Patho Notes for Final Exam

8/17/2019 Patho Notes for Final Exam

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9 Pathology Blueprint Final Exam

85 questions 2 hours

1) Assessing patient for paino COLDSPA

2) Discerning what things go where on patient’s health histor!) Assessing for co""on s#in changes $!)

o Occurs in aging s#in% hair% an& nailso S#in

Pale S#in lesions Dr Lose turgor $chec# ' pinching of s#in)

o (air thinnero *ails thic#ene&% ellow% 'rittle $not ellow nail sn&ro"e +ust aging) $if all nails ha,e

the changes then pro'a'l local- .f on +ust one or few nails% then pro'a'l not local)$sste"ic ,s local causes of nail pro'le"s)

/) 0n&erstan&ing #i&ne stones $)o enal calculi are a tpe of o'structi,e &isor&ero enal Calculi $3heories)

Saturation theor 0rine is supersaturate& with stone co"ponents- $calciu"%salts% uric aci&% "agnesiu"% phosphorous% csteine)

4atri theor Organic "aterials act as a ni&us for stone for"ation- $crstals 6

organic co"ponents crstali7e an& all things li#e calciu" an& salts to attach to) .nhi'itor theor A &ecienc of su'stances that inhi'it stone for"ation- $natural

stone inhi'itors are "agnesiu" an& citrate)• 3a"horsphalt 6 4ucoprotein $glucoprotein) that is pro&uce& ' #i&ne to

&ecrease crstalli7ation *o one reall #nows eactl how this is cause&

o 9our 3pes of enal Calculi Calciu" stones $i-e-% oalate or phosphate)

•

4ost stones are calciu" oalate or calciu" phosphate• .ncrease& calciu" in the 'loo& an& urine so we get renal calculi% ecessi,e

'one resorption $'one loss which is people on steroi&s% el&erl% an& thei""o'ile) therefore e,erone at the hospital is at ris# for renal calculi

4agnesiu" a""oniu" phosphate stones

• Stru,ite

• Cause& ' 'acteria that has urace which increases the phosphate

• Causes (0:; stones calle& stag horns

• 3hese stones ou can’t get out with a laser ou nee& surger

• 3he cause a lot of &a"age 0ric aci& stones

• :out or situations that increase uric aci& li#e che"otherap• 0ric aci& stones grow 'est in an aci&ic en,iron"ent

• (igh purine &iet Csteine stones

• A"ino aci&

• 0suall what #i&s get $genetic &efect)

• Causes the" to get the stru,ite stones 'ut there is no 'acteria so no

infection process enal Colic

• 0reters stretching fro" the stone


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9 • Pain in the


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9 o *o 'loo& test conr"s this F +ust 'ecause ou ha,e high uric aci& in 'loo& &oesn’t

"ean ou ha,e gouto .ncrease& seru" uric aci& crstals precipitate in the +oint in0* Oliguria 6 0rine output less than /GG "L per &a Anuria 6 0rine output less than 5G "L per &a (igher specic gra,it H 4O; concentrate& urine Lower specic gra,it H D.L03; "ore Iwater’ urine

o Phases of Acute enal 9ailure .nitiation phase 6 Onset- >egins with the initial insult an& en&s when oliguria

&e,elops• .ncrease in >0* an& creatinine that can last hours to &as

• 0rine output is less than !G "L or less per hour $anuria) Oliguric phase 6 Decrease in urine output approi"atel 1GG 6 /GG "LE2/ hours-

.t &oesn’t respon& to 0*% potassiu"% an& "agnesiu"

• Decrease in 'icar'onate% calciu"% an& :9

• 9 F ; a'nor"alities% an& "eta'olic aci&osis

• Can last fro" 1J2 wee#s

• 0re"ic s"pto"s rst appear an& lifeJthreatening con&itions such as

hper#ale"ia &e,elop

Diuretic phase 6 Occurs when the source of the o'struction has 'een re"o,e&'ut there is resi&iual scarring an& e&e"a of the renal tu'ules eist

• A gra&ual increase in urine output which signal that :9 has starte& to

reco,er- 3he patient will ha,e a lot of urine in the phase 6 a'out /L in 2/hours- Patient +ust cant concentrate their urine $increase& specic gra,it)

• :ra&ual onset H 2J wee#s after oliguric phase

• ;lectrolte losses 'ecause the are putting out so "uch urine

• 4onitor the" for &eh&ration 6 A&"inister crstalloi&s $D5 or *S) to

pre,ent &eh&ration• 4onitor the >0* an& creatinine le,els 6 3hese will le,el oK at a lower le,el

an& plateau up an& &own

• :9 will 'e increase& $this increase contri'utes to the "assi,e loss ofelectroltes which requires the a&"inistration of .= crstalloi&s)% urineoutput will 'e 2J/ L per &a

eco,er phase 6 Can last up to a ear

• ;&e"a &ecreases

• enal tu'ules 'egin to function a&equatel

• 9 F ; 'alance are restore&

• :9 has returne& to BG nor"alo 3pes of Acute Mi&ne .n+ur

Prerenal


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9 • 4ar#e& &ecrease in renal 'loo& C >loo& loss or &ecient &iet Low he"oglo'in% he"atocrit% seru" iron% an& ferritin

o 4egalo'lastic ane"ia

>ig% giant% ineKecti,e cells 3hose with ,ita"in >12 &ecienc "ost co""onl get it $Co'ala"in)

• Pernicious ane"ia 6 >orn with &ecienc $get >12 shots for the rest of their

life)• Can get it fro" ,egetarian &iet $'eans)

• 4ost co""on reason is alcoholis"- 3oo "uch alcohol results in this

• Loo# at "ean corpuscular ,olu"e on C>C- As it ele,ates cells get 'igger ."paire& D*A snthesis H enlarge& >Cs 9olic aci& &ecienc

o Sic#le cell ane"ia .nherite& &isease that causes sic#ling of the cells


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9 Cells of this shape get stuc# e,erwhere $#i&ne an& arteries which causes

ische"ia) also causes great pain 3he cells &on’t act correctl Patients with this are reall co"pro"ise& Dilute the eKect ' gi,ing ase"ent "e"'rane is how things get fro" 'loo& into the #i&ne Causes things to sta in the 'loo& an& we retain too "uch water an& toins etc-

o Chronic glo"erulonephritis De,elops fro" an acute case 4ost resol,e fro" proper treat"ent 'ut not alwas so the 'eco"e chronic Scarring an& pro'le"s en& in renal failure Strep is ,er &angerous so alwas watch for #i&ne failure Cola colore& urine 6 =isi'le 'loo& in the urine $*CL;N)

1!) .ncontinence $)o 0rinar incontinence 6 .n,oluntar loss of urineo Stress incontinence

0rine lea#age &ue to wea#ness of &etrusor "uscles Seen in wo"en who ha,e gi,en 'irth ,aginall Also seen in o'esit People cough% laugh% or ha,e a =alsal,a "aneu,er the lea# urine Megel eercises are goo& for this


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9 o 0rge incontinence

Strong &esire to ,oi& frequentl which causes an o,eracti,e 'la&&er (a,e to go reall 'a& an& can’t get so"ewhere fast enough

o 4ie& incontinence stress urge incontinence Co""on in ol&er wo"en% "enopausal wo"en% "an who ha,e ha& ,aginal

'irths% an& o'esito O,er


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9 o Chronic pancreatitis $pancreatic cancer) has si"ilar signs an& s"pto"s to acute

pancreatitis1) :;D $5)

o :astroesophageal re


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9 0nco"pensate& $PCO2 R !5 "" (g p( B-/)

• Direct cause is alwas hper,entilation hper,entilation is painEaniet%asth"a% pneu"onia% an& at high altitu&e represents eKort to raise PO2 atthe epense of ecessi,e car'on &ioi&e ecretion-

• >rain in+ur or tu"or a'nor"alit of respirator controls.18) Appen&icitis $5)

o .nCs% an& e"ergenc &ue to

peritonitiso 3ests for appen&icitis

e'oun& ten&erness Psoas sign 6 Pain in LQ when right leg is hpereten&e&- .lliopsoas "uscle is

irritate& O'turator sign 6 Pain in LQ when leg is rotate& in an& out (persensiti,it test 6 ;aggerate& pain &ue to s#in hpersensiti,it

1?) 0lcerati,e colitis $5)o 3pe of $chronic) in


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9 .f the get an infection though the coul& &ie 'ecause pins go straight to 'ones

an& it’s har& to treat the 'one "arrow 'ecause not goo& circulator access to'one "arrow $,er scar)

o Seg"ental Piece of the 'one co"e out

o >utterite of the 'one co"e out 0suall co"es fro" &isease $"a'e fro" in+ur)

4eans that part of the 'one is not strong Seen in Paget’s% ;wing sarco"a in #i&s% lots of 'one cancers can present li#e this Also in osteopenia% an& osteoporosis in el&erl >ones that +ust aren’t ,er soft

o ."pacte& 9e"oral 'one i"pacts up into the pel,is u"p out of win&ow an& lan& on feet

2!)

Osteoporosis $?)o So"eone with osteopenia has a fracture

then ou #now it "eans osteoporosiso Decrease& 'one "ineral &ensit $>4D)

o Decrease& cancellous $spong) 'one strengtho Decrease& 'one "atri an& "inerali7ationo >one resorption 'one for"ation

2/) >arlow an& Ortolani’s $?)o De,elop"ental &splasia of the hip $congenital 'irth &efect)

Co""on at 'irth an& chec# for it at 'irth :et the" in a harness $Pla,ic#’s harness) to #eep +oint sta'le an& #eep hip in

soc#et so it can grow full >arlow’ an& Ortolani’s signs $tests)

• >arlow’s 6 9eel if it thun#s out of the soc#eto Put ngers 'ehin& the gluteus an& the thigho A&&uct the thigh an& ou can hear it popping out

• Ortolani’s 6 >ring thighs 'ac# in ou can hear it going 'ac# in 9in& it earl so there is no pro'le" with growth an& &e,elop"ent


10/27

9

25) >reast ea" $)o As# if the are n&ing an lu"ps an& if the lu"p is changingT

.f it changes with "enstrual ccle it is pro'a'l not cancero e&ness% war"th% &i"pling

Di"pling 6 Portion of the 'reast that is in&ente&

• 3elling ou so"ething a'out what is un&erneath the s#ino Change in the si7e of the 'reast or consistenc $soft 'eco"es r" etc-)o (istor of present heath concern COLDSPA

Character% onset% location% &uration% se,erit% pattern% associate& factorso Past health histor

.f the ha,e ha& an 'reast &isease% 'reast trau"a% or i"plants Cancer ris# is increase& with 'reast i"plants Also &isgure"ent is increase& with 'reast i"plants Age of "enstruation an& "enopause

• ;arlier "enstruation an& "ore &elae& "enopause increases ris# As# a'out chil&ren

• Age of "o" with rst pregnanc increases ris# of >C if rst chil& is after

age of !G or if the ne,er ha,e a chil& $'reast function "eant to pro,i&e"il#)

o 9a"il histor *u"'er one thing is to #now histor of pri"ar fe"ale relati,e

• (as "o" or sister ha&Eha,e 'reast cancer

• 4eans that wo"en is at a "a+or increase& ris# for 'reast cancer

• :enetic test can pro,e thiso Lifestle an& health practices

3a#ing hor"onesT Contracepti,esT

• Stop at age !G 'ecause of ris# for car&io,ascular an& cancer

Antipschotic &rug use $increases ris#) Li,eEwor# in area conta"inate& with 'en7ene% as'estos% or ra&iation CaKeine inta#e ;ercising without proper 'ra support

o A'nor"alities on .nspection Peau &’orange 6 Orange peel 'reast- >unch of tin &i"ples- .nAD Paget’s &isease 6 Presents as a scal rash usuall aroun& nipples or areola- =er

in,asi,e as well- 3hat in,asi,e "eans it’s so"ewhere else as well- etracte& nipple 6 Suggests "alignanc-


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9 Di"pling 6 Cause& ' "alignant tu"or that has 'rous stran&s attache& to the

'reast tissue an& fascia of the "uscles- As "uscle contracts it &raws the 'reasttissue an& s#in with it% causing &i"pling or retraction

etracte& 'reast tissue 6 estricte& "o,e"ent or retraction when ha,ing theclient lean forwar& at waist "eans 'rosis an& ation of the un&erling tissues&ue to "alignant tu"or-

o A'nor"alities on Palpation Cancerous tu"ors 6 .rregular% r"% har&% not &ene& "asses that "a 'e e&

or "o'ile- 0suall not ten&er an& occur after age of 5G• 4alignant tu"ors often foun& in upper outer qua&rant of 'reast- 3he are

unilateral with irregular% poorl &elineate& 'or&ers- (ar&% nonJten&er% an&e& to un&erling tissue-

9i'roa&eno"as 6 Lesions that are lo'ular% o,oi&% or foun&- 9ir"% wellJ&ene&%sel&o" ten&er% an& usuall singular an& "o'ile- Occur "ore co""onl 'etweenpu'ert an& "enopause-

• 0suall 1J5 c"% roun& or o,al% "o'ile% r"% soli&% elastic% nonJten&er%single or "ultiple 'enign "asses foun& in one or 'oth 'reasts

• 9i'rocstic 'reast tissue that feels rop% lu"p% or 'u"p in teture isreferre& to as no&ular or glan&ular 'reast tissue

>enign 'reast &isease 6 Also calle& 'rocstic 'reast &isease- 4ar#e& ' roun&%

elastic% &ene&% ten&er% an& "o'ile csts- 4ost co""on fro" age !G to"enopause% after which it &ecreases-

• Consists of 'ilateral% "ultiple% r"% regular% ru''er% "o'ile no&ules% withwellJ&e"arcate& 'or&ers- Pain an& fullness occurs +ust 'efore "enses-

• 4il# csts 6 Sacs lle& with "il#

• 4astitis 6 .nfection

• 3hese can turn into an a'scess &uring 'reast fee&ing or after recentlgi,ing 'irth

• Lipo"as 6 Collection of fatt tissue that can appear as a lu"p2) =aginitis2B) Sphilis

28) Chla"&ia an& gonorrhea2?) O,arian cancer!G) >P(

o ;nlarge& prostate that puts pressure on the ureter- *or"al in "en as the ageo 3he pressure is what is responsi'le for the signs an& s"pto"so .f it gets too 'ig then there is &ri''ling of urine% or can’t start the strea" etc-o Prostate shoul& nor"all 'e the si7e of a walnuto .f 'igger than walnut then ou can’t n& the ,alle $sulcus)

!1) Seual assault assess"ent $8)o Pregnant wo"en a"ong the "ost a'use& group

!2) Dia'etes!!) Dia'etic #etoaci&osis

!/) (po an& hperthroi&is"!5) 3hroi& crisis!) (pocalce"ia an& hpercalce"ia $)

o Ca $Calciu") 8-5J1G-8 ";qEL $stan&ar& ,alues so it can 'e unique to the la') Closel regulate& ' #i&nes an& parathroi& hor"one Plas a role in 'loo& clotting% hor"one secretion% receptor functions% ner,e

trans"ission% an& "uscular contraction (as in,erse relationship with phosphorus

• .f calciu" is high then phosphorus is low an& ,ice ,ersa


12/27

9 (as snergistic relationship with "agnesiu"

• 4eans that the are co"pati'le an& go the sa"e wa egulate& '

• =ita"in M J Co"es fro" the :. tract 'acteria

• Parathroi& hor"oneo Sitting on the throi&o e"o,e the throi& in throi& &isease then ou re"o,e the

parathroi& an& patient has trou'le with calciu"% "agnesiu"% an&

phosphorus• Calcitonin J Co"es fro" the throi&

o Calciu" ."'alance $loo# at what’s unique% unusual% an& what is A>C) (percalce"ia

• .ncrease& inta#e or releaseo Calciu" antaci&so Calciu" supple"entso Cancero .""o'ili7ationo Corticosteroi&so =ita"in D &ecienco (pophosphate"ia

• Decit ecretiono enal failureo 3hia7i&e &iureticso (perparathroi&is"

(pocalce"ia

• ;cessi,e losseso (poparathroi&is"o enal failureo (perphosphate"iao Al#alosiso Pancreatitiso Laati,eso Diarrheao Other "e&ications

• Decient inta#eo Decrease& &ietar inta#eo Alcoholis"


13/27

9 o A'sorption &isor&ers

o (poal'u"ine"iao Calciu" Assess"ent

(percalce"ia

• &srhth"ias% ecg changes $sa"e on 'oth)

• confusion $sa"e on 'oth)

• &ecrease& "e"or $sa"e on 'oth)

• hea&ache

• letharg% stupor% co"a• "uscle wea#ness% &ecrease& &eep ten&on re


14/27

9

!8) (( an& *S hper os"olarit $)!?) A&&ison’s/G) 4ie&e"a/1) Crohn’s &isease $5)

o 3pe of $chronic) inrea#s the s#in &own

• 4a#es it soup

• 3he get this fro" sweat% incontinence% an& not "o,ing *utrition

• *ee& protein% lots of calories

• Sic# people are at a ris# factor 'ecause the aren’t eating 9riction or shear against surfaces

• Sli&e o,er so"ething can tear an& shear the s#in

• Shear 6 Cut oK the 'loo& suppl• See this in patients that are constantl getting "o,e&

3issue tolerance &ecrease&

• .""une sste" an& integrit of the tissueo Pressure 0lcer is# e&uction

.nspect the s#in at least &ail an& "ore often if at greater ris# using ris#assess"ent tool $such as >ra&en Scale or P0S( tool) an& #eep


15/27

9 9or &r s#in use "oisturi7ers a,oi& low hu"i&it an& col& air-

A,oi& ,igorous "assage-o Pressure 0lcer Stages $stages can happen reall rapi&l if pressure is not release&)

Stage . 6 S#in is in contact an& it is non 'lancha'le- Can 'e a re& 'lotch- Stage .. 6 Shallow or open ulcer with re& or pin# woun& 'e&% or an intact 'lister- Stage ... 6 All the s#in is gone $epi&er"is an& &er"is) an& ou’re into the su'Q-

.nto the fat $ellow whitish loo#)- 3his is where tunneling starts- 0lcer "a loo#s"all 'ut eten&s far 'eon& un&er the surface-

Stage .= 6 9ull sic#ness- ;poses ten&ons an& "uscles- 0n&erling structuresan& e,en 'one-

0nstagea'le 6 9ille& with eschar $'lac# har& plaque 'o& "a#es to heal thewoun&)- Can’t stage 'ecause the eschar 'loc#s the woun& 'e&-

oun& "ust alwas heal fro" the 'otto" up- Can’t allow s#in to grow o,er the'otto" up till the woun& 'e& heals- Pac# ulcers-

/5) S#in ea"ination/) Loo#ing at A>: le,els $)

A>: Le,elsp( A B-!/ 6 B-/5 >

PCO2 $lungs) > !5 6 /5 A

(CO!$#i&nes)

A 22 6 2 >

/B) Discerning &iKerence 'etween aci&osis an& al#alosis $)o p( 6 ( elps &istinguish 'etween aci&osis an& al#alosis 'ut &oesn’t re,eal the causeo PCO2 6 .n&icates whether con&ition is cause& ' respirator sste"

PCO2 o,er /5"" (g H espirator sste" is CA0S; of pro'le" H espirator

aci&osis PCO2 'elow !5 "" (g H espirator sste" not the cause 'ut is CO4P;*SA3.*: PCO2 within nor"al li"its H espirator sste" not the cause or co"pensating PCO2 in,erse with 'loo& p( $PCO2 rises as 'loo& p( falls)

o (CO! 6

4eta'olic aci&osis H (CO! 'elow 22 ";qEL 4eta'olic al#alosis H (CO! a'o,e 2 ";qEL (CO! in &irect correlation with 'loo& p( $(CO! rises as 'loo& p( rises)

/8) D.C $/)o 0lti"ate outco"e is 'lee&ing e,en though it is a coagulation pro'le"o Loss of platelet factorso >o& clots too "uch therefore it is then una'le to cloto >o& 'lee&s out

/?) Acquire& i""une &ecienc5G) Discerning assess"ent of the ees $8)

o .nternal ;e Structures .nspect the optic &isc- .nspect the retinal ,essels-

• e&&ish orange in light s#inne& people

• >rown in &ar# s#inne& people

• Arteries an& ,eins are unique 'ecause the are switche& in the retina

• Optic ner,e inserts at fo,ea

• 3he 'ig ,essel are the ,eins an& the arteries are s"all

• >lue ,essels are arteries

• e& ,essels are ,eins


16/27

9 .nspect the retinal 'ac#groun&-

• See cotton wool spots "eans retinal &a"age fro" hperglce"ia .nspect the fo,ea an& "acula-

• 9o,ea is locate& nasall an& is a ellow &isc an& roun&

• .f it is swollen the phsiologic cup then there is intracranial pressure

• 4acula .nspect the anterior cha"'er

51) Sensorineural ,ersus con&ucti,e hearing issues $8)o Con&uction

So"ething is 'loc#ing the hole $con&uction) Swi""er’s ear 6 ater staing the ear canal

• Uou get 'rea#&own $"aceration) fro" wet s#in that stas wet for too long Surfer’s ear 6 >one 'eco"es in


17/27

9 *ee& to #now if it is a pro'le" with con&uction of sensorineural

*egati,e o"'erg is nor"al5/) ;e assess"ent $8)

o Distant =isual Acuit Cranial ner,e 2 J Optic Snellen chart *or"al acuit is 2GE2G with or without correcti,e lenses

o *ear =isual Acuit

Cranial ner,e 2 J Optic (an&hel& ,ision chart *or"al acuit is 1/E1/ with or without correcti,e lenses

o Confrontation 3est 3esting ,isual el&s Peripheral ,ision People nee& peripheral ,ision for 'alance% an& to &ri,e

o 3esting ;traocular 4uscular 9unction Corneal light re


18/27

9 • Da"age to central cor& that &oesn’t reach the outsi&e

• 3here will sacral sparing 6 will ha,e &iVcult with 'owel an& 'la&&er

• ill "ostl ha,e upper etre"it s"pto"s

• *ot lower etre"it s"pto"s Anterior cor& sn&ro"e anterior section of cor&

• 4otor functions aKecte& touch sense not aKecte&

• Pro'le" with the anterior cor& arter $front si&eE,entral)

• Arter has a pro'le" for so"e reason J Co"pression% tu"or% or ltic

pro'le" where it has 'een lse& ' trau"a• Loss of "otor function% an& pain% an& te"perature 'ut proprioception is

"aintaine& Posterior cor& sn&ro"e

• Da"age to posterior cor& $'ac# or &orsal si&e)

• :et loss of proprioception

• >oth upper an& lower loss of function to spinal cor& >rownJSWquar& sn&ro"e one si&e of cor&

• 4otor function lost on that si&e painEte"perature sensation lost fro"

other si&e• (alf of the right or left si&e of the 'rain has an in+ur $he"iJsection) ou

get ipsilateral wea#ness $sa"e si&e) with loss of proprioception $testsensation of position) an& contralateral loss of pain an& te"peraturesensation

Conus "e&ullaris sn&ro"e sacral an& lu"'ar

• >owel% 'la&&er% seual function &efectso Autono"ic Dsre


19/27

9 • Da"age here "eans the ha,e inner,ation an& function of all upper

etre"it "uscles inclu&ing the han& 5 Lu"'ar 5 Sacral Depen&s on the le,el of in+ur gi,es ou the signs an& s"pto"s 3o upper "otor neurons $312 an& a'o,e)

• Spinal re


20/27

9 o Changes in ,ision

o *ausea an& ,o"itingo 3hese are ,er concerning

Sei7ures

• hat happene& 'efore% &uring% or after

• >efore ou can ha,e an aura $the #now it’s co"ing)% in,oluntararticulations $screa"s) $not nor"al screa"s)

• During &o the ha,e tonicJclonic "o,e"ents $rhth"ic contracting)% are

the awa#e an& alert% &o the pass out% &o the hit their hea& an& fall% &othe lose control of their 'owel an& 'la&&er $i"portant info to note)

• Phsiological pro'le" with sei7ingT $hat &o sei7ures &oT) *ot +ust fallingan& getting hurt- >esi&es the 'rain- 4uscles contract o,er an& o,er'ecause of the aci& 'uil&ing up $"oglo'in "uscle &u"p which is toic)

• Di77iness% nu"'ness% tingling $"ore signs to loo# at)

• Changes in sensor $s"ell% hearing% ,ision% te"perature% an& a'ilit tofeel)

o Changes in spea#ing an& &iVcult swallowing are i"portant

• Changes in te"perature an& a'ilit to feel

• Pro'le"s with "uscle control $too wea# to contract)o

Past health histor (istor of hea& in+ur (istor of central an& peripheral infections .nfections 6 4eningitis% encephalitis% sphilis $these can &a"age ner,ous sste") (istor of "e"or loss 6 =er concerning% 'oth short ter" an& long ter"

• Long ter" is "ore concerning

• .n "e"or loss short ter" goes rst% long ter" goes last

• 3he last person re"e"'ers 'efore the forget e,erthing is their na"e

• 9orgetting this is 'a& (istor of s"o#ing% &rin#ing% ta#ing &rugs $all of these eKect the ner,ous

sste")

(istor of lifting things for a li,ing 6 Can &a"age neurological sste" &oing thato 9a"il historo Lifestle an& health practices

G) Cranial ner,e tests $B)o Cranial ner,es rh"e J On ol& Ol"pus towering top a 9inn an& :er"an ,iewe& so"e

hopso SensorE4otor rh"e J So"e sa "arr "one 'ut " 'rother sas 'ig 'rainsE'oo's

"atter "ore1) Cranial ner,e tests $B)

o . 6 Olfactor Sensor 3est with s"ell $#eep their ees close&)

o .. 6 Optic Sensor 3est with Snellen for ,isual acuit

• Shoul& 'e 2GE2G

• Legal &enition of 'lin&ness is 2GE2GG

• *ee& to 'e 2G feet awa

• osenthal is 1/ inches awa an& is the han& hel& oneso ... 6 Oculo"otor

4otor .nner,ates the eeli& 6 shoul& 'e 2"" o,er the iris


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9 .f ou can see the entire iris in whole ee that is hperthroi&is"

Calle& eophthal"os ;tra ocular "o,e"ent test 6 Loo# for ees to oth $"otor an& sensor) 3est ' s"iling% frowning% puVng out chee#s% showing teeth% closing ees against

resistance Shoul& 'e equal on 'oth si&es of the face

o =... 6 Acoustic $=esti'ular Cochlear) Sensor 3est hearing Do the whisper test% enee an& e'er

• hisper 'ehin& their ear an& see if the can hear

• e'er nor"al 6 (ear the ringing in 'oth ears

•

enee nor"al 6 Air con&uction is twice the 'one con&uction 3est whether it is sensor neural loss or con&ucti,e loss 4ost co""on con&ucti,e hearing loss is wa Don’t e,er put col& water in so"eone’s ear $test ,esti'ular cochlear)

o .N 6 :lossopharngeal $3est ? an& 1G together) >oth 3ongue 'la&e in "outh an& sa ahh Loo# for the u,ula an& soft palate to rise equall at the "i&line .f it &oesn’t rise in the "i&line this is scarring

o N 6 =agus >oth


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9 :ag re


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9 3est with anthing that requires coor&ination

Cere'ellu" function/) D=35) Arterial insuVcienc $re,iew) $/)) (eart failure $/)

o Co"pensation in heart failure 6 >ase& on 9ran#JStarling law of the heart .f the car&iac output goes &own the 'o& will tr to co"pensate ' sti"ulating

the s"pathetic ner,ous sste"% an& the reninJangiotensinJal&osterone sste"

which causes "ocar&ial hpertroph $"a#e heart cells get 'igger) All these "etho&s can te"poraril increase the car&iac output 'ut in the long

ter" the "a#e it worseo 4anifestations of (eart 9ailure

9lui& retention% e&e"a% respirator &istress% pul"onar congestion% fatigue%

eercise intolerance% canosis% s"pathetic ner,ous sste" eKects 'ecause ofthe o,erco"pensation% an& if reall 'a& CheneJSto#e’s 'reathing $'reathingpattern ,er specic to heart failure shallow 'reathes% &eep% then shallow% thenapnea% then starts all o,er)

;Kects of i"paire& pu"ping% &ecrease& renal 'loo&


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9 o o"en woul& &ie 'efore the coul& 'e &iagnose& with coronar heart &isease 'ecause

the &on’t present with the sa"e s"pto"so o"en present with aniet $su&&en onset)% the &on’t ha,e chest paino .f so"eone is ha,ing an 4. loo# at en7"es in 'o&- 3he cells &ie an& 'rea# aparto 4ost accurate "ar#er of 4. fro" ische"ic cell &estruction is troponin $shows as

ele,ate&)o Acute coronar sn&ro"es $4. in&icators)

;C: changes

• 3Jwa,e in,ersion 6 epolari7ation of the ,entricles- 9ollows the S wa,e$QS is the contraction)

o .sche"ic heart "eans our heart can’t repolari7e correctl- So there

is an in,ersion- Dips 'elow the central line an& 'eco"es a 0• S3Jseg"ent &epression or ele,ation 6 Distance 'etween S an& 3 wa,e

• A'nor"al Q wa,e 6 =er strong in&icator or 4. Seru" car&iac "ar#ers

• Proteins release& fro" necrotic heart cells

• 4oglo'in% creatinine #inase% an& troponino Creatinine #inase 6 >rea# &own "uscle cells- *ot specic to car&iac-

Coul& also "ean the run three "iles $also s#eletal)

o 3roponin 6 4ost specic to car&iac "uscleo 4oglo'in 6 Co"es fro" car&iac an& s#eletal "uscle 'rea#&own

o Chest pain 6 Se,ere% crushing% constricti,e O li#e heart'urn $if heart'urn isn’t getting

'etter)o S"pathetic ner,ous sste" response

:. &istress% nausea% ,o"iting 3achcar&ia an& ,asoconstriction Aniet% restlessness% feelings of i"pen&ing &oo"

o (potension an& shoc# 6 ea#ness in the ar"s an& legs $another s"pto" of wo"en)o Car&iac arter is the worst arter to ha,e an 4. in

Lateral ascen&ing arter 6 Supplies 'loo& to the septu" of the heart

Co""onl calle& the wi&ow "a#er 'ecause it causes the" to +ust &rop o,er&ea&

o Co"plications of acute 4. 6 (eart failure% car&iogenic shoc#% pericar&itis%

thro"'oe"'oli% rupture of the heart% ,entricular aneurs"s% an& chronic pain8) Mnowing nor"al 'loo& ,alues $/)?) Car&iac assess"ent $/)BG) espirator tract infection an& assess"entB1) COPDB2) COPDB!) .nterpreting respirator assess"ent n&ings $&isease 'ase& on assess"ent n&ings)B/) .nterpreting respirator assess"ent n&ings $&isease 'ase& on assess"ent n&ings)B5) Pul"onar e"'olus

B) espirator assess"ent $nor"al an& a'nor"al n&ings)BB) COPDB8) A&,entitious lung soun&s


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9

B?) Co"part"ent sn&ro"e8G) 3esticular pain81) 4enstrual ccle82) Autoi""une8!) Congesti,e heart failure $/)8/) Co""on ee &iseases $8)

o Con+uncti,itis 6 .n


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9 3 &iuretic car'onic anh&rase inhi'itor $&ia"o) or "annitol% or "a nee&

surgical inter,ention to relie,e pressure Close&Jangle J worse 'c pressure can’t escape OpenJangle J pressure &e,elops o,er ti"e% not as 'a& as close&Jangle

85) ;n& stage renal &isease $)o Chronic #i&ne &iseaseo 9ewer nephrons are functioningo :lo"erular ltration rate signicantl lower for "ore than ! "onths

*or"al :9 H 12G 6 1!G Decrease& :9 of less than G "eans a'out half of the nephrons are lost 1 "illion nephrons in the #i&ne :9 less than G "eans 5GG%GGG nephrons

o e"aining nephrons "ust lter "ore (pertroph 6 3he re"aining nephrons ha,e to lter "ore 0*• C*S% :.% i""une &istur'ances

Altere& 0* H 1G 6 2G $B 6 18)


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9

Documents

Patho Notes for Final Exam