How would you describe the different mechanisms of cell injury?
Ischemia- lack of blood flow
infectious agents- bacteria/virus
immune reactions- allergy (pollen)
genetic factors- sickle cell anemia
nutritional factors- vitamin deficient
physical factors- dehydration, trauma
chemical
what are some of the ways cells can adapt?
atrophy- wasting away
hypertrophy- cell gets bigger
hyperplasia- increase in number
metaplasia- change in function
dysplasia- combo of hyper and meta-plasia
what are some causes for atrophy?
vascular insufficiency
malnutrition
reduction in hormone levels
immobilization
pain limiting function
chronic inflammation
How can hypertrophy be an adaptation?
through working out
how can hypertrophy be pathological?
cardiac cells; high blood pressure
What is the only way that a cell can only under go hyperplasia?
if the cells is still able to undergo mitosis.
what are some examples of hyperplasia?
menstrual cycle - uterine response to increased hormones
skin callous formation
prostate enlargement
What affect does smoking have on the epithelial tissue in the throat?
metaplasia- this is a change in morphology and function due to conversion of one type of adult cell to another type.
smoking causes cilated pseudostratified columanr epithelial cells to convert to stratified squamous epithelium.
A pre-neoplastic state would be considered what type of cellular adaptation? How would you describe this adaptation?
dysplasia- increased cell numbers that also has altered cell morphology and loss of histological function.
What is the main purpose of inflammation?
It is essential for healing to occur.
When might it be common to see chronic inflammation?
overuse/repeated trauma
autoimmune diseases
viruses
How is chronic inflammation different than acute inflammation?
the cellular response involves lymphocytes and macrophages instead of neutrophils.
The scar formation is > and the tissue is very different than before.
You know the phases of tissue repair. What are they?
inflammatory
proliferative
remodeling/maturation
Basically, what does autoimmune mean?
The body is unable to recognize self from non-self. It can affect any cell or organ in the body.
T/F: if an injury is bad enough a wound can hang around in the inflammatory phase a little bit longer?
TRUE!
What goes on during the inflammatory phase?
phagocytosis-1-4 days
fibroblasts
mitosis- endothelial cells
What phase of tissue repair does hyperplasia take place?
proliferative
How long does the proliferative phase last?
day 3- 3 weeks
What happens to connective tissue during the proliferative phase?
fibroblasts migrate into the wound along fibrin strands and secrete collagen and mucopolysaccharides.
How would you describe granulation during the proliferative phase?
endothelial buds develop from intact capillaries and connect with other buds to form new vasulature.
What is wound contraction and when does it take place?
myofibroblasts accumlate in wound margins; proliferative
erythemia, heat, edema, pain, decreased function/loss ROM, and increased muscle tone or spasm are?
cardinal s/s of inflammation
what are the potential systemic effects of inflammation?
elevated vital signs
metabolic, hemodynamic, and hemolytic changes
There are 4 stages of acute inflammation. What are they?
vascular
hemostatic
cellular
immune
What are the ways you can have a vascular response?
vasoconstriction
vasodilation
edema
what is the purpose of acute inflammation?
mobilize and transport the bodys defenses
What are the chemicals that phagocytic cells are very attractive to during the vascular response?
histamine
prostaglandins
bradykinins
When do platelets form?
hemostatic phase
What is the main purpose of the cellular response?
draw leukocytes to the area to initiate phagocytosis. leukocytes release enzymes to kill, inactivate, and degrade microbial agents, foreign antigens, and necrotic tissue.
polymorphonulear leukocytes, what are they?
neutrophils that inhibit microbial growth. they have a 10-24 hr lifespan and then are replaced by monocytes/macrophages.
Monocytes clean house and release growth factors that promote healing and regeneration
What sets off the acquired immune response?
T&B cells that underwent hyperplasia.
t-lymphocytes are what kind of immune response?
cell mediated
b-lymphocytes are what kind of immune response?
humorally mediated
During the remodeling phase, collagen orientation depends upon what?
random, final orientation dependent upon loads placed on healing tissue.
what is the time frame for the remodeling/maturation phase?
day 9 and onward. can take 3-18 months depending on the damaged tissue.
What is the study of blood and the blood forming tissues?
hematology
T/F: blood is a connective tissue.
TRUE!
Blood has 3 important jobs. What are they?
delivery system- takes away the bad stuff
regulatory- carries hormones
defense- fights off foreign invaders
What makes up blood?
plasma: "water" of the blood 55% of blood volume
formed elements: RBC's WBC's, platelets
What hematocrit would it not be safe for exercise?
<25%
What hematocrit would light exercise be indicated?
>25%
what hematocrit would resistive exercise as-tol be indicated?
30-32%
What is the INR and what do you want it to be?
international ratio; how fast their blood clots; 2-3
What is hematopoiesis and where does it take place?
it is blood cell formation and it takes place in the red bone marrow.
What is a hemocytoblast?
a stem cell for all blood types
what is erythropoiesis and what is its production dependent upon?
it is the production of the hormone erythroietin that is produced in the kidneys in response to decreased O2 levels and increased androgen levels.
its production is dependent upon: iron B12, and folate
What is the main function of erythrocytes?
they carry O2 and CO2.
what is the life span of a erythrocyte?
120 days; 1 week to go from stem cell to reticulocyte, then released into the stream, then24-48 hrs to become mature RBC.
break down the word "hemoglobin" into its componets
Heme: iron containing
gobin: protein; 4 chains with an atom of iron in the middle that binds O2.
T/F: the main function of leukocytes are to be a defense mechanism for the body.
TRUE!
There are two types of lymphocytes. What are they and what do they do?
acquired immunity by :
T-cells: direct cell attack
B-cells: production of antibodies
What are your first line defenders?
The phils:
Neutro
Eosino
Baso
T/F: polymorphonuclear leukocytes are part of our innate immunity and they attack any invader regarless of previous exposure. They phagocytize a broad range of bacteria and infectious agents based upon very common characteristics of those agents.
TRUE!
what acts as a "plug" to an injury?
platelet
What can affect your ability to clot?
anti-coagulation drugs (aspirin)
exercise
liver disease
radiation/chemo
What is the lifespan for a platelet?
8-10 days
What would some s/s that would make you suspicous of leukemia?
fever and night sweats
HAs
easily bruised or bleed
bone or joint pain
enlarged spleen
swollen lymphnodes in the axilla, neck, or groin
frequent infections
tired or weak
loss of weight and loss of hunger
what is the distingyishing characteristic of hodgkins lymphona?
reed-sternberg cells
what other sites can hodgkins lmphoma spread to?
spleen
liver
bone marrow
lungs
What are the clinical manifestiations of hodgkins lymphoma?
irregular fever
night sweats
fatigue
in some cases s/s of pulmonary and spleen involvement
What are the two initial locations for hodgkins lymphoma?
an immune complex mediated hypersensitivity disorder is what type?
type 3
If you have no reaction until your second exposure, what type of hypersensitivity do you have?
type 4
T/F: typical S/S of a type 1 hypersensitivity would include redness, swelling, itiching and runny nose due to for example, hay fever.
TRUE!
You have a pt. who after just a few minutes of exercising with a ther-band starts wheezing, turning blue, swelling of the hands and has difficulty breathing.
what should you automatically suspect?
allergic to latex and anaphylaxis
clinical s/s of type 2 hypersensitivity include?
ha
chest pain
back/flank pain
tachcardia and hypotension
hematuria
nausea and vomiting
urticaria
What is it called when antigen-antibody complexes are deposited in tissue rather than be cleared from the body?
immune complex disease- type 3 hypersensitivity
What are some of the common sites for the "immune complex disease" to deposit the antigens/antibodies?
skin (urticaria)
joints (RA)
vasculature
kidneys (nephritits)
pleura (pleuritis)
pericardium (pericarditis)
Fever, arthralgias, synovitis, lymphadeonpathy, urticaria, and visceral inflammation are all examples of what?
clinical S/S for type 3 hypersensitivity
contact dermatitis and transplant rejection are examples of what type of hypersensitivity?
type 4
What do immunosuppressive drugs do?
they "dumb down" the immune system. Used during organ and blood transplants that are very closely matched to the receipent so that rejection is less likely to occur.
T/F: we don't treat patients pathologies, we treat patients with a protocol to their specific pathologies.
TRUE!
What is the combination of factors for an autoimmunity disorder?
genetic, hormonal, and environmental.
What are some organ specific autoimmunities?
addisons- adrenal cortex-
graves- thyroid- over functioning of the thyroid
diabetes-pancreas-type 1( decreased insulin) type 2 (resistance to insulin)
pernicious anemia
ulcerative colitis
S/S of hyperglycemia:
gradual onset
flushed face
thirst
fruity odor to breath
HA
hyperventilation
lethary/confusion/coma
abdominal pain and distntion
blood glucose level >250
S/S of hypoglycemia (insulin shock)
rapid onset
pallor/perspiration
blurred vision, numbness of lips and tongue
HA
nervousness, iritability, increased HR
difficulty speaking or concentrating
poor coordination
What glucose levels would you not exercise a pt?
>250
<70
What do ulcerative coitis and crohns have in common?
they are both inflammatory bowel conditions (IBD's)
T/F: IBD's can have referred pain to LB, hip or groin?
TRUE!
T/F: there is a high prevalence of osteoporosis with IBD's?
TRUE!
A chronic, systemic inflammatory disorder of unknown eitology typicall involving synovial joints but can also affect other organs is known as ___________.
RA
How many of the criteria must be met for a positive diagnosis of RA?
4 out of 7 and must be present for 4-6 weeks.
What do you monitor for with a RA pt?
gait disturbances
hyper-reflexia
upper motor neuron signs (babinskis, shimizu..)
What is a chronic, systemic, inflammator rheumatic conncective tissue disease that is characterized by multiple autoantibodies?
systemic lupus erythematosus (SLE)
What is a common rash shape you will see with SLE pt's and where would you find this rash?
butterfly; face
What is sclerosis and what can if affect?
Hardening; skin, blood vessels, tendons, joints, skeletal muscles, and other organ systems
since there is no cure for systemic sclerosis/scleroderma, we focus on treating the S/S. How would you go about treating them?
skin: control itching and watch for infection
musculoskeletal: strength and ROM to manage myositis and fibrotic myopathy
jt and tendons: activity and stretching
what is inflammatory myopathy that results in symmetrical weakness of striated skeletal muscle and primarily affects proximal muscles of the shoulder and pelvic girdle?
polymyositis
non-infectious, inflammatory and erosive rheumatic disease are all characteristics of ___________ that target 1.____________, 2_____________, and 3. ______________.
spondyloarthropathies
1. SI joints
2. connections bw disc and bone
3.facet joints
The most common s/s for a spondyloarthropathie is?
backache
inflammation of the fibrous part of the joint capsule and ligaments (via the synovium) that leads to fusion is known as ____________.
ankylosing spondyitis
You have a patient with ankylosing spondylitis what should you address during intervention?
postural training focusing on extension and rotation
breathing exercises (diaphragmatic)
stretching
What are some of the common sites affected by ankylosing spondylitis?
neck
shoulder
lumbosacral
hips
knee
heel
SI jt
Sterile inflammatory arthropathy distant in time and space to the initial inciting infective process (commonly follows veneral disease or bacilary dysentery) is known as ____________.
Reiters syndrome
the classic triad of symptoms with reiters syndrome include:
urethritis
conjunctivitis
arthritis
T/F: there is a genetic predisposition to psoriatic arthritis and it mostly affects the DIP joints of the hands. It can affect the axial skeleton 20 yrs after the initial involvement.
TRUE!
what do MRSA, VRE, and myobacterium tuberculosis have in common?
they are superbugs
What are the first two things you should do to prevent the spread of diseases?
vaccine
wash those dirty hands!
what are infections predisposers for?
heart disease
mental illness
autoimmune diseases
There are a bunch of systemic symptoms of infection, but what are the 3 main ones?
fever
chills
malaise
Bacterial infections cause what kind of changes within the blood composition?
leukocytosis
What affect does viral infections have on blood composition?
leukopenia- decrease number of WBC's.
What happens to lymph nodes during acute infection?
they are tender asymmetrically, enlarged and matted together. Overlying skin may be red and warm and it can cause a regional muscle spasm.
S/S of infection can present in multiple systems of the body. What are they and give an example.
We have all had some form of viral infections and there are quite a few, what are the most common ones?
blood born: Hep B and C, HIV
Herpes: cold sores/genital, chicken pox, mono
respiratory: flu, RSV
meningitis
childhood: chickenpox, mumps, measles
What is the difference between HSV1 and HSV2?
HSV1 are coldsores and are found on the lips. HSV2 are found on the genital and are sexually trasnmitted. There is no cure for either.
What is varicella zoster and what is the only way that you can get it?
Shingles; if you had chicken pox as a child. It will come back in the form of shingles.
T/F: a shingles outbreak will usually follow a certain myotomal route?
TRUE!
What is mono?
epstein barr virus- a form of herpes; self limitying lymphoproliferative disorder. transmitted through saliva. takes 4-8 weeks for incubation.
what are some of the common findings with mono and what implication do they have on a young athlete?
splenomegaly, hepatomegaly (liver) that usually resolves without permanent damage, can take up to 3 months. For young athletes there is a return to play protocol.
How does cytomegalovirus present in babies and how might they become infected?
fever, splenomegaly, hepatitis, pneumonitits, respiratory distress syndrome, interinal ulcerations, calcification around the ventricles of the brain in babies with CNS infection.
breast milk, congenitally, peri or post-natally.
What s/s would someone have to make you suspect they had the flu?
fever
non productive cough
chills
ache
malasie
HA
sore throat
T/F: in adults RSV is a mild respiratory infection. In babies however it is a sever life threatning infection.
TRUE!
T/F: viral meningitis is worse than bacterial meningitis and the prognosis is slim.
SO FALSE! The exact opposite it true!
What happens to the meninges if you have viral meningitis?
they become inflamed due to infectious agent crossing the blood brain barrier and entering the CSF.
Which are the biggins, mumps or measles?
mumps
what are single cell organisms that do not need another living organism for growth and reproduction?
bacteria
Why does bacteria thrive in the human body?
warmth and an excellent source of nutrition
what is the most common bacterial pathogen that resides on the skin?
staphlococcus
How does staph spread?
direct contact with people or surfaces; burns, surgical wounds, IV devices, malnourished, new borns, elderly, and diabetics are at greater risk.
T/F: scarlet fever usually follows untreated streptococcal?
TRUE!
basically what is strept pharyngitis?
bacterial sore throat
_____________________ is an invasive infection of fascia with infectious thrombosis of vessels that pass between the skin and deep circulation resulting in skin necrosis.
necrotizing fascitis
What are the S/S of necrotizing fascitis?
initially skin is red, shiny swollen, hot, tender and painful with sharp margins.
acute inflammation of the skin ans sucutaneous tissue with resultant lymphangitis and systemic s/s of fatigue, malaise, and HA.
streptoccal cellulitis
____________ is a rare but life threatening disease that results in severe pain, inflammation in the affected muscle and is treated with surgical debridement and IV penicillin
streptococcal myositis
How is group B of strept acquired?
passing through the birth canal.
Who does bacterial meningitis primarily affect?
immunosupressed, young and old. Prompt diagnosis is critical in infants as death is common.
T/F: tuerculosis is treatable but highly contageious.
TRUE!
What is a form of bronchopneumonia caused be legionella pneumonophila? Where are you most likley to come in contact with it?
legionnaires disease; warm standing water
The endocrine system plays a role in many parts of life. What are they?
growth and development
metabolism
sexual differeniation and reproduction
adaptation to changing environment
digestion
What secretes hormones directly into the blood stream and lymphatic system as a means to regulate and intergrate body functions?
endocrine glands
chemical messangers that moduate (not iniate) cellular and systemic responses by interacting with high affinity receptors of specific cells are known as what?
hormones
T/F: can one hormone have different affects depending on the target tissue?
TRUE!
T/F: a single body function can be regulated by several different hormones.
TRUE!
How does the endocrine and neurologic system work together?
regualte metabolism, water and salt balance, BP, response to stress, and sexual reproduction.
what is the bridge by which multiple body systems relay messages to the pituitary gland?
hypothalmus
What are the two ways that they hypothalmus controls functions of the endocrine organs?
neural pathways
hormonal pathways
There are 8 major endocrine glands. What are they?
pituitary (anterior and posterior)
thyroid
parathyroids
adrenal (cortex and medulla)
pancreas
gonads
thymus
kidneys
what are the hormones produced in the anterior pituitary?
GH- growth of bones and muscles
TSH- secretory activity in the thyroid
gonadotrophs- FSH and LH
lactotrophs- make prolactin
ACTH- secretory activity of adrenal cortex
ADH and oxytocin are produced where?
posterior pituitary
What are the 3 hormones produced in the thyroid?
T4-thyroxine
T3- tri-iodothyroine
calcitonin
parathyroid hormone (PTH) increases serum calcium levels by acting on?
bones
kidneys
intestinal tract
What two hormones are produced in the adrenal cortex?
aldosterone (mineralcocorticoid)
cortisol "hydrocortisone"
What two hormones are produced in the adrenal medulla?
epinephrine and norepinephrine
What hormone defect can cause dwarifism and gigantism?
growth hormone- pituitary disorder
What would acromegaly look like?
bones of face, jaw, hands and feet become broader and heavier.
_____________ is an inadequate ADH level that leads to inadequate H2O re-sorption from the kidneys
diabetes inspidus
A goiter is an example of what type of endocrine disorder?
thyroid
Briefly describe graves disease?
form of hyperthyroidism. S/S include tachycardia, nervousness, heat intolerance