1
Q
Hormones secreted by the anterior pituitary
A
ACTH, thyroid stimulating hormone (TSH), LH, FSH, prolactin, growth hormone, and melanocyte stimulating hormone (MSH)
2
Q
Hormones secreted by the posterior pituitary
A
Vasopressin (ADH), oxytocin
3
Q
Disorder of too much ADH
A
SIADH
- Hyponatremic
- hyperosmolarity
- hypervolemia/ wt gain
4
Q
Disorder of too little ADH
A
DI
- Polyuria, polydipsia
- UOP 8-12 L/day (norm 1-2)
- low urine specific gravity
- low urine osmolarity
- hypernatremia
5
Q
Too much GH
A
Gigantism- kids and adolescents
Acromegaly- adulthood
6
Q
Hypofunction of pituitary gland
A
- Panhypotituitarism (all hormones affected)
- ACTH deficiency- cortisol deficiency
- TSH deficiency-altered metabolism
- FSH and LH deficiency- lack of secondary sex characteristics
- GH deficiency- lack of growth in children
7
Q
DM type 1
A
Polyuria, polydipsia, polyphagia
Weight loss, fatigue
-Pancreatic atrophy and loss of beta cell function, no longer producing insulin
8
Q
DM type 2
A
Cells become insulin resistant
-fatigue, recurrent infections, visual changes, s/s of neuropathy
9
Q
Signs of hypoglycemia
A
tachycardia, palpitations, diaphoresis, tremors, pallor, arousal anxiety
10
Q
DKA
A
Polyuria, dehydration, kussmal respirations, sweet/fruity breath, glucose over 250, acidotic, urine ketones
-usually associated with type 1
11
Q
HHS
A
- emergency
- precipitated by infections, noncompliance of meds, usually type 2 DM
- glycosuria, polyuria, dehydration, coma
- glucose over 600
12
Q
Somogyi effect
A
hypoglycemia with rebound hyperglycemia
- usually type 1 and kids
- eat a high protein snack at night to prevent hypoglycemia
13
Q
Dawn phenomenon
A
early morning glucose elevation without nocturnal hypoglycemia
-increase nighttime insulin dose to peak during the morning
14
Q
Microvascular complications of DM
A
retinopathy, neuropathy, and nephropathy
15
Q
Macrovascular complications of DM
A
CAD, CVA, PAD, infection
16
Q
Hyperparathyroid
A
- increase in pth levels
- hypercalcemia, hyperphosphatemia, pathologic fractures
17
Q
Hypoparathyroid
A
- decrease in pth levels
- hypocalcemia, hypophosphatemia, muscle spasms, chvostek’s sign (cheek), and trousseau sign (BP cuff)
18
Q
Addison’s disease
A
adrenal insufficiency; low cortisol levels, elevated ACTH
-weakness, hyperpigmentation, vitiligo
19
Q
Cushing’s
A
too much ACTH leads to excessive cortisol levels
-truncal (central) obesity, moon face, buffalo hump, na/h20 retention, glucose intolerance, purple striae, brown hyperpigmentation of skin
20
Q
Thyrotoxicosis
A
hyperthyroidism
-low TSH and high T3 and T4
21
Q
Grave’s disease
A
hyperthyroidism
-increased metabolic rate, tachycardia, heat intolerance, weight loss, insomnia, palpitations, diarrhea, goiter, exopthalmus
22
Q
Thyrotoxic storm
A
rare and life threatening
- results from excessive stress, increased T3 and T4
- hyperthermia, tachycardia- esp atrial tachydysrhythmias, high output heart failure, delirium, nvd
23
Q
Hypothyroidism
A
- primary is iodine deficiency (most common worldwide)
- autoimmune thyroiditis (most common in US)
- congenital
- thyroid carcinoma
- secondary hypothyroidism
24
Q
Hypothyroidism (cont.)
A
- low basal metabolic rate, cold intolerance, lethargy, lower body temp, possible diastolic hypertension
- myexedema: non-pitting edema esp around eyes, hands, and feet, thickening of tongue
25
Myxedema coma
* emergency
| - diminished LOC, hypothermia without shivering, tachypnea, hypotension, hypolgycemia, lactic acidosis, coma
26
Chromosomes
carries genetic information; 23 pairs of chromosomes
27
Genes
tells body how to make proteins; responsible for inherited characteristics
28
Allele
one of the possible forms of a gene (2 possible forms are dominant and recessive)
29
Codon
a set of three adjacent nucleotides or a triplet that constitutes the genetic code for a particular amino acid that is to be added to a polypeptide chain in the synthesis of a protein
30
Autosome
22 chromosome pairs in both males and females; not sex (X and Y)
31
Genotype
the set of genes in our DNA that is responsible for a particular trait
32
Phenotype
the physical characteristics of a trait
33
Hemizygous
males, having only one X chromosome, are said to be hemizygous for genes on this chromosome.
-females are homozygous because they have 2 X chromosomes
34
Transcription
the process of making an RNA copy of a DNA molecule
| -gene splicing occurs (cleans it up to get ready for translation)
35
Translation
RNA is decoded in a ribosome (site of protein synthesis) to produce a specific amino acid chain, or polypeptide.
36
DNA
Cytosine (C), thymine (T), adenine (A), guanine (G)
| A to T, C to G
37
RNA
Cytosine (C), uracil (U), adenine (A), guanine (G)
| A to U, C to G
38
Mutation
any inherited alteration of genetic material
39
Mutagens
are agents, such as radiation and chemicals, that increase the frequency of mutations
40
Autosomal recessive inheritance
two copies of an abnormal gene must be present in order for the disease or trait to develop
41
Turner syndrome
females only have one X chromosome
- absence of ovaries
- short stature
- webbing of the neck
- widely spaced nipples
42
Klinefelter syndrome
Individuals with at least one Y and two X chromosomes
- male appearance, gynecomastia, small testes, sparse body hair
- treat with testosterone
- likelihood of disorder increases with mother's age
43
Down syndrome
Trisomy 21
- mental challenges, low nasal bridge, epicathal folds, protruding tongue, flat/low set ears, poor muscle tone
- increased risk for congenital heart disease, respiratory infections, and leukemia
44
Genetics of common diseases
CAD, htn, DM
45
Alzheimer disease
produces amyloid plaques and neurofibrillary tangles
| -risk doubles if you have a first-degree relative
46
Alcoholism
risk is 3-5x higher in the individual with an alcoholic parent
-adoption studies- studies show it runs in genes rather than caregiver/environment
47
Schizophrenia
recurrence risk among offspring of one affected parent is 10x higher than the gen population
48
Bipolar affective disorder
also called manic depressive disorder
- risk rises 5-10% in an individual who has an affected first-degree relative as compared to normal, which is 0.5%
- genes that affect serotonin, dopamine, and noradrenaline systems have been implicated
49
Dominance and recessiveness
If two alleles are found together, then the allele that is observable is dominant and the one whose effects are hidden is recessive
50
Carrier
Has a disease allele but is phenotypically normal; can pass disease to offspring
51
Autosomal aneuploidy
Aneuploidy is a somatic cell that does not contain a multiple of 23 chromosomes.
- Trisomy: cell contains 3 copies of one chromosome
- Monosomy: presence of only 1 copy of any chromosome (is often fatal)
52
Deletions
chromosome breakage or loss of DNA
| -ex: cri du chat syndrome; "cry of the cat"-low birth weight, mentally challenged, and microcephaly
53
Duplications
excess genetic material; usually have less serious complications
54
Inversion
chromosomal rearrangement in which a chromosome segment is inverted
-ABCDEFG becomes ABEDCFG
55
Translocation
the interchange of genetic material between nonhomologous chromosomes
56
Fragile sites
chromosome develops breaks and gaps when the cells are cultured in a folate-deficient medium
57
Congenital malformations
congenital diseases present at birth; having other disorders along with the congenital disease is common
58
Concordant traits
both members of a twin pair share a trait;
| more genetic
59
Discordant traits
A twin pair does not share a trait;
| more environmental
60
Polygenic trait s
effects of multiple genes cause the variations in traits
| -focus is on the genes- usually many (poly) genes
61
Multifactoral traits
environmental factors cause the variations in traits
62
Quantitative traits
are measured on a continuous numeric scale
| follows a normal bell curve for distribution
63
Incidence Rate
the number of new cases of a disease reported during a specific period (typically 1 year) divided by the number of individuals in the population
64
Prevalence Rate
the proportion of the population affected by a disease at a specific point in time; varies from population to population
65
Epigenetics
are chemical modifications of DNA sequences that alter the expression of genes, resulting in disease and phenotypic variations
66
DNA methylation
makes part of the gene silent or inactive
67
Genomic imprinting
the process of gene silencing, in which genes are predictably silenced, depending on which parent transmits them
68
Prader-Willi
inherited from dad
- abnormal pairs of the long arm of chromosome 15
- short stature, hypotonia, small hands/feet, obesity, mild mental retardation, hypogonadism
69
Angleman syndrome
Same deletion of pairs from long arm of chromosome 15 as prader willi, but angleman is inherited from mom*
-severe mental retardation, seizures, ataxic gait
70
Beckwith-Weidemann syndrome
overgrowth condition accompanied by an increased predisposition to cancer
- large for gestational age, neonatal hypoglycemia, large tongue
- uniparent disomy, affecting chromosome 11
71
Russel-silver syndrome
undergrowth condition
| -growth retardation, proportionate short stature, leg length discrepancy, small/triangular shaped face
72
Layers of epidermis (from outermost to innermost)
- stratum corneum
- stratum lucidum
- stratum granulosm
- stratum spinosum
- stratum basale
73
Langerhans cell
- migrate from epidermis to bone marrow
- immune defense against environmental triggers
- present antigens to T cells
74
Merkel cells
- touch receptors on epidermis
| - identifies stress occurring on skin
75
Keratinocytes
- produce keratin
| - promotes hydration of skin
76
what is the dermis composed of?
elastin
collagen
reticulum
gel-like ground substance connective tissue
77
Layers of the dermis
Papillary- hair follicles, sebaceous and sweat glands, blood/lymph vessels, mast cells (release histamine), macrophages
Reticular- histocytes and fibroblasts that help with wound healing
78
Eccrine sweat glands
- in dermis
- thermoregulators through evaporation
- palms, soles, forehead
79
Apocrine sweat glands
- stink!
| - scalp, axilla, genitalia, face, abd
80
Hypodermis
- deep, fatty layer of skin
- adipocytes and connective tissue
- veins and arteries run through this layer
81
Staging pressure ulcers
1. nonblanchable
2. partial; epidermis and/or dermis
3. full thickness: subcutaneous
4. full thickness; muscle, bone
82
atopic dermatitis
*eczema
severe pruritus- hallmark sign
eczematoid appearance with redness, edema, and scaling
83
where does atopic dermatitis appear in infants?
scaly red lesions appear on face, scalp, trunk, extensor surfaces of arms/legs
84
where does atopic dermatitis appear in children and adults?
neck, AC and popliteal fossa, hands, feet
85
chronic eczema
- thick, leathery, hyperpigmented skin
| - lichenification
86
stasis dermatitis occurs as a result of?
venous stasis
edema
vascular trauma
87
stasis dermatitis sequence of events
```
edema
erythema
pruritus
scaling
petechiae
hyperpigmentation
ulcerations
```
88
seborrheic dermatitis involves what areas of the body?
is it constant or intermittent?
```
-chronic skin inflammation involving:
scalp
eyebrows
eyelids
nasolabial folds
axillae
chest
back
```
-periods of remission/exacerbation
89
seborrheic dermatitis in infants
"cradle cap"
90
psoriasis
- T cell autoimmune mediated skin disease
- cells do not have time to mature or keratinize
- systemic: arthritis and CV disease
91
Lichen planus
- benign self limiting inflammatory disorder
- more prevalent during spring/fall
- may be linked to Hep C
92
manifestations of Lichen Planus
- nonscaling flat papular violet-colored lesion
- pruritus on wrists, ankles, lower legs, and ginitals
- oral=white lacy rings
93
acne vulgaris
- inflammatory disease of pilosebaceous follicles
| - hypertrophy of sebaceous glands and telangiectasia
94
acne rosacea
chronic immune mediated skin inflammation
| easily exacerbated
95
acne rosacea manifestations
- telangiectasia
| - rhinophyma (bulbous nose)
96
folliculitis
infection of hair follicles
S. aureus
pustules with erythema
97
furuncle
*boil
inflammation from preceding folliculitis
follicular wall into surrounding dermis
S. aureus, MRSA
98
carbuncle
collection of infected hair follicles
abscess can develop
erythematous, painful, drainage
99
cellulitis definition, cause?
infection in dermis/subcutaneous
| staphylococcus or GBS, MRSA
100
erysipelas definition, cause?
superficial cellulitis
acute infection of upper dermis
streptococcus pyrogenes
face, ears, lower legs
101
tinea cruris
jock itch
inner and upper surface of thighs
scaling vesicular patches, defined border
102
tinea manus
hand
dry, scaly, erythematous OR moist vesicular lesions
clusters, intense itching
103
HSV 1
infected saliva
| cold sores/fever blisters
104
HSV 2
genital infections
skin to skin contact during viral shedding
mother to neonate; high mortality
105
varicella and herpes zoster
what kind of virus?
where does infection occur?
DNA virus
infection occurs within keratinocytes
contact, airborne precautions
106
verrucae
cause?
transmission?
*warts
caused by HPV
transmitted by touch
107
manifestations of verrucae
rough, grayish surface
108
condylomate acuminata
venereal warts
sexually transmitted, highly contagious
oncogenic HPV primary cause of cervical cancer
109
condylomate acuminata
veneral warts- very contagious
sexually transmitted
cauliflower like lesions
110
kwashiorkor
protein deficient
1-4 years of age weaned from breast milk to high starch
can have leaky guy, inflammation, store fat in liver, pancreatic atrophy
111
marasmus
deficient in all nutrients (protein, carbs)
younger than 1 year old
stunned growth, muscle/fat wasting, anemia, diarrhea, dermatosis, low Hgb
112
gastrin
"stimulates secretion of gastric juice"
enhances relaxation of stomach
enhance peristalsis of stomach
113
cholecystokinin
stimulates digestion of fat and protein
114
D cells
somatostatin- inhibitory
decreases release of glucagon/insulin
slows gastric motility/perstalsis
115
Kupffer cells
phagocytic cells
| central to innate immunity
116
stellate cells
remove foreign substances from blood
| trap bacteria
117
pit cells
natural killer cells
| interferon y- tumor defense
118
what stimulates pepsin?
| what inactivates it?
acetylcholine stimulates
alkaline environment of duodenum inactivates
119
what is saliva composed of?
```
water with mucous
sodium bicarb
potassium
chloride
salivary amylase
```
**has IgA**
120
acute liver failure patho
hepatocytes become edematous, patchy areas of necrosis and inflammatory cell infiltrates disrupt the parenchyma
*hepatic necrosis irreversible
121
acute liver failure s/s
anorexia, N/V, abd. pain, progressive jaundice
122
consequences of portal HTN
varices
splenomegaly
hepatopulmonary syndrome
123
MCC of ascites
cirrhosis
124
hepatitis
autoimmune or viral inflammation of the liver
125
phases of hepatitis
Prodromal: 2 weeks post exposure to jaundice
Icteric: jaundice phase
Recovery: when jaundice resolves
126
manifestations of cirrhosis
nausea, anorexia, fever, abd pain, jaundice
127
cirrhosis patho
- irreversible inflammatory fibrotic disease that disrupts liver function
- biliary channels blocked, causes portal HTN
128
biliary cirrhosis
- begins in bile canaliculi and ducts
- primary: autoimmune- T lymphocyte mediated
- secondary: obstruction
129
black pigmented cholelithiasis
form in gallbladder
| chronic liver and hemolytic disease
130
brown pigmented cholelithiasis
bacterial infection in bile ducts
| bili stasis or bili parasites EW!
131
manifestations of cholecystitis
inflamed gallbladder
| - fever, leukocytosis, rebound tender, abd guarding
132
pancreatitis patho
- damage to pancreatic cells and ducts that causes a leakage of pancreatic enzymes into pancreatic tissues
- the enzymes can leak into blood and cause injury to blood vessels and other organs
133
chronic pancreatitis patho and manifestations
- destroyed acinar cells and islets of Langerhans
- pancreatic parenchyma destroyed
- s/s: may have continuous or intermittent abd pain
134
intussusception
- telescoping or invagination of one part of the intestine to another
- MCC: ileum into cecum
135
intussusception s/s
- abd pain
- vomiting soon after pain
- "currant jelly" stools (dark and gelatinous)
- infants: sausage shaped mass, colicky, flexes knees
136
Hirschsprung disease
- obstruction of colon
| - failure of neural crest cells to migrate to GI tract: "skipped segments"
137
Hirschsprung disease manifestations
delayed meconium, poor feeding, poor weight gain, abd distention
138
lower airways: pulmonary anatomy
trachea** who knew?!
bronchi
bronchioles
139
carina
ridge where trachea divides into R and L bronchi
140
hila
where R and L bronchi enters lungs
| blood and lymph vessels
141
goblet cells
produce mucous
142
surfactant
lipoprotein that coats the inner surface of the alveolus
| decreases surface tension which prevents collapse
143
left shift oxyhgb dissociation curve
- Hgb increased affinity for O2
- alkalosis
- hypothermia
- hypocapnia (hyperventilation)
144
right shift oxyhgb dissociation curve
- Hgb decreased affinity for O2
- acidosis
- hyperthermia
- hypercapnia (hypoventilation)
145
emphysema patho
- abnormal permanent enlargement of the gas exchange airways
- destruction of alveolar walls without obvious fibrosis
- loss of elastic recoil
146
primary emphysema?
| secondary?
primary- deficiency of a1- antitrypsin
secondary- cigs, air pollution, childhood resp. infections
147
emphysema manifestations
- thin
- dyspnea on exertion (may progress)
- little cough, little sputum
- tachypnea w prolonged expiration
- barrel chest
- tripod position
148
Laryngotracheobronchitis
who?
when?
*croup
6 mo-3 years old
late autumn/winter
149
causes of Laryngotracheobronchitis
commonly caused by a virus
- parainfluenza
- influenza A
- RSV
150
manifestations of Laryngotracheobronchitis
```
usually after episode of rhinorrhea
sore throat
fever
seal like barking cough
hoarse voice
inspiratory stridor
```
151
pulmonary edema patho?
| MCC?
- excess water in the lung from disturbances of capillary hydrostatic pressure, capillary oncotic pressure, or capillary permeability
- MCC- L heart fail
152
early asthmatic response
IgE causes mast cells to degranulate, releasing a large # of inflammatory mediators
- vasodilation
- increased cap. permeability
- bronchial smooth muscle contraction
- mucosal edema
153
ARDS patho and manifestations
alveoli fill with fluid
- massive pulmonary inflammation
- increased cap. permeability
- pulmonary edema
- shunting
- V/Q mismatching
- hypoxemia
154
manifestations of atelectasis
dyspnea
cough
fever
leukocytosis
155
posterior pituitary- ADH
ADH
- controls plasma osmolality (ADH released when increased)
- causes water reabsorption in the kidneys
156
too much ADH
```
SIADH
hyponatremia
hypoosmolality
urine hyperosmolality
hypervolemia
```
157
too little ADH
DI (neuro, nephro, dipsogenic)
- inability of kidney to increase permeability to water
- 3 P's
- inability to concentrate urine
Advanced Patho NP
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