TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS, Exams of Nursing

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TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS Spinal Cord Injuries ❖ Primary spinal cord injury: initial mechanical trauma and immediate tissue destruction ➢ If not immediately mobilized ➢ Longitudinal stretch of cord Injury Description Cord concussion Results in temporary disruption of cord-mediated functions Cord contusion Bruising of neural tissue causes swelling and temporary loss of cord-mediated function Cord compression Pressure on cord causes ischemia to tissues; must be decompressed to prevent permanent damage to spinal cord laceration Tearing of neural tissue of spinal cord; may be reversible if only slight damage sustained by neural tissues; may result in permanent loss of cord-mediated functions of spinal tracts are disrupted Transection Severing of spinal cord causes permanent loss of function Complete All tracts in spinal cord are completely disrupted; all cord- mediated functions below transection are completely and permanently lost incomplete Some tracts in spinal cord remain intact, together with functions mediated by these tracts; has potential for recovery although function is temporarily lost Hemorrhage Bleeding into neural tissue as a result of blood vessel damage; usually no major loss of function Damage or obstruction of spinal blood Causes local ischemia TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS supply ❖ Secondary spinal cord injury ➢ Cascade of vascular, cellular, and biochemical events beginning minutes after injury and continuing for weeks ■ Hemorrhages- central gray matter ■ Inflammation ■ Edema-white matter impairs microcirculation of the cord ■ Ischemia ➢ C1-C4 ■ Swelling may be life-threatening because CV and respiratory control functions can be lost ➢ Vertebral Injuries ■ Acceleration, deceleration, deformation forces occurring at impact TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS PRIMARY BRAIN INJURY FOCAL BRAIN INJURY Localized injury from impact CLOSED BRAIN INJURY Blunt trauma Coup Injury is directly below site of forceful impact Contrecoup Injury is on opposite side of brain from site of forceful impact Epidural hematoma Vehicular accidents, minor falls, sporting accidents Subdural hematoma Forceful impact: vehicular accidents or falls, especially in elderly persons or persons with chronic alcohol abuse Subarachnoid hemorrhage *worst headache of my life Bleeding caused by forceful impact, usually vehicular accidents or long distance falls OPEN INJURY Penetrating trauma: missiles, bullets, sharp objects i.e. knives, ice picks Compound fracture Objects strike head with great force or head strikes object forcefully; temporal blows, occipital blows, upward impact of cervical vertebrae DIFFUSE AXONAL INJURY Traumatic shearing forces, tearing of axons from twisting and rotational forces with injury over widespread brain areas; moving head strikes hard, unyielding surface or moving object strikes stationary head; torsional head motion without impact SECONDARY BRAIN INJURY SYSTEMIC PROCESSES Hypotension, hypoxia, anemia, hypercapnia, hypocapnia INTRACEREBRAL PROCESSES Inflammation, cerebral edema, ICP, brain herniation, decreased cerebral perfusion pressure; ischemia Cellular processes Release of excitatory neurotransmitters TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS (glutamate); failure of cell ion pumps, mitochondrial failure, disruption of blood brain barrier ➔ · Types of traumatic brain injury: alteration in brain function or other evidence of brain pathology caused by an external force such as MVA or falls ◆ Primary: direct impact ● Focal Brain Injury 2/3rds head injury deaths ○ Observable bain lesion ○ Force of impact typically produces ◆ Contusions ◆ Subdural hematomas TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ◆ Epidural hematomas ◆ Intracerebral hemorrhage ○ Open Injury: penetrating trauma or skull fracture ◆ Break in dura results in exposure of cranial contents ○ Closed brain injury: observable brain lesion in precise location ◆ Most are mild ◆ Head strikes hard surface or rapidly moving object strikes head ◆ Dura remains intact and brain tissues are not exposed to the environment ○ Coup injury ◆ Injury directly below point of impact ○ Contrecoup ◆ Injury on side opposite impact related to brain rebounding and hitting opposite side of skull ○ Contusions can cause ◆ Epidural hematomas: bleeding between dura mater and skull ● 1-2% major head injuries ● Most common in 20-40 years ● Medical emergencies ◆ Subdural hematomas: bleeding between dura mater and arachnoid membrane ● Tearing of veins ● Acute symptoms ○ Headache, drowsiness ○ restlessness/agitation ○ Slowed cognition, confusion ○ Progress to loss of consciousness, respiratory pattern changes, and pupillary dilation ○ Measured with GCS, ICP monitoring, brain imaging ○ 80% develop chronic headaches ● Chronic TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS sounds 3 Eye opening to verbal command Inappropriate words Flexion to pain 4 Eyes open spontaneously confused Withdrawal from pain 5 N/A oriented Localizing pain TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS 6 N/A N/A Obeys commands ➔ Intervertebral disk herniations: displacement of nucleus pulposus or annulus fibrosus beyond the intervertebral disk space ◆ Rupture Causes ● Trauma ● Degenerative disc disease ◆ Common Locations ● L4-L5, L5-S1 ● C5-C6 C6-C7 ◆ Pain can radiate along sciatic nerve ➔ Muscular dystrophy: inherited disorders that cause progressive muscle fiber loss leading to weakness. They cause significant disability, Lifelong neurologic, orthopedic, and pulmonary complications: Genetic testing increasingly being used for diagnosis and classification ◆ Duchenne Muscular Dystrophy ● Generally diagnosed around 3-4 years of age ● Most common of the neuromuscular disorders ● X-linked ● Generally affects males ● Caused by mutations in the gene that encodes dystrophin ○ Large, membrane-stabilizing protein ● Gait abnormalities, difficulty getting up from ground, and frequent falls ○ Enlarged calf muscles, WEAK ○ Waddling gait ○ Gower sign-climbing up legs( DIFFICULTY GETTING UP FROM GROUND) ○ Walks on toes ● Progressive weakness results in loss of ambulation between 12- 15 ○ Respiratory insufficiency ○ Cardiomyopathy TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ○ Orthopedic complications ○ Cognitive dysfunction ○ Constipation and incontinence of urine ● Treatment with oral corticosteroids-=standard of care ● Diagnosis ○ CK elevated up to 100 times normal level ○ Genetic testing ◆ Spinal muscular atrophy TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ○ Manifestations ◆ Night pain ◆ Swelling, warmth, redness ◆ Cough, dyspnea, chest pain ◆ Limp or pathological fracture ○ Treatment ◆ Chemotherapy and surgery ◆ Ewing Sarcoma-most lethal ● Malignant round cell tumor of bone and soft tissue ● 5-15 years ● Midshaft of long bones or in flat bones ● Metastasizes to every organ ● Manifestations ○ Pain increasing in severity ○ Fever ○ Malaise ○ anorexia ➔ Types of fractures i.e. differences between stress, pathologic, and greenstick ◆ Fractures ● A fracture is a break in the continuity of a bone ○ Classifications ◆ Complete or incomplete ● Complete:bone broken entirely ● Incomplete: bone is damaged but still in one piece ◆ Closed or open ● Open: skin open ◆ Comminuted: bone breaks into more than 2 fragments ◆ Linear: runs parallel to the long axis of the bone ◆ Oblique:occurs at a slanted angle to shaft of bone ◆ Spiral: encircles the bone ◆ Transverse: occurs straight across the bone ○ Incomplete Fracture ◆ Greenstick: perforated one cortex and splinters spongy bone of inner ◆ Torus: cortex buckle does not break ◆ Bowing: bending of bone ● Longitudinal force applied to bone TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Common in children ◆ Pathologic: fracture at a point where bone has been weakened by disease ● Tumors ● osteoporosis TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ◆ Stress: forces placed on bone are cumulative, eventually causing a fracture ◆ Fatigue: repetitive, sometimes abnormal stress or torque applied ○ Healing: ◆ Direct/primary ● Most often occurs when surgical fixation is used to repair a broken bone ● Intramembranous bone formation ● No callus formation ◆ Indirect (SECONDARY) ● Most often observed when a fracture is treated with a cast or other nonsurgical method ● Intramembranous and endochondral bone formation ● Callus formation ● Remodeling of solid bone ○ Manifestations ◆ Unnatural alignment, swelling, muscle TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ◆ Rapid breakdown of muscle that causes the release of intracellular contents, including the protein pigment myoglobin, into the extracellular space and bloodstream ◆ Can result in acute renal failure and electrolyte imbalances ◆ Causes ● Direct trauma (immobility fall with prolonged immobility) TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Drugs ● Excessive muscular contraction (sporadic strenuous exercise) ● Infections or toxins ◆ Serious complications ● Acute renal failure ● Electrolyte imbalance ◆ CLASSIC TRIAD ● Muscle pain ● Weakness ● Dark urine ◆ Diagnosed when CK level five to ten times upper limit of normal (about 1000 units/L) ◆ Hypocalcemia early in myoglobinuria followed by late hypercalcemia ◆ Risk of renal failure increases with increases in serum CK, potassium, and phosphorous ● CK levels>15,000 LIKELY acute renal failure ◆ Treatment Goals ● Maintain adequate urinary flow ● Prevent kidney failure ➔ Osteomalacia ◆ Inadequate and delayed mineralization of osteoid in mature compact and spongy bone ◆ Remodeling cycle proceeds through osteoid formation but calcification does not occur; the result is soft bones ◆ VITAMIN D DEFICIENCY is most important contributing factor ◆ Clinical manifestations ● Diffuse muscular and skeletal pain and tenderness ○ Hips most common ● Waddling gait ● Facial deformities ● Bowed legs ● Pseudofractures: fractures with callus formation in lower extremities ● Fragility fractures ● Bone malformation ● Phosphate level greater than 5.5 mg ◆ Rickets is similar in children TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ➔ Paget Disease ◆ Second most common bone disease after osteoporosis ◆ Also called osteitis deformans TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ◆ Treatment ● Antibiotics, débridement, surgery, hyperbaric oxygen therapy ➔ Degenerative joint disease ◆ Osteoarthritis ● Local areas of loss and damage or articular cartilage ● Characterized by inflammation, new bone formation of joint margins, subchondral bone changes, synovitis, and thickening of the joint capsule ● Mainly involves load bearing joints ● Prevalence increases with age ● Obesity and trauma are risk factors ● Clinical manifestations ○ Pain in one or more joint (worsens with activity) ○ Stiffness (diminishes with activity) ○ Swelling ○ Tenderness ○ Enlargement of the joint ◆ Heberden and Bouchard nodes in hands ○ Limiting range of motion ○ Muscle wasting ○ Partial dislocation ○ Deformity ● Conservative treatment ● Exercise and weight loss ○ Pharmacologic therapies ○ Analgesics and anti-inflammatories ○ Nutritional supplements ● Surgical treatment ○ Used to improve joint movement, correct deformity or malalignment, or create a new joint with artificial implants ◆ Inflammatory joint disease (arthritis) ● Inflammatory damage or destruction in the synovial membrane or articular cartilage TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Systemic signs of inflammation ● Infectious or noninfectious ➔ Rheumatoid arthritis ◆ Autoimmune disease ◆ Characterized by joint swelling and tenderness ◆ 1st joint tissue affected is synovial membrane ◆ Cartilage damage from three processes ● Neutrophils and other cells in the synovial fluid become activated TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Inflammatory cytokines induce enzymatic breakdown of cartilage and bone ● T cells also interact with synovial fibroblasts, converting synovium into a thick, abnormal layer of granulation tissue (pannus) ◆ Insidious onset ◆ Systemic manifestations ● Inflammation, fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness ● Painful, tender, stiff joints ● Joint deformities ◆ Symmetric joint swelling DIFFERENTIATES from OA ◆ Swan neck deformity ◆ Boutonniere deformity ◆ Rheumatoid nodules: collection of inflammatory cells surrounding a central core of fibrinoid and cellular debris ● extrasynovial ● Elbows, fingers ◆ Kaplan syndrome: pulmonary nodules and pneumoconiosis (chronic inflammation of lungs from inhalation of dust) ◆ Early treatment may prevent systemic and joint abnormalities ◆ Diagnosis ● Rheumatoid factor ● anti citrullinated protein antibody (ACPA) *most specific marker* ● Prolonged morning stiffness ◆ Treatment ● Disease-modifying antirheumatic drugs (DMARDS) ○ Methotrexate ○ Azathioprine ○ Sulfasalazine ○ Hydroxychloroquine ○ Leflunomid ○ Cyclosporine ● Biologic DMARDS: affect specific processes in development of RA TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS eventually fuses ◆ Syndesmophyte: new enthesis forming on top of old one ◆ Clinical manifestations ● Low back pain ○ Early 20s TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Stiffness ● Knee pain in women ● Sacroiliac pain in men ● Classic bamboo spine ● Loss of normal lumbar curvature (lordosis) ● Kyphosis with age (Increased concavity of upper spine) ◆ Treatment ● Education ● PT ● NSAIDS ● Biologic agents ➔ Fibromyalgia: chronic musculoskeletal syndrome with diffuse joint and muscle pain, fatigue, increased sensitivity to touch ◆ Absence of inflammation ◆ Fatigue ◆ Nonrestorative sleep ◆ Anxiety and depression ◆ Increased sensitivity to heat, cold, and electrical stimuli ◆ Most common in women ages 30-50 ◆ Possible alteration in genes affecting serotonin, catecholamines, and dopamine ◆ Irritable bowel syndrome ◆ Migraine ◆ Chronic fatigue ◆ Manifestations ● Prominent symptom of fibromyalgia is diffuse, chronic pain ● Profound fatigue ◆ Diagnosis ● Axial pain, left- and right-sided pain, and upper and lower segment pain; and a symptom severity (SS) score ● SS score includes symptoms such as fatigue, waking unrefreshed, and cognitive difficulty ➔ · Subarachnoid hemorrhage: ◆ o Escape of blood from defective or injured vessels into the subarachnoid space TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ◆ o Secondary to rupture aneurysm ◆ o Sudden onset of “worst headache of my life.” ◆ o Elevated ICP ◆ o Blood in CSF TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS o Parkinsons: degenerative disorder of the basal ganglia with loss of dopamine-secreting neuron Dopamine depletion and excess cholinergic activity cause tremor, rigidity, and akinesia ● Progressive dementia ● After age 40 but increases after 60 ● Most cases sporadic or idiopathic ● Lewy bodies ● Bilateral ● Postural abnormalities ● Slurred speech ● Short accelerating steps ● Excessive sleepiness ➔ · Herpes zoster/viral skin conditions ◆ Herpes simplex virus ● HSV-1 and HSV-2 ● Transmitted by contact with infected saliva ● Associated with oral infections or infection of the cornea, mouth, and orolabia—HSV-1 ● Lesions for HSV-1 appear as clusters of inflamed and painful vesicles on erythematous base ● Genital infections are more commonly caused by HSV-2 ◆ Herpes zoster (shingles ) caused by same herpesvirus/varicella-zoster as chickenpox ● Caused by the same herpesvirus—varicella-zoster virus (VZV) ● Primary infection followed years later by activation of the virus to cause herpes zoster (shingles) ● Virus remains latent in trigeminal and dorsal root ganglia ● Pain and paresthesia localized to affected dermatome ● Vesicular eruptions ● Antiviral drugs ● Vaccine available ◆ HPV: TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Warts ● Benign lesions caused by the human papillomavirus (HPV) ● Common warts occur most often in children and usually on the fingers ● Plantar warts are usually on pressure points on bottom of feet ● Venereal warts (condylomata acuminata) ○ Cauliflower like lesions TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ○ Vaccine available ➔ · Sickle cell disease ◆ Sickle cell disease is an autosomal recessive disorder. ◆ It is characterized by the production of hemoglobin S (Hb S). Hb S forms due to a genetic mutation when the amino acid valine replaces glutamic acid. ◆ Decreased oxygenation (hypoxemia) and dehydration can lead to sickling of the erythrocyte. Illness, stress, temperature changes, and high altitudes can also cause sickling to occur. ◆ Sickle cell trait ● Child inherits Hb S from one parent, Hb A from another ◆ Other forms: ● Sickle cell–thalassemia disease ● Sickle cell–Hb C disease ◆ Can result in: ● Vaso-occlusive crisis (thrombotic crisis) ● Aplastic crisis ● Sequestration crisis ● Hyperhemolytic crisis ◆ Pain is a MAJOR indicator of vaso-occlusive crisis and is due to occlusion and infarction related to increased viscosity and obstruction of blood flow. ◆ Sickled cells may also die prematurely which can result in anemia. Jaundice may occur due to the faster rate of RBC death as the liver is unable to filter them out and bilirubin may accumulate. ◆ sickle cell trait is a genotype but not a phenotype. A child inherits one normal hemoglobin (A) allele from one parent and one abnormal hemoglobin (S) from another parent . Carriers TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ○ Immature myeloid blasts in marrow and organs from oncogenic mutation ○ More difficult to treat than ALL ○ Common in older adults ○ DIC is a complication ○ Sometimes seen after high dose chemo for other cancers TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Chronic Lymphoblastic Leukemia ○ Most common >60 ○ B cell neoplasm with markers on CD5, CD20, CD23 ○ Smudge cells seen ○ Often Asymptomatic ○ Richter’s transformation-evelop new large cell lymphoma ● Chronic Myelogenous Leukemia ○ BCR-ABL on chromosome 22 ○ Seen in adults 30-90 ○ “Philadelphia Chromosome” 9:22 translocatio=poor prognosis ○ Tyrosine kinase ○ Low alkaline phosphatase ○ Splenomegaly ➔ · Hodgkin lymphoma-group of lymphoid cancers ◆ Malignant lymphoma that progresses from one group of lymph nodes to another ● B cells are present (Reed sternberg cells) ◆ Painless cervical lymph nodes are often 1st sign ● Contiguous spread ◆ Asymptomatic mediastinal mass noted on routine chest x-ray ◆ Epstein-Barr virus (EBV) frequently involved ◆ Well defined staging system ◆ Fever, weight loss, night sweats ◆ 5 types of HL ◆ Adolescents ◆ Increases risk of developing a secondary cancer ◆ Treatment by chemotherapy and radiation ◆ ➔ Non-Hodgkin lymphoma: progresive clonal expansion of B cells, T cells, or NK cells ◆ Cancer of immune cells B or T ◆ Median age of diagnosis =67 ● Disease of middle age ◆ More men than women ◆ Risk factors include being older, male, or white, plus having TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS one of the following: ● Certain immune disorders, autoimmune disease, or HIV/AIDS ● Exposure to mutagenic chemicals ● Infection with certain cancer related viruses ● Immune suppression related to organ transplantation ◆ Progressive clonal expansion of B cells, T cells, and/or NK cells ● Oncogene activation linked to chromosome translocations TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ➔ · Polycythemia vera: mutation in Janus kinase 2 gene ◆ Mutation in tyrosine kinase ◆ Slowly growing blood cancer ◆ Acquired mutation in JAK2 gene ◆ Bone marrow makes too many RBC ● Stem cell disorder with hyperplastic and neoplastic bone marrow alterations ◆ Increase in RBC, WBC, and platelets along with splenomegaly ◆ Manifestations due to increased red cell mass and hematocrit ● Increased blood volume and viscosity ● Hypercoagulopathy ◆ Erythrocytosis is essential component ● Polycythemia: increase in blood volume and viscosity ● Hematocrit 44.4-47.5% ◆ Manifestations ● Plethora (ruddy, red color of the face, hands, feet, ears, and mucous membranes) ● Engorgement of retinal and cerebral veins ● Headache, drowsiness, delirium, mania, psychotic depression, chorea, and visual disturbances ● PRURITUS especially after warm showers ◆ Treatment ● Frequent phlebotomy ● Aspirin ● Hydroxyurea ➔ · Multiple myeloma (Kahler's disease) ◆ Malignant proliferation of plasma cells ◆ Infiltrate bone marrow and aggregate into tumor masses in skeletal system ◆ Lytic bone lesions ◆ Manifestations include hypercalcemia, renal failure, anemia, immune abnormalities ◆ Preceded by monoclonal gammopathy of undetermined significance TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ◆ Several treatment options based on patient and disease ◆ Clonal plasma cell cancer-slow proliferation of tumor cell masses in the bone marrow (LYTIC BONE LESIONS) ◆ Malignant transformation begins early in B-CELL development ◆ Back pain/bone pain TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ◆ Primary amyloidosis ◆ Renal insufficiency ◆ IgG IgA ◆ BENCE JONES PROTEIN is present in the blood and urine ➔ · Difference between neurogenic, and nephrogenic diabetes insipidus ◆ Diabetes insipidus is a loss of either ADH secretion of ADH action resulting in more concentrated urine and a dilute serum ◆ Nephrogenic diabetes insipidus: kidneys sensitivity to ADH decreases ● Originates in kidneys from congenital defect in receptor ● Or direct toxicity (i.e lithium) ● Diagnosis ○ High serum ADH ◆ Neurogenic diabetes insipidus aka Central diabetes insipidus ● Posterior pituitary secretion of ADH decreases ● Usually secondary to intracranial process ○ Tumor ○ Post-neurosurgery ○ Head trauma ○ Meningitis ○ Encephalitis ● Diagnosis ○ Low serum ADH ➔ · Lab findings for Graves disease ◆ Hyperthyroidism ◆ Decreased TSH ◆ Increased T3 ◆ Increased T4 ◆ Increased radioactive iodine uptake ◆ Beta blockers TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ➔ · Pheochromocytoma ◆ Pheochromocytoma is a rare tumor that usually starts in the cells of one of your adrenal glands. Although they are usually benign, pheochromocytomas often cause the adrenal gland to make too many hormones ◆ Headaches ◆ Sweating ◆ Pounding of the heart ◆ Being shaky ◆ Being extremely pale ◆ Hyperfunction of adrenal medulla ◆ Sympathetic paragangliomas of the adrenal medulla ◆ Rare but 10-20% malignant ◆ Cause excessive production of norepinephrine ● Can also crete epinephrine ◆ Release catecholamines in response to stressors ◆ Manifestations ● Persistent HTN TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Headache TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Pallordiaphoresis ● Tachycardia ● Palpitations b ➔ · Diabetes mellitus: group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin actions, or both ◆ Type 1 5-10% of cases ● Autoimmune beta-cell destruction (in pancreas) ● Leads to absolute insulin deficiency ◆ Type 2 ● Progressive loss of beta-cell insulin secretion ● Background of insulin resistance ● Decreased secretion of amylin ◆ 3 Ps ● Polydipsia ● Polyphagia ● Polyuria ◆ Diagnosis ● Fasting blood sugar >126 ● Random glucose >200 ● A1C >/= to 6.5 ◆ DKA TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ○ Increased erythrocyte destruction ○ Combination of the above ● Classifications ○ Etiology ○ Morphology ■ Size TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ● Identified by terms that end in -cytic ● Macrocytic, microcytic, normocytic ■ Hemoglobin content ● Identified by terms that end in -chromic ● Normochromic and hypochromic ● Anisocytosis ○ Red cells present in various SIZES ● Poikilocytosis ○ Red cells present in various SHAPES ● Physiologic manifestations ○ Reduced oxygen carrying capacity-hypoxemia ● Variable symptoms based on severity and the ability of the body to compensate ● Classic anemia symptoms ○ Fatigue ○ Weakness ○ Dyspnea ○ Pallor ● MACROCYTIC NORMOCHROMIC ANEMIAS ○ Also termed megaloblastic anemias ○ Characterized by unusually large stem cells ○ Result Of defective DNA synthesis ■ Caused by deficiencies in B12 or folate ● Coenzymes for nuclear maturation and the DNA synthesis pathway ■ RNA processes occur at normal rate ○ PERNICIOUS ANEMIA ■ Caused by lack of intrinsic factor from gastric parietal cells ● Required for vitamin B12 absorption ● Results in vitamin B12 deficiency TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ■ Early symptoms nonspecific and vague ■ When hemoglobin at 7-8 g/dl ● Weakness ● Fatigue ● Paresthesias ● Difficulty walking ● Loss of appetite ● Abdominal pain ● Weight loss ● Sore tongue TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ■ Manifestations ● Summon anemia signs/symptoms ● Hemochromatosis ● Myelodysplastic vs sideroblastic anemia syndrome in idiopathic ○ NORMOCYTIC NORMOCHROMIC ANEMIA ■ Characterized by RBCs that are normal in size and hemoglobin but insufficient in number ■ Aplastic ■ Posthemorrhagic ■ Acquired hemolytic ■ Hereditary hemolytic ■ Anemia of chronic inflammation ● MYELOPROLIFERATIVE RBC DISORDERS ○ Polycythemia ■ Overproduction of RBCs ○ Relative polycythemia ■ Result of dehydration ■ Fluid loss results in relative increases of RBC counts and HgB and Hct values ○ Absolute polycythemia ■ Primary absolute ● Abnormality of stem cells in the bone marrow ● Polycythemia vera (PV) ○ JAK2 mutation ■ Secondary absolute ● Increase in erythropoietin as a normal response to chronic hypoxia or an inappropriate response to erythropoietin secreting tumors TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS ○ Polycythemia vera ■ Abnormal, uncontrolled proliferation of RBCs, WBCs, and platelets ■ Insidious ■ Manifestations due to red cell mass and hematocrit ● Increased blood viscosity ● Hypercoagulopathy ■ Iron overload ■ Hereditary hemochromatosis ● Autosomal recessive disorder of iron metabolism TEST 4 PATHO STUDY GUIDE LATEST UPDATE 2022/2023,BEST FOR SUCCESS Hemolytic anemia is a disorder in which red blood cells are destroyed faster than they can be made Conditions that may lead to hemolytic anemia include inherited blood disorders such as sickle cell disease or thalassemia, autoimmune disorders, bone marrow failure, or infections. Peripheral smear and reticulocyte count Serum bilirubin, lactic dehydrogenase (LDH), haptoglobin, and alanine aminotransferase (ALT) Antiglobulin (Coombs) test and/or hemoglobinopathy screen