PTA 240 Final Study Guide PDF

PTA 240 Study Guide – Final Exam ******Know the anatomy and physiology of body systems we have discussed****** Chapter 1 – Health vs. Disease & Disability Know all Chapter 3 – Cell Injury & Death Know all Chapter 4 – Genetic Congenital Disorders Huntington’s disease An autosomal dominan...

PTA 240 Study Guide – Final Exam ******Know the anatomy and physiology of body systems we have discussed****** Chapter 1 – Health vs. Disease & Disability Know all Chapter 3 – Cell Injury & Death Know all Chapter 4 – Genetic Congenital Disorders Huntington’s disease An autosomal dominant disorder Causes brain degeneration, developing in mid-life Characterized by: ○ Progressive mental deterioration ○ Abnormal “jerky” movements Caused by deterioration of neurons in the basal ganglia Genetic counseling should be given to children of persons with the disease to determine if they carry the abnormal gene PT- fall prevention, safe ambulation, balance, coordination, wheelchair mobility, mobility Cystic fibrosis An autosomal-recessive disease that often causes death early in life Its most serious symptoms affect: ○ The lungs (blockage of respiratory passages) ○ Pancreas (cyst formation that causes degeneration Cystic fibrosis is very common ○ 1 of every 22 Caucasians carry a gene for the disease Down syndrome The most common chromosomal disorder ○ Occurring in about 1 out of every 800 births The features of these conditions include: ○ Reduction in normal body growth ○ A head that is smaller and “squared” ○ A flattened than normal facial profile ○ A small, depressed nose ○ Slanted eyes ○ Malformed ears Patellar dislocation Extreme foot pronation Scoliosis  In infants and young children ○ Hypotonia ○ Joint laxity Higher risk of developing Alzheimer’s ○ Symptoms by age 40 Chapter 7 – Inflammation & Healing Know all Chapter 9 - Skeletal Disorders Kyphosis A “humped” curvature of the thoracic spine ○ Known as “humpback” or “hunchback” It is common in postmenopausal females with osteoporosis Different types include: ○ Postural- the most common type It can be corrected by learning better posture techniques ○ Scheumermannns ○ Gibbus deformity ○ Congenital ○ Nutritional Diagnosis and Treatment ○ Kyphosis is diagnosed by physical examination and X-rays Treatments: ○ Physical therapy, medication, and surgery Posture correction and exercises that strengthen the spinal muscles may help to correct the curvature Lordosis Commonly referred to as “swayback” ○ An exaggerated inward (anterior) curve of lumbar spine Affecting patients of all ages ○ It causes the abdomen and buttocks to protrude ○ This causes the lower back to be curved inward Causes include ○ pregnancy, obesity, achondroplasia, diskitis, kyphosis ○ osteoporosis, spondylolisthesis ○ Abdominal weakness, poor body mechanics Diagnosis and Treatment ○ Lordosis is diagnosed through patient history, examination, range of motion tests, neurological tests, and spinal X-rays Treatments: ○ Analgesics ○ Anti-inflammatories  ○ Physical therapy ○ Weight loss Scoliosis Lateral curvature of the spine ○ Affects females more than males It usually affects teenagers when body growth is more rapid ○ Can be structural or functional Functional scoliosis ○ Temporary ○ Muscle imbalance Structural scoliosis ○ Permanent sideways curvature of the spine Scoliossi usaully causes: ○ Back pain ○ A rib or shoulder blade hump ○ Unaligned hips and shoulder It is usually of unknown origin ○ May be genetically linked ○ Related to abnormalities of connective tissue, platelets, skeletal muscle, spinal column, rib cage Diagnosis and Treatment ○ Diagnosis is based on bending movements Adams forward bend test Wherein the spine moves to one side while the shoulder blade moves upward ○ Treatment often includes back braces aimed at keeping the condition from worsening ○ idiopathic scoliosis cannot be cured BUT can be managed Bracing, PT, surgery ○ Functional scoliosis can be helped with PT ○ Surgery is not indicated until the curvature is between 30 and 40 degrees Osteoporosis A decrease in bone mass and porosity of the bone ○ This leads to major orthopedic problems in nearly one-third of U.S. women Compression fractures of the spine often affect the height of the patient Commonly affected sites: ○ Distal radius, spine, femoral neck, greater trochanter Spinal nerve root compression ○ May result in radiation pain “bloated” feelings, kyphosis, and a Dowager’s hump The most common group affected by osteoporosis in women after menopause who are estrogen-deficient Diagnosis and Treatment: ○ Diagnosis can be confirmed by: Examination  X-rays and CT scan DEXA scan ○ Prevention and early detection are essential to prevent associated deformities and fractures ○ Antiresorptive agents include: Gondal hormones (estrogen) Calcitonin Fluorides Bisphosphonates Fractures Stress fractures or incomplete fractures may not actually break the bone into two pieces Fractures can be caused by ○ Injury (trauma) ○ Disease that creates bone weakness (pathologic fractures) Usually cause ○ Intense pain, inflammation, discoloration ○ Bleeding if the skin is punctured They are usually caused by stress, trauma, or disease Diagnosis involves physical examination, radiologic studies Treatment includes: ○ Splinting ○ Open or closed reduction via surgery ○ Attaching screws and other equipment ○ Cleaning ○ Casting Types of fractures Open ○ If the bone has protruded through the skin ○ Any object that has punctured the skin to break a bone Also called compound fracture Closed (simple fractures) Complete ○ Completely through a bone Incomplete ○ Bone is fractured, but not in two pieces Greestick ○ Appear as partial breaks Displaced ○ Bone fragments are out of position Comminuted ○ There are more than two ends or fragments Compression ○ Bone appears “mashes” down Impacted  ○ Bone forced over the other end Avulsion ○ Small bone fragments separated from bone Longitudinal ○ Length of bone Transverse ○ Across or at a 90-degree angle to bone Oblique ○ Diagonal pattern Spiral ○ Twist around bones Stellate ○ Star-like patterns Chapter 11 – Joint & Soft Tissue Disorders Rheumatoid Arthritis (RA) Rheumatoid arthritis is a systemic autoimmune disorder ○ Affects the joints and connective tissues throughout the body It mostly often affects young and middle-aged women ○ Usually affects the small joints of the hand and feet It produces a chronic inflammation and thickening of the synovial membranes Often causes noticeable deformity and destruction in the metacarpophalangeal joints Its exact cause is unknown It is believed to be hereditary ○ May also be triggered by viral infections Clinical Manifestations ○ General fatigue ○ Weight loss ○ Symmetric joint swelling ○ Pain and stiffness (more prominent in the morning) Diagnosed by testing blood for antibodies called rheumatoid arthritis ○ It is also based on family history, physical examination, and lab tests Treatment goals are to: ○ Reduce pain, minimize stiffness and swelling ○ Maintain mobility, prevent joint deformity Osteoarthritis (OA) Also known as degenerative joint disease ○ Joints simply wear out from use It is now the leading cause of disability in the U.S. ○ Due increased elderly population ○ Affects the joints of the hands, hips, knees, and spine Affects weight-bearing joints ○ swelling, pain ○ Bone spurs- limit joint movement  ○ May require total joint replacement Osteonecrosis When blood supply to epiphyses of bones is limited ○ Necrosis and degeneration Occurs in children and adolescents ○ Also called avascular necrosis Usually affects: ○ The femoral head, tibial tubercle ○ articular surface of the femoral condyle Clinical manifestations ○ Causes pain and disability ○ Progressive joint collapse increases pain Worsened in WB, motion, relieved by rest ○ Joint effusion ○ Tenderness ○ Limping Treatments include: ○ Limited movement, lipid-reducing drugs, bisphosphonates, NSAIDs, assistive devices, exercise, electrical stimulation, surgery Chapter 12 – CNS Stroke Also known as a brain attack or cerebrovascular accident (CVA) More common in people older than 50 ○ Major cause of death Sudden impairment of cerebral circulation Usually causes serious damage or necrosis in brain tissue Stoke may cause: ○ Sudden unconsciousness ○ Permanent neurological damage ○ Death Stroke typically results from cerebral embolism, thrombus, or hemorrhage Risk factors: ○ Hypertension, family history of stroke or transient ischemic attacks, high cholesterol, obesity, smoking A stroke may be confirmed by EEG, CT, or MRI Left-side body system damage is indicative of right-side brain damage, vice versa Treatment: ○ Anticoagulant and hypertensive medication ○ Physically disabled patients may require long-term physical and speech therapy Transient Ischemic Attack (TIA) An episode of cerebrovascular insufficiency TIAs are warning signs of an impending stroke  Usually associated with partial occlusion of a cerebral artery by an atherosclerotic plaque or an embolus Common symptoms include: ○ Dizziness, limb weakness, numbness ○ Slurred speech ○ Bried or mild loss of consciousness Diagnosis and Treatment: Diagnosis is based on patient history, physical exam, and neurological exams. Is an arteriogram indicating a blocked blood vessel ○ Surgery may be utilized to open the vessel or bypass the blockage A common surgery to correct blood flow for TIA carotid endarterectomy Epilepsy A chronic brain disease caused by intermittent electrical activity Incidence is highest during childhood ○ Also common in the elderly ○ Involving recurring seizures (sudden attacks) ○ Not all seizures are characterized by convulsions About one-half of all seizure disorder cases are idiopathic Diagnosis and Treatment: Diagnosis is based on one or more seizures ○ Tests such as EEG, CT, or skull X-rays Epilepsy is usually treated with anticonvulsive medication Alzheimer’s A degenerative disorder of the cerebral cortex ○ Especially the frontal lobe The most common cause of dementia in older adults ○ Usually affecting people age 70 or older ○ Begins with slight mental impairments and short-term memory loss Takes up to 10 years to develop into late-stage Alzheimers ○ It is of unknown origin but has been linked to heredity, autoimmunity, toxicities, and viruses Diagnosis and Treatment: CT and MRI scans have the potential to reveal microscopic plaques and characteristic brain atrophy There is no cure or definitive treatment Treatment is supportive Increase in aid in support, nutrition, hydration, hygiene, and safety Parkinson’s Progressive neurodegenerative disorder ○ Primarily affects movement ○ Gradual loss of dopamine Affects men in their 50s and 60s more than women ○ Involves slow, progressive brain degeneration It characteristically produces:  ○ Progressive muscle rigidity ○ Akinesia ○ Involuntary tremor Pathology ○ Dopamine neuron loss Involved in movement control ○ Formation of Lewy Bodies Abnormal protein- disrupts cells; contributes to cell death ○ Neuroinflammation Degeneration of neurons triggers an inflammatory response. Diagnosis and Treatment: Parkinson's is of unknown origin ○ It appears related to brain cells with deficient dopamine Diagnosis is based on the patient's age, history, characteristic signs, and symptoms Treatment usually involves dopamine replacement ○ Though the disease itself is incurable Amyotrophic Lateral Sclerosis (ALS) A degenerative disease that affects the upper and lower motor neurons ○ Commonly called “Loud Gehrig's Disease” It is a chronic, progressively debilitating disease ○ May be fatal in less than 1 year Onset is usually between ages 40 and 70 ○ It affects three times as many men as women, without a cure Multiple Sclerosis (MS) A chronic inflammatory disease involving demyelination of white matter of the brain and spinal cord Symptoms: ○ Lack of coordination, muscle weakness, or numbness ○ Unsteady gait, paresthesia, vertigo ○ Difficulty speaking Acute attacks are treated with corticosteroids ○ Chronic dorms are treated with interferons, immune modulators, and antineoplastic agents Traumatic Brain Injury (TBI) Trauma to the brain, neck, and spinal cord can cause many types of disabilities and even death Types: ○ Concussion ○ Contusion ○ Diffuse Axonal Injury ○ Penetrating Injury Traumatic brain injury (TBI) is a complex injury ○ Many symptoms and disabilities Symptoms:  Physical ○ Headaches, dizziness, fatigue, sleep disturbances nausea, and balance problems Cognitive ○ Memory issues, difficulty concentrating, confusion, and impaired judgment Emotional and behavioral ○ Mood swings, irritability, anxiety, and depression Speech and language difficulties ○ Aphasia and dysarthria Spinal Cord Injury (SCI) When the vertebral column is damaged there is also the possibility of spinal cord damage When the lower part of your body is affected ○ Paraplegia When the arms and legs are both affected ○ Quadriplegia or tetraplegia Complete vs. incomplete ○ Complete- total loss ○ Incomplete- some preserved function Symptoms and Treatment: Spinal cord injury often causes loss of feeling and movement below the area of injury When the C1-C3 area of the spinal cord is injured ○ Often fatal due to breathing centers in the medulla being affected Treatments: ○ Medications ○ Emergency surgery ○ Immobilization with traction-like devices Chapter 13 – PNS Peripheral neuropathies Classified into three different types 1. Axonal neuropathies Axons are the main target of damage When a peripheral nerve is cut: ○ Wallerian degeneration occurs ○ Parts of axons distal to the transaction point are disconnected from the central neuron. ○ Damage occurs over a long period of time ○ Loss of sensation, muscle weakness, loss of reflexes 2. Demyelinating neuropathies Schwann cells and their myelin sheaths targets ○ Produce myelin sheath- fatty layer insulates axons Axons relatively unaffected Almost random pattern of sheath degeneration  ○ Fatigue ○ Loss of refluxes ○ Tingling ○ Numbness ○ Pain ○ Weakness ○ Paralysis 3. Neuropathies Results from neuron destruction Leading to secondary degeneration of axonal processes Caused by herpes zoster or toxins Dysfunction able to affect proximal and distal body parts Guillain-Barre Acute inflammatory demyelinating polyneuropathy A type of peripheral neuropathy ○ May cause life-threatening respiratory paralysis ○ Weakness usually occurs in distal limbs ○ Affects proximal muscle function in 2-3 weeks Known as ascending paralysis Features include ○ Inflammation and demyelination of spinal nerve roots and peripheral nerves About 66% of cases are preceded by flu-like illness Peripheral nerves become inflamed ○ Infiltration by lymphocytes, macrophages, and a lower number of plasma cells Linked to infection with Epstein-Barr virus or Mycoplasma pneumonia Diagnosed by examination, electrodiagnostic tests, and analysis of cerebrospinal fluid (CSF) Diabetic neuropathy Type of metabolic neuropathy Most common cause of peripheral neuropathy Numbness, loss of pain sensation Balance difficulties Parathesias- pins and needles Dysesthesis- unpleasant sensations- burning and aching Diagnosis ○ Patient history, physical examination, EMG, sensory tests Treated with: Antiepileptic drugs such as pregabalin serotonin-norepinephrine reuptake inhibitors Tricyclic antidepressants Capsaicin cream Duloxetine Extended-release tapentadol Carpal Tunnel Syndrome (CTS)  Most common type of entrapment neuropathy From compression of medial nerve Nerve ischemia results Affects 3%-6% of population Sensory symptoms in nerve distribution- pain, N&T, weakness Treated with: ○ Splinting ○ Corticosteroids ○ Anesthetics ○ Surgical decompression ○ Changing ergonomics Bells’ palsy Also called idiopathic facial paralysis, facial nerve palsy It is a sudden and unilateral paralysis Most common between ages 15 and 45 This may be due to: ○ Meningitis, tumors, diabetes, head trauma ○ Cranial nerve inflammation, HIV ○ Herpes type 1, herpes zoster, pregnancy Often develops overnight Symptoms: ○ Facial weakness, facial drooping, altered sense of taste, tearing or drooling, pain ○ Treated with corticosteroids, acyclovir Chapter 14 – Cardiovascular Disorders Coronary Artery Disease (CAD) CAD involves the arteries supplying the myocardium They are marked by atherosclerotic deposits with a thrombus blocking them This causes temporary cardiac ischemia ○ Eventually a myocardial infarction The first symptom is usually angina pectoris More severe pain of MI may occur ○ An ECG can show visible changes in function ○ Arteries narrow and develop atherosclerosis due to plaque deposits in the interiors of arteries Treatment: Once coronary arteries are about three-fourths occluded ○ Chest pain begins to develop Treatment involves attempts to restore adequate blood flow to the myocardium. ○ Often by using vasodilators To open constricted arteries, angioplasty is often attempted ○ A catheter is introduced through the skin into a large artery and threaded into the narrowed coronary artery to increase the size of the artery’s diameter Atherosclerosis  Causes constriction of the coronary arteries ○ Results in many consequences The plaque-like deposit of material is called an atheromatous plaque of atheroma. The plaques, which become surrounded by fibrous tissue, are called stable plaque.s Therefore. The small artery becomes permanently narrowed Arteriosclerosis Commonly called “hardening of the arteries” It is most common in the elderly and in diabetes ○ Involving loss of elasticity and cardiac ischemia Eventually, cells of the myocardium weaken and die ○ Interference with the heart’s pumping ability ○ Heart failure Angina pectoris Angina chest pain is most commonly defined as chest pain after exertion ○ Results from reduced oxygen supply to the myocardium There are three types 1. Stable (exertional)- the most common form, it occurs when a coronary artery is narrowed due to severe buildup of plaque. Rest improves symptoms 2. Unstable- requires emergency treatment. Can occur without physical exertion, and it is unrelieved by rest or medications 3. Prinzmetal's (variant)- rarest type Caused by a spasm in a coronary artery- may occur with or without CAD Treatment Includes: Ceasing strenuous activity and placing nitroglycerin tablets under the tongue If it persists after 20+ minutes of treatment, immediate medical attention is required When exercise is allowed ○ Frequent rest periods are usually required Myocardial Infraction (MI) “Sudden death of a segment of the heart muscle caused by an abrupt interruption of blood flow to part of the heart” Caused by an occlusion of coronary artery ○ Resulting in ischemia and infarction (death) of the myocardium Besides chest pain: ○ Dyspnea, irregular heartbeat, and sweating Treatment: Begins with administration of oxygen ○ Then morphine to control pain Aspirin is given to reduce risk of additional ischemic damage Vasodilation is attempted with a nitroglycerin drip Lidocaine is given by IV drip, after a leading bolus, to help control arrhythmias Thrombolytic drugs may be administered  ○ An attempt at angioplasty may occur within 6 hours Congestive Heart Failure (CHF) CHF is the acute or chronic inability of the heart to pump enough blood to meet the body’s demands for homeostasis It usually develops silently ○ Gradually increasing dyspnea ○ Indicated by distention of neck veins and ankle edema If right-sided the liver and spleen enlarge If left-sided, it may be related to aortic valve stenosis, hypertension, hyperthyroidism, or infraction of the left ventricle Class I- no limitations Class II- slightly limited physical activity Class III- moderate- very limited physical activity Class IV- severe- cannot perform physical activity without discomfort Etiology: CHF may be caused by underlying conditions: ○ MI ○ Cardiac valve damage ○ Arrhythmias ○ Cardiomyopathy ○ Hypertension ○ CAD ○ Chronic obstructive pulmonary disease (COPD) Diagnosis: The presence of fluid in the lungs will be indicated by ○ Radiographic film evidence ○ Diminished breath sounds Treatment: Directed at reducing the heart's workload and increasing its efficiency ○ Digitalis preparations ○ Beta-blockers ○ ACE inhibitors ○ Diuretics ○ Vasodilators Chronic CHF is vulnerable to major organ impairment and complications Cardiac arrest The sudden, unexpected cessation of cardiac activity It is a true life-threatening emergency 911 should be called immediately, and CPR initiated ○ As well as defibrillation if avialable The patient will be unresponsive with no palpable pulse and no respiratory effort Causes of Cardiac Arrest: Arrhythmia Respiratory arrest  Myocardial infarction Drowning Massive hemorrhage Drug Overdose Treatment: Within 4-6 minutes, CPR must be initiated Defibrillation should be attempted by trained people Medications include: ○ Epinephrine ○ Isoproterenol ○ Dobutamine ○ Antiarrhythmic drugs (lidocaine and bretylium) Valvular heart disease An acquired or congenital disorder ○ Potentially harming any of the heart’s four valves It most often affects the mitral valve ○ But may also affect the aortic valve It may exist as: ○ Insufficiency- failure of the valves to close completely ○ Stenosis- hardening of the cusps of the valves, preventing complete opening or impeding blood flow Types of Valvular Heart Disease Mitral insufficiency- abnormality of the mitral leaflets that open and close Mitral stenosis- narrowing of the valve ○ Due to valvular abnormalities, fibrosis, or calcification Aortic insufficiency- when blood flows back into the left ventricle during diastole Aortic stenosis- when increased left ventricular pressure attempts, to overcome the resistance of the narrowed valvular opening Hypertension (HTN) Essential (primary) hypertension is a condition of abnormally high blood pressure in the arterial system Symptoms: ○ Nosebleed (epistaxis), headaches, lightheadedness, or syncope Stress- a major risk factor Other causes may include: ○ Age, family history, race ○ Hyperactive (type “A”) personality ○ Lifestyle factors Treatments: ○ Diuretics ○ Beta-adrenergic blockers ○ Vasodilators ○ Calcium channel blockers ○ Angiotensin-converting enzyme (ACE) inhibitors  ○ PT treatment Hypertension is usually first diagnosed by a blood pressure reading of more than 140/90 ○ Followed by consistently elevated BP, medical history, and physical exam. and lab tests Orthostatic hypotension Also called “postural hypotension” Systolic BP decreases of 30 mm Hg or more or decreases of 10 mm Hg or more in systolic and diastolic arterial BP with pulse increase of 15 bpm or more upon standing from a sitting or supine position Most common in frail, older adults Symptoms: Blurring or loss of vision Dizziness and syncope Treated with: ○ Sitting up and exercising in bed ○ Rising slowly ○ Adequate hydration ○ Limit or avoid alcohol ○ Exercise as much as possible ○ Avoid standing for long periods ○ Elastic stockings Aneurysm The weakening and resulting local dilation of the wall of an artery Types of aortic aneurysms include: ○ Saccular- when increased arterial pressure pushes out a pouch or bulge on one side of the artery ○ Fusiform- when the arterial wall weakened around its circumference, having a spindle-shaped ○ Dissecting- when blood is forced by layers of the arterial wall, causing them to separate Diagnosis and Treatment: For abdominal aneurysm, the aortic mass is noted mid-abdomen A bruit may be heard on auscultation of the area Diagnosis is confirmed via: ○ Radiographic studies ○ Ultrasonography ○ Computed tomography (CT) ○ Magnetic resonance imaging (MRI) Treatment usually involves surgery Thrombosis Occurs after clots are lodged in vessels Venous thrombosis ○ From vein disease or injury, immobility, fractures, medication, obesity, genetic disorders, clotting disorders  Arterial thrombosis ○ From arteriosclerosis plaque rupture, blood clotting Treated with: ○ Anticoagulants ○ Catheters ○ Wire mesh stents ○ Clot-dissolving medications Pulmonary embolism Lodging of a blood clot in a pulmonary artery Most common cause of sudden death in hospitalized patients Most common signs: ○ Dyspnea, chest pain, anxiety, cough Treated with: ○ Oxygen, IV saline, vasopressors, thrombolytics, embolectomy Deep Vein Thrombosis (DVT) Mostly affects the lower legs, thighs, and pelvis ○ Danger of clots occurring in the femoral and pelvic veins becoming emboli It is mostly asymptomatic until embolization occurs ○ May be fatal Risk Factors Include: ○ Immobility ○ Dehydration ○ Varicose veins ○ Leg surgery ○ Pelvic surgery ○ Obesity ○ Pregnancy Treatment: ○ Bed rest ○ Elevation ○ Anticoagulants ○ Leg exercises Chapter 15 – Blood Disorders Blood components Blood is a connective tissue that contains cellular and liquid components Hematocrit refers to the proportion of blood that is made up of cells (RBC, WBC, and platelets) Plasma is the liquid portion of blood consisting of water, protein, clotting factors (fibrinogen), nutrients, gases, waste products Serum- liquid that remains after cells and fibrinogen have been removed ○ Used for diagnostic tests Plasma contains proteins such as: ○ Albumin- maintains the blood osmotic pressure  ○ Globulins- antibodies (immune defense) ○ Fibrinogen- needed for blood clot formation- prevents excessive bleeding RBCs Red bone marrow is the site of origination of all blood cells Red blood cells (RBCs) are also called erythrocytes Hemoglobin The kidneys secrete a hormone called erythropoietin, which stimulates the production of erythrocytes in the red bone marrow. WBCs White blood cells (leukocytes) Leukocytes do not have hemoglobin and they move through capillary walls by diapedesis Neutrophils- the most common type, making up 50% to 60% of WBCs Lymphocytes- make up 30% to 40% of WBCs ○ Adaptive immunity- specific response Basophils- migrate from the blood to enter tissue ○ Become mast cells capable of releasing histamine and heparin Eosinophils- combat parasitic infections ○ Modulate inflammatory response in allergic reaction Monocytes- enter tissue to become macrophages Platelets Also called thrombocytes ○ Vital for blood clotting and hemostasis Diagnostic tests A complete blood count (CBC) is taken to test for: ○ Total RBCs ○ WBCs ○ Platelets ○ Morphology (size and shape) ○ Hemoglobin ○ Differential WBC count ○ Hematocrit Inflammation or infection is often signified by leukocytosis ○ An increase in WBCs in circulation Certain viral infections, radiation, and chemotherapy cause leukopenia, a decrease in leukocytes Reticulocyte count helps bone marrow function to be assessed Bleeding time tests can determine blood-clotting disorders Iron deficiency anemia Iron deficiency anemia is a common worldwide cause of anemia It results from increased demands on the stored iron in the body that exceed the amount the body can supply Microcytic (small), hypochromic (pale) erythrocytes are the result Signs and Symptoms  Cold intolerance Delayed wound healing Palpitations syncope(fainting) Etiology less than adequate iron in the diet, chronic blood loss, hemorrhoids, cancer, or excessive menstrual flow Disorders that can impair iron absorption Protein deficits Leukopenia Leukopenia- extremely low levels of leukocytes Damages the immune system to reduce the body’s response to bacterial infections Immune function greatly decreased Signs and Symptoms: May be of rapid onset Thrombocytopenia Consists of a decrease in platelets Can lead to an inability of normal blood clotting Chapter 16 – Lymphatic Disorders Lymphedema An abnormal collection of lymph fluid in soft tissues, often in the extremities There are two broad categories ○ Primary (idiopathic) ○ Secondary (acquired) lymphedema Stages ○ Stage 0 (latent) Reduced lymph transport capacity with no clinical edema ○ Stage 1 Protein-rich pitting edema, reversible with elevation Increases with activity, heat, or humidity ○ Stage 2 Irreversible swelling, development of fibrosis stiffening/hardening of tissues ○ Stage 3 Additionally, atrophic changes include hardening of dermal tissue, skin fold, skin papillomas (wart-like growths) May see functional impairment of limb Signs and Symptoms: Swelling and heaviness in the arms, hands, fingers, legs, feet, and toes Lymphedema of the lower extremities begins with mild swelling of the foot that extends to the entire limb ROM may be limited Etiology  Most often caused by inflammation, obstruction, or removal of lymph vessels Lymphoma Malignant neoplasms involve in the proliferation of lymphocytes in lymph nodes Clinicians attempt to classify them based on whether the tumor is aggressive or slow-growing There are two main types: ○ Hodgkins lymphoma ○ Non-Hodgkins Lymphoma Stages of Lymphoma Development Stage I- a single lymph node or region Stage II- two or more lymph node regions ○ In a relatively localized area Stage III- nodes on both sides of the diaphragm ○ And spleen Stage IV- diffuse extra lymphatic involvement ○ Usually in the bones, lungs, or liver Hodgkin’s Disease Occurs primarily in adults 20 and 40 years of age, in both sexes In the early stages, when malignancy is localized, the prognosis is excellent It usually involves a single lymph node in the neck ○ Then spreads to adjacent nodes in a very ordered fashion Moving on to organs via the lymphatic system Reed-Sternberg Cell is very large and is looked for in the lymph node as a marker for diagnosis of the condition Diagnosis and Treatment: Initial diagnosis often results from abnormalities in a chest X-ray Lymph node biopsy may also be used ○ Which if positive reveals Reed-Sternberg cell Treatment: ○ Radiation, chemotherapy, and surgery ○ One of the most effective combination drugs is ABVD Non-Hodgkin’s These lymphomas are increasing partially because of associated HIV infection Nearly 80% of cases involve B-lymphocytes The initial manifestation involved enlarged but painless lymph nodes ○ With clinical signs and stages that are similar to Hodgkins lymphoma Etiology is unknown, but viral cause is suspected Diagnosis and Treatment: The presence of widespread metastasis is often the basis for diagnosis Intestinal nodes and organs are frequently involved in the early stages Treatment is similar to Hodgjin’s lymphoma ○ However, it is more difficult to treat when tumors are not localized Chapter 17 – Integumentary System Disorders Contact dermatitis A common inflammation of the skin Diagnosis and Treatment Diagnosis is based on the appearance of the lesion Treatments: ○ Topical glucocorticoids; cool, wet cloths; oral antihistamines; and colloidal oatmeal baths Cellulitis Cellulitis (erysipelas) is an infection of the dermis and subcutaneous tissue. ○ Usually secondary to an injury, boil, or ulcer Cellulitis often occurs in the lower trunk and legs Ulcers Also known as bed sores They are localized in areas of dead skin affecting the epidermis, dermis, and subcutaneous layer.s Stages of Ulcers ○ Stage I- surface reddening, unbroken skin Stage II- wound extends through all skin layers ○ Stage IV- involves underlying muscles, tendons, and bones; can produce life-threatening infections ○ Stage V- surgery or amputation is indicated Burns Skin injuries caused by either: ○ Heat (thermal) ○ Non-thermal sources Rule of Nines for adults ○ 9% head, 9% each upper limb, 36% trunk, 1% genitals, 18% each lower limb Children- lund and Browder Chart ○ 13% head, 2% neck, 4% each upper arm, 3% each lower arm, 2.5% each hand, 26% trunk, 1% genitals, 2.5% each buttock, 8% each upper leg, 5.5% each lower leg, 3.5% each foot Rule of nine in infants- ○ 18% head, 9% each upper limb, 18% trunk, 1% genitals, 13.5% each lower limb Three Categories of Burns ○ First-degree Affects the epidermis only ○ Second-degree (partial-thickness) Affects the epidermis as well as the dermis ○ Third-degree (full-thickness) Affects all tissue layers, causing charred skin that may be numb Infections are a major concern Diagnosis and Treatment: Diagnosis of burns is based on the appearance of the signs and symptoms Treatment is focused on the prevention of infection Atopic Dermatitis (Eczema) Often occurs in infancy ○ It may continue through adulthood The term atopic means the allergic condition may be inherited Secondary infections from scratching and viral infections may occur Eczema flare-ups are often triggered by anxiety, conflict, or stress Psoriasis A common, chronic inflammatory skin disorder ○ Marked by thick, flaky, red patches of various sizes Psoriasis leads to ○ Dermal and epidermal thickening ○ Increased e[idermal shedding Lesions appear as small red papules that enlarge and form silvery plaques Chapter 18 – Respiratory System Disorders Asthma Periodic episodes of severe but reversible bronchial obstruction ○ In patients who have hypersensitive to hyperresponsive airways May lead to irreversible lung damage and development of chronic obstructive lung disease Symptoms: ○ Episodes of dyspnea and wheezing on exhalation ○ Result from bronchospasm Severe attacks lasting for days are referred to as status asthmaticus, which is more common in the elderly ○ These attacks are life-threatening medical emergencies Asthma is related to family history or hay fever, asthma, and eczema Treatment: ○ Avoiding allergens, desensitization, education, deep breathing techniques, proper posture ○ Medications: bronchodilators, mucolytics, glucocorticoids, and leukotriene receptor antagonists COPD Chronic obstructive pulmonary disease ○ Actually describes both chronic bronchitis and emphysema, which often coexist Patients have high levels of carbon dioxide in their blood, but cannot increase breathing to remove it Grading ○ 1- mild- minimal shortness of breath ○ 2- moderate- shortness of breath upon exertion ○ 3- severe- the condition affects quality of life ○ 4- very severe- shortness of breath Greatly impairs the quality of life  Exacerbations may become life-threatening Smokers often develop COPD after 40 or 50 years ○ Symptoms can occur many years after quitting Symptoms ○ Dyspnea, chronic coughing, wheezing, hemoptysis ○ Cyanosis, weight loss, pursed lip breathing, barrel chest Treatments ○ Bronchodilators, inhalers, cough medications ○ Mucolytics, vaccination against influenza Emphysema A form of chronic obstructive pulmonary disease ○ Characterized by abnormal, permanent enlargement of the acini, with destruction of the alveolar walls Symptoms: ○ Coughing, dyspnea, tachypnea, wheezing, barrel chest ○ Decreased breath sounds, clubbed fingers or toes Treatments: ○ Bronchodilators, antibiotics, increased fluid intake, and light oxygen therapy Bronchitis Inflammation of the bronchi due to irritants or infection Symptoms: ○ Increased mucus production, productive cough, hypertrophy of the mucus-secreting glands, thickening of the mucous membrane, bronchiectasis Treatments: ○ Antibiotics, bronchodilators, oxygen therapy corticosteroids ○ Avoidance of smoking, air pollutants Including secondhand smoke Pulmonary embolism A sudden pulmonary artery blockage by an embolism Symptoms: ○ Coughing, dyspnea, apprehension, and chest pain It can be confirmed with X-rays, lung scans, MRI, or pulmonary angiography Treatment involves oxygen therapy and anticoagulation medications Pulmonary edema Fluid collecting in the alveoli and interstitial tissue ○ It may be a life-threatening medical emergency Symptoms include coughing (often wet, frothy), orthopnea, rales, and hemoptysis Treatments include oxygen therapy, positive-pressure mechanical ventilation, diuretics, cardiogenic, and morphine Pneumothorax A collection of air in the pleural cavity that often results in partial or complete lung collapse on the affected side Symptoms:  ○ Sudden, severe chest pain; severe dyspnea; shock; shallow respirations; sucking breath sounds ○ Shift of the mediastinum to that side This is a medical emergency If not an emergency, treatments include thoracentesis, oxygen therapy, and analgesics Chapter 19 – Digestive System Disorders Reflux Esophagitis (GERD) Causes a burning sensation in the epigastric area Known as “heartburn” An inflammation of tissue at the lower end of the esophagus Reflux esophagitis is caused by a backflow reflux of stomach acid through the cardiac sphincter Diagnosis requires an upper GI series and X-rays, possibly followed by EGD with biopsy Treatments: ○ Avoiding large meals, spicy foods, caffeine, and tight clothing Medications: ○ Laxatives, stool softeners, antacids ○ A variety of specially-designed drugs Gastritis An inflammation of the stomach ○ May be acute or chronic It usually causes abdominal pain ○ May also cause belching, nausea, and vomiting It may be caused by: ○ Use of NSAIDs ○ Alcohol consumption ○ Smoking ○ Bacterial infections Diagnosis: ○ A blood test that checks for anemia ○ Stool test checking for the presence of blood and H. pylori ○ An upper GI endoscopy or EGD Gastritis is treated with medications to reduce stomach acid For H. pylori, treatment with antibiotics is indicated Peptic ulcer Diverticulitis Causes cramping and low abdominal pain It occurs more with increased age and is linked to ○ Lack of physical activity ○ Poor bowel habits ○ Poor dietary habits Diagnosis is made via colonoscopy to examine the diverticula Treatments include:  ○ Increasing dietary fiber and, if acute, the use of antibiotics IBS IBS is the most common disorder of the intestines ○ Often confused with inflammatory bowel disease (IBD) ○ It is also known as spastic colon It can cause abdominal pain, altered motility, constipation diarrhea IBS may be related to stress, spicy food, alcohol, caffeine, certain food seasonings Diagnosed via stool samples, blood tests, endoscopy, X-rays, and colonoscopy Treatments include: ○ Avoiding stress and dietary causes ○ Stress-reduction techniques Biofeedback, counseling, regular exercise, meditation, deep breathing, hypnosis, and yoga Hepatitis Inflammation of the liver leads to abnormal function and other disease states Six main viral types: ○ Hepatitis A (HAV)- the least serious form ○ Hepatitis B (HBV)- serum hepatitis ○ Hepatitis C (HCV)- similar to hepatitis A But attacks RNA of cells instead of their DNA ○ Hepatitis D (HDV)- elta virus ○ Hepatitis E (HEV)- does not result in chronic hepatitis ○ Hepatitis G (HGV)- newly discovered Caused by transfused blood May be transferred through pregnancy or sexual intercourse Cholecystitis Inflammation of the gallbladder ○ Often caused by a gallstone obstructing bile flow It may be prevented by maintaining healthy body weight and a high-fiber diet Complications include ○ Rupture of the gallbladder and potential peritonitis ○ Bile back up into the liver ○ Potential liver damage and cirrhosis Confirmed by ultrasound, specialized MRI and X-rays Treatments include ○ Cholecystectomy, followed by avoidance of most fatty foods This usually offers a good prognosis Cholelithiasis The presence of gallstones in the gallbladder or bile ducts Gallstones affect women more than men ○ With nearly 600,000 people in the U.S. having them removed each year They usually cause symptoms because they block the outflow of the gallbladder or its ducts Symptoms include  ○ Nausea, vomiting, upper right abdominal pain after fatty meals, complications such as cholecystitis and jaundice Gallstones are formed from cholesterol and bile salts, with cholesterol stones being the most common type Based on the “five Fs”: ○ Female gender ○ Fair complexion ○ Fat or obese body state ○ Forty years of age or older ○ Fertile state or having already had children Confirmed via patient history, ultrasound, and a cholecystography Cholelithiasis is treated with extracorporeal shockwave lithotripsy (ESWL), which breaks up stones so that they can be passed- ○ If not effective or indicated, a cholecystectomy is performed. Chapter 20 – Urinary System Disorders Signs of abnormalities Anuria- no urine output Dysuria- difficulty or pain when urinating Frequency- urinating frequently Hematuria- blood in the urine Nocturia- increased voiding during the night Oliguria- decreased urine output Proteinuria- proteinn in the urin Pyuria - pus in the urine Urgency- the need to urinate immediately UTI Any disease of the urinary tract ○ Including the kidneys, bladder and urethra Common forms: ○ Cystitis ○ Pyelitis ○ Pyelonephritis ○ Urethritis Renal failure The kidney's inability to clean the blood of wastes High levels of urea cause uremia ○ As urea is converted to ammonia ○ It has toxic effects on the entire body Symptoms include: ○ Drowsiness, confusion, visual disturbances, convulsion ○ Urine smell or the breath, nausea, vomiting, diarrhea It may be acute or chronic  ○ embolism shock, dehydration, congestive heart failure, stones, tumors, or enlarged prostate Patient history, physical examination, and blood tests assist in diagnosing renal failure ○ It is indicated by elevated blood creatinine and elevated BUN Treatments include: ○ Limiting protein, sodium, and fluid intake ○ Antihypertensives, diuretics, antibiotics ○ Dialysis (often involving the use of an arteriovenous shunt) ○ Kidney transplantation Urinary incontinence The loss of control of urine flow It affects females much more than males- ○ Of females 60 or older, nearly 40% are affected Overflow incontinence- the bladder does not properly empty and leaks when overfilled Stress incontinence- urine cannot be held when coughing, laughing, or sneezing Urge incontinence- there is a sudden uncontrollable urge to empty the bladder Female incontinence may be caused by childbirth, pregnancy, hysterectomy, menopause Male incontinence may be caused ban y enlarged prostate or prostate surgery Diagnosis involves a medical history, physical examination, urinalysis, keeping “voiding” diary, CBC, cystometry cystoscopy Treatments include: ○ Wearing incontinence pads or clothing ○ Pelvic muscle exercises, biofeedback therapy Neurogenic bladder Dysfunction is caused by injury to a part of the nervous system controlling the bladder or urinary tract Symptoms include: ○ Lack of feeling the need to void or having it constantly ○ Incontinence ○ Inability or difficulty in emptying the bladder ○ Bladder spasms It may be related to: ○ Spinal cord injury stroked, herniated disks, tumors ○ Dementia, diabetes, Parkinsons Disease, multiple sclerosis ○ Brain tumors Diagnosis: ○ Patient history, physical examination, neurologic examination, urologic studies Treatments Include: ○ Prevention of UTIs ○ Control of incontinence  ○ Intermittent self-catheterization Chapter 22 – Endocrine System Disorders Hyperpituitarism Hyperprituitaruism is an abnormal increase in hormone production by the pituitary ○ Especially affecting the production of growth hormone ○ This leads to excessive growth of bones and tissues Hypersecretion of the pituitary produces ○ Gigantism (if it begins before puberty) Increased rates of growth Slowed sexual development Slowed mental development ○ Acromegaly (if it begins after puberty) Enlargement of the small bones of the hands, feet, and face Causes include benign pituitary tumors or carcinoid tumors Diagnosis is based on physical examination; MRi; and blood tests that reveal high levels of growth hormone, thyroid hormone, and prolactin In children, the growth process can be slowed by ○ Microsurgical removal of the pituitary tumor ○ Radiation ○ Drug therapy In adults, surgical removal of a pituitary tumor often leads to hypopituitarism, with reoccurrence of pituitary tumors common Hypopituitarism (Dwarfism) An abnormal decrease in pituitary activity leading to deficiency or absence of some or all of the trophic hormones The most severe decrease in growth hormone causes dwarfism ○ Affected children are proportionally small ○ May be underdeveloped sexually ○ Have mental challenges A pituitary tumor is commonly the cause of hypopituitarism Clinical history and blood tests confirm diagnosis Physical examination determines growth rates that are below normal Treatment involves hormone replacement therapy ○ Somatotropin (hGH) may be administered until the child reaches 5 feet in height Replacement of thyroid and adrenal hormones, as well as sex hormones, may be required Hyperthyroidism (Grave’s Disease) Defined as excessive secretion of thyroxine by the thyroid gland Graves disease is a condition of primary hyperthyroidism that occurs when the thyroid gland is hypertrophied completely ○ Results in a diffuse goiter ○ It mostly affects women between the ages of 20 and 40 Symptoms include:  ○ Increased metabolic changes, rapid heartbeat ○ Palpitation, nervousness, excitability, insomnia ○ Weight loss even with excessive appetite ○ Profuse perspiration, warm and moist skin Graves disease is believed to be an autoimmune disorder characterized by abnormal stimulation of the thyroid gland by thyroid-stimulating antibodies A thorough patient history is taken Serum levels of T3 and T4 are studied A thyroid scan Blood tests Treatments include: ○ Propylthiouracil, methimazole, beta-blockers ○ Radioactive iodine therapy or surgery Hypothyroidism (Cretinism and Myxedema) Common in iodine-deficient areas of the world ○ May result in metal deficiency Cretinism is a form of hypothyroidism that develops during infancy or early childhood Myxedema is a form of hypothyroidism that develops in older children or adults and be severe Cretinism causes ○ Menat land growth retardation, protruding abdomen ○ Broad nose, short forehead, wide-set eyes Myxedema causes menorrhagia in females ○ Dry skin, reduced sweating, facial bloating ○ Tongue thickening, puffy eyelids Causes include: ○ Failure of the thyroid to develop or function normally ○ Enzyme deficiencies ○ Fetal or maternal thyroid deficiency Cretinism is indicated by blood tests that show an absence or reduction of T4 with elevated levels of thyrotropin, thyroid scan, and radioactive iodine uptake tests Thyroid hormone therapy may promote physical growth Lifelong thyroid replacement therapy will be required ○ For myxedema, T4 is administered to achieve normal thyroid function Hyperparathyroidism Results from overproduction of parathormone (PTH) by one or several of the parathyroid glands ○ Classified as primary or secondary It causes calcium to be pulled from the bones ○ Causing weakness and fractures It is usually caused by a parathyroid tumor or idiopathic hyperplasia of one of the glands Hypoparathyroidism A decrease in the normal amount of parathormone leads to abnormally low blood calcium levels  Symptoms are mostly those of: ○ Hypocalcemia, muscle spams, tetany ○ Laryngeal spasms Death by asphyxiation if severe It usually results from: ○ Surgical removal of all the parathyroid glands ○ A thyroidectomy Diagnosed by physical examination, blood tests, and x-rays Treatment includes: ○ Parenteral administration of calcium and vitamin D ○ Oral calcium Exercises are designed to strengthen the bones and improve balance Cushing’s syndrome The manifestation And hypercortisolism due to any cause The pituitary results from excessive ACTH production by a tumor of the pituitary gland The second form is caused by a benign or malignant adrenal tumor Symptoms include: ○ A rounded moon-shaped face ○ Fatigue ○ A “buffalo hump” on the upper back ○ Hypertension ○ Poor wound healing, osteoporosis, rib fractures It may be caused by: ○ A pituitary gland or adrenal cortex tumor ○ After prolonged doses of cortisone Diagnosis is based on cortisol hypersecretion determined by a 24-hour test, measuring plasma levels of ARCH and MRI or CT scans Treatments include: ○ Surgical removal of the pituitary or adrenal cortex tumor ○ Lifetime hormone therapy Diabetes mellitus A chronic metabolic disorder characterized by hyperglycemia ○ Type 1- absolute insulin insufficiency Usually occurs in children and young adults ○ Type 2-insulin resistance with varying degrees of insulin secretory defects Usually occurs in obese adults after the age of 40 ○ Gestational diabetes Emerges during pregnancy when a previously non-diabetic woman shows glucose intolerance Polyuria ○ Increased urine production Polyphagia ○ Increased hunger  Glycosuria ○ Glucose in urine Hyperglycemia ○ Elevated blood sugar levels Formation of ketones in the blood and urine ○ Breaking down for energy ○ Diabetic ketoacidosis (DKA)- life-threatening Primary diagnosis by two criteria, which are obtained more than 24 hours apart: ○ Fasting plasma glucose level of 126 mg/dL or more on at least two occasions ○ Typical symptoms of uncontrolled diabetes and random blood glucose levels of 200 mg/dL or more ○ Blood glucose of 200 mg/dL or more 2 hours after ingesting 75 grams of oral dextrose ○ It may also be based on diabetic retinopathy and urinalysis Effective treatment optimizes blood control and decreases complications Treatment involves patient education and lifelong attention to diet, medication, and exercise A special HbA1C test should be given every 3-6 months to measure glycosylated hemoglobin in the blood Hypoglycemia Abnormally low blood sugar ○ It occurs when blood glucose levels drop below 60 mg/dL Symptoms are the same for diabetes and include light headaches, sweating, and trembling Common causes: ○ Excessive exercise, fasting skipping regular meals ○ Over administration of insulin, pancreatic adenoma ○ GI disorders, certain hereditary conditions Chapter 23 – Male Reproductive Disorders Prostatitis May be chronic or acute, bacterial or nonbacterial When acute, the gland becomes tender and swollen, feeling “soft” upon palpation Symptoms include: ○ dysuria, urinary frequency, urinary urgency ○ low back pain or abdominal pain Acute bacterial prostatitis is usually caused by Escherichia coli ○ Followed by Pseudomonas, Proteus, or Streptococcus faecalis Diagnosis and Treatment Prostatitis is usually diagnosed via urine culture, complete blood count, and transrectal ultrasound Treatments (if bacterial) include ciprofloxacin and other antibacterials Nonbacterial prostatitis may be treated with anti-inflammatory drugs and prophylactic antibacterials Prostate cancer Usually affects men older than the age 50 ○ Causes many deaths- it is the most common cancer in older men in the U.S. Most prostate cancers are adenocarcinomas that arise from the surface tissue Unfortunately, these tumors often metastasize to bones of the pelvis, spine, femur, or ribs relatively early Four Stages: 1. Stage A- small, non-palpable, encapsulated tumors 2. Stage B- palpable tumors confined to the prostate 3. Stage C- tumors that extend beyond the prostate 4. Stage D- distant metastases are present Pathology Prostate cancer often causes a hard nodule in the gland's periphery, usually the posterior lobe, that is detectable via rectal examination The cause of prostate cancer has not been determined, but may be linked to, ○ Genetic factors ○ Environmental factors ○ Hormonal imbalances Diagnosis and Treatment Prior to treatment, the disease is usually confirmed via the presence of prostate-specific antigen (PSA) and elevated prostatic acid phosphatase ○ All men over age 45 should be tested annually to check for serum markers Treatments include surgery and radiation Chapter 24 – Female Reproductive Disorders Endometriosis A condition in which the functional endometrial tissue is found in ectopic sites (outside the uterus) including the: ○ Ovaries ○ Vagina ○ Intestines ○ Posterior broad ligaments ○ Pelvis ○ Perniem ○ Vulvs The inflammation returns with every cycle Fibrous tissue forms, which may be palpated ○ Leading to adhesions and obstructions Pathology Endometriosis primarily causes dysmenorrhea with pain, infertility, profuse menses, dysuria, suprapubic pain, and hematuria (bladder) The ectopic endometrium occurs because of the hormone cycle and may be related to genetic predisposition and depressed immune system function Diagnosis and Treatment  Diagnosis- requires a laparoscopic examination, with biopsy Treatment: ○ Hormonal suppression of endometrial tissue ○ Pain medication ○ Surgical removal of ectopic endometrial tissue cervical cancer Cervical cancer is readily detected ○ If found early it is the most easily cured cancer of the female reproductive system Most cervical cancers are squamous cell carcinomas arising in the transitional zone between different epithelia of the vagina and uterine corpus Adenocarcinoma may also occur Pathology Cervical cancer usually causes: ○ A bloody, watery vaginal discharge that may be heavy and foul smelling ○ Lesions are usually a mass or ulcer on the surface of the cervix Invasive cervical cancer has a long pre-malignant stage, often lasting for more than 10 years Risk factors: ○ Lack of regular cervical Pap smear screening ○ Exposure to human papillomavirus (HPV) Unprotected sex with multiple partners early and frequently in life also increases risk Diagnosis and Treatment Most females are diagnosed with cervical cancer between the ages of 35 and 55 The most common diagnostic sign is an abnormal Pap smear test result, confirmed by a biopsy of a cervical lesion Treatment is based on staging and may include cryoblation, laser therapy, electrocoagulation, and (in extreme cases) hysterectomy Cystocele Cystocele ○ Fallen (prolapsed) bladder ○ From childbirth, constipation, heavy lifting Symptoms may include urinary incontinence, frequent urination, a feeling of fullness or pressure in the pelvic area, or difficulty fully emptying the bladder Uterine prolapse Occurs when pelvic floor muscles stretch and weaken ○ The uterus descends into the vaginal canal ○ Often affects postmenopausal women who have delivered multiple children Treated with: ○ Insertion of a supportive pessary device ○ Surgical repair Chapter 29 – Pediatric Disorders Duchene Muscular Dystrophy An X-linked recessive disorder  ○ Progressive, proximal muscle weakness Symptoms start in early childhood ○ Affects 1 of every 3,600 live male births ○ Lower limbs are usually first affected Waddling gait Gowers Sign ○ Eventually causes immobility Early teens are usually in wheelchair No cure Treatment focuses on managing symptoms ○ Exercises Maintain flexibility and strength Avoid high-impact ○ Orthoses, braces ○ Prednisone ○ surgery Spinal Muscle Atrophy (SMA) Degenerative of motor neurons Leads to easting of spinal muscles, weakness ○ Second most common fatal autosomal recessive disorder- after cystic fibrosis Autosomal recessive, confirmed by genetic testing ○ Severe form: Werding-Hoffman disease Treatments include: ○ Neurology ○ Pulmonology ○ Surgery ○ Nutrition ○ Orthoses ○ Medication ○ Respiratory therapy ○ Physical therapy Osteogenesis imperfecta Rare congenital disorder Involved collagen synthesis Also called “brittle bone disease” ○ Short stature, deformed cranium and limbs, frequent fractures, blue sclera ○ Type II (most severe) usually fatal after birth Treatments include: ○ Splints, supports, metal rods ○ Internal fixation of fractures ○ Medications Legg-Calve-Perthes Also called “coxa plana”  Ischemic necrosis that leads to flattening of the femur due to vascular interruption ○ Mostly affects boys 4 to 10 years of age Stages: Synovitis, necrosis of ossification center of the femoral head, revascularization, healing Treatments include: ○ Bed rest ○ Traction ○ Splint or cast ○ Leg brace ○ Physical therapy ○ Surgery ○ Hip spica cast Spina bifida Defective closure of the vertebral column ○ Due to low folate levels during pregnancy A serious neural tube defect ○ Affects 1 of every 1,500 births in the U.S. When severe, there may be sensory deficits, paralysis, stridor, apnea, swallowing and orthopedic problems, leg atrophy Treatments Include: ○ Surgery ○ Antibiotics ○ Shunting Cerebral palsy Persistent disorder of posture, movement Due to defects or lesions in infant's brain Appear before 5 years of age 70% of cases involve spasticity Usually diagnosed by MRI Treatments Include: ○ Physical therapy ○ Bracing ○ Medications ○ Surgery Erb’s palsy Peripheral nerve injury ○ Brachial plexus ○ This may occur because of excessive stretching of the head and neck away from the shoulders during head-first deliveries ○ During breech deliveries, excessive lateral traction on the trunk before the head is delivered can tear the cervical cord Affect the nerves of the arms (usually the upper arm) Treatments include:  ○ Immobilization, exercise, positioning, physical therapy Chapter 30 – Aging and Disease Process Aging Begins at birth, but becomes evident at around age 30 The period of life from old age until death is called senescence As we age, the body generally reduces in function, at cellular, tissue, and organ levels Aging may be genetically programmed or predetermined (apoptosis) Integumentary System The wrinkling of the skin is due to reduced amounts of elastic fibers and a toughening of collagen fibers. Skin turgor is the ability of the skin to change shape and return to normal, and is determined by hydration and age. Musculoskeletal System Common changes due to aging include osteoporosis, osteoarthritis, and herniated intervertebral disc.s Musculoskeletal Conditions Osteoporosis is seen primarily in older females, though it can affect any older adult. Muscles decrease in strength and mass in a process known as sarcopenia, and may even atrophy to a certain degree. Osteoporosis Loss of calcium and bone mass, as a result of aging, leads to osteoporosis Risk factors include: ○ Decreased estrogen levels due to aging ○ Decreased calcium, vitamin C, and vitamin D intake ○ Decreased osteoblastic activity ○ Decreased stress on bone or weight-bearing activity ○ Hereditary predisposition Decreased Bone Mass and Density Caused by reduced new bone deposition The bones may become porous and brittle, leading to fractures In the spine, spontaneous fractures of the vertebrae result in decreased height and kyphosis Recommendations to Reduce Risk and Progression of Osteoporosis Administration of bisphosphonates Individualized hormonal therapy Increased calcium intake with adequate vitamin D weight-bearing exercise, walking, physiotherapy, rehabilitation programs Herniated Intervertebral Discs As discs of the spine degenerate, sudden stress may cause a herniation of a disc. This causes pressure on spinal nerves and severe back pain When pressure is not relieved, permanent nerve damage may result Loss of height becomes apparent as the intervertebral discs become thinner Neurological and Sensory Systems Neurons in the brain are not replaced after birth A natural reduction in brain mass occurs as we age Decreased cellular response to neurotransmitter chemicals (such as norepinephrine) leads to delays in synaptic transmission in the brain Older people often have decreased reflexes, short-term memory loss lapses, and slower response times Hearing Conditions Common hearing conditions in older adults include: ○ Meniere’s disease ○ Otosclerosis ○ Tinnitus Cardiovascular System Aging causes the heart’s fibers and connective tissues to change Collagen fibers and fatty tissue can interfere with the heart’s ability to contract and conduct normal electrical impulses Often, heart valves become thicker, less flexible, and less efficient As arterial walls lose elasticity and accumulate collagen because of aging, they thicken Respiratory System Respiration becomes reduced in older individuals due to skeletal, cartilage, lung, and muscular changes. Residual volume increases and expiration is reduced Decreased perfusion and reduced gas exchange in the alveoli is caused by vascular degeneration in the lungs Urinary System Aging causes reduced kidney function because of degeneration of tubules and blood vessels as well as loss of glomeruli. Loss of bladder function, incomplete bladder emptying, and reduced bladder capacity may lead to nocturia, frequency, and infection.s Incontinence may be caused by a weakened urethral sphincter in combination with a reduced ability to perceive when the bladder is full. Reproductive System  In females, as menopause begins at around age 50, the ovaries stop responding to FSH and LH, ovulation ceases, and estrogen and progesterone levels decline Hormonal changes also cause: ○ Breast tissue decreases in volume ○ Hot flashes ○ Headaches ○ Insomnia ○ Irritability Disease Processes Associated with Aging In the elderly, infections are common because of normal defense mechanisms and tissue healing and impacted Increased use of medications in older people increases the chance of undesirable drug interactions.