2. HIV - lab values, transmission, (CD4 count) … (* Look for key words! 2
answers where CD4 count is low but second part of the Q is tricky)
(3Q)
a. Transmission: through blood, semen, vaginal fluids, breast milk
b. CD4+ count of 200 or less = AIDS!
the arteries).
ii. CAD is commonly divided into 2 types of disorders:
diagnosing MI
e. acute MI (could result from non-STEMI or STEMI)
5. Stress response (what does body do, what will be increased, what
would metastasize?
a. Metastasis = process of cancer cells moving from their original site to a
different site in the body; Gains access to blood and lymph channels to
metastasize to other areas (local to distant sites)
b. Where they metastasize depends…but medicine shows that there
are certain types of cancers that have a tendency to metastasize
to specific areas
i. ex. prostate cancer tends to metastasize to bone
ii. ex. breast cancer tends to metastasize to the lungs and
brain
iii. ex. liver cancer tends to metastasize lung
a. BENIGN NEOPLASM
i. Well-differentiated cells clustered together in a single mass
ii. Usually the cells resemble the tissue of origin (meant to be there)
but continuously grow and develop into tumors, complications can
occur when there is a mass invading a space (think about what else in
that space can be affected as a result), so benign tumors must still be
removed!
iii. Some benign tumors are also known for their ability to cause
alterations in body function by abnormally producing hormones
iv. The rate of growth is progressive + SLOW
v. Grow by expansion with no invasion of surrounding tissue NO
METASTASIS!
b. MALIGNANT NEOPLASM
involvement? not? (1 Q)
a. TNM classification system for clinical staging of cancer
i. T = size and extent of the main tumor.
1. TX = main tumor cannot be measured
2. T0 = main tumor cannot be found
3. T1,2,3,4 = refers to size or extent of main tumor (higher number = larger
tumor)
ii. N = number of nearby lymph nodes that have cancer.
1. NX = cancer in nearby nodes cannot be measured
2. N0 = no cancer in nearby nodes
3. N1,2,3 = refers to number + location of nodes that contain cancer (higher
number = more cancerous nodes)
iii. M = metastasis
1. MX = metastasis cannot be measured
2. M0 = cancer has not spread to other parts of body
3. M1 = cancer had spread
b. STAGES:
i. STAGE 1
1. intact skin
2. non-blanchable
3. erythema
4. no dressing!
ii. STAGE 2
3. ulcer drains
iii. STAGE 3
c. obesity
d. pregnancy
e. smoking
f. injury or surgery
g. cancer
14. VERCHOW’S TRIAD - what are the risk factors for the
development of thrombi? SELECT ALL THAT APPLY (hyper
coagulability state…)
15. what age group affected by either AML or ALL (50 yr old, 4 or 3-yr
old) … should have idea of what type of cancer it is coming in
hematemesis), diarrhea
cyanosis
v. HCO3 = 21 – 28
vi. O2 sat = 95 – 100%
secretions
1. Chronic inflammation of bronchi + bronchioles caused
by chronic exposure to irritants (irritants trigger
inflammation vasodilation, congestion, mucosal
edema, and bronchospasm)
2. Affects AIRWAYS ONLY - NOT ALVEOLI
3. Chronic inflammation increase # and size of mucous
glands and increase mucous production!
4. Decrease pAO2 (hypoxemia) and increased pCO2
(respiratory acidosis)
5. “Blue bloaters”
iii. COMPLICATIONS OF COPD:
1. Affects oxygenation and tissue perfusion to all tissues in
body
2. Hypoxemia + acidosis
3. Respiratory infection (b/c mucous accumulation and not
coughing it out…ENCOURAGE FLUIDS +
COUGHING!)
4. Cardiac failure (cor pulmonale = increase strain on
the R side of heart due to lung disease, so you’ll have
an increase pressure of blood flow through the lungs)
5. Cardiac dysrhythmias
iv. CONSEQUENCES COPD:
1. Decreased ability to exhale (b/c mucous productions)
2. Stale air in lungs
3. Low O2 levels
4. High CO2 levels
v. Arterial blood gases show hypercapnia and hypoxemia
vi. FEV1: will decrease
vii. Chest x-ray: show flattening of diaphragm because the lungs are filled with trapped air.
viii. Complete blood count: polycythemia, increase hemoglobin concentration
ix. When the patient goes into a respiratory failure the first thing the doctor checks is
Arterial blood gas (ABG) labs
x. Increased CO2 retention: hypercapnia. Because you can’t exhale the CO2.
xi. The most common indication seen in a patient is respiratory acidosis, pH less than 7.35.
xii. COPD can’t be cured but you can slow it down. STOP SMOKING!
MI
i. STEMI – most commonly transmural infarcts involve the full
thickness of the ventricular wall (usually LV and interventricular
septum); most commonly with SINGLE ARTERY OBSTRUCTION
1. ST- segment elevation = Q wave elevation
2. Acute Myocardial Infarction – ischemic death of myocardial
tissue; remodeling and stunning (structural changes), the
myocardial cells lose contractility. Cardiac cells can withstand
ischemia for approximately 20 MINUTES after that irreversible
infarction
ii. NSTEMI – most commonly subendocardial infarcts involve the inner
1/3 to inner ½ of the ventricular wall. Occur more frequently in
presence of severely narrowed but patent arteries
1. ST-segment depression = Q wave depression
hypoxia
ii. Pulmonary edema
1. Orthopnea
a. Cough with frothy sputum
b. Nocturnal dyspnea
water
b. Pee a lot
40. parathyroid lab values (don’t stress them but know NEG vs POS
feedback…)
a. low Ca+ in body high PTH secretion
b. decreased TSH
c. increased T3 + T4
bloodstream
2. contiguous spread = secondary to contiguous focus of infection;
direct inoculation from an exogenous source or from an adjacent
extraskeletal site
3. chronic osteomyelitis = occur secondary to an open wound
b. OSTEOPOROSIS metabolic bone disease; porous bones; susceptible to
fractures; imbalance in bone formation vs. breakdown
i. Old bone is being reabsorbed aster than new bone is being
made
there will also be some acid base imbalances, kidneys also play big
role in absorbing / activating vitamin D (kidney disease you will have
issues with lower calcium levels, phosphate imbalance (vitamin D
controls Ca+ and phosphorus levels in the blood), osteoporosis
sometimes b/c the kidneys absorb vitamin D and helps the body
absorb/maintain calcium and phosphorus levels
1. Causes:
a. Big one – HTN **
b. Anything that vasoconstrict … decreased flow
c. Smoking risk factor
d. Diabetes
e. Chronic pain medication use
f. Glomerulonephritis
2. Dx what stage do a biopsy
3. Renal insufficiency èup to 25%
4. Renal failure è is anything less than 20% of kidney fxn
5. Build up of waste, affects mind at risk for encephalopathy (a
disease in which the functioning of the brain is affected by some
agent or condition (such as viral infection or toxins in the blood).
6. Hyperphosphate, hypercalcemia, lactic acid elevated, risk for
CHF (b/c BP is off), risk for anemia (the RX itself is dialysis that
can cause hemolysis of the RBCs + platelet disfxn (so a lot of
peteichiae as well), confusion, encephalopathy
7. Decrease in EPO (erythryopoietin), as a result anemia
8. Protein urea measures injury repair
9. Neuro complications – increased ammonia
10. Main clinical manifestation = UREMIA (accumulation
of nitrogenous wastes)
11. Skeletal disorders b/c of PTH (not enough Ca+ in the blood,
so there will be excess PTH which tells the body to pull the Ca+
out of the bone and into the blood)
12. Anemia + coagulation disorders b/c EPO is decreased
13. “UREMIC FETOR” = urine-like odor in the breath
14. KNOW this pic:
c.
d. UTI is a big cause of pyelonephritis
a.
b. PRERENAL FAILURE most common form of acute renal failure **
i. BEFORE KIDNEY decrease in renal blood flow!
ii. Martinez: main thing to do with these patients is give tons of fluids to
perfuse the kidneys…mostly decrease in fluid or volume so
hypovolemic shock patients, clinically they will have less than 400 mL
of urine output a day (very little)….ultimately if you don’t perfuse the
kidney you will have ischemia hypoxia acute tubular necrosis
1. main cause of pre-renal failure = impaired perfusion (martinez)
2. Book: Causes of prerenal failure include profound depletion of vascular
volume (e.g., hemorrhage, loss of extracellular fluid volume), impaired
perfusion due to heart failure and cardiogenic shock, and decreased
vascular filling because of increased vascular capacity (e.g. anaphylaxis or
sepsis).
3. RESULTS:
4. GFR declines
5. Oliguria (~less than 400 mL of urine a day)
6. Ischemia hypoxia acute tubular necrosis (eventually)
7. Acute renal failure prerenal:
c. INTRA-RENAL FAILURE
i. Martinez: associated with ischemia or any type of nephrotoxicity,
inflammatory, destruction of the actual renal tubules (actual kidney
itself), damage to parenchyma of actual kidney….
1. Ex. acute glomerulonephritis an acute inflammation of the
kidney caused by an immune response (formation of immune
complexes in the circulation that start to deposit into the
glomerulus, so you have activation of the IgG (any time u see IgG
usually it means that its gone? when you see IgM its an acute)
2. Caused by any type of injury as result of nephrotoxic medications
(can be caused by antibiotic TX, a malignancy, or HTN that is out
of control)
3. *TEST pts that has strep throat can develop an acute post
strep glomerulonephritis (must treat patients quickly when
they have step throat) b/c the bacteria can transfer to the
kidneys; AMANDA look up uric acid cast, myoglobulin, rhabdo
breakdown of muscle tissue?
4.
ii. Intrarenal renal failure or acute kidney injury, as it is now more commonly
known, results from conditions that cause damage to structures WITHIN the
kidney.
iii. The major causes of intrarenal failure are ischemia associated with prerenal
failure, toxic insult to the tubular structures of the nephron, and intratubular
obstruction. Acute glomerulonephritis and acute pyelonephritis also are intrarenal
causes of acute renal failure. Injury to the tubular structures of the nephron is
the most common cause and often is ischemic or toxic in origin.
d. POSTRENAL FAILURE
i. the rate you produce the aqueous humor is higher than the
obstruction in the iris that is not letting the humor come out, so it
will stay inside and intraocular pressure will increase, compress
the optic nerve and the blood vessels
i. relief by sleep