Exam Key Concepts

Exam Key Concepts NOTE: This study tool is not all-inclusive but has the intent to outline the major content being covered on the exam. • Skin Lesions may be caused by systemic disorders ( liver ) Systemic infections( chickenpox, rash ) Allergies Localized factors ( exposed to toxins ) ABCDEF to assess the skin Differents type of lesion Macule : Nodule: Papule: Pustule: Vesicle: Plaque: Ulcer: Fissure: Diagnosis for skin=> culture and staining, biopsy, blood test, and skin testing patch Treatment=> antihistamine or glucocorticoids Skin Inflammatory Disorders • Contact Dermatitis May be caused by : exposure to allergens ( metals, cosmetics, sensitive, chemicals, plants) . Pruritic may develop a few hours after exposure. It is type IV hypersensitivity. Direct chemical or mechanical irritation, does not involve inflammation. Signs and symptoms: Allergies( pruritic area, erythematous and edematous ares, area often covered with small vesicles) chemical irritation ( Edematous and erythematous area, and may be pruritic or painful) Treatment: remove irritant with topical glucocorticoids ( anti-inflammatory). Urticaria (Hives) • May be caused by: type 1 hypersensitivity, caused by ingested substances like shellfish, drugs, or certain fruits. Can be found in the skin, all over body, sometimes in pharyngeal mucosa ( airway obstruction) Signs and symptoms: Eruption of hard, erythematous lesion , and highly pruritic lesion. Treatment: over-the-counter histamine, glucocorticoids (airways obstruction), and xolain ( for chronic and children older than 12 ). • Atopic Dermatitis ( eczema) => inherited tendency Common in infants & may persist into adulthood Erythematous rash w/ serous exudate Chronic inflammation results from the response of allergen( eosinophilia & incres. IgE level) Signs and symptoms: Pruritic, lesions are moist, red, and vesicular Located in the face, neck, arm, legs ,and buttocks In adults, dry rash, scally Thick and patches leathery Pruritus is common Treatment : elimination of the aggravating agents, use topical glucocorticoids, and antihistamines •Psoriasis( genetics) ❖ Chronic inflammatory disorder ❖ Happens on teenage years ❖ Abnormal activation of T cells ❖ Shedding occurs on 1 day ❖ Lesions are commonly found on the face, scalp, elbow, and knee Signs and symptoms : ❖ Red patches of skin, dry skin ❖ Small scaling spots ❖ Itching, burning, or soreness Treatment : ❖ glucocorticoids ( to reduce proliferation ) ❖ Tar preparation ❖ Methotrexate ( in severe cases) Skin Infections ❖ May be caused by bacteria, viruses, fungi , microbes, and parasites ❖ Opportunistic microbes ❖ Abrasions or cuts ❖ Causative organism needs to be identified for appropriate treatment May be caused by : primary by resident flora, secondary by developing wounds or pruritic lesions • Cellulitis also called erypsipelas Infection of the dermis and subcutaneous tissue Can be lead to funrouncle( boil) or ulcer if arising Causative agents : staphylococcus aureus and streptococcus Occurs in lower trunk and legs with restricted and immunocompromised Signs and symptoms ❖ Reddened area ❖ Edematous ( swelling) ❖ Pain ❖ Red streaks in the lymphs vessels to the infected area Treatment : Antibiotics to treat the infection and analgesics for pain • Furuncles ( boil) Causative agent : staphylococcus aureus Begins with hair follicle ( folliculitis) and spread into the dermis Located in the face, neck, and back Large amount of exudate Autoinoculation ( spread oneself ) Signs and symptoms ❖ Firm red lesions ❖ Painful nodule ( develops into a large painful abscess, ❖ abscess produce a large of exudate ❖ Carbuncles ( furuncles that coalesce to form a large mass infection ) Treatment : ❖ Warm compression to promote drainage ❖ Analgesics as ibuprofen ❖ Cut and drain the abscess , and antibiotic if necessary • Impetigo Common infection in infants and children, also occurs in adult Highly contagious infection especially in neonates Commonly in face Causative agent: staphylococcus aureus Pruritus common( leads to scratching and further spread of infection) Signs symptoms ❖ Small red vesicles, which rapidly enlarge ❖ yellowish-brown crusty masses ❖ vesicles develop around the primary site by autoinoculation with hands, towels, or clothes. ❖ Pruritus is common, leading to scratching and further spread of infection. Treatment : Topical antibiotics in early stages Systemic administration if lesions are extensive Antibiotic-resistant strains of S. aureus are increasing in numbers. (Local outbreaks of infection may result) • Viral Infections= herpes simplex , verrucae, and tinea) • Herpes Simplex 2 types: types 1 also called stores or fever blisters, occur on or near lips Types 2 happen in genital They have similar effects The primary infection may be asymptomatic( virus remain in the latent stage in the sensory nerve ). May be triggered by common cold, sun exposure or stress May be spread by direct contact w/ fluid from lesion Signs and symptoms ❖ Preliminary burning or tingling nerve, at the site on the lips ❖ Painful vesicles which can form a crust Treatment: Acute stage and shedding, and spreading can reduced by antiviral drugs ( acyclovir ( zovirax) or valacyclovir( Valtrex). But no cure • Fungal Infections ( mycoses) From scraping of the skin Most are superficial ( fungi live off the dead ) Candida infection is often associated with diabetes Diagnosed from skin scrapings Become fluorescent in ultraviolet light Microscopic examination Culturing of samples Treatment : specific antifungal agent are required • Tinea It is ringworm May be caused by several types of superficial 3 types : capitis, corporis, and unguium Tinea Capitis=> infection of the scalp, common in school-aged children May be caused by : Microsporum cani ( transmitted by cats and dogs) Trichophyton tonsurans( caused by humans). Signs and symptoms ❖ Circular bald patch observed ( hair is broken off) ❖ Erythema or scaling may be apparent Treatment : Oral antifungal ( griseofulvin ) Tinea Corporis=> infection of the body, particularly the non hairy parts. Signs and symptoms ❖ Round lesion with clear center (ringworm) ❖ Pruritus may be present. Treatment : antifungal ( tolnaftate or ketoconazole) Tinea pedis => also called athlete foot, particular the toes Associated with swimming pools and gymnasiums The organisms may be normal flora that becomes opportunistic Signs and symptoms: ❖ Skin between toes is inflamed ❖ Painful and pruritic fissures ❖ Feet may have a foul odor Treatment : Antifungal medication Tinea unguium=> also called onychomycosis, is an infection of the nails, particularly the toe nails. Signs and symptoms : ❖ Nails turn white, then brown. ❖ Nail thickens and cracks. ❖ Infection tends to spread to other nails Treatment : topical antifungal • Skin Tumors Warning signs of skin cancers ❖ A sore that does not heal ❖ A change in shape, size, color, or texture of a lesion, especially an expanding, irregular circumference or surface ❖ New moles or odd-shaped lesions that develop ❖ A skin lesion that bleeds repeatedly, oozes fluid, or itches How to reduce skin cancer ❖ Reducing sun exposure at midday and early afternoon ❖ Covering up with clothing (remaining in shade, Wearing broad-brimmed hats to protect face and neck) ❖ Applying sunscreen or sunblock ❖ Protecting infants and children from exposure and sun damage to skin 3 types of skin cancer: • Squamous Cell Carcinoma Easy to detect , accessible for treatment when identified at an early stage. Painless, malignant tumor of the epidermis Found on the exposure areas of the skin( face and neck) Smokers at higher risk Signs and symptoms: ❖ Development of a scary, slightly elevated ❖ Irregular border ❖ Central ulceration Treatment : highly prognosis if caught early • Malignant Melanoma Highly metastatic Develops in melanocytes( from a nevus (mole) Signs and symptoms : ❖ ❖ ❖ ❖ Multi Colored lesion with irregular border Grow quickly Change in shape, color, size, texture May bleed Treatment : surgically removed, radiation, chemotherapy • Kaposi Sarcoma Occurs with people with AIDS and immunodeficiency May affect the viscera in the skin Signs and symptoms : ❖ Purplish macules ( in the face, scalp, oral mucosa, or lower extremities ) ❖ Nonpruritic lesions ❖ Nonpainful ❖ Lesions progress to form large, irregular shaped ❖ Immunocompromised patients ( lesion develop rapidly ) Treatment : Radiation, chemotherapy, surgery Chapter 10 • Composition of Blood • Blood Cells and Hematopoiesis • Hemostasis • Diagnostic tests • Blood Dyscrasias o Anemias Iron Deficiency Anemia Pernicious Anemia Sickle Cell Anemia Aplastic Anemia • Blood-clotting Disorders o Hemophilia A o Disseminated Intravascular Coagulation (DIC) • Neoplastic blood Disorders o Polycythemia o Leukemias Chapter 12 • Conduction System • Control of the Heart • Cardiac cycle • Blood Pressure • Diagnostic tests • Coronary Artery Disease o Arteriosclerosis & Atherosclerosis o Angina pectoris( chest pain) o • o • o • o Myocardial Infarction (MI) Congestive Heart Failure (CHF) Including Left-sided CHF vs Right-sided CHF Congenital Heart Defects Valvular Defects Vascular Disorders Arterial Disorders Hypertension (HTN) Also called silent killer 3 types of hypertension Primary or essential is idiopathic Secondary HTN result from renal( nephrosclerosis ) or endocrine ( hyperaldosteronism ) Signs and symptoms ❖ Morning headache ❖ Fatigue ❖ Malaise ❖ Blood pressure always high Treatment : life changing by reducing salt intake, reduce body weight and stress, increase cardiovascular fitness o o Peripheral Vascular Disease Venous Disorders Varicose veins • Shock Chapter 13 • Ventilation Inspiration + expiration NB : Air always moves from high pressure to low pressure Higher pressure in the atmospheric-> inspiration( air moves from the atmosphere into the lungs) Higher pressure in the alveoli -> expiration ( lungs through the atmosphere ) Medulla and pons=> centers for breathing Chemoreceptors=> detect changes in CO2, H2, O2 in blood or CSF Two types of chemoreceptors, central and peripheral; central ( located in the medulla) peripheral in the carotid bodies. General Manifestations of Respiratory Disease Sneezing, coughing, • Pneumonia It can be caused by Viral, bacterial, or fungal infection. It can be in both lungs or in one lobe. Changes in the interstitial tissue, alveolar septae, alveoli Can get it from the hospital (nosocomial) or from community Lobar Pneumonia All of one lobe or two lobes Caused by Strep. Pneumoniae Inflammation of alveaolar wall and leakage of cells, Fibrin, and fluid into alveoli causing consolidation Pleura may be imflammed It’s sudden and acute High fever and chills Productive cough with rusty sputum Rales progressing to absence of breath sounds in affected lobes. Antibacterial treatment Bronchopneumonia Scattered small patches Multiple bacteria Inflammation and purulent exudate in alveoli Often arising from prior pooled secretion or irritation It is insidious with mild fever Productive cough with yellow-green sputum Dyspnea (shortness of breath) Antibacterial treatment • Tuberculosis (TB) Mycobacterium tuberculosis transmitted by oral droplets Crowded conditions & lowered resistance due to Immunodeficiency, Malnutrition, Alcoholism, Chronic disease, HIV infection Primary infection affects lungs- Somewhat resistant to drying and many disinfectants Can survive in dried sputum for weeks Destroyed by ultraviolet light, heat, alcohol, glutaraldehyde, formaldehyde Normal neutrophil response does not occur Primary tuberculosis is asymptomatic This form is contagious Secondary or re-infection with TB Occurs when client’s cell-mediated immunity is impaired because of: Stress, malnutrition, HIV infection, Age Mycobacteria begin to reproduce and infect lungs. Active TB, which can be spread to others! • Asthma Hypersensitivity type 1, hyperresponsive tissue Located in small bronchi, bronchioles Inflammation, bronchoconstriction, increased mucus produced Obstriction, repeat attacks lead to damage Cough and dyspnea, wheezing Thick, tenacious mucus Intrinsic asthma Onset during adulthood Hyperresponsive tissue in airway initiates attack Stimuli include: Respiratory infections, Stress, Exposure to cold, Inhalation of irritants, Exercise Drugs • Chronic Obstructive Pulmonary Disease (COPD) Group of chronic respiratory disorders Causes irreversible and progressive damage to lungs Debilitating conditions that may affect individual’s ability to work May lead to the development of cor pulmonale (right-sided congestive heart failure) Respiratory failure may occur. o Emphysema Smoking and genetic. It’s located in the alveoli Destruction of alveolar walls and septae Contributing factors: Genetic deficiency, Genetic tendency, Cigarette smoking Pathogenic bacteria Progressive difficulty with expiration, Air trapping and increased residual volume Overinflation of the lungs Fixation of ribs in a respiratory position, increased anterior-posterior diameter of thorax (barrel chest), Flattened diaphragm (on radiographs). ● Advanced emphysema and loss of tissue Adjacent damaged alveoli coalesce, forming large air spaces. Pneumothorax Occurs when pleural membrane surrounding large blebs ruptures Hypercapnia becomes marked. Hypoxia becomes driving force of respiration. Frequent infections Pulmonary hypertension and cor pulmonale may develop in late stage. Signs and symptoms Dyspnea; Occurs first on exertion Hyperventilation with prolonged expiratory phase Development of barrel chest Anorexia and fatigue, Weight loss Clubbed fingers Diagnostic Tests Chest radiography Pulmonary function tests Treatment Avoidance of respiratory irritants Immunization against influenza and pneumonia Pulmonary rehabilitation Adequate nutrition and hydration Improves energy levels, resistance to infection Bronchodilators, antibiotics, oxygen therapy as condition advances o Chronic Bronchitis Inflammation, obstruction, repeated infection, chronic coughing twice for 3 months or longer in 2 years. History of cigarette smoking or living in an urban or industrial area Mucosa inflamed and swollen Hypertrophy and hyperplasia of mucous glands Fibrosis and thickening of bronchial wall Low oxygen levels Severe dyspnea and fatigue Pulmonary hypertension and cor pulmonale • • Pulmonary Edema Pulmonary Embolus