Disambiguation
What is it called when a person "bears down": Is it the Valsalva Maneuver or the Heimlich Maneuver?
VALSALVA
Which process comes first among Post-Mortem Changes in the body: Putrefaction (microbial decomposition of tissue) or Livor Mortis ("Blue Color Death")?
LIVOR MORTIS
Someone puts an ungrounded piece of metal into an electrical outlet and as a result experiences burns on several parts of their body. This is an example of what type of injury:
Biologic, Chemical, Physical, or Nutritional?
PHYSICAL AGENT (one subtype of which on Darrah's outline is "electrical")
TRUE OR FALSE: The cardinal signs of acute inflammation include: Heat, Swelling, Necrosis, Redness, and Loss of Function
FALSE
necrosis is not a cardinal sign, rather pain is.
The 5 cardinal signs again are:
redness, swelling, heat, _pain_, loss of function
A teenage friend of yours with DM presents with confusion, slurred speech, and decreased level of consciousness (LOC). Although there are a number of conditions that could lead to these signs and symptoms, the fact that they recently gave themselves an injection of Regular (fast acting) Humalog insulin yet have not eaten anything recently cause you to suspect this as as the most likely cause
HYPOGLYCEMIA
Tumor Necrosis Factor (TNF) and Interleukin (IL) are examples of which of the following: Arachidonic Acid Metabolites, Cytokines, or Free Radicals?
CYTOKINES
the main agitator of the immune response
When immobility leads to the weakening of bone matrix, which is HIGHER, osteoblastic activity or osteoclastic activity?
OSTEOCLASTIC ACTIVITY
(i.e. the process of breaking down bone)
is greater than osteoblastic activity
(i.e. the process of building up bone)
Charcot deformity (no foot arch), blindness, renal failure, GI dysfunctions (such as nausea, vomiting, diarrhea, and constipation), neuropathic pain or numbness, hypertension, coronary artery disease, and peripheral vascular disease are ALL potential complications of this condition
CHRONIC HYPERGLYCEMIA as a result of uncontrolled Diabetes Mellitus (DM)
TRUE OR FALSE: Venous pooling as a result of immobility leads to Orthostatic Hypotension
TRUE
This form of Diabetes Mellitus (DM) often is "insideous," slow to develop and often showing no outward signs for quite a while
TYPE II DM
Explain the difference between these two types of cellular adaption: Hypertrophy and Hyperplasia
Hypertrophy is when cells of a certain type get LARGER, whereas Hyperplasia is when the NUMBER (not the size) of the cells increase
The VASCULAR phase of the Inflammatory Response includes (step 1) brief vasoconstriction that is followed by vasodilation (characterized by redness&warmth in tissues); and (step 3) leakage of fluid into the extravascular space (characterized by edema, pain, impaired function). WHAT IS THE STEP IN BETWEEN THESE (i.e. what is step 2)?
INCREASED VASCULAR PERMEABILITY
meaning that capillaries become more permeable to fluid leaking out, allowing for step 3 (leakage of fluid into ExtraVasc Space) AND causing the blood to become more concentrated and more viscous
What happens when there is an excess accumulation of Calcium inside of a cell due to Impaired Calcium Homostasis?
It actives enzymes that break down the cell (the "-ases"), causing the cell to degrade
[recall the film clip of the Joker falling into the vat of green acid]
TRUE OR FALSE: Cell changes tend to be a very early sign of injury in the body
FALSE
Cell changes are a LATE sign of injury, only manifesting after a long process of cellular adaptation, and only when cell function is lost
Are hyponatremia, fatigue/sleepiness, and blurred vision signs and symptoms more characteristic of Acute Hyperglycemia or Chronic (long-term) Hyperglycemia?
ACUTE HYPERGLYCEMIA, fatigue being most common.
These s/s manifest together with other s/s including:
The 3 Ps: Polyuria, Polydipsea, Polyphagia
Skin infections
DKA and HHC
Explain the difference between the "Dawn Phenomenon" and the "Somogyi Effect"
The Dawn Phenomenon is part of normal circadian rhythm that we all go through, where a person's blood glucose hits its lowest level in the middle of the night (around 5 AM);
the Somogyi Effect is the body's overreactive response to low blood glucose, where hypoglycemia at any time of day leads a few hours later to HYPERGLYCEMIA as the body attempts to correct and it overcompensates
One of the three main pathways Tom describes progressing from Chronic Hyperglycemia is MACRO-VASCULAR, i.e. "Blood Vessel Endothelial Damage." Which of the following disease complications does NOT result from this pathway: Hypertension, Peripheral Vascular Disease, Stroke, Renal Failure, Heart Attack
RENAL FAILURE
because, according to his chart, this stems from the "Capillary" pathway instead, Glomerulosclerosis causing Diabetic Nephropathy causing Renal Failure.
Free Radicals damage cells in three distinct ways. NAME AT LEAST TWO
1) DAMAGE CELL MEMBRANES
2) DAMAGE CELL PROTEINS
3) DAMAGE CELL DNA and RNA
TRUE OR FALSE: If Total White Blood Cell (WBC) count is over 10,000, that is higher than normal limits and is often a sign of infection, inflammation, and/or tissue necrosis.
TRUE
This is the internal biological reason why a patient who has hypoglycemia may present with s/s such as tremor/shaking, tachycardia, and sweating (diaphoresis)
These are all ADRENERGIC s/s that follow from the Adrenal glands releasing EPINEPHRINE in response to low blood glucose
Name TWO of the the THREE DIFFERENT TYPES of Cellular Necrosis, and explain how they are different
2) COAGULATIVE = denaturing of enzymes and structural proteins, turning wound site into firm gray mass, characteristic of hypoxic injury
3) CASEOUS = dead cells persisting with "cheesy" consistency, most commonly seen in TB tubercles
There are THREE main pathways for what Darrah labels the "Stress Response." Name at least TWO and describe them
1) Sympathetic Adreno-Medullary (S.A.M.) Axis, stress releases catecholomines
2) Hypothalmus-Pituatary-Adrenomedullary (H.P.A.) Axis, stress releases cortisol
3) Immune System, interacting with endocrine response to stress leads to depressed immune response
For more details, see notes from Week 1 lecture
This is the name for a serious skin breakdown that can result from someone who is immobile in bed for a long period of time, caused by skin occlusion on pressure points leading to ischemia together with the wetness resulting from sweat that is not allowed to evaporate.
DECUBITUS ULCER
TRUE OR FALSE: Although Hyperkalemia (high blood K+) may be an early stage of disease progression in Type I DM, late disease progression more commonly leads to HYPOKALEMIA (low blood K+)
TRUE
Hyperkalemia is only a temporary reaction to Increased H+ ions and More H+ excreted in urine (see the center of the chart) whereas increased glucose in the urine and eventual decreased Perfusion leads over time to Hypokalemia as well as Acute Renal Failure (see the bottom left side of chart)
When a person with DM presents with poor pupil accommodation, this is just one of a number of s/s (along with bladder dysfunction, sexual dysfunction, GI dysfunction, CV dysfunction, etc) that are part of the "Autonomic Dysfunction" category of symptoms that all result from THIS pathway
The Neurologic pathway of reactions to Chronic Hyperglycemia (see the handout) where Glucose Accumulates in Nerve Cells and leads (on the bottom portion of the chart) to DIABETIC NEUROPATHY and from there potentially to Autonomic Dysfunction (see bottom left)