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Final Exam Study Guide, Unit 3 Study Guide, Unit 1 Study Objectives, Unit…

- - - - Mode of action
        
        neural pathways are activated causing nausea, gastric dysrhythmia causes release of vasopressin
    - - Mode of action
        
        Divided into upper/ lower. Loss of 1 L within hours, increased peristalsis, diarrhea, N/V, increased BUN, decreased BP, high HR
      - S & S
        
        dark tarry stools, bloody stool, vomiting blood, anemia
    - - Mode of action
        
        Can be caused by dysphagia
      - S & S
        
        clearing or wet coughing after eating, angina, dyspnea, cyanosis, diaphoresis
    - - Mode of action
        
        three or fewer bowel movements / week, caused by medication, dairy, mental stress, lacking fiber, lacking fluids, surgery
      - S & S
        
        straining, lumpy hard stools, sensation of blockage or incomplete defecation, abdominal pain, distension,
    - - Mode of action
        
        pressure gradient > 5 mm Hg
      - S & S
        
        blood pools into lower esophagus, abdomen, stomach, rectum
  - - - Mode of action
        
        A type of motility disorder, the nerves in the esophagus degenerate ceasing peristalsis.
      - S & S
        
        dysphagia, heartburn, reflux, halitosis (bad breath)
    - - Mode of action
        
        dilated sub mucosal veins in esophagus. Consequence of portal hypertension due to cirrhosis or alcoholism,
      - S & S
        
        severe GI bleeding, weight loss, N/V, jaundice, dark urine, edema, bruising, pruritis, cramps, hematemesis (coffee grounds), melena, hypotension, tachycardia, pallor
    - - Mode of action
        
        stomach acid flows into esophagus (acid reflux)
      - S & S
        
        heartburn, dysphagia, acid reflux at night, cough, laryngitis, worsening asthma
    - - Mode of action
        
        commonly caused by H. pylori and NSAIDs
      - S & S
        
        stomach pain, fullness/ bloating, heartburn, nausea,
    - - Mode of action
        
        valve between stomach and small intestine thickens blocking food
      - S & S
        
        forceful vomiting, dehydration, weight loss, hunger
    - - Mode of action
        
        genetic and environmental risks. Syndromic (have congenital anomalies) Nonsyndromic (no anomalies)
    - - Mode of action
        
        most common cause of intestinal obstruction in young children. Impairs blood flow.
      - S & S
        
        ischemia, gangrene, perforation
    - - Mode of action
        
        damaged small intestine lining (villi). Gluten sensitive enteropathy. Considered autoimmune disease.
      - S & S
        
        Bloating, diarrhea, steatorrhea, Vit A deficiency, VIt D deficiency, Hypocalcemia, PTH stimulated, Vit K deficiency, fatigue, abdominal pain, anemia, bone pain, poor skin turgor, dehydration
    - - Mode of action
        
        small bowel obstruction causes distension -> dehydration results -> hypovolemia -> bowels burst -> sepsis -> death
      - S & S
        
        increased pulse/ BP/ dehydration, pain, low bowel sounds, fever, N/V, anorexia, board-life abdomen, rebound tenderness
  - - - Mode of action
        
        Common causes are hernias and tumors, and adhesions.
      - S & S
        
        abdominal cramps, diarrhea, hyperactive, high-pitched peristalsis
    - - Mode of action
        
        IBD, Begins in the rectum, can remain localized there. Large ulcers and exudate. Fistulas and abscesses DO NOT occur.
      - S & S
        
        pseudopolyps, abdominal cramps, bloody stool, anemia, anorexia, weight loss. joint pain
    - - Mode of action
        
        IBD, involves the entire large colon through the layers of mucosa and submucosa. Characterized by inflammation, abscesses, and ulcers
      - S & S
        
        cobblestoning, diarrhea, abdominal pain, abscesses, fistulas, fever, anorexia, weight loss, tender abdomen, rectal bleeding
    - - Mode of action
        
        caused by absence of aganglionosis in intestinal wall. Affects colon. Significant genetic component.
      - S & S
        
        causes distended colon
  - - - Mode of action
        
        A: contaminated water/ food
        B: Birth, blood, unprotected sex (mother to child)
        C: Birth, blood, unprotected sex (blood is common)
      - S & S
        
        main sx: jaundice, clay colored stools, and dark urine
        B: aching joints, abdominal pain, liver cancer, cirrhosis. Vaccine available.
        A: clay colored stool, liver damage, no cirrhosis or cancer. Vaccine available.
        C: clay colored stool, abdominal pain, liver cirrhosis, cancer
    - - Mode of action
        
        inflammation of the gallbladder from gallstone obstruction
      - S & S
        
        pain and tenderness, fever, chills, N/V
    - - Mode of action
        
        inflammation causes leakage of pancreatic digestive enzymes
        often from alcohol ingestion and cholelithiasis
        
        risk factors include: cystic fibrosis, hypercalcemia, excessive alcohol consumption precipitated by hyperlipidemia
      - S & S
        
        abdominal pain, dull and steady, N/V, diarrhea, anorexia, tachycardia, hypotension, dyspnea, tachypnea, Cullen's Sign, Grey-Turner sign, virchow's node, calcification (when untreated)
    - - Mode of action
        
        build up of bilirubin in bloodstream. Occurs when bile is blocked from getting into the intestine. Bile backs up into the liver and bile salts accumulate in the bloodstream.
      - S & S
        
        jaundice, high bile salts, pruritus
    - - Mode of action
        
        The cause of non-alcoholic fatty liver disease (NAFLD) is unknown. Risk factors include obesity, gastric bypass surgery, high cholesterol, and type 2 diabetes.
      - S & S
        
        Most people have no symptoms. In rare cases, people may experience fatigue, pain, or weight loss. Over time, inflammation and scarring of the liver (cirrhosis) can occur
    - - Mode of action
        
        causes cirrhosis of liver, fat accumulates in and around hepatocytes,
      - S & S
        
        pain, N/V, fever, jaundice, dark urine, enlarged liver, hepatic tenderness, hyperbilirubinemia, GI bleeding
    - - Mode of action
        
        Cholelithiasis = stones in the gallbladder
        
        · Cholecystitis = inflammation of the gallbladder, which can be acute or chronic
        
        · Choledocholithiasis = stones in the common bile duct that can lead to a backup of bile into the gallbladder and liver
      - S & S
        
        Biliary sludge, stasis, stones made of cholesterol, colic (pain , steady and intense), N/V, pain incited by fatty food
    - - Mode of action
        
        cause unclear, but very common. CEA tumor marker
      - S & S
        
        bilirubin/ bile back up, back pain, clay colored stool, dark urine, steatorrhea,
- - - - Mechanism of action
        
        high levels of uremic toxins accumulate in blood, kidneys cannot excrete daily load of toxins in urine and are failing.
        
        Oliguric (excrete < 500 mL per day)
        Nonoliguric (excrete > 500 mL per day)
        
        Prerenal: Hypovolemic shock & cardiovascular failure
        Postrenal: obstruction causes excessive fluid pressure and nephron shut down, renal failure, enlarged prostate, kidney stones, bladder tumor, injury
        Intrarenal: ischemia, toxins, inflammation, drugs, infection
      - S&S
        
        Oliguria, azotemia (elevated urea, creatinine, uric acid), fluid (Na, H) retention (edema), electrolyte imbalance, metabolic acidosis, CHF (from pulmonary edema), HYPERkalemia, HYPERphosphatemia, HYPOcalcemia, anemia, postural hypotension, hypovolemia, proteinuria, tachycardia, lethargy, cool/ clammy skin, crackles in lungs
    - - Mechanism of action
        
        loss of nephrons leading to inability to produce sufficient urine. Renal mass is reduced. Reduced tubular secretion and reabsorption.
        
        GFR < 20%
        Creatinine > 5 mg/dL
        
        3 stages:
        
        Early = unaffected nephrons (BUN 20-50 mg/dL)
        
        75% renal function lost (BUN > 100 mg/dL; Cr > 4 mg/dL)
        
        End stage = GFR < 20% (BUN > 200 mg/dL; Cr >5 mg/dL)
      - S&S
        
        Early: asymptomatic, normal lab values
        Second: increased BUN and Cr; oliguria
        Third: Great increase in BUN and Cr; oliguria & uremia
        General: hypervolemia, HYPOcalcemia, HYPERkalemia, azotemia, metabolic acidosis, anemia, peripheral neuropathy, hypertension, anorexia, pruritis, generalized edema
    - - Mechanism of action
        
        inflammation of capillary loops of the glomeruli, often follows a strep infection (antigen-antibody complex), leading cause of CRF in US
        
        Acute: immune complexes cause inflammation/ edema, proteins and blood escape in urine
        Chronic: slow loss of function, decrease in kidney size, nephrons destroyed.
      - S&S
        
        Acute: Azotemia, fatigue, anorexia, N/V, oliguria, dyspnea
        Chronic: develops asymptomatically, noticed once renal failure occurs
        General: Causes renal and respiratory failure, HA, HTN, periorbital edema, weight gain (edema), proteinuria, hematuria, oliguria, dysuria
    - - Mechanism of action
        
        infection, classified according to site infected. Caused by bowel incontinence, surgery, sex, urinary calculi, improper cleaning
        
        Urethritis, prostatitis, cystitis (most common)
        
        Enter by ascending from mucous membranes (ex. E.col)- frequent in females OR blood (less common)
        
        Uncomplicated (isolated incidence)
        Complicated (2+ incidences, or male)
      - S&S
        
        Urinalysis: 100-100K bacteria CFU
        Dysuria, Urinary frequency and urgency, nocturia, cloudy/ foul smelling urine, pyuria. hematuria, malaise, chills, fever, N/V, low back pain
        
        Elderly: nocturia incontinence, confusion (first sign), behavior changes, lethargy, anorexia
    - - Mechanism of action
        
        Mainly calcium crystals excreted in urine, causes obstructions, caused by dehydration, immobility, excess dietary intake
        
        3 factors that form stones: saturated urine, mucoproteins, deficiency of substances that hinder stone formation (pyrophosphate and nephrocalcin)
        
        Contributing Factors: hypercalcemia, hyperparathyroidism, vitamin D overdose, bone disease, immobility
      - S&S
        
        flank pain, upper outer abdomen, suprapubic pain, N/V, cool/ clammy skin, urgency and frequency, hematuria
    - - Mechanism of action
        
        Body passes excess protein in urine. Caused by damage to blood vessels in kidneys that filter waste,
      - S&S
        
        Think "PALE" : Proteinuria, hypoAlbuminemia, hyperLipidemia, Edema
        Peripheral edema, periorbital swelling, foamy urine, proteinuria, weight gain (From edema) fatigue, anorexia
    - - Mechanism of action
        
        inflammatory disorder causing kidney damage of tubules, abscesses, scar tissue, caused by E. coli, spread through blood or urinary tract, causes end stage renal or chronic renal failure, having DM is a risk factor.
      - S&S
        
        Rapid onset, fever, chills, malaise, N/V, flank pain, back pain, frequency and dysuria, cloudy or bloody urine, foul smelling, distress, painful urination,
        
        Elderly: behavior changes, confusion, incontinence, general deterioration
    - - Mechanism of action
        
        cyst formation and kidney enlargement,
        adult dominant type is slow and progressive with end stage renal disease, cysts can develop in other areas of the body and cause hemorrhage.
      - S&S
        
        hypertension, lumbar pain, widening abdomen, swollen or tender abdomen
    - - Mechanism of action
        
        Overactive (Urge): oversensitive bladder from infection or neurologic disorder
        
        Overflow: urethral blockage, bladder unable to empty
        
        Stress: relaxed pelvic muscles, increased abdominal pressure, occurs during coughing and sneezing
      - Etiology
        
        Stress: aging, childbirth, weak pelvic muscles
        
        Overactive: strong desire to void, neurogenic (CVA, MS, Parkinson's), Myogenic (aging, DM)
        
        Overflow: fecal impaction, benign prostatic hyperplasia (prostate gland enlargement), DM, calcium channel blockers
- - - - Mode of Action
        
        Caused by excess ADH, low serum osmolarity. excessive water reabsorption
      - S&S
        
        Dilutional Hyponatremia, low urine output, cognitive changes, N/V, seizure, coma, cerebral edema, hypervolemia,
    - - Mode of Action
        
        Hyper: Graves disease (autoimmune stimulation), thyroid adenoma, excessive pit TSH excretion, goiter, excessive iodine ingestion, excessive thyroid replacement
        
        Hypo: Hashimoto's, thyroid receptor antibodies, antithyroglobulin, antithyroperoxidase antibody (hallmark), hyperlipidemia, hypercholesterolemia, anemia, increased carotene levels, hoarse voice,
      - S&S
        
        Hypo: cold intolerance, weight gain, lethargy, fatigue, memory deficits, muscle cramps, constipation, decreased fertility, hair loss, puffy face, brittle nails, MYXEDEMA (nonpitting edema and thickened leg skin, periorbital edema, cardiovascular collapse, hypoglycemia, acidosis, coma), pseudodementia, depression, neuropsychiatric problems in elderly, weight gain, decreased fertility, delayed reflexes, sluggishness, feeling cold, constipation
        
        Hyper: anxiety, tremor, tachycardia, feeling warm, weight loss, exophthalmos, atrial fibrillation, decreased fertility
        Graves: nervousness, insomnia, sensitive to heat, weight loss, goiter, audible bruit, atrial fibrillation, exophthalmos
    - - Mode of Action
        
        Caused by lack of ADH (hypopituitarism) or kidney fails to respond to ADH. Nephron does not perform antidiuresis (no reabsorption of water), body loses high amounts of water in urine, urine is very dilute. Bloodstream loses water, causing hypernatremia and dehydration.
      - S&S
        
        polydipsia, polyuria, confusion, myoclonus, seizure, coma, hypernatremia, cognitive changes, weakness, lethargy,
    - - Mode of Action
        
        Hyper: excessive secretion, causing hypercalcemia and bone breakdown
        
        Hypo: insufficient PTH, leads to death, tetanic convulsions, and hypocalcemia
      - S&S
        
        Hypo: muscle cramps, irritability, tetany, convulsion, Trousseu's and Chvostek's sign
        
        Hyper: muscle weakness, neuropathy, hypertension, poor concentration, kidney stones, metabolic acidosis, osteopenia, constipation, depression, painful bones, renal stones, abdominal groans, and psychic moans
    - - Mode of Action
        
        Hyper: caused commonly by pituitary adenoma (most common is prolactinoma)
        
        Hypo: caused by tumors (adenoma), radiation, trauma, ischemia (Sheehans syndrome), infarction, hemorrhage, empty sella syndrome, and pan hypopituitarism
      - S&S
        
        Hypo: dwarfism in infants, hypercholesterolemia, weight gain, low fertility, delayed reflexes, sluggish, feeling cold, constipation, lethargy, fatigue, hypotension, depression, excessive urination, dehydration, adrenal insufficiency, hypothyroidism, diabetes insipidus (DI = lack of ADH)
        
        Hyper: excessive growth, gigantism (in children), Anxiety, tremor, tachycardia, feeling warm, weight loss, exophthalmos, atrial fibrillation, low fertility, menstrual abnormalities, amenorrhea, galactorrhea, vaginal dryness, osteopenia, hypogonadism, decreased libido, erectile dysfunction, infertility
    - - Mode of Action
        
        Insufficiency:
        Addison's Disease: adrenal insufficiency, autoimmune destruction of adrenal gland. Treat using corticosteroids.
        corticosteroids cause suppression of CRH and ACTH. Can cause gland to atrophy and not secrete as much cortisol. Can lead to Cushing's syndrome. Harmful effects include psychiatric problems, shriveled testes, liver damage, bloated face, and CAD
        Aldosterone deficiency: Aldosterone normally functions to reabsorb water and excrete K. Dysfunction causes hyponatremia, hyperkalemia, and dehydration
        
        Excessive:
        Hyperaldosteronism: a common cause of secondary HTN
        Cushing's Syndrome (hyperadrenalism): hyperactive adrenal gland
        Cushing's Disease: tumor of pituitary that produces large amounts of ACTH
        Excessive ACTH--> MSH secreted --> stims melanocytes (tanned appearance)
        Pheochromocytoma: excessive secretion of epinephrine stimulating SNS. Caused by adrenal tumor.
      - S&S
        
        Adrenal insufficiency: weakness, hypotension, fatigue, inability to concentrate, emotional lability, anorexia, N/V, hypoglycemia, electrolyte imbalances, loss of pubic hair , amenorrhea
        Cushing's (hyperactive): weight gain, moon faces, buffalo lump, apple shaped fat, stretch marks (striae), easy bruising, poor healing, hirsutism (women with male hair growth), obesity, elevated glucose levels, fatigue, weakness
        High Cortisol: block insulin leading to glucose intolerance and hyperglycemia; osteopenia, osteoporosis, immunosuppression, hypertension
        Pheochromocytoma: HTN, tremors, increased cardiac contractility, tremors, cardiac arrhythmias, elevated HR
        Addison's: Hypoglycemia, weakness, lethargy, hyponatremia, hyperkalemia, cardio collapse and shock , bronze skin, GI issues, weight loss, hypotension, body hair changes
    - - Mode of Action
        
        Gluconeogenesis: fasting --> fat breakdown (glycogen in liver depletes and fats/ proteins synthesized to glucose) --> ketoacids/ ketones --> excessive leads to ketoacidosis
        
        DKA: T1DM --> no insulin --> cells starve --> gluconeogenesis
        
        carbohydrate metabolism disorder characterized by hyperglycemia due to body unable to produce or utilize insulin. Insulin and glucose hitch a ride into the cells providing energy, glycogen (stored in liver/ muscle), or fat storage.
        
        T1DM: immune mediated; destruction of insulin
        T2DM: resistance to insulin, pancreas exhaustion
        
        HHS: T2DM --> insulin not absorbed in cells --> hyperglycemia --> ICF to ECF --> cells dehydrate / starve and gluconeogenesis
      - S&S
        
        Hypo: poor brain function; pancreatic glucagon --> breaks down glycogen stores --> raises bgl
        sweating, hunger, dizzy, nervous, confusion, seizure, LOC, tachycardia
        
        Hyper: causes endothelial injury and inflammation --> foam cells / endothelin --> atherosclerosis/ vasoconstriction, causes glucosuria, dehydration, hypokalemia, hyperosmolality
        hormones that increase insulin: GH, cortisol, epinephrine, progesterone, estrogen
        
        T1DM: TRIPLE P; polydipsia, polyuria, polyphagia; diabetic ketoacidosis (DKA)
        T2DM: TRIPLE P; polydipsia, polyuria, polyphagia, pancreas overworks to produce insulin, obesity, NO DKA, hyperosmolar, hyperglycemia
        
        DKA: T1DM, acetone breath, ketones in urine, Kussmaul's polyuria, polydipsia, polyphagia, weakness, abdominal pain, Kussmaul's respirations, N/V, dehydration, ketonuria, ketone body odor, glycosuria, dilutional hyponatremia, false hyperkalemia, cerebral edema,
        early signs: confusion, headache, lethargy, papilledema, HTN, hyperpyrexia
        
        HHS: T2DM, no fruity smell, no ketones, normal pH, shallow breaths, dehydration profound. hyperglycemia, hyperosmolarity, dehydration, anorexia, weight loss, weakness, visual disturbances, poor turgor, tachycardia, confusion, seizures, coma
      - Metabolic Syndrome: precursor to T2DM, characterized by obesity, HTN, low HDL, high LDL, insulin resistance
      - Preventative :
        Blood pressure: lower than or equal to 120/80 mm Hg
        Low-density lipoprotein (LDL) cholesterol: less than or equal to 100 mg/d
        HDL cholesterol: greater than or equal to 60 mg/dL
        Triglycerides: less than or equal to 150 mg/dL
        
        T2DM: Risk factors:
        delivery of 5 kg baby, BMI greater than 25, and hypertension
        
        Long Term Complications:
        blindness, renal failure, CAD, stroke, PVD, paresthesia, hypotension, decreased digestion, male impotence
  - - - · Primary disorder: dysfunction caused by the endocrine gland itself
      - · Secondary disorder: dysfunction caused by abnormal pituitary activity
      - · Tertiary disorder: dysfunction caused by a hypothalamic origin
  - - - Hormone functions:
        
        GH: regulates growth and physical development (bones, muscles, fat tissue)
        
        LH/ FSH: (gonadotropins) stimulate testes and ovaries, sex hormones (testosterone and estrogen)
        
        Prolactin (PSH): stimulates mammary glands of breasts
        
        TSH: stimulates thyroid gland
        
        ACTH: (corticotropin) stimulates adrenal glands to produce cortisol
        
        ADH (vasopressin): regulates water excretion by kidneys
        
        Oxytocin: facilitates childbirth and breastfeeding, the 'love' hormone
      - Hormone Malfunctions:
        Overproduction-
        
        GH: acromegaly, gigantism
        
        ACTH: Cushing disease
        
        Prolactin: Galactorrhea, erectile dysfunction, infertility, amenorrhea
        
        Underproduction:
        
        ADH: diabetes insipidus
        
        Hypopituitarism (general, multiple hormones)
- - - - Causes: Hypotension, hypovolemia, dehydration, low cardiac output, low perfusion of kidneys
        
        Results in renin secretion by kidney, initiating RAAS to replenish blood volume and raise blood pressure
        
        SIADH causes secretion of ADH and excess water reabsorption, resulting in hypervolemia and dilutional hyponatremia
      - Liver produces Angiotensin I
        
        Angio I to Angio II via ACE stimulates release of aldosterone and vasoconstriction (raising BP),
        
        Aldosterone stimulates sodium, water reabsorption and potassium secretion into urine
      - Release of renin can lead to aldosterone release, but renin does not directly increase sodium and water retention by the kidneys. Aldosterone does
    - - High osmolarity (ICF to ECF) , cells shrink, stimulates osmoreceptors in hypothalamus
        
        Promotes release of ADH from post pituitary which causes retention of water
- - - - S&S
        
        Diagnostics
        
        Colonoscopy every 1-2 years
        beginning at 10-12 years old
        
        cancer of colon/ rectum: rectal bleeding, diarrhea, abdominal bleeding
    - - S&S
        
        Diagnostics
        
        Risk Factors
        
        damage to fibrillin
        
        disproportionate arms, legs, toes, fingers,
        long and slender build, long/narrow face,
        high arched neck/crowded teeth,
        indented/protruding sternum, dislocated eye lenses, high pressure in eyes, cystic changes in lungs, flexible joints, flat feet, curved spine, abnormal heart sounds
        
        cardiovascular disease major cause of death
    - - S&S
        
        flat nasal bridge, macroglossia, almond shaped eyes, irregular mouth, widely separated 1st/2nd toe, single crease in palm
    - - S&S
        
        Risk Factors
        
        long repeating CGG sequence
        
        Cognitive impairment, familiar mental retardation (FMR), Mild-to-moderate autistic-like behaviors
    - - Treatment
        
        S&S
        
        Risk Factors
        
        Caucasians, newborns screened
        
        very skinny,
        regular lung problems
        
        pancreatic enzyme supplements,
        bronchodilators, mucolytics,
        nutritional supplements
      - impacts lungs and pancreas
- - - - Chronic
        i.Related to unsuccessful acute inflammatory response
  - - - Type 2:
        Antibody reacts with antigen (IgG & IgM)
        Hemolytic Blood transfusions: chest pain, increased HR & RR, hypertension, chills, fever, renal failure, circulatory collapse, disseminated intravascular coagulation
        Chronic lymphocytic leukemia: fatigue, weakness, hypoxia, breathless
        
        Type 3:
        Result of body's failure to rid itself of antigen-antibody immune complexes
        Glomerulonephritis, Lupus, Rheumatoid arthritis
        S&S: vague and non specific; cytokines released; healthy tissue damage; chronic immune response
        
        CELL-mediated reaction (not antibodies);
        delayed; regulated by T cells
        Targets mycobacteria, fungi, and parasites
        Contact dermatitis, Positive TB test reaction, Transplant rejection
        S&S: variable, inhaled agents cause respiratory issues, black lung disease
  - - - Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        xray, elevated ESR, CRP, leukocytes, RF may be positive
        
        Joint pain and swelling, systemic S&S, deformities (Swan's and Boutonniere's) Ulnar deviation
        
        NSAIDs, corticosteroids
    - - Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        mainly women of child bearing age, prescence of EBV antibodies, UV light
        
        Ig's to DNA and Smith (sm) antigen
        
        butterfly rash across bridge of nose and cheeks; joint pain and swelling, weight loss, fever, pleural effusion, anemia, thrombocytopenia, splenic enlargement, cardiac valve deformities, renal dysfunction
        
        corticosteroids, immunosuppressive drugs
    - - Treatment
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        children under 2
        
        adults 60+
        
        physical exam: lung crackles
        
        xray
        
        sputum culture
        
        serotype urinary antigen test
        
        fever
        
        cough
        
        chest pain
        
        dyspnea
        
        tachypnea
        
        tachycardia
        
        sweats
        
        fatigue
        
        antibiotics
        
        vaccine
        
        SOME ANTIBIOTIC RESISTANCE
    - - Treatment
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        hospital acquired infection
        
        stool culture
        
        diarrhea, fever,
        abdomen pain,
        
        antibiotics;
        can destroy gut flora,
        rehydration
        
        stool transplant
    - - Treatment
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        young, old
        
        throat culture, nose, sputum
        
        fever, chills, headache, myalgia, arthralgia, cough, sore throat
        
        increased risk for pneumonia
        
        vaccine
        
        antipyretic, hydration, rest
    - - Treatment
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        children
        
        PE, history, PCR,
        IgM and IgG test
        
        fever, cough, respiratory illness, conjunctivitis, edema, photophobia, Koplik's spots (rash)
        
        eye damage,
        pneumonia
        
        vaccine
        
        rest, hydration
        antipyretic, vit A
- - - - abnormal cells
        
        localized
        
        well differentiated
        
        not invasive
        
        slow growing
      - Ex. adenoma, lipoma*, Hemangioma, Desmoid tumors, Nevi, Myomas
    - - abnormal cells, unlimited lifespan
        
        travel/ spread via bloodstream or lymphatic system
        
        poorly differentiated
        
        invasive
        
        Highly anaplastic, little resemblance to origin cells
        
        lack adhesion
        
        erratic, slow to fast growth
        
        genetic mutations occur
        
        frequent metastasis
      - Ex. Carcinoma, adenocarcinoma, sarcoma, osteoma, chondroma, leukemia, lymphoma
    - - new growth, tumor
  - - - Stage 2: Promotion
        
        Stage 3: Progression
        
        Phase between premalignant lesions and invasive cancer.
        final neoplastic transformation stage.
        genetic changes and cell proliferation, tumor size increases rapidly, metastatic potential
        
        Lengthy and reversible process.
        Proliferating pre-neoplastic cells accumulate.
        Process can be altered by chemo
        If the daughter cells are not found to carry the DNA mutation, then the initiated cells are harmless to the body and will not move on the division process
      - gene alteration resulting in dysregulation of biochemical pathways (ex. apoptosis)
    - - Lung = bone, brain
        Colon=liver
        breast=bone, brain, liver, lung
        prostate=vertebrae
        melanoma=brain
    - - Step 1: Determine benign or malignant
        Step 2: Grading to predict disease course
        Step 3: Staging
        Step 4: Screening for tumor cells
        
        Grades:
        1= well differentiated
        2= moderately
        3= poor
        
        Staging:
        Uses TNM system (tumor size, lymph node involvement, metastasis to distant organs)
        
        Tumor Markers:
        colorectal = CEA
        Breast = CA 15, HER2
        Pancreatic = CA 19
        Liver = AFP
        Ovarian = CA 125
        Prostate = PSA
        
        stages of Cancer:
        1: in situ
        
        limited spread (local)/ lymph nodes
        
        large spread
        
        metastatic
  - - - Human Papilloma Virus (HPV)
        sexually transmitted
        
        Treatment
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        cervical cancer
        penis cancer
        anal and throat cancer
        vaginal cancer
        
        biopsy, ELISA, IgG, Pap smear
        
        wart like lesions (condyloma acuminata), rectal bleeds, pain or fullness in anus, bowel movement changes, anal discharge, swollen lymph nodes
        
        no cure, cosmetic removal, vaccine!
      - Hepatitis B and C
        
        Risk Factors
        
        hepatocellular cancer
        non hodgkin's lymphoma
    - - lung cancer
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        smoking, asbestos, familial history (ras oncogene), radon, HIV, environmental toxins
        
        Non-Small Cell:
        subtly dev. over long time;
        
        1 more item...
        
        xray, CT, MRI,
        biopsy, sputum analysis
        
        cough, sputum (bloody), stridor, chest pain, dypnea
        
        Immune checkpoint inhibitors, surgery, radiation, chemo, Wedge resection, lobectomy (lobe removal)
      - Breast Cancer
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        50+ years old, genetics (BRCA1/2), increased estrogen, prolonged reproductive life, having no children, HER2 positive.
        
        history, PE, mammogram, ultrasound, biopsy, fine needle aspiration, galactogram
        
        palpable mass, nip discharge, swelling in one breast, peau d-orange (thickening skin like an orange peel), Paget's disease of the breast (redness, crusting, tenderness of nipple)
        
        chemo, surgery, adjuvant therapy
      - Cervical Cancer
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        smoking, sexually transmitted diseases, HPV, immunosuppression, genetics (TNFa)
        
        pap smear, biopsy
        
        vaginal bleeding, burning on urination, constipation, hematuria, leg edema, pain , hydronephrosis
        
        laser ablation, loop excision, surgery, hysterectomy, Brachytherapy, radiation,
      - Prostate Cancer
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        50+ years, family, fatty foods, red meat, smoking, high calcium, alcohol, genetics (BRCA1/2), diet
        
        DRE, PSA, biopsy, prostate surface antigen
        
        early stage has no symptoms; obstructs urine flow, urine stream stops/starts, straining, decreased flow, incomplete emptying, hematuria, anemia, anorexia, back pain, azotemia (rise in nitrogen waste- BUN & Creatinine)
        
        surgery, brachytherapy, cryotherapy, radiation, surveillance, hormonal therapy
        
        growth dependent on testosterone
        slow growing
        adenocarcinoma
      - Colorectal Cancer
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        polyps, age 45+, genetics, IBD (colitis, Crohn's), red meat diet, tobacco, low fiber, high fat, low fruits and vegetables, insulin resistance, physical inactivity, low vitamin diet
        
        early diagnosis is key, colonoscopy, DRE, FOBT, enema, ultrasound, CT, MRI,PET, CBC, stool DNA test,
        
        may be asymptomatic for years, abdominal cramping, weight loss, anemia, GI issues, bloody stool, constipation, rectal bleeding, melena (tarry black stool)
        
        surgery, colectomy, chemo, rads,
      - Liver Cancer
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        Asia and sub-Saharan Africans (1/200 people);
        US (1/20,000 people), 3x more common in men, obesity, diabetes, smoking, long-term androgenic steroids, exposure to toxins, long-term oral contraceptive use
        
        AFP blood test (60% accurate) if >500ng/mL, ultrasound, CT scan, MRI, hepatic angiography, percutaneous liver biopsy.
        
        Hep B/C, Alcoholic liver disease, alpha-antitrypsin deficiency, hemochromatosis, non-alcoholic cirrosis, abdominal pain, weight loss, fever, ascites, jaundice, esophageal varices, enlarged liver
        
        surgery, chemo, brachytherapy, radioablation, liver transplant; vaccine for Hep B, antiviral therapy for Hep C
      - Kidney Cancer
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        64 years old+, 2x likely for women, African Americans, hereditary (VHL syndrome, tuberous scelrosis complex, Cowden disease, hereditary papillary renal carcinoma (HPRC), Bir-Hogg-Dube syndrome), environmental (smoking, obesity, hypertension, cystic kidney disease, asbestos, tricholorethylene, vinyl chloride, cadmium, herbicides, benzene, smoking). Use of NSAIDs. Family history of Wilms tumor
        
        hypoalbuminemia, proteinuria, hypercalcemia, ultrasound, CT, MRI, PET, biopsy,
        
        hematuria, flank pain, abdominal mass, some are asymptomatic, anemia, weight loss, fatigue, Hypercalcemia, liver dysfunction, erythrocytosis, polyneuromyopathy
        
        surgery, chemo for Wilms tumor, slow growing
      - Disorders of WBC
        
        Neutropenia
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Causes
        
        1 more item...
        
        leukopenia (<1000), neutropenia (<1500), agranulocytosis (severe neutropenia)
        
        fatigue, fever, chills, ulcerations (skin. mouth, GI), respiratory infection, septicemia, susceptible to infections
        
        antibiotics, hematopoietic growth factors (stim stem cells), colony stimulating factors
        
        important to inflammatory response
        
        Leukemia
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        1 more item...
        
        abnormal lymphocytes (L) and myelocytes (M)
        Acute: ALL and AML
        Chronic: CLL and CML
        CBC, decreased WBC, Hct, Hgb, increased clot time, uric acid, biopsy
        
        pallor, fever, fatigue, bleeding, weight loss, lymphadenopathy (enlargement), CNS (N/V, headache, coma, seizures)
        
        affects stem cells in bone marrow resulting in abnormal cells, abnormal cells with increased life span/proliferation
        
        Acute Lymphocytic Leukemia (ALL)
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        1 more item...
        
        requent/ lots of infection, S&S appear like anemia, lymphadenopathy in liver and spleen, bone pain in sternum, tibia, femur, unexplained bruising, bleeding, nosebleeds, and CNS issues.
        
        chemo (3 yrs), blood transfusions
        
        lymphoblast accumulate (immature WBC)
        
        Acute Myelocytic Leukemia (AML
        
        Treatments
        
        S&S
        
        Diagnostics
        
        2 more items...
        
        anemia, thrombocytopenia (low clotting), leukopenia
        
        chemo, blood transfusions, antibiotics, bone marrow transplant
        
        immature myeloid cells accumulate
        
        Chronic Lymphocytic Leukemia (CLL)
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        1 more item...
        
        enlarged lymph , spleen, weight loss, infections, fatigue
        lymphocytosis (> 20K)
        
        chemo, stem cell transplant
        
        proliferation of immature B and T lymphocytes
        most common type
        
        Chronic Myelocytic Leukemia (CML)
        Philadelphia chromosome 22
        
        Treatments
        
        S&S
        
        Diagnostics
        
        Risk Factors
        
        1 more item...
        
        Phase 1: chronic, neutrophils begin to lose differentiation
        Phase 2: accelerated, unable to function, more undifferentiated
        Phase 3: blast crisis, no differentiated
        
        Philadelphia chromosome (abnormal chrom 22)
        blast crisis = >30% bone marrow cells are blast cells (immature)
        aplastic anemia (decrease in RBC anemia, WBC leukopenia, and platelets thrombocytopenia)
        
        curable, bone marrow transplant, Tyrosine kinase inhibitors, chemo
        
        proliferation of mature granulocytes (WBC)
- - - - Etiology/risk
        
        Signs
        
        headache, nausea, vomit, lethargy, confusion, seizures/coma, CNS changes, patient falls, diminished deep tendon reflexes, muscle weakness, flat veins, spasms, cramps
        
        occurs in low or high blood volume
        
        Insufficient Na in bloodstream, or excessive water causing dilutions. diarrhea, sweat, vomit, burns, wounds, gastric lavage, hyperglycemia, laxatives, renal disease, muscle cramps
        
        If less than 1500 mg Na intake per day
        diuretic use, fluid loss, burns/wounds, dehydration OR excess hydration
    - - Etiology/risk
        
        Signs
        
        fever, edema,
        oliguria, thirsty, cells shrink, CNS, often use hypotonic solution to treat. weak pulse, tachycardia, decreased refelxes
        
        DEHYDRATION, water loss, diarrhea, vomiting,
        salt loading
        infants/elderly
        kidney dysfx, hypercalcemia, potassium depletion,
        Loop diuretics, hyperaldosteronism,
  - - - Etiology/risk
        
        Signs
        
        EKG: peaked T wave
        diarrhea, apathy, confusion
        numbness of extremities, increased excitability, muscle spasms, heart arrhythmias, abnormal pulse rate
        
        leaks into ECF
        after major trauma
        leads to cardiac arrest
    - - Etiology/risk
        
        Signs
        
        anorexia, nausea,
        vomiting, sluggish bowel,
        irregular heartbeat,
        postural hypotension,
        muscle fatigue,
        leg cramps,
        decreased deep tendon reflexes,
        prolonged PR, flattened T,
        Prominent U wave, cardiac dysrhythmias
        
        Digitalis (Digoxin) Toxicity
        
        Occurs because: digoxin normally
        binds to ATPase pump on same site
        as K+, so when K+ is low, digoxin binds
        more easily to ATPase, exerting inhibitory
        effects
        
        foods with K+: Banana,
        orange juice, meat,
        green leafy vegetables,
        rainbow trout/tuna,
        oranges, cantaloupe, peaches
        
        LOOP DIURETICS, Slow bowel sounds, NPO status, alcoholics, bariatric surgery, eating disorders, heart failure patients receive diuretics' and digitalis meds which makes them susceptible to low potassium. Requiring nasogastric suctioning.
  - - - Etiology/risk
        
        Signs
        
        Chvostek's sign (facial spasm)= +
        Trousseau's sign (carpal spasm)= +
        seizures, hypotension, arrhythmia,
        bone pain, dry skin, cataracts, depression, dementia, respiratory difficulty, tetany, muscle cramping, increased excitability, seizure, confusion
        
        hypoparathyroidism;
        hyperphosphatemia, hypoalbuminemia, hypomagnesemia, sepsis, loop diuretics
        renal failure, vit D deficiency
    - - Etiology/risk
        
        Signs
        
        bone tenderness, arrhythmias,
        renal stones, constipation, depression,
        muscle weakness, anorexia, decreased excitability, hypophosphatemia, arrhythmia, sluggish muscles, kidney stones
        
        hyperparathyroidism;
        hypophosphatemia, malignant cells invading bone, causing bone destruction, diuretics
  - - - Etiology/risk
        
        Signs
        
        tremors, paresthesia, hyporeflexia, anorexia, dysphagia, joint stiffness, bone pain, osteomalacia, RBC/ WBC/platelet dysfunction, neural dysfunction
        
        high calcium levels, hyperparathyroidism, vit D deficiency, diuretic use, decreased intestinal absorption, increased excretion by the kidneys, severe burns,
    - - Etiology/risk
        
        Signs
        
        calcification, tetany,
        increased RBC,
        hypotension
        
        kidney failure,
        low calcium,
        hypoparathyroidism, hypomagnesemia,
        many cancers can raise Ca levels in the blood
  - - - Etiology/risk
        
        Signs
        
        neuromuscular manifestations,
        Tetany, Chvostek's sign,
        Trousseau's sign, Babinski's sign,
        EKG similar to hypokalemia (U wave),
        cardiac arrhythmias,
        respiratory paralysis,
        complete heart block, coma, death
        
        diarrhea, laxatives
        renal excretion, sepsis,
        burns, wounds, hypocalcemia, hypokalemia, starvation, diuretics
    - - Etiology/risk
        
        Signs
        
        decreased neuromuscular fx,
        hyporeflexia, weakness,
        hypotension, arrhythmias,
        
        kidney failure
        leads to cardiac arrest (>10), hypothyroidism, hyperparathyroidism,,
      - Acid-Base Balance
  - - - Etiology/risk
        
        Signs
        
        Low pitting edema
        
        water pores toward ISF/ICF
    - - Etiology/risk
        
        Signs
- - - - Compensatory Mechanisms
        
        Likewise, in conditions in which pH is too high, the kidneys reabsorb more H+ and excrete more HCO3, thereby lowering the pH, compensating for alkalosis. .
        
        The kidneys’ compensation is slow and may take days to reach maximal effectiveness
        
        In conditions in which pH is too low, or acidic, the kidneys excrete more acid (H+) and reabsorb more base (HCO3−). These actions lessen the amount of acid in the blood while adding more base (HCO3−), thereby raising blood pH and compensating for acidosis.
      - Medical Intervention
        
        Acidosis: administer sodium bicarb, intubate/ mechanical ventilation
        
        Alkalosis: CO2 rebreather mask to increase CO2
    - - Medical Intervention
        
        Acidosis: administer sodium bicarb, give insulin in Diabetic Ketoacidosis (DKA)
        
        Alkalosis: administer Acetazolamide (increase bicarb excretion), antiemetic meds when vomiting
      - Compensatory Mechanisms
        
        In conditions in which pH is too low, or acidic, the lungs increase breathing to expel CO2 (hyperventilation).
        When pH is high, the lungs slow breathing to retain CO2 (hypoventilation)
        
        The lungs are fast to react
  - - - Respiratory Acidosis
        PH blood (<7.35); pCO2 (>45)
        
        Causes
        
        Airway
        
        Drug induced CNS depression
        
        CNS origin
        
        Pulmonary Disease (COPD)
        
        Thoracic cage / Shallow breathing (hypoventilation)
        
        Compensation
        
        Kidney: HCO3 would increase
        
        Lungs: Increase breathing, less CO2, give oxygen
        
        After compensation: you get more acid in the urine, and bicarb regeneration
      - Respiratory Alkalosis
        PH blood (>7.45); pCO2 (<35)
        
        Causes
        
        CNS trauma (brain injury, stroke)
        
        anxiety, hypoxemia
        
        hypermetabolic state
        
        excessive mechanical ventilation
        
        hyperventilation
        
        Compensation
        
        Kidney: HCO3 would decrease; H+ is retained
        
        Lungs: Decrease breathing (ex. breathe into paper bag to retain CO2)
        
        After compensation: Acid secretion in urine decreased, bicarb regeneration decreased
    - - Metabolic Acidosis
        PH blood (<7.35); HCO3 (<22)
        
        Causes
        
        renal failure causing acid waste, decreased renal acid secretion
        
        lactic acidosis
        
        ketoacidosis of diabetes
        
        Compensation
        
        Lungs: Respiration rate would increase, blowing CO2 out, hyperventilation
        
        IV fluids with Bicarb, potassium supplements, mechanical ventilation
        
        After compensation: increased acid in urine and bicarb regeneration
        
        Increase in H ions, loss of alkali
      - Metabolic Alkalosis
        PH blood (>7.45); HCO3 (>26)
        
        Causes
        
        Post code excess bicarb IV
        
        Excess bicarb (HCO3) ingestion
        
        Addition of base to body fluid
        
        vomiting of excess gastric acid
        
        loss of H+
        
        Compensation
        
        Lungs: breathing will slow down to compensate and retain CO2
        
        Kidney: attempts to retain H+; retaining H+ OVER K+. HYPOKALEMIA OCCURS
        
        Administer potassium, saline, acetazolamide (diamox)
        
        After compensation: decreased acid excretion and bicarb regeneration
- - - - Normal Values mm Hg:
        
        CVP (preload): 1-5
        
        PAP: 17-32/ 4-13
        
        CO: 4-8 L/min (dec as ventricles fail)
        
        SABP: 90-140/ 60-80 (dec. in LVF)
        
        PCWP: 12-15 (Inc. in LVF)
        
        LVEF (stroke volume):
        lower than 40= LVF
      - CO = HR X SV
        incr preload = inc CO
        SV varies directly with preload and inversely with afterload
      - Preload: volume of blood returning to the heart- right atrial volume. volume of blood in the heart at the end of diastole
        CO: blood the heart pumps out of the LV each minute
        Afterload: Resistance that the ventricle must overcome to pump blood- aortic pressure
      - Which is a major determinant of diastolic blood pressure? Systemic vascular resistance
  - - - ECG: abnormalities, no specifics to heart failure
        Echo: size/fx/ structure of ventricles
        MGAS: dye injection, volume of ventricle contraction
        Catheterization/Angiography: hemodynamic monitoring, artery illumination
        Serum Electrolytes (hyponatremia, hypokalemia)
        Chest x ray (cardiomegaly = LVF)
        BNP testing = high >100 = heart failure
    - - Drugs:
        Aim to increase blood flow and O2
        
        Beta Blockers
        (Metoprolol, bisoprolol, atenolol) blocks SNS, cause lower HR, BP, lowers force of contraction, reduces O2 demand
        
        ACE inhibitors
        (Ramipril. captopril, lisinopril) blocks angiotensin II decreasing vasoconstriction, reduces sodium/ water retention, dilates arteries, reduces afterload, reduced O2 demand
        
        ARBs
        similar to ACE inhibitors,
        
        Aldosterone antagonist
        inhibits sodium, water retention, inhibits release of potassium, often results in hyperkalemia
        
        Diuretics
        reduce edema, often result in hypokalemia
        
        Inotropic Agents (Digoxin, dobutamine) incr. contraction force, slows HR, increased contractility
        
        Natriuretic
        induce diuresis
        
        Neprylisin Inhibitors
        prolonged natriuresis, however causes vasoconstriction
        
        Nitrates (or NTG)
        (NO) vasodilators, lower BP, increases coronary perfusion, reduces O2 demand
        
        dilates arteries (perfusion)
        
        reduces afterload / preload
        
        reduces O2 demand
        
        Calcium Channel Blockers
        reduced contractility, decreased O2 demand
      - Lifestyle:
        
        low-fat diet
        
        no smoking
        
        exercise
        
        low fluid, salt, cholesterol, alcohol
    - - Cholesterol = lipid that maintains cell membrane (normal up to 200 mg/dl)
        Comes from = animal fat and liver
        LDL = deposits cholesterol in tissues on artery walls
        HDL = takes cholesterol to liver for excretion, away from artery walls
    - - A group of symptoms that increase risk of coronary artery disease. Patients have 3X risk for atherosclerosis and stroke.
        
        apple shaped obesity
        
        glucose intolerance (>100 mg/mL)
        
        hyperinsulinemia
        
        decreased HDL
        
        hypertriglyceridemia
        
        hypertension (HTN)
    - - high lipids, glucose, nicotine, cholesterol
        
        endothelium is the primary site
        
        conditions such as hyperlipidemia, HTN, diabetes
      - Desirable blood levels:
        HDL cholesterol
        Greater than 40 mg/dL for men and 50 mg/dL for women
        LDL cholesterol
        Less than 130 mg/dL for most people
        Less than 100 mg/dL for people with heart disease or diabetes,
        less than 70 mg/dL , if they had a heart attack or stroke
  - - - Diagnosis Criteria:
        
        nocturnal dyspnea
        
        JVD
        
        lung crackles
        
        edema
        
        nocturnal cough
        
        exertion dyspnea
        
        pleural effusion
        
        reduced vital capacity
        
        tachycardia
        
        weight loss (4.5 kg or more)
      - S&S
        LVF (left for lungs)
        
        dyspnea
        
        cough
        
        orthopnea (lying flat)
        
        PND (dyspnea at night)
        
        weak pulses
        
        decreased perfusion, confusion, disorientation
        
        crackles
        
        pink frothy sputum
        
        RVF (right for rest of body)
        
        JVD
        
        Ascites
        
        GI disturbances
        
        reflux
        
        hepato-spleno-megaly
        
        peripheral edema
        
        pulmonary embolism
      - Four factors of heart failure:
        
        increased fluid volume
        
        impaired ventricular filling
        
        degeneration of ventricular muscle
        
        decreased ventricular contractile function
      - Causes:
        
        Ischemic Heart Disease- repeated insults to myocardium
        
        Chronic HTN- leading cause of LVF,
        
        Chronic pul. disease- leading cause of RVF
        
        Cardiomyopathy- myocardium injury
        
        Dysrhythmias
        
        Heart Valve (mitral regurgitation, atrial stenosis)
        
        Diabetes
        
        Multiple MIs
      - Pathophys::
        LVF:
        
        increased afterload- DIRECTLY AFFECTS CARDIAC OUTPUT*
        
        Hypertrophy
        
        decreased filling
        
        reduced SV and CO, arterial pressure
        
        decreased circulation results in feedback loop causing increased vasoconstriction & blood volume
        
        SNS stimulation = increased HR = more weakened heart
        
        RAAS stims = increased BP = more weakened heart
        -pulmonary edema
        
        RVF:
        
        causes hypoxemia
        
        forward contractile force is diminished
      - Treatments:
        
        aimed at reducing preload & afterload & increasing contractility
      - Early signs of cardiac problems in elderly:
        
        mental status changes
        
        agitation
        
        frequent falls
  - - - Risks:
        
        hypokalemia (from diuretic use)
        
        digoxin use
      - Supraventricular (SA node, atria, AV node)
      - Ventricular (bundle of His, Purkinje fibers, ventricular muscle)- potentially fatal
    - - tachy-dys: reduces time available for ventricular filling
        brady-dys: minimizes cardiac output, slows HR
        Atrial-dys: diminishes the volume emptied into the ventricle, decreasing SV
      - Premature ventricular contraction (PVC): when ectopic pacemaker initiates a contraction. Beats without waiting for completion of each action potential. Leads to fibrillation, rapid heart beat, quivering ventricle, no blood ejecting.
  - - - Severe Hypovolemic Shock
        
        large depletion of blood or fluids.
        low blood pressure, reduced blood flow,
        RAAS is activated, vasoconstriction occurs,
        Causes SNS stimulation, increased HR and contractility. .
      - Cardiovascular shock
        
        Caused by heart failure and severe MI or cardiac tamponade
        Causes severe HTN and tachycardia, decreased renal perfusion
        cold, clammy skin, decreased BP (below 90 mm Hg systolic), increased HR, change of consciousness
        loss of perfusion in arteries, low urine output, cyanosis, SNS and RAAS is stimulated causing vasoconstriction
  - - - HTN: Aging adults require higher BP for organ circulation (150/90).
        
        Risk factors include diabetes, obesity, sedentary behavior, tobacco, excess sodium, low potassium, low vitamin D, excess alcohol, stress.
        
        secondary factors: increased renin, aldosterone, angiotensin, and catecholamine (hyperthyroidism, Cushing's syndrome, estrogen)
        
        Causes damage to arteries and resistance against left ventricle.
        
        Results in muscle hypertrophy, ischemia, infarction, and heart failure
      - Atherosclerosis: primarily located in tunica intima, Risk factors: Men, Old, Diabetes, African American, Genetic disposition, Tobacco, HTN, Obesity, high fat diet, high stress,
      - Varicose Veins: caused by high pressure in veins, damaging valves, prolonged standing, sitting, pregnancy, obesity. Effects include edema of legs
        DVT: DV insufficiency causes edema, heaviness of leg, dusky color of leg. Result from incomplete clearance of waste, accumulation of CO2, lactic acid. Leads to DVT, a clot that moves to the IVC then the right side of the heart into pulmonary artery. Risk factors include Virchow's triad, venous stasis (first sign: nocturnal swelling), hypercoagulability, vascular damage. Signs include tenderness, redness, warmth, swelling.
        Thrombophlebitis: inflammation preceding clot
        Phlebothrombosis: clot, unassociated with inflammation
- - - - Cough, dyspnea, hemoptysis, atelectasis. hypoxia, respiratory failure (pulmonary edema, PE, pneumonia, pneumothorax)
      - Hypercapnia, hypoxia, pulmonary HTN,
    - - Upper
        
        one of the more frequent reasons to seek care
        includes nose, oropharynx, larynx, trachea, and two main bronchi/ bronchioles
        
        conducts air into the lower airways
        
        Mucociliary apparatus: inside the bronchioles, secrete mucus that traps foreign organisms and protects the lower respiratory system
        
        Rhinitis, Pharyngitis, Sinusitis, Tonsillitis, Epiglottitis, Laryngitis, Tracheitis,
      - Lower
        
        gas exchange by oxygenating blood and excreting CO2 at the alveoli
        
        Bronchitis, Pneumonia, Abscess, Tuberculosis,
    - - viruses alter the pulmonary immune defenses making the lungs vulnerable to bacterial infection. Common culprits causing secondary infections are influenza, rhinovirus, syncytial virus
    - - Causes: commonly strep and staph bacteria
        Treatment: anti-fungal,
      - Community Acquired: obtained outside hospital setting,
      - Side Effects: pleuritic chest pain, crackles, cough with sputum, tachycardia, dyspnea, rigors, fever, chills,
        consciousness changes and low/normal temp with older adults
    - - characterized by diffuse alveolar injury, capillary damage, pulmonary infiltrates, and severe hypoxemia
      - causes include multisystem organ failure, sepsis, aspiration of gastric contents, systemic illnesses, and injuries
        death often results as treatments are ineffective
      - Signs include sudden pulmonary edema, severe hypoxemia, and hypercapnia. Hypoxemia does not improve with oxygen.
    - - a consequence of LEFT SIDED HEART FAILURE
      - Creates a fluid barrier to oxygen transfer across the alveoli-capillary interface
      - Symptoms: Hypoxia, crackles in lungs, NO FEVER
    - - radon gas, smoking, second hand smoke, chemical agents, asbestosis, silicosis
    - - signs: diminished gag or cough reflex, decreased level of consciousness
      - results can range from no injury to death
        small quantities is common, and can be coughed out
        those with underlying disease are at greater risk
      - more common in the right lung- due to the right bronchus being vertical and wider than the left bronchus
  - - - Right sided heart failure:
        
        hypoxemia, hypercapnia, edema
        elevated PVR --> HTN
        
        Ascites, dyspnea, hepatosplenomegaly, anorexia, dependent edema, pink frothy sputum, distended jugular veins,
      - Chronic hypoxia
        
        requires oxygen therapy
      - Emphysema and chronic bronchitis (see Coggle)
    - - Caused by compressive force on the alveoli, such as a mass, obstruction of bronchioles, complications post surgery due to sedation,
      - Results in collapse of alveoli and reduced gas exchange, Predisposes patient to pneumonia.
      - To relieve it, coughing and deep breathing are recommended
    - - Chronic
        
        airway stays small. chronic inflammation and tissue remodeling
      - Acute
        
        hypersensitivity reaction: bronchospasm. edema. airway obstruction
      - Mode of action: Triggers (irritants, infections, others) --> mediator release (histamine, leukotriene, cytokines --> hyperactive response and chronic responses
    - - obstructive
        
        trouble exhaling air from lungs; difficult to inhale fresh air. The old air obstructs the new air
        
        increase in resistance to airflow from the trachea and larger bronchi to respiratory bronchioles
        
        emphysema, chronic bronchitis, bronchiectasis, and asthma
      - restrictive
        
        trouble fully expanding their lungs. Difficult to fill their lungs with air. Lungs are restricted from normal breathing.
        
        reduced expansion of lung tissue and decreased total lung capacity (TLC)
        
        hypersensitivity pneumonitis, pulmonary fibrosis, pneumoconiosis, and thoracic cage deformities
- - - - Ischemic Penumbra
        
        About: perimeter around core ischemic area, reparable damage, but susceptible to ischemia
        Symptoms: cerebral edema, anoxic encephalopathy
      - About: caused by blood clot in cerebral artery, leads to cerebral infarction (-->brain death)
        Causes: arteriosclerosis, carotid stenosis, atrial fibrillation
      - Lacunar Infarcts
        
        Small areas of ischemia associated with HTN, smoking, diabetes
    - - About: disrupts cerebral circulation, no permanent damage
    - - Aphasia (speaking/ understanding)- left hemisphere
        
        Broca's area --> expressive aphasia (speak)
        Wernicke's area --> receptive aphasia (understanding)
      - Pressure on the brainstem:
        
        low LOC, irregular respiratory rate, bradycardia, hypertension
      - General: F-A-S-T (facial droop, arm weakness, speech, time to call 9-1-1)
        
        slurred speech, loss of gag reflex, facial droop, hemiparesis, hemiparalysis, vision loss, less of sensation, confusion, sleepiness, coma, disorientation
      - Slow progression of one-sided weakness or sensory loss and slurring speech = more characteristic of ischemic stroke
        
        Sudden headache, elevated blood pressure, depressed level of consciousness = more indicative of hemorrhagic
    - - About: caused by rupture of cerebral artery, leads to compression (loss of blood flow)
        Causes: HTN, aneurysm rupture
    - - HTN, diabetes, smoking, obesity, low exercise, atrial fibrillation, oral contraceptives, alcohol, TIA
    - - IV mannitol, hypertonic saline (for cerebral edema), IV thrombolytic therapy (tPA)
  - - - About: Chronic neurological disorder that leads to demyelination of brain, spinal chord, and optic nerves; leads to autoimmune inflammatory disorder
        Symptoms: weakness, numbness, tingling sensations, balance problems, blurred vision, and fatigue; sensory loss/motor impairment; ataxia/tremors/dysarthria; dysphagia & aspiration pneumonia (in later stages); hemiparesis/paraparesis/quadriparesis, cognitive impairment
        Cause: Progressive and chronic damage leading to nervous system damage and disability
        Treatment: immunosuppressant therapy, corticosteroids, antiviral drugs, antibiotics, antiplasmodics
    - - About: dopamine depletion disorder tat causes neurological motor issues
        Symptoms: spasmodic muscle movements, slow movements, rigidity, bradykinesia, akinesia, resting tremors, muscle rigidity, micrographia, facial stare, shuffling, low monotone speech, depression
        Cause: progressive loss of dopamine-producing cells within basal ganglia of brain (Ach stimulates muscle movement, dopamine inhibits -> depletion of dopamine creates imbalance); accumulation of proteins in Lewy bodies in brainstem, spinal cord, and cortex
        Treatment: Levodopa, carbidopa, anticholinergic medications
    - - About: chronic neurological disorder characterized by recent seizures (sudden, abnormal discharge of neurons)
        Symptoms: altered state of consciousness, motor, sensory, automatic, and behavioral manifestations
        Cause: brain neoplasms, cerebrovascular disease, congenital malformation, degenerative brain disorder, environmental stimuli, genetics, head trauma, infections, metabolic disturbances, perinatal injury, withdrawal from alcohol/sedatives; Young - head trauma, Old - stroke
        Treatment:
      - Seizures
        
        About: occurs with an abrupt imbalance between excitatory & inhibitory impulses within a region of cortical neurons favoring hyperexcitability
        Treatment: dilatin, phenobarbital, gabapentin, status epilepticus (Vlaium, Dilantin, phenobarbital), dextrose, surgery
        
        Focal Seizures
        
        About: arise from a neuronal area localized within one cerebral hemisphere
        Symptoms: motor, sensory, autonomic impairment without cognitive impairment
        Diagnosis: EEG will show abnormal spike discharges in limited regions over related area
        
        Generalized Seizures
        
        About: arise within a neuronal hemisphere and rapidly involve neurons distributed across both hemispheres
        Can be convulsive or non-convulsive
        
        Absence Seizures
        
        Myoclonic Seizures:
        
        Tonic-Clonic Seizures
        
        Atonic Seizures
        
        Status Epilepticus
  - - - C1
      - No control of head, neck, diaphragm, dependent care, respirator, no bladder/bowel control, wheelchair bound
      - C4
      - Sensation head, neck, some control of head, neck and diaphragm movement, dependent care
      - C5
      - Controls head, neck, shoulders, flexes elbows, dependent care
      - C6
      - Use of shoulder, extends wrists, dependent care
      - C7-8
      - Extends elbows, flexes wrists, use of some fingers, dependent care
      - C1-8  Quadraplegic
    - - Thoracic:
      - 1-5: Paraplegic with diaphragmatic breathing, arm function intact, loss of leg function, bladder and bowel
      - 6-12: Paraplegic; no abdominal reflexes present; no bowel and bladder control, no sensation to groin
      - Thoracic to Lumbar:
      - T12-L5: Bowel and bladder dysfunction; lower leg weakness, hip and knee movement, can walk with assistance
      - Sacral:
      - S1-5: Loss of bladder, bowel, and sexual function. No paralysis of legs, loss of sensation to scrotum, perineum, penis, anal area and upper inner aspect of the thighs.
- - - - Hormonal
      - Anatomical
        
        Infertility: Causes: Coital problem, endometriosis, tubal damage, ovulatory failure, sperm problem
      - Infectious
        
        Bacterial Vaginosis: Fishy odor, white discharge, pruritis, inflammation, dyspareunia, no dysuria, mild vulva irritation, bacterial coated epithelial cells, partners do NOT need to be treated.
        
        STI: Trichomoniasis: Musty odor, green discharge, tenderness, dysuria, dyspareunia, pruritis, vulva redness, cervical petechia, motile protozoa, DO NEED to treat partners
        
        STD: Syphilis: primary [ chancre lesions on penis or labia ], secondary [ rash, oral lesions, neurosyphilis, cranial nerve defect, ocular uveitis, acute hepatitis, nephrotic syndrome ], tertiary [ pain/ sensory defects, ulcerating granulomas, aortic aneurysm, coronary arteritis. Affects almost every body system. HIV susceptibility. Fetus can become infected prior to birth. Jarisch-Herxheimer- happens during tx when large numbers of bacteria are killed by antibiotics at once, releasing endotoxins, causing fever, chills, skin lesions
        
        SRD: Gonorrhea: causes cervicitis, proctitis, urethritis, pelvic inflammatory disease (PID),conjunctivitis,andpharyngitis. Can cause ectopic pregnancy, infertility, HIV susceptibility, vaginal discharge, dysuria, genital pruritus, spotting. DO TREAT newborns whose mothers are infected.
        
        STD: Chlamydia: risk includes unprotected sex, inflammation of cervix, DO TREAT partners, DO TREAT newborns whose mothers are infected.
        
        Candida (Yeast): overgrowth of yeast, caused by diabetes, HIV, anti-biotic use, pregnancy
        
        HPV: soft chancre lesion, painful ulcers, lymphadenopathy, VERY common, genital warts, causes cancers. Acute phase [ lesions, contagious ], Latent phase
        
        STD: Herpes: cold sores, blisters, ulcers, fetal infection,
        
        STD: Pelvic Inflammatory Disease (PID): SERIOUS, infection of upper repro organs, risk includes intrauterine device, D&C, abortion, no contraceptives. Sx: Gonorrhea, pain, fever, chills, infertility, ectopic pregnancy, high temperature, abnormal discharge, WBCs, elevated erythrocyte sedimentation rate/ c reactive protein, salpingitis, tenderness on palpation, Chandelier sign (tender cervix)
      - Cancers
        
        Prostate
        
        About: prostate produces seminal fluid,
        Symptoms: high PSA antigen, BUN, Creatinine in blood, lumps felt via rectal exam. dysuria, frequency, small urinary stream, nocturia, painful bowel movements/ ejaculation, hip/back pain, lymphedema, thrombophlebitis, inability to empty bladder
        Tx: radiation, prostatectomy, antineoplastic therapy
        
        BPH:
        About: is enlarged prostate (benign, non-cancerous), common in men, elevated BUN, Creatinine, PSA, UA, WBC
        Symptoms: Urinary retention causes overflow incontinence, calculi, UTI/ kidney infections occur, dysuria with age, greater frequency of urination, hesitancy, straining
        Causes: increased testosterone,/ estrogen, smoking
        Tx: Alpha adrenergic blocking drugs, antiandrogen drugs, TURP, indwelling catheters, suprapubic catheters
        
        Ovarian
        
        Cervical
  - - - About: primary [ no periods by 16 yrs ], secondary [ no periods for 3+ months ]
        Symptoms: no periods
        Causes: menopause, pregnancy, excessive exercise, low body fat, PCOS, thyroid disorders, stress, PCOS, Asherman's, Sheehan's, prolactinoma
        Tx: lifestyle, medicine, surgery, psychotherapy
    - - About: primary [ normal ], secondary [ repro tract disease ]
        Symptoms: primary [ occurs 8-72 hours after onset of period and improves with age ], secondary [ occurs >3 days starting 1-2 days before period onset and worsens with age ]
        Cause: secondary [ endometriosis, uterine fibroids, PID ]
        Tx: diet, exercise, medication
    - - About: growth of endometrial tissue outside the uterus
        Symptoms: menstrual pain, sex pain, irregular bleeding, abdomen pain, infertility, hematuria, painful bowel movement, painful urination, fatigue, dysmenorrhea, dyspareunia, dyschezia, dysuria Risk factors include obesity, late menopause, short menses, low birth weight, chemicals, genetics
    - - About: very common, leading cause of infertility, cysts inhibit ovulation, may be associated with metabolic syndrome
        Symptoms: infertility, body hair growth, weight changes (gain), low sex drive, irregular periods, thinning hair, high testosterone, insulin resistance, fatigue, acne, mood changes
        Cause:
        Tx:
    - - About: cause of infertility, reduced blood flow to the penis
        Symptoms: inability to have an erection
        Causes: CVD, diabetes, hormonal imbalance, neurogenic disorder, injury, anatomical abnormality, arteriosclerosis
- - - - About: yeast like fungus
        Symptoms: red itchy skin, defined borders, white patchy scaling, pustules, burning, thrush (mouth)
        Causes: warm moist area, change in pH, increased bGL, immune system change. At risk includes diabetes, Cushing's, poor nutrition,
        Treatment: antifungal, Nystatin, steroids
    - - About: bacterial infection (strep A, S. aureus)
        Symptoms: edema, bright red patchy, indefinite border. Found on legs, ears, face. Late stages: pustules, abscess, necrosis
        Causes: At risk- diabetes. HIV, neoplasms, poor circulation, trauma, skin ulcers
        Treatment: antibiotics, elevate extremities
    - - About: varicella-zoster (chickenpox virus); when activated, moves through sensory nerve pathways
        Symptoms: pain/neuronal necrosis, vesicles on posterior surface of body, crusting, lesions, permanent blindness
        Causes: chickenpox virus travels down nerve fibers to dorsal ganglia and resides in dormant state
        Treatment: antiviral drugs (Zovirax), antibacterial cream, topical anesthetic agents, narcotics for pain, amitriptyline (for sedative effect)
    - - About: dermatitis (inflammation)
        Symptoms: itching, redness, vesicles, crusty ooze
        Causes: common household goods (soap, clothes)
        Treatment: remove irritant, antipruritic cream, steroids, antihistamines. washing
    - - About: chronic inflammatory
        Symptoms: affects scalp, hairline, elbows, knees. Circular, patchy, silvery scales, redness
        Cause: t-cell immune response to antigen
        Treatment: steroids, emollients
    - - About: malignant lesion arising from epithelial cells
        Symptoms: slightly elevate pearl colored nodule slowly grows into lesion
        Cause: UV light creates DNA mutation on p53 gene
        Treatment: surgery, radiation therapy
    - - About: epidermis tumor, localized --> regional metastasis
        Symptoms: grows rapidly, may metastasize, firm tumors, elevated surface
        Cause: skin lesions (ulcers, warts, sunburn), p53 gene mutation
        Treatment: good prognosis, radiation, surgery
    - - About: cancerous lesion arising from epidermal melanocyte cells; A(symmetry)B(order)C(olor)D(iameter)s; 4 stages
        Symptoms:
        Cause: existing mole superficially spreads; sun exposure is common risk factor
        Treatment: premalignant - suspicious tissue removed; malignant - surgical excision, dissection of regional lymph nodes, antineoplastic therapy
- - - - About: large amounts of pain; progression can cause ischemia, necrosis, and impairment
        Symptoms: pain out of proportion of an injury, edema, pallor, paresthesia, weak pulse, pressure > 30mmHg
        Cause: when tissue pressure exceeds perfusion pressure in a closed space
        Treatment: immediate surgical eval required at first signs, surgical fasciotomy
    - - About: overstretching of tendon/ligament
        Symptoms: bruising, swelling, pain
        Cause: twist/ pull of muscle, commonly ankle
        Grade 1- mild, no tearing/ loss of function
        Grade 2- partial tear, reduced function
        Grade 3- complete tear, loss of function
    - - About: overuse of muscles or result of injury in which body alters the way it moves
        Symptoms: pain, weakness, spasms
        Cause: often in lower back and hamstring muscle
    - - About: Bruise
        Symptoms: bluish appearance
        Cause: falls, sports injury,
    - - About: disrupted continuity of a bone; can disrupt blood flow, pulse, sensation, neurovascular integrity
        Healing: Stage 1- inflammatory
        Stage 2- Granulation
        Stage 3- Callus formation (osteoblast/ chondroblast)
        Stage 4- Lamellar bone deposition (strengthening)
        Stage 5- Remodeling (osteoclast/ osteoblast)
    - - About: most common = staphylococcus aureus
        Symptoms: fever, chills, nausea, vomiting, increased pressure in area, warmth, edematous, erythematous, odor
        Cause: complications of open wounds/surgical intervention
        Treatment: anitbiotics
    - - About: surgical vessel damage and venous stasis used be immobilization increases risk of clot
        Symptoms: few to none, area may be tender, edema, warm, palpable, Homans sign (pain in calf w/ dorsiflexion of foot)
        Cause: vessel damage + immobilization needed postoperatively
        Diagnosis: prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen level, platelet count
        Treatment: blood thinners, surgical insertion of Greenfield filter
    - - About: similar to DTV
        Symptoms: dyspnea, cyanosis, cough, tachypnea, hemoptysis, chest pain, tachycardia
        Cause: similar to DVT
        Treatment: anticoagulation meds, thrombolysis, pulmonary thrombectomy
    - - About: deterioration of bone because of insufficient blood supply
        Symptoms: pain/weakness, motor weakness, abnormal gait, lack of rehab progress
        Cause: fractures of the femoral head and neck, scaphoid, and proximal humerus
        Treatment: after MRI, surgical removal of necrotic bone
    - - About: porous bone disease, particularly in trabecular bone. Osteopenia is the thinning of bone prior to onset.
        Symptoms: kyphosis, loss of height, fragility fracture (hip)
        Risk: female, postmenopause, poor calcium/vit D intake, steroids, hyperthyroidism, hyperparathyroidism, excess alcohol
        Cause: poor diet, lack of exercise, lack of sunlight exposure
        Diagnostic: measure osteocalcin (high = bone resorption), measure urine telopeptides (high = bone resorption)
        Treatment: diet, bisphosphonates, calcitonin, estrogenlike drugs, surgery
    - - About: fracture with no chance of healing
        Symptoms: pain, dysfunction of limb, muscle weakness, posttraumatic arthritis
        Cause: bone in an unacceptable position leads to malunion
        Treatment: ultrasonic bone stimulator, surgery
    - - About: chronic disability, affects joints (spine, hip, knee), inflammation causes cartilage degradation.
        
        osteophytes (bony projections) develop near cartilage loss
        
        Chondrocytes synthesize proteoglycan fluid to repair cartilage causing joint swelling
        Risk: age, obesity, history of sports/ trauma
        Symptoms: joint pain, stiffness, swelling, altered gait, limited range of motion, Herbeden's nodes (DIP), Bouchard's nodes (PIP)
        Treatment: NSAIDS, exercise, braces, canes, steroids, diet supplements, artificial joint fluid, surgery
    - - About: vertebrae disc compression
        Symptoms: back pain, weakness, neuropathy
        Lumbar Sx: lower back pain, radiates down leg/ butt/ thigh, worstens when sitting, bending, lifting, numbness in legs, foot drop
        Cervical Sx: neck pain, numbness in arm/hand, weakness
        Spinal Stenosis: narrow spinal canal, common occurrence
        Assessment: deep tendon reflexes, muscle strength, sensory dermatomes
        L4- patella reflex
        L5- dorsiflexion of foot
        S1- Achilles reflex, plantar flexon
        Straight leg Raising Sign Test- applies pressure on sciatic nerve (60 degrees or fewer is a positive test)
        Treatment: NSAIDs, muscle relaxants, PT, surgery
      - Cauda Equina Syndrome: compressed nerves cause loss of bowel or bladder function. MEDICAL EMERGENCY.
        
        Can lead to incontinence and paralysis
  - - - Osteoblast: bone-forming [MODELING], raise Calcium / Phosphorous level of bone
        Osteocyte: mature osteoblast; maintain bone
        
        Osteoclast: resorption/ degradation of existing bone [REMODELING, 10% annually], regulated by estrogen, androgen, vit D, PTH
        1+2= basic multicellular unit (BMU)
    - - Trabecular (porous; wrist, hip, vertebrae), more osteoporosis risk
        Cortical (solid)
    - - *Affected by: nutrition, physical exercise, age, hormones, vitamin D
        Age: At 30 yrs old, the osteoclast activity exceeds osteoblast activity
        Exercise: moderate w/ weight bearing maintains bone strength
    - - surgery patients susceptible to DVT and PE
        
        surgery patients often need anticoagulant therapy
        
        NSAIDS, analgesia, opioids, muscle relaxants
        
        RICE therapy: Rest, Ice, Compression, Elevation
        
        PT, massage, acupuncture, TENS, chiropractic
        
        Reduction (realigning bones)
        
        Traction (pulling on fracture to relieve pressure?)
      - Reduction:
        
        closed- device worn outside area
        
        open- incision and insertion of hardware
    - - Signs: pain, decreased moto strength, hypoesthesia, paresthesia, weak pulse, atrophy
      - Check pulses and DISTAL sensation to injury
    - - Calcitriol (vit D)
        
        PTH makes bone release calcium during hypocalcemia in blood, leads to osteoporosis
        
        Calcitonin- produced by thyroid gland, enhances calcium entry into bone and blocks bone breakdown, stimulated by calcium
        
        Estrogen- inhibits bone breakdown, stims bone formation
        
        Testosterone- stims muscle growth, increasing bone formation
    - - Osteocalcin (synovitis, early OA) (high = bone resorption, OP)
        
        Hyaluronic acid (synovitis, early OA)
        
        Urine telopeptides (high = bone resorption, OP)