Endocrine/Urinary/Reproductive
What are the three reportable STIs?
Chlamydia, Gonorrhea, Syphilis
Name the five different types of cellular adaptation.
Atrophy: decreased cell size that works to shrink a muscle; the result of decreased workload (muscle wasting; not a decrease in number)
Hypertrophy: increased cell size due to an increased work load; muscle gets bigger- can lose mobility; ex-bodybuilding
Hyperplasia: increased number of cells; can be a problem when the tissue is increasing in size and number; ex- enlarged prostate
Metaplasia: the replacement of normal cells with abnormal cells; from chronic exposure to something where the body will adapt the cells to live in that certain environment;
ex) Barrett’s esophagitis- can be a precursor to cancer, smoker: lining of bronchi changes to abnormal cells
Dysplasia: a permanent mutation of a normal cell, can never return to normal; will turn into cancer if not removed; ex- cervical dysplasia
What are the most prominent EKG changes with Hyper and Hypokalemia?
Hyper-peaked T-wave
Hypo- flattened t-wave
Name the differences between Kyphosis, Lordosis, and Scoliosis.
Kyphosis
-increase in the curvature of the thoracic spine outward
Lordosis
-concave exaggeration of the spine (seen in pregnancy)
Scoliosis
-lateral deviation (like a snake)
Name the three types of vascular birthmarks.
*macular stains: called salmon patches, angel kisses, stork bites
Most common birthmark
Faint red marks on the forehead, eyelids, posterior neck, nose, upper lip, posterior head
Becomes bright red when the baby cries
Fades by 2 years
*hemangiomas: called strawberries
Bright red patch
Can be superficial or deep
Grows during the child’s first year
Some can leave scars (can be rectified with plastic surgery)
Usually found on the head and neck, but can appear anywhere (location can impair certain functions such as sight, breathing, or feeding)
Tx: steroids
*port-wine stain: looks like wine
Mostly found on the face, neck, arms, legs
Can be any size
They typically darken and thicken over time
Does not resolve on its own
Can cause possible sight issues
Tx: laser therapy (attempts to burn it off)
What are the two conditions that are typically associated with hyperpituitarism?
Increased GH- Acromegaly (increases bone size; larger hands, feet, large head or skull)
SIADH- too much ADH; retaining fluid
Name and define the five different types of pain.
Somatic pain- painful stimuli to skin, joints, muscles, and tendons (easy to pinpoint)
Visceral pain- painful stimuli to internal organs (symptoms more vague, diffuse, and can be sensed in parts of the body away from the originating organ- referred pain-; gallbladder pain in shoulder and ribcage/ jaw pain for acute MI)
Phantom pain- pain after removal of a body part (seen with amputations, may go away from some but not for others; body not recognizing severed nerves-may admin psych drugs; acute amputation: pain may go away, however chronic amputation-pain may be persistent)
Intractable pain- chronic, unrelenting, and debilitating pain (does not respond well with medication, comes from traumatic, crushing injuries-MVA-, can lead to amputation for pain relief)
Neuropathic pain- pain from damaged peripheral nerves( diabetes, PVD, chronic, can turn intractable)
Name the two types of stress ulcers and what they are associated with.
*stress ulcers: develop d/t a major physiological stressor on the body (widespread burns, massive trauma, MVA, sepsis, TBI)
Curling’s ulcers- associated with burns
Cushing’s ulcers- associated with TBIs
-most frequently develop in the stomach; ulcers can from w/n hours of an event
*give prophylactic meds (GERD meds)
What is the difference between passive and acquired immunity? What type of immunity do these fall under?
Active acquired: immunity gained by actively engaging with antigen (vaccinations, direct exposure)
Passive acquired: immunity gained by receiving antibodies made outside of one’s own body (mom to baby, breastfeeding, covid antibodies)
Adaptive humoral immunity
Stage 1: skin is intact, nonblanchable erythema is present
Stage 2: erosion or blister with or without true ulcerations, no exposed subq tissue
Stage 3: full-thickness skin loss with damage to the subq tissue down to underlying fascia
Stage 4: full-thickness skin loss with extensive destruction, tissue necrosis, and damage to exposed supporting structures (muscle, tendons, even bones)
Unstageable: full-thickness skin and tissue loss in which the extent of damage cannot be determines d/t slough or eschar
*tunneling
Name the two main types of diabetes and what the pathology is of each type.
Type one: previously called insulin-dependent or juvenile-onset
The immune system destroys the beta cells in the pancreas
-irreversible
-trigger to cause the issue: infection, physical stress, emotional stress
type 2: Previously called non-insulin-dependent or adult-onset
-typically begins as prediabetes
Risk factors: advancing age, obesity, family history, history of gestational diabetes, physical inactivity, African Americans, Hispanics, Native Americans, Asians, Native Hawaiians or other Pacific Islanders
-initially managed with oral antidiabetic medications (helps to produce more insulin or improve the quality that is produced)
-supplemental insulin is often necessary as pancreatic production declines
-try to keep the A1C under 7
Name and define the four types of necrosis.
Liquefactive: something triggers a corrosive enzyme in the body to get released; when released it dissolves the cells and tissue into a more liquid state (ex- issue with the brain, TBI, head trauma, stroke
Caseous: cells that die off and the debris from this stays in the tissue for too long; can stay in the tissue for months-years, and degenerates the tissue in that area→ cottage cheese appearance (ex- TB)
Fat: involves the fat- lipase enzymes that break down the triglycerides into fatty acids where it combines with electrolytes and creates a “soap”; compromised of dying tissue that has a chalky, opaque appearance (ex- * injury to breast (surgery, trauma), abdomen)
Coagulative (ex- gangrene): gangrene from impaired BF + infection, Related to the blood
What is GERD and how do you help mitigate the symptoms?
-chyme and bile that periodically backs up from the stomach into the esophagus
-the acidity causes a lot of irritation and can be damaging to the mucosa
Main cause: lower esophageal sphincter dysfunction (age, certain conditions or foods)
Triggers: spicy food, citrus, chocolate, caffeine, coffee, tea, soda, carbonated beverages (sparkling water), tomatoes, peppermint, *alcohol, nicotine, hiatal hernia, obesity (weight pushes against the sphincter), pregnancy (esp. In last trimester), medications, delayed gastric emptying
s/s: heartburn, epigastric pain especially after eating or lying down on the back, dysphagia, dry, non-productive cough(caused by irritation of the esophagus), laryngitis, pharyngitis, feels like something is stuck in the throat, regurgitation
*may be confused for a heart attack since they might think they experience angina; rule out cardiac issues first
-chronic esophagitis- causes the mucosa to become ulcerated→ ulcers cause Barrett’s esophagitis which is a precursor to cancer
Can also cause strictures, ulcers
*do not leave untreated
Bile and chyme can enter the trachea and cause COPD, chronic cough, asthma attack
Dx: h/p, barium swallow, EGD, *esophageal pH monitoring (NG tube in the nose with measuring device, swallowable capsule that measures pH as it passes through the system), manometry, imaging to r/o other conditions
Tx: avoid triggers, avoid clothing restrictive around the waist (reduce psi), eat small, frequent meals, High fowler’s positioning for 2-3 hours after meals, weight loss, stress reduction (the flight or fight response increases the production of stomach acid), elevate the HOB (at least 6 inches; harder to backflow being upright), meds: antacids, acid-reducing agents, mucosal barrier agents, herbal therapies (licorice, chamomile, slippery elm), surgery (tighten the lower esophageal sphincter to being a smaller opening and a tighter close)
Name 10 of the types of fractures.
Simple- single break in the bone where the ends maintain their alignment and position
Transverse- a break straight across the bone
Oblique- the fracture is at an angle to the bone shaft
Spiral- fracture twists around the bone shaft; typically seen in child abuse
Comminuted- multiple fracture lines and multiple bone pieces
Greenstick- incomplete break; common in children and heals quickly; bones not calcified
Compression- bone is crushed or collapse into smaller pieces; can happen spontaneously in older adults especially when the bones become more brittle
Complete- the fracture has broken into two or more separate pieces
Incomplete- the bone is partially broken but not all the way through
Open (compound)- the skin in broken and bone fragments or edges protrude out of the skin; causes more damage to the soft tissue; risk of infection
Closed- skin is intact
Impacted- one end of the bone has been forced into the adjacent bone
Pathologic- secondary to other conditions; tumors, osteoporosis,
Depressed- occurs in the skull only; a broken piece is forced inwards toward the brain
Stress- repeated excessive stress; bones in the feet
What are the two conditions that contribute to COPD and what is seen with each.
Chronic bronchitis: increased mucus production in the trachea and bronchi. This causes a productive cough for at least 3 months of a year for two consecutive years. Often referred to as “blue bloater.” This is d/t the cyanosis and there are signs of peripheral edema. Ronchi, crackles, wheezing. Mild signs of respiratory distress.
Emphysema: obstructive disease that results in increased lung expansion d/t air trapping; causes irreversible damage to the alveolar walls and causes permanent enlargement of the air spaces. This then makes it difficult to exhale air out of the lungs. Referred to as a “pink puffer” d/t red or pink skin and a barrel chest bc of increased lung volume. Diminished breath sounds. s/s of severe respiratory distress (pursed lip breathing and use of accessory muscles).
What is glomerulonephritis? What are the two types are what is seen with each type?
Main cause: strep infection
*the leading cause of renal failure; (other two causes is HTN and diabetes)
Impacts more men than women
With the inflammation- impairs the kidneys’ ability to excrete waste and excess fluid
2 types:
Nephrotic- results from antibody-antigen complex; gets lodged in the membrane of the glomeruli; triggers a massive inflammatory response,
Causes: T2DM, Hep B, Lupus (systematic diseases) gold therapy (used for medication and tx of RA), NSAIDs, idiopathic
Membrane of the glomeruli become more permeable; protein, lipids, and fats in the urine, less circulatory albumin, third spacing (anasarca), dark, cloudy urine (brown or coca-cola urine), immunoglobulins in the urine
-risk for infection and atherosclerosis (d/t to permeable membrane lipids enter bloodstream and vessels)
Nephritic-results from antibodies; solely caused by strep infections
s/s: gross hematuria (large amount of blood), urinary casts (extra byproducts of cell destruction noted in the blood), increased leukocytes, low GFR (leading to end-stage renal disease), azotemia (high levels of urea in the blood), oliguria (less than 400mL in 24 hrs), HTN
Tx: antibiotics, steroids, BP meds, temporary dialysis, if caught early there is general recovery with minimal damage
Name the differences between Meniere's disease and Vertigo.
-disorder of the inner ear (typically the result of swelling or stertching inside the membranes of the ears; interferes with the hair receptors that help us recognize sound)
Cause: unknown (could potentially be fluid buildup, seasonal allergies, sinus infections, head trauma, autoimmune conditions)
-see more in women, first emergence/exacerbations of the disease bw ages 20-50 y.o.
s/s: acute/ intermittent episodes of vertigo, tinnitus, unilateral hearing loss, sensation of fullness, n/v, diarrhea, headache, uncontrollable eye movement (typically unilateral, same side as the affected ear)
-barometric psi drops make the exacerbations worse
Dx: h/exam, neuro assessment, hearing/balance test, imaging
*can result in permanent hearing loss
Tx: relieving the inner ear pressure (drain fluid if there is buildup) and relieving symptoms (meclozine for vertigo, fennigrin, immodium)
NO CURE
Vertigo: illusion of motion (feels as if everything is spinning)
*peripheral (the problem originates in the ear) vs central (the problem originates in the brain)
-having meniere’s, can be triggered by the drop in barometric psi, triggered by ear infection, sinus infection(peripheral), stroke patients, having brain tumors, MS, migraines, seizures, TBI (central)
Additional s/s: n/v
Causes: depends on the type
Dx: h/exam, test to identify the underlying cause (CT of the brain, looking for s/s of infection)
Tx: anticholinergic agents
Antihistamines→ suppress the nucleus from firing, which reduces the stimulation that one is spinning
Benzodiazepines→ calm the patient to function
Antiemetics
Safety precautions→ prevent falls, no driving or walking
What are the four alterations that occur to our ABGs and what is seen with each?
Metabolic acidosis: too much hydrogen ion (too much CO2) OR not producing enough Bicarb
Causes of acid excess- tissue injury or tissue hypoxia resulting in lactic acid buildup; results in anaerobic metabolism; can be r/t medications, toxins, kidney problems (end-stage renal disease), ketoacidosis, rhabdomyolysis
Causes of low bicarb- vomiting, diarrhea, kidney problems
s/s: headache, malaise, lethargy, coma, Kussmaul’s respirations (deep, rapid, labored breathing)
Tx: treat underlying cause or reverse it, give more bicarb
Metabolic alkalosis: too much bicarb or not enough acid (or both)
Causes of excessive bicarb: meds with bicarb, antacid use, LRs,
Causes of deficient acid: GI losses (v,d), kidney disease, low potassium
s/s: neuro related, confusion, hyperactive reflexes, paresthesia, tetany (muscle spasms), seizures, depressed respiratory system, coma
Treat underlying cause; replace electrolytes; admin Diamox to pee off bicarb,
Respiratory acidosis: any problem in the lungs that causes CO2 retention
Causes: asthma exacerbation, COPD, pulmonary edema, pleural effusion
s/s: headache, tremors, muscle twitching, tachycardia, bradycardia, hypotension
Treat underlying cause, give O2, and admin meds that improve resp. System (bronchodilators)
Respiratory Alkalosis: a problem in the lungs that causes exhalation of too much CO2 (hyperventilation)
Causes: anxiety, pain, high fever, severe hypoxia, ASA overdose
s/s: parethesia, dizziness, light-headedness, syncope, vertigo, irritability, muscle twitching, tetany, seizures,
Treat underlying cause, can have them breathe into paper bag, in severe cases, may need to be intubated
Name the four types of hypersensitivities and an example for each.
Type 1- IgE mediated, immediate, local, or systemic
-T-helpers stimulate B cells to produce IgE that sensitizes mast cells and basophils
-requires repeated exposure to allergen (typically second exposure)
-causes: hay fever, pollen, seasonal allergies, food allergies
Type 2- cytotoxic hypersensitivity, immediate, targets single cells
-IgG/IgM antibodies bind to antigen on individual’s own cells, triggering antibody production in macrophages (originates in B cells, one cell in the body seen as antigen)
-cell lysis occurs due to activation of complement protein and phagocytosis
Cause: blood transfusion reaction, hemolytic anemia (Rh factor
Type 3- immune-complex mediated; delayed, local, or systemic
-antigen-antibody complexes accumulate in tissue, triggering complement system’s inflammatory response
*created large masses, created IgG
Causes: autoimmune conditions (lupus, RA, rheumatic fever, celiac)
Type 4- delayed hypersensitivity, two phases: sensitizing-primary contact with antigen and effector- second exposure and up to 3 day reaction
-cell-mediated (T cells); not antibody mediated, antigen presentation results in cytokine release, severe tissue injury, and fibrosis
Causes: transplant rejection, contact dermatitis
Define stroke volume, ejection fraction, preload, and afterload.
stroke volume: amount of blood ejected from the heart with each contraction
→ ejection fraction: how much blood the L ventricle pumps per contraction (never at 100%; healthy is 50-70%) (can be LVEF)
-afterload: pressure needed to eject blood (depends on viscosity and amount of peripheral resistance)
-preload: amount of blood returning (dependent on blood volume, and the efficacy of the venous system)
Name the phases of AKI and the stages of chronic kidney disease including the GFR for each stage.
AKI: Asymptomatic
Oliguric (less than 400 mL in 24 hrs); fluid volume excess, azotemia, HTN, metabolic acidosis
Diuretic (output greater than 5 L a day); fluid volume deficit, dehydrated, abnormal electrolytes, hypotension,
Recovery phase; GFR returns to normal, can take up to 2 years
CKD:
Stage 1- kidney damage is evident but the GFR is still normal (greater than 90)
Stage 2- GFR decreased to 60-89
Stage 3- GFR- 30-59
Stage 4- GFR 15-29
Stage 5- GFR is less than 15 and dx with end-stage renal disease; dialysis, kidney transplant
Name the two types of glaucoma, their manifestations, and treatment.
Open-angle: most common, psi increases gradually (over years; will be painless, typically affects both eyes/ bilat, will have tunnel vision, blurry eyesight, halos around lights, color discrimination problems); tx is focused on decreasing intra-ocular psi→ beta blocker eye drops, may need surgical intervention (laser therapy)
Angle-closure: sudden blockage of aqueous humor outflow; (sudden blockage of the fluid in the eye; could be caused by a traumatic eye injury/MVA/assault, sudden pupil dilation, prolonged pupil dilation; sudden eye pain that is severe, headache, n/v, hazinees of the cornea, halos around the lights, may have non-reactive pupils, eye becomes red and edematous); tx is normally laser surgery or releasing the psi via drilling hole in the iris→ once the psi relieves a bit try beta blockers
Name the five different types of anemia and what is seen with each.
*Iron-deficiency anemia
Cause: decreased iron intake/absorption, increased bleeding
s/s: cyanotic sclera, brittle nails, decreased appetite, headache, irritability, stomatitis, pica, delayed healing
Dx:blood smears (anemia produces RBCs that are smaller)
determine underlying cause (stop the bleeding), supplemental iron intake, supplemental vitamin C intake
Pernicious Anemia
-anemia due to Vitamin B12 deficiency
*typically caused by autoimmune destruction of the parietal cells in your stomach (lack of intrinsic factor which helps with absorption of B12)
s/s: bleeding gums, diarrhea, impaired smell, loss of deep tendon reflexes, anorexia, personality or memory changes, stomatitis, paresthesia(numbness and tingling), unsteady gait, nose bleeds, heavy periods
Dx: serum B12, antibody testing, CBC, reticulocyte count (how well does the body respond to making RBCs), blood smears (the RBC will be large)
Tx: B12 supplemental intake (cyanocobalamin)- can be oral or nasal
-no intrinsic factor at all- sublingual or injection
Aplastic Anemia
-bone marrow depression of all blood cells
Causes: idiopathic/ autoimmune conditions (lupus, RA)
medications/ treatments (abx, anticonvulsants, chemo)
Viruses (ebv, hepatitis DEF), toxins (pesticides), infectious disease (HIV, covid), pregnancy, cancer
s/s: pancytopenia
Dx: CBC, bone marrow biopsy, bone smear (cells look normal in size)
Tx: addressing the underlying cause
(blood transfusion, platelet transfusion, infection prevention- no visitors, no fresh fruit or flowers, avoid sick people or crowds, prophylactic rounds of abx); monitoring for bleeding
Hemolytic Anemia
-excessive erythrocyte destruction, or hemolysis (could be dying off too quick)
Causes: idiopathic/autoimmune causes
Types:
-sickle cell anemia: erythrocytes are crescent/sickle shaped (inherited disorder)
*RBC typically round, impaired shape impairs the ability to transport hemoglobin
Cause: hemoglobin S
*primarily found in african americans (1 in every 350-400); can also be found in hispanics, middle eastern, mediterranean, asians, indians
s/s: abdominal/bone pain, dyspnea, angina, stroke (blood cells get stuck in organs and do not flow as smooth in the bloodstream d/t shape)
Dx: hemoglobin electrophoresis(pull the erythrocytes out to see how many are sickle shaped), CBC, Bilirubin tests (bilirubin is the byproduct of when a sickle cell breaks down, it can cause liver failure)
Tx: medications(analgesics), avoiding triggers(no dehydration, avoid infection and fevers, avoid cold temps-vasoconstriction), O2, IVF (more fluids help the sickle cells from getting stuck), pain management, genetic counseling(can pass it onto children), stem cell/bone marrow transplants, infection control measures (hand hygiene), vaccinations against infections (get the flu vaccine, pneumonia, covid), blood transfusions
-thalassemia:
Genetic disorder in which abnormal hemoglobin arises d/t lack of either alpha or beta globin (produced in the liver and are important since they transport different nutrients to the red blood cell)
-cells are more flat and rectangular in nature
s/s: hypercoagulability (more likely to produce a clot), ineffective erythropoiesis (the bone marrow produces red blood cell precursors that help develop red blood cells, die off prematurely before they form a true blood cell); (will die off quickly)
-delayed growth and development in babies that make it to full term
-these cells like to get stuck in the liver, causing jaundice
-SOB
-can have kidney impairment: dark urine
-premature heart failure, premature cardiomegaly
-chance for spleen rupture
-bone deformities
Dx: CBC, hemoglobin test (how much hemoglobin per cell)
Tx:Blood transfusion
Iron chelation therapy (pulls excess iron out of the blood; this helps when blood transfusions are given to avoid critically high levels of iron)
Folic acid supplements (can sometimes help with the shape of the cell), blood/bone marrow stem cell transplants, splenectomy, infection control (same interventions as with sickle cell to avoid triggers)
Describe a TIA and CVA, what can be seen with each and how to treat.
Transient Ischemic attack (TIA)
-temporary episode of cerebral ischemia; results in temporary symptoms of neurological defects
-normally only last for a few minutes; typically resolved within 24 hours
-warning sign that a CVA may be impending; not everyone will have a TIA prior to a CVA
-ischemia can occur for various reasons during a TIA (clot, plaque, artery stenosis, cerebroarterial injury- severe hypertension)
Risk factors: migraines, smoking, DM, advancing age, inadequate nutrition, hypercholesterolemia, oral contraceptive use, excessive alcohol consumption, illicit drug use
Complications: permanent brain damage, injury from falls, CVA
-manifestations start very suddenly and last for a short period of time
*same manifestations as a stroke (2-30 minutes; resolves w/n 1-2 hours)
s/s: muscle weakness or paralysis of the face, arm, or leg, unilateral paresthesia, aphasia (difficulty speaking) or receptive aphasia (difficulty understanding), dysphagia, dysgraphia (difficulty writing), difficulty reading, vision issues (diplopia, blurred vision, partial or complete loss of vision), changes in sensation, changes in levels of consciousness, personaliy/mood/emotional changes, confusion, agnosia, ataxia (poor coordination), vertigo/dizziness, incontinence
Dx: h/p, head CT, CTA, MRI, MRA, carotid ultrasound, cerebral ateriogram, EEG, blood tests (looking for hypercholesterolemia, hyperlipidemia, thick or thin blood)
Tx: manage any underlying conditions. Antiplatelet meds, anticoagulants, angioplasty, carotid endarterectomy (cut out blocked artery and reattach)
-smoking cessation, minimize dietary cholesterol and fat, increase fruit and veggie intake, exercise regularly, limit alcohol consumption, no illicit drug use
Cerebrovascular accident (CVA)
Causes: total vessel occlusion or cerebral vessel rupture
-blood thinners, antiplatelets, or clot busters to tx clot formation
Types:
-ischemic (damage is permanent); typically from an occlusion
-hemorrhagic; ruptured blood vessels; less common, most fatal
*5 minutes of altered brain perfusion can cause permanent brain damage
Complications: neurologic deficits and death
Risk factors: physical inactivity, psychosocial stress, obesity, hypertension, smoking, dyslipidemia, DM, atherosclerosis, oral contraceptive use, excessive alcohol consumption, illicit drug use, advancing age, African Americans, Hispanic, living in the southeastern U.S.
-manifestations are similar to those in a TIA; symptoms do not resolve
-manifestations may improve with time and therapy but they can remain, creating complications
*headaches may be present with hemorrhagic strokes d/t increasing ICP
-Intervening w/n the first 3 hours can have better outcomes
Dx: h/p, head CT, MRI
Tx: requires prompt treatment to minimize brain damage
Determining whether the CVA is ischemic or hemorrhagic in origin prior to treatment
Ischemic strokes: thrombolytic agents, ASA, angioplasty, carotid endarterectomy
Hemorrhagic strokes: surgical repair of aneurysms and blood removal
-hypertonic saline and antihypertensives
-multidisciplinary team management
-strategies to prevent complications of immobility
Name Blood Flow through the heart OR the different types of Pneumonia.
Inferior and superior vena cava
Right atrium
Tricuspid valve
Right ventricle
Pulmonic valve
Pulmonary arteries
LUNGS
Pulmonary veins
Left atrium
Mitral valve
Left ventricle
Aortic valve
BODY