the vessel wall, forming a "fatty streak." |
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Term
| What are the next two steps of atherosclerosis following formation of the fatty streak? |
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Definition
1) Smooth muscle cells migrate over top of fatty streak
2) Fibrin deposits form hard plaque |
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Term
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Definition
| Large accumulation of foam cells with very thin covering of smooth muscle and fibrin, likely to crack/rupture, which causes platelet adhesion and thrombus formation. |
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Term
| Stable angina and claudication |
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Definition
Stable angina: A stable plaque that only causes tissue ischemia and pain with exercise
Claudication = same but in peripheral arteries |
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Term
| Define peripheral artery disease (arteriosclerosis obliterans) and indicate who is likely to have it. |
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Definition
Atherosclerosis of the arteries of the limbs, especially the legs.
Common in diabetics, smokers, and those with other atherosclerotic disease |
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Term
| Intermittent claudication |
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Definition
| Pain in the legs that occurs with ambulation and is relieved with rest |
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Term
| Gender and coronary artery disease |
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Definition
| Men > women before age 55, women > men after age 55 |
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Term
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Definition
| LDL carries cholesterol to the tissues, and HDL returns excess cholesterol to the liver where it turns off further LDL synthesis. |
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Term
| High levels of ___ and low levels of ___ are both associated with increased risk for CAD. |
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Definition
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Term
| Cholesterol-lowering drugs |
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Definition
| HMG coenzyme A (CoA) reductase inhibitors, also known as the “statins.” |
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Term
| Silent myocardial ischemia. Three types of patients who commonly suffer this. |
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Definition
Dysfunction in autonomic nerves. Individuals present with myocardial ischemia (and even infarction) without any symptoms of chest discomfort.
1) Common in diabetics.
2) Stress-induced increases in myocardial demand for oxygen (tachycardia, increased blood pressure) may also present with silent ischemia. 3) Transplanted hearts also lack autonomic innervation and can suffer considerable ischemic injury in the absence of symptoms. |
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Term
| Four blood studies diagnosing myocardial ischemia. |
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Definition
| Measurement of lipids, hematocrit, blood urea nitrogen (BUN), and creatinine (Cr) |
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Term
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Definition
| Used when catheter-based or surgical interventions are considered. Radiocontrast dye is injected via a catheter into the coronary vessel so that plaques can be visualized. |
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Term
| Two types of acute coronary syndromes |
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Definition
| Myocardial infarction and unstable angina |
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Term
| Two categories of myocardial infarction |
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Definition
Non-STEMI (subendocardial or non-Q wave MI)
STEMI (transmural or Q wave MI) |
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Term
| Define non-STEMI (also called subendocardial or non-Q wave MI) |
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Definition
| Ischemia first affects the part of the heart muscle closest to the endocardium (subendocardial tissue). Does not extend all the way through heart wall. |
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Term
| Define STEMI (also called transmural or Q wave MI) |
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Definition
| Necrosis or near-necrosis penetrates all the way from the endocardium to the pericardium (full thickness) |
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Term
| What can be detected in the blood to confirm myocardial infarction versus ischemia? |
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Definition
| Intracellular enzymes released from necrosed myocytes. |
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Term
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Definition
| Temporary loss of contractile function that persists for hours or days after perfusion has been restored after MI. |
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Term
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Definition
| Tissue that survives persistent ischemia through metabolic adaptation to prolong myocyte survival until perfusion can be restored. |
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Term
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Definition
| Myocyte hypertrophy and loss of contractile function of heart muscle distant from the site of infarction. |
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Term
| Five classic symptoms of myocardial infarction. |
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Definition
Crushing chest pain
Dyspnea (difficulty breathing)
Diaphoresis (sweating)
Nausea and vomiting
Dizziness |
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Term
| What does the ECG look like with STEMI vs non-STEMI heart attacks? |
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Definition
Ischemia and non-STEMI usually present with ST depression
STEMI is characterized by elevations in the ST segment with subsequent development of Q waves. |
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Term
| Four priorities for managing an MI. |
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Definition
Resuscitation and stabilization
Reperfusion (thrombolytic therapy or emergent surgery)
Prevention of complications
Quality of life and risk reduction |
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Term
| Acute pericarditis and symptoms (4) |
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Definition
| Membranes become inflamed and roughened Chest pain that worsens with respiratory movement or lying down; low-grade fever; sinus tachycardia; friction rub |
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Term
| Pericardial effusion. Symptoms? |
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Definition
| Accumulation of fluid in the pericardial sac, usually secondary to acute pericarditis Often asymptomatic unless cardiac compression results |
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Term
| Constrictive pericarditis |
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Definition
| Fibrotic scarring of pericardium resulting in encasement of the heart in a rigid shell |
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Term
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Definition
| Ventricles become dilated, impairing systolic function and significantly reduces myocardial contractility, resulting in heart (biventricular) failure |
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Term
| Most common cause of dilated cardiomyopathy |
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Definition
| Ischemic heart disease with damage to a significant portion of the myocardium |
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Term
| Asymmetrical septal hypertrophic cardiomyopathy, and likely consequence? |
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Definition
| Heart septum enlarges, potentially causing left ventricular outflow obstruction and heart failure |
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Term
| Hypertensive (or valvular) hypertrophic cardiomyopathy |
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Definition
| Develops secondary to hypertension or valvular stenosis. The ventricles enlarge in an attempt to compensate for the increased workload |
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Term
| Restrictive cardiomyopathy |
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Definition
| Decreased compliance/rigidity of the myocardium, resulting from severe scarring or infiltration of abnormal substances into the myocardium. Significantly increases ventricular filling pressures and impedes ventricular filling. |
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Term
| Two primary valvular dysfunctions |
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Definition
Stenosis = valve orifice is constricted and narrowed
Regurgitation / insufficiency = valve does not shut completely and allows backflow |
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Term
| Most common cause of aortic stenosis in adults. |
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Definition
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Term
| Common congenital cause of aortic stenosis |
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Definition
| Presence of a bicuspid (rather than a tricuspid) valve. |
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Term
| Cause of aortic stenosis in the elderly |
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Definition
| Degeneration and calcification of the valve with aging |
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Term
| Mitral stenosis can be congenital, but it is most commonly caused by ______ or _____ in adults. |
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Definition
| Rheumatic heart disease or bacterial endocarditis. |
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Term
| Marfan syndrome is associated with which two types of valvular dysfunction? |
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Definition
| Aortic and mitral regurgitation |
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Term
| Five causes of aortic regurgitation in adults. |
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Definition
1) Rheumatic heart disease
2) Bacterial endocarditis
3) Syphilis
4) Hypertension
5) Atherosclerosis |
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Term
| Four causes of mitral regurgitation. |
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Definition
1) Rheumatic heart disease
2) Bacterial endocarditis
3) Congestive cardiomyopathy
4) Atherosclerosis |
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Term
| If a mitral valve prolapse worsens, what might it become? |
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Definition
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Term
| Surgical treatment of valvular disesase |
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Definition
| Most eventually require a porcine or mechanical valve. Another option is percutaneous transluminal balloon valvuloplasty |
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Term
| What prophylactic drugs do people with valvular disorders usually receive? (2) |
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Definition
| 1) Antibiotics prior to any surgery to prevent bacteria from being released into bloodstream 2) Anticoagulants |
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Term
| Rheumatic fever stems from what bacterial infection? |
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Definition
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Term
| Another term for congestive heart failure. |
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Definition
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Term
| Systolic left heart failure |
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Definition
| Heart is unable to generate an adequate cardiac output, causing inadequate perfusion of tissues |
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Term
| What are the three determinants of stroke volume that determine cardiac output? |
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Definition
1) Contractility
2) Preload
3) Afterload |
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Term
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Definition
| The fraction of the left ventricular end-diastolic volume (LVEDV) that is ejected with each beat |
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Term
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Definition
| Amount of diastolic volume (LVEDV) that is available to the myocardium as it begins its contraction in systole. |
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Term
| What three factors primarily affect preload? |
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Definition
Contractility
Afterload
Blood volume |
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Term
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Definition
| Resistance to ventricular ejection, is most often determined by the amount of peripheral vascular resistance |
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Term
| Two common causes of increased afterload |
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Definition
Hypertension
Aortic valve stenosis |
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Term
| How does hypertrophy of the myocardium contribute to contractile dysfunction? |
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Definition
| The hypertophied cells are energy-starved because they demand more oxygen than the coronary arteries can provide, thus compounding contractile dysfunction |
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Term
| How does the sympathetic nervous system compound the problem of decreased cardiac contractility? |
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Definition
| When reduced contractility causes underperfusion of important tissues (like the kidney), which activates the RAA system, increasing blood volume (preload) and peripheral resistance (afterload) |
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Term
| Neurohumoral treatment of heart failure? |
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Definition
| Beta-blockers and ACE inhibitors. Drugs to block catecholamines (ep and nor-ep), angiotensin and aldosterone, and natriuretic peptides |
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Term
| Three main categories of clinical manifestations with heart failure. |
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Definition
1) Changes in the heart structure and function
2) Pulmonary congestion (pulmonary edema)
3) Vital organ underperfusion |
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Term
| Diastolic left heart failure |
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Definition
| Compliance of the left ventricle is decreased and cannot relax to take in diastolic filling without increasing pressure. Pressure is reflected back to the left atrium and the pulmonary venous system and results in pulmonary congestion. |
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Term
| Pure diastolic heart failure is characterized by what two criteria? |
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Definition
1) An increase in left ventricular end-diastolic pressure (LVEDP) without an increase in left ventricular end-diastolic volume (LVEDV) OR
2) A decrease in ejection fraction |
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Term
| Relationship of left diastolic heart failure to left systolic heart failure. |
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Definition
| Often first step in development of left systolic heart failure. |
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Term
| Three causes of right heart failure |
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Definition
1) Left heart failure severe enough to greatly increase pulmonary artery pressure
2) Lung disease that causes diffuse pulmonary vasoconstriction and increased pulmonary artery pressure
3) Disorders that directly affect right ventricular contractility |
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Term
| Three clinical manifestations of someone with right heart failure. |
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Definition
| Jugular venous distension, hepatomegaly, and peripheral edema |
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Term
| High-output heart failure |
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Definition
| Inability of the heart to adequately supply the body with blood-borne nutrients, despite adequate blood volume and normal or elevated myocardial contractility. Heart rate and stroke volume increase in an attempt to compensate, but still not adequate. |
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Term
| Four common causes of high-output heart failure. |
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Definition
1) Anemia
2) Septicemia causing systemic vasodilation and increased oxygen demand
3) Hyperthyroidism (acceleration of cellular metabolism, increasing tissue demand for oxygen)
4) Beriberi, a thiamine deficiency disorder |
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Term
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Definition
| Cardiovascular system can no longer provide adequate perfusion of nutrients and oxygen to vital tissues |
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Term
| Four steps of shock process |
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Definition
1) Lower O2 = less ATP production
2) Cell lysis due to electrolyte pumps stopping
3) Ischemic cells activating inflammatory response (cytokines, lysosomal enzymes, clotting cascade)
4) Anaerobic metabolism produces lactic acid, causing metabolic acidosis and eventually MODS |
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Term
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Definition
| Heart is unable to generate an adequate cardiac output; severe systolic heart failure |
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Term
| When cardiogenic shock occurs in the setting of acute myocardial infarction, mortality is greater than __%. |
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Definition
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Term
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Definition
| Any condition that can result in the loss of greater than 15% of the intravascular volume |
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Term
| Six conditions that can cause hypovolemic shock. |
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Definition
Dehydration
Overuse of diuretics or dialysis
Hemorrhage
Burns
Extreme hyperglycemia or hypercalcemia
Severe diarrhea |
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Term
| Distributive shock, and three types. |
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Definition
Inability to maintain an adequate peripheral vascular resistance
Neurogenic
Anaphylactic
Septic |
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Term
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Definition
| Injury to the brain or spinal cord or the administration of certain drugs results in the loss of sympathetic stimulation |
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Term
| Most common source for gram-negative septic shock. |
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Definition
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Term
| Most common source for gram-positive septic shock. |
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Definition
| Percutaneous indwelling vascular catheters that bring in gram-positive bacteria from the skin |
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Term
| Systemic inflammatory response syndrome (3 steps) |
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Definition
1) Bacterial toxins activate macrophages
2) Macrophages release inflammatory cytokines
3) Complement and coagulation systems are activated |
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Term
| Seven complications of systemic inflammatory response syndrome leading to septic shock |
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Definition
1) Decreased peripheral resistance
2) Decreased cardiac output
3) Increased capillary permeability
4) Hypotension
5) Decreased tissue perfusion
6) Lactic acidosis
7) Widespread coagulation |
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Term
| The five most common manifestations of multiple organ dysfunction syndrome |
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Definition
1) Acute respiratory distress syndrome (ARDS)
2) Disseminated intravascular coagulation (DIC)
3) Acute tubular necrosis (ATN)
4) Liver and heart failure
5) Central nervous system (CNS) dysfunction |
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Term
| What new drug has been shown to improve outcomes in cases of septic shock? |
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Definition
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