Damjanov Chapter 2

Question 1

Both _____ and ______ fatigue can be

Answer 1

mental; psychological; relieved by rest!!

Question 2

Most common form of fatigue?

Answer 2

1. Psychogenic
2. Organic
3. Undetermined

Question 3

For muscular fatigue, list steps of why you have this problem?

Answer 3

1. Muscles depleted of fuel in form of nutrients and energy-rich compounds like creatine phosphate or adenosine triphosphate
2. Lactic acid accumulates and internal milieu acidifies, inhibiting actin-myosin interaction and muscle cell contraction
3. Increased [phosphorus] concentration in cytosol affects Ca release from internal stores, preventing action on contractile fibers

Question 4

Psychogenic fatigue is not

Answer 4

relieved by rest

Question 5

Anxiety states, depression, and sleep disorders could

Answer 5

cause fatigue

Question 6

Pharm causes of fatigue include

Answer 6

sleeping pills, tranquilizers, some antihypertensive drugs; also recreational drug abuse

Question 7

Neuromuscular disorders like what can cause

Answer 7

Parkinson’s, MS, myasthenia gravis, muscular dystrophy;

fatigue with muscle weakness!!

Question 8

Weight loss can result from

Answer 8

1. insufficient intake of food
2. malabsorption of nutrients
3. loss of metabolites and nutrients (vomiting, diarrhea, diabetes)
4. increased demand for nutrients and calories (infancy, childhood, pregnancy, chronic infetions, burns, malignant tumors, hyperthyroid)

Question 9

In starvation, how does the body respond?

Answer 9

1. Reduce energy expenditure (fat tissue lost first)
2. Liver and intestines reduced in weight
3. Weight of heart, skeletal muscles, kidneys reduced, and skin atrophic
4. BRAIN INTACT and intellect NOT AFFECTED
5. HR, RR slow, muscles weak, gonads make less sex hormones

Question 10

Typical presentation of someone with cachexia?

Answer 10

1. Weakness, weight loss in someone with cancer or something like TB or AIDS
2. Muscle wasting (tired, weak, can’t work)
3. BMR increased (proteins, carbs, fats metabolized)
4. Increased BUN, creatinine
5. Anemia, hypoalbuminemia
6. Reduced glucose utilization, increased gluconeogenesis (hyperglycemia and insulin resistance)
7. Increased free FA’s

Question 11

Cachexia in cancer patients can be due to?

Answer 11

1. Obstruction of GI tract (think stomach, esophagus carcinoma; also carcinoma of head of pancreas)
2. Anorexia
3. Early satiety (hyperglycemia, too much protein and aa’s)
4. Increased energy expenditure
5. Cytokines released in response to tumor growth (anorexia, hypermetabolism, muscle proteolysis, apoptosis)
6. Therapy (chemo)

Question 12

For body temp, skin receptors respond to what, and central receptors respond to what?

Answer 12

external temperatures; temperature of the blood

Question 13

Resetting of thermostat in times of fever is due to

Answer 13

action of cytokines released from activated macrophages, and lesser extent, activated T lymphocytes; think interleukins (IL-1, IL-6), TNF, and IFN;
endogenous pyrogens act on endothelial cells of OVLT, which make prostaglandin PGE2 and diffuses to adjacent hypothalamus and raises set point for thermoreg;
leads to vasoconstriction of dermal vessels, cessation of sweating, and shivering of muscles

Question 14

Afebrile infections can often occur in middle-aged adults with

Answer 14

CHF or chronic renal insufficiency

Question 15

Fever related to noninfectious disease can be due to

Answer 15

1. endogenous pyrogens from inflamm cells infiltrating various organs, after tissue necrosis after infarction, gout, drug reaction
2. think endothelial cells or fixed macrophages like Kupffer cells, glial cells, dermal Langerhan cells
3. Tumor cells

Question 16

High temps can help cause

Answer 16

increased HR and RR, BMR; sweating and chills; headache, convulsions

Question 17

Heat stroke can cause

Answer 17

high fever, but NO SWEATING (a failure of central thermoregulation)

Question 18

Nociceptors can be classified as; they include

Answer 18

thermal, mechanical, chemical, or polymodal nociceptors;

fast, myelinated mechanical Adelta fibers and slow unmyelinated polymodal C fibers

Question 19

Peripheral sensitization is

Answer 19

associated with hyperalgesia, an increased feeling of pain and a reduced threshold to pain

Question 20

Endorphins can

Answer 20

bind to opioid receptors on sensory neurons, modifying the perception of pain

Question 21

Nociceptive pain

Answer 21

originates in skin and subcutaneous tissue and corresponds to innervation of anatomic dermatomes and is called somatic pain (sharp, prickling, severe)

Question 22

Parietal pain

Answer 22

originates from parietal peritoneum or pleura; can be localized or diffuse (appendicitis vs. peritonitis respectively)

Question 23

Visceral pain

Answer 23

pain originating from nerve endings in internal organs

Question 24

Neuropathic pain and examples?

Answer 24

1. Back pain due to compression of spinal nerves from herniated disc
2. Herpes simplex neuropathy involving facial nerve
3. Pain due to SCI;
   injury to peripheral sensory nerves or nerves in spinal cord and brain

Question 25

Migraine with aura is associated with

Answer 25

premonitory aura or prodrome of neurologic symptoms; think bright spot in center of visual field that flickers and changes color; also pins and needles in fingers and tingling in area of nose, mouth, and lips (digitolingual paresthesia)

Question 26

Migraine pain can be precipitated by

Answer 26

alcohol, MSG, estrogen, etc.; premenstrual period, exposure to bright light, changes in weather

Question 27

Distribution of headache for tension:

Answer 27

bilateral, tightness, "headband distribution"; | tenderness over temporalis muscle

Question 28

Distribution of cluster headaches

Answer 28

severe unilateral periorbital or temporal lancinating pain (occur more often on awakening)

Question 29

For secondary headaches, how can you get this extracranially and intracranially?

Answer 29

E: muscle spasm, contraction of arteries, temporal arteritis, inflammation of mucosa of nasal sinuses; I: dura at base of brain, arteries, venous sinuses and major veins, and CN V, VII, IX, X

Question 30

Low back pain can come about from

Answer 30

psychogenic factors (depression, stress, anxiety), ligamentous sprain (deep structures of back), fibromuscular pain, sciatica (herniation of intervertebral disc

Question 31

Chest pain can come about from

Answer 31

1. dermal pain (herpes zoster) 2. myalgia 3. ostalgia (periosteum of ribs and vertebrae) 4. Posterior root pain (compression of nerves due to deformities of thorax) 5. Pleural pain (irritating parietal pleura) 6. Esophageal pain (heartburn) 7. Cardiac pain 8. Pericardial pain

Question 32

Abdo pain could come from

Answer 32

1. visceral pain (vague, poorly localized) 2. parietal (visceral can become parietal if parietal peritoneum is involved!!) 3. Referred pain 4. Metabolic or toxic pain (porphyria or diabetic acidosis) 5. Neurogenic pain (think tabes dorsalis) 6. psychogenic pain

Question 33

UMN weakness can cause

Answer 33

hemiplegia, dysarthria/dysphonia, dysphagia, spasticity

Question 34

Tics are a feature of

Answer 34

Tourette's syndrome, an AD disease affecting usually males (think complex motor tics of face, like blinking, frowning, sniffing; and phonic tics, like throat-clearing, grunting, barking)

Question 35

Flapping of hands in e.g. a postural tremor is known as

Answer 35

asterixis, a common sign of end-stage liver disease

Question 36

Chorea could be combined with

Answer 36

athetosis, slow writhing movements involving entire extremity

Question 37

Syncope is a

Answer 37

transient sudden loss of consciousness with loss of postural tone, then spontaneous recovery; caused by CEREBRAL ISCHEMIA

Question 38

Cardiac syncope could be due to

Answer 38

aortic stenosis!! also hypertrophic cardiomyopathy, malfunctioning cardiac prostheses, thromboemboli; think FAINTING

Question 39

Vasomotor syncope is

Answer 39

related to increased vagal tone and inadequate sympathetic regulation of peripheral circulation; think SWALLOWING, carotid sinus syncope, micturition syncope

Question 40

Orthostatic hypotension are

Answer 40

idiopathic, maybe seen in diabetes mellitus patients, those with adrenergic blockers, also anaphylactic drug reaction

Question 41

Coma only develops if

Answer 41

both hemispheres of brain are affected

Question 42

Metabolic and toxic causes of coma are

Answer 42

see in end-stage renal or hepatic failure, metabolic diseases like diabetes, acid-base imbalance

Question 43

Stages of coma:

Answer 43

1. diffuse cerebral cortical depression (respiration fine, maybe hyperventilation; pupils midposition and normally reactive, extraocular reflexes are intact; extremities hypo/hypertonic) 2. Diffuse deep-hemispheric depression: hyperventilation, alkalosis, or maybe Cheyne-Stokes respiration; pupils same as earlier; extremities are diffusely hypertonic, decorticate response 3. Thalamic impairment: Cheyne-Stokes breathing, hyperventilation; pupils small, reactive to light; eyes in abducted position; decerebrate response to noxious stimuli 4. Pontine impairment: breathing irregular with apnea; pupils UNREACTIVE and midposition or narrow; could have complete ophthalmoplegia; could see flaccid quadriplegia and no decerebrate or decortication 5. Medullary impairment: breathing irregular depth and pattern (ataxic); pupils dilated and unreactive; ophthalmoplegia complete; flaccid quadriplegia

Question 44

Macule: large macules are

Answer 44

patches

Question 45

Large papules are

Answer 45

plaques