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Questions and Answers
Which system has the highest number of questions in the exam breakdown?
What percentage of the exam questions come from Lectures 6 and 7?
How many questions are dedicated to the Oncology topic in the exam?
Which system contains the fewest questions according to the breakdown?
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What is a suggested focus area while studying for the exam?
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What is the primary function of the liver in relation to blood proteins?
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What triggers the gallbladder to contract and expel bile?
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Which factor is NOT affected by aging in relation to liver function?
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Which substance is produced by the pancreas?
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What is the consequence of decreased liver blood flow with aging?
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What is a common symptom associated with hepatic disease?
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What role does bile play in digestion?
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Which of the following changes occurs in the liver due to aging?
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Which factor is crucial for maintaining bone strength?
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What is the most common cause of osteoporosis in women?
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Which is a common clinical manifestation of osteoporosis?
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What physical change is associated with Paget Disease?
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Which exercise is most beneficial for individuals with Paget Disease?
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What is a common neurological manifestation of Paget Disease?
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What is the impact of mechanical stimuli on mature bone?
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Which deformity is most commonly associated with Paget Disease?
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What role does physical therapy play for patients with osteoporosis?
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Which of the following describes the bone changes in Paget Disease?
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What hormone is primarily associated with stimulating the adrenal glands?
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Which condition is characterized by an undersecretion of all six anterior pituitary hormones?
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What condition results from excessive levels of growth hormone before epiphyseal closure?
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Which of the following is a common symptom of hyperthyroidism?
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What is a key symptom of Addison's disease?
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What is a primary characteristic of Type 1 Diabetes?
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What complication is commonly associated with poorly controlled diabetes?
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Which treatment option is typically used for Cushing's syndrome?
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Which symptom is indicative of hypothyroidism?
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What condition is associated with excessive insulin production in the body?
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Which of the following is a common risk associated with obesity?
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Which nutritional requirement should be considered for a patient with Cushing's syndrome?
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Which sign is a typical manifestation of hyperglycemia?
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What is a common treatment for Hashimoto’s thyroiditis?
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What is the most common cause of cirrhosis?
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Which symptom is specifically associated with jaundice?
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What condition is 85% of ascites cases associated with?
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Which of the following symptoms indicates neurologic involvement due to liver impairment?
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What is a significant complication of portal hypertension?
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What finding is NOT typically associated with liver dysfunction?
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What is recommended for patients with cirrhosis regarding exercise?
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Which Hepatitis virus requires prior infection with Hepatitis B for transmission?
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When is jaundice typically expected to resolve after treating the underlying cause?
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Which of the following is a symptom of ascites?
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What is the primary function of hepatic tissue that gets impaired in cirrhosis?
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Which of the following is NOT a typical sign of liver dysfunction?
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What exercise should be avoided in patients with increased abdominal pressure due to liver issues?
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Which assessment is crucial for monitoring patients with ascites?
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Study Notes
Osteoporosis
- Bone strength depends on bone density and bone quality
- Bone density is how many bone cells per square millimeter
- Bone quality is the health of bone cells
- Bone mineral density is the mass of minerals per volume of bone
- Peak bone mass is achieved in the third decade of life
- If peak bone mass is low, osteoporosis and fractures are likely
- Mechanical stimuli are the only stimuli capable of inducing modelling in mature bone
- Estrogen deficiency is the most common cause of osteoporosis in women
- Clinical manifestations of osteoporosis:
- Loss of height
- Postural changes (kyphosis)
- Back pain (low back and rhomboids)
- Muscular pain
- Trigger points
- Fractures (compression fractures are the most common)
- Functional impairment
- Disability
- Decreased quality of life
Paget Disease
- Increased bone resorption by osteoclasts and excessive and disorganized formation of new bone by osteoblasts
- Bone marrow gets replaced by vascular and fibrous tissue
- Enlarged bones are weak, leading to deformity, fracture, and arthritis/pain
- Cause is unknown
- Considered an osteoclastic disorder, but also involves osteoblasts
- Unrestrained proliferation of osteoclasts kickstarts the process
- Osteoblasts cannot keep up
- Initial resorption stage followed by abnormal regeneration
- New bone is coarse, irregularly thickened, rough, and pitted
- Clinical Manifestations:
- Pain - headache, myalgias, arthritis, radiculopathy
- Skeletal - bone pain and deformities (femur is the most commonly affected bone, kyphoscoliosis is the most common deformity)
- Neurologic - nerve compression, impaired cognition
- CV - increased cardiac output, heart failure
- Fatigue, tinnitus, dizziness/vertigo
Hepatobiliary System - Anatomy
- Liver
- Produces albumin and plasma proteins
- Produces bile
- Converts and excretes bilirubin
- Produces clotting factors
- Stores vitamins
- Gallbladder
- Stores and concentrates bile
- Expels bile into the duodenum when food is present
- Bile alkalinizes intestinal contents and emulsifies, absorbs, and digests fat
- Cholecystokinin causes the gallbladder to contract
- Pancreas
- Exocrine secretion of digestive enzymes and pancreatic juices
- Pancreatic juices are transported through the pancreatic duct to the duodenum
- Secretion of glucagon and insulin by the islets of Langerhans
Hepatobiliary System - Aging
- Decreased response to drugs depending on liver function, affecting multiple systems
- Liver contains many immune cells and produces proteins associated with the acute inflammatory response
- Age-related cell changes impact immunity, often requiring drug dosage modification with age
- Liver volume decreases 20-40%, and blood flow decreases up to 35%
- Liver function tests (AST, ALT, ALP, GTP, and serum bilirubin) remain unchanged with age
Signs and Symptoms of Hepatic Disease
- GI symptoms (nausea, vomiting, anorexia, abdominal pain)
- Edema/Ascites
- Dark urine and light stools
- Skin changes
- Jaundice (elevated bilirubin)
- Bruising
- Spider angiomas & palmar erythema (elevated estrogen)
- Neurologic involvement (from ammonia buildup)
- Confusion
- Sleep disturbances
- Muscle tremors
- Hyperreactive reflexes
- Asterixis
- Musculoskeletal pain - midscapular pain, right shoulder/upper trap/subscap, thoracic
- Hepatic osteodystrophy - manifests as osteomalacia/osteoporosis
Jaundice
- Overproduction of bilirubin:
- Reabsorption of hematoma
- Blood transfusion
- Decreased uptake or conjugation in bilirubin metabolism
- Hepatocyte dysfunction
- Hepatitis
- Chronic hepatic disease
- Impaired bile flow
- Cholethiasis
- Primary sclerosing cholangitis
- Pancreatic cancer
- Pancreatitis
- If the underlying cause of jaundice is treated, it typically resolves in 4-6 weeks
Ascites
- Abnormal accumulation of fluid in the peritoneal cavity
- 85% of cases associated with decompensated liver cirrhosis
- Fluid accumulates due to portal hypertension
- Signs and Symptoms:
- Clinically detectable once more than 500 mL has accumulated
- Weight gain
- Abdominal distention
- Increased abdominal girth
- Peripheral edema
- Dyspnea when fluid displaces the diaphragm
Cirrhosis
- Chronic progressive inflammation of the liver
- #1 cause: viral hepatitis
- Cycles of inflammation, and healing with formation of fibrous bands of connective tissue
- Irreversible
- Clinical Manifestations:
- Interference with liver functions (processing amino acids, carbs, lipids, and vitamins; metabolizing cholesterol, hormones, vitamins, meds, and toxins)
- Treatment based on complications
- Transplant is best for long-term survival
Portal Hypertension
- Portal: area where blood vessels enter the liver
- Venous blood from the stomach, large and small intestine, pancreas, and spleen is transported via portal vein to the liver
- Pressure increases when pressure in the portal vein is higher than pressure in the inferior vena cava
- Usually related to cirrhosis (structural changes and hyperdynamic vascular responses)
- Ultimately, blood backs up in the stomach, esophagus, umbilicus, and rectum
- Engorged vessels
- Varices
- Bleeding
- Clinical manifestatons:
- Gastroesophageal varices (very serious and accounts for 1/3 of deaths related to cirrhosis and bleeding; endoscopy is needed for everyone with cirrhosis to screen, usually treated prophylactically with beta blockers)
- Bleeding
- PT Implications:
- Portal pressure is highest at night, after eating, and with coughing, sneezing, and exercise
- Interventions should prioritize reducing abdominal pressure
Hepatitis
- Acute or chronic inflammation of the liver from a virus, a chemical, a drug reaction, or alcohol abuse
- Types:
- Hepatitis A
- Acute infection only
- 25% of people do not progress to cirrhosis or cause cirrhosis prematurely
- Does not progress to chronic disease
- Transmission: fecal-oral; food and water
- Symptoms - Malaise, Fatigue, Mild Fever, Nausea, Vomiting, Anorexia, RUQ discomfort, Diarrhea, Jaundice, Dark urine, Clay-colored stools
- Treatment - Supportive care
- Vaccine - Yes
- Hepatitis B
- 75-85% of acute infections become chronic
- 10-20% progress to cirrhosis
- Associated with liver cancer
- Transmission - Parenteral, sexual contact, vertical, contact with blood or open sores
- Symptoms - Malaise, Fatigue, Mild Fever, Nausea, Vomiting, Anorexia, RUQ discomfort, Diarrhea, Jaundice, Dark urine, Clay-colored stools
- Treatment - Acute: supportive, Chronic: combination interferon and antivirals
- Vaccine - Yes
- Hepatitis C
- Coinfection of HBV and HDV leads to more acute disease
- 75-85% of acute infections become chronic
- 10-20% progress to cirrhosis
- Associated with liver cancer
- Transmission - Parenteral, hemodialysis, vertical, blood before 1987, organs before 1992
- Symptoms - Malaise, Fatigue, Mild Fever, Nausea, Vomiting, Anorexia, RUQ discomfort, Diarrhea, Jaundice, Dark urine, Clay-colored stools
- Treatment - Acute: supportive, Chronic: interferon alfa2a or alfa2b
- Vaccine - No
- Hepatitis D
- Can only get Hep D if already infected with Hep B
- More acute disease
- Transmission - Parenteral, sexual contact, perinatal
- Symptoms - Malaise, Fatigue, Mild Fever, Nausea, Vomiting, Anorexia, RUQ discomfort, Diarrhea, Jaundice, Dark urine, Clay-colored stools
- Treatment - None
- Vaccine - No, but Hep B vaccine can prevent Hep D
- Hepatitis E
- Acute, self-limiting infection
- Does not progress to chronic
- High mortality in pregnant women
- Transmission - Same as Hep A
- Symptoms - Malaise, Fatigue, Mild Fever, Nausea, Vomiting, Anorexia, RUQ discomfort, Diarrhea, Jaundice, Dark urine, Clay-colored stools
- Treatment - Preventive measures
- Vaccine - Not in the US; vaccine approved in China in 2012
- Hepatitis A
Oncology
- Risk Factors, Pathogenesis, and Clinical Manifestations
- General and specific to lung, breast, and colorectal
- PT Implications for treatment
- Impact of pain and metastases
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Description
This quiz assesses your understanding of the Oncology exam breakdown, focusing on various systems and their question distributions. You'll explore the number of questions allocated to different topics, including Lectures 6 and 7, and determine strategic study areas.
