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Patho III final
GI, Neuro
| Question | Answer |
|---|---|
| Cancer of the lower intestinal tract (colorectal cancer) is the second most frequent cause of death in the USA for both men and women (____% of all cancer deaths) | 10-15 |
| _____ are closely associated with development of cancer. | Colorectal polyps |
| Most colorectal cancers are moderately differentiated ____ with a long preinvasive phase and a tendency to grow slowly. | adenocarcinomas |
| On the right colon, ___ lesions along one wall of the cecum and ascending colon show pain, a palpable mass in the lower right quadrant, anemia, and dark red or mahogany blood mixed with stool | polypoid |
| Tumors of the left colon start as a small, elevated, button-like mass which grow ____ and spread along the entire bowel wall eventually ulcerating in the middle as the tumor penetrates the blood supply. | circumferentially |
| systemic lmyphatic spread occurs along the aorta to mesenteric and pancreatic lymph nodes and ___ follows invasion of the mesenteric veins (left colon) or superior veins (right colon) which drain into the portal circ. | liver metastasis |
| rectal carcinomas are defined as tumors occurring _____-, which can spread through the rectal wall to nearby structures | up to 15cm from the anal opening |
| a diet rich in ____, ___, ___ and ___ and low in ___ can modify cancer risk | vegetables, grains, fruit, calcium, fat |
| The staging of colorectal cancer involves: | preoperative testing and operative exploration |
| Stage A of the Dukes classification staging of colorectal cancer: | cancer limited to the bowel wall |
| Stage B of the Dukes classification staging of colorectal cancer: | cancer extending through the intestinal wall |
| Stage C of the Dukes classification staging of colorectal cancer: | nodal metastases regardless of extension into bowel wall |
| Stage D of the Dukes classification staging of colorectal cancer: | distant metastases regardless of primary size |
| Treatment for cancer of the colon is always____. | surgical |
| resection and anastomosis can be performed for cancer of the ___, ___, ___ or ____ colon and upper rectum | ascending transverse descending, sigmoid |
| ____ is often given before surger to shrink the tumor and or alter the malignat cells so they will not survive after surgery | Radiation therapy |
| ____ is used to reat metastic disease and c | Chemotherapy |
| ____ and ____ are the most common disorders of the gallbladder | obstruction , inflammation |
| Obstruction of the gallbladder is caused by ___. | gallstones (cholelithiasis) |
| ____ stones of the gallbladder are the most common and risk factors included obesity, middle age, female gender, american indian, and gallbladder, pancreatic, or ideal disease | cholesterol |
| ____ stones, which are common, occur later in life and are associated with cirrhosis | pigmented |
| ___ and ___ are the cardinal manifestations of cholelithiasis | abdominal pain and icterus |
| vague symptoms include heartburn, flatulence, epigastric discomfort, and food intolerances, particularly to ___ and ____. | fats and cabbage |
| icterus indicates that the stone is located in the _____. | common bile duct |
| abdominal tenderness and fever indicate___. | cholecystitis |
| ___ or ___ can confirm a diagnosis of cholecystitis | cholangiography or radioactive scan |
| is a rare disease which incidenc in the USA and Europe i s less than 1% of new cancers per year | carcinoma of the esophagus |
| The clinical manifestations of esophageal carcinoma are | chest pain and dysphagia |
| cancer of the ____ represents about 2% of all new cancer cases in the USA annually,more in men, but in countries such as Japan | Stomach |
| is radiation therapy normally successful in gastric cancer? | no |
| hepatocellular carcinoma can be ___, ___, ___ | nodular, massive, diffuse |
| A sudden explosive disodrderly discharge of cerebral neurons characterized by a sudden transietn alteration in brain function, usually involving motor, sensory, autonomic, or psychic clinical manifestations | A seizure |
| T or F. A seizure is a syndrome or symptom and not a specific disease entity | True |
| The term convulsion, sometimes applied to seizures refers to the ____ movement associated with some seizures | clonic tonic |
| The term ___ is applied to conditions in which no underlying correctable cause for the seizure is found so they recur without treatment | epilepsy |
| Etiology factors in seizures: (there are four) | cerebral lesions, biochemical disorders, cerebral trauma, epilepsy |
| seizures are also classified by: (four items) | clinical manifestations, site of origin, response to therapy, EEG findings |
| Generalized seizures involve neurons bilaterally, often DO NOT have a local onset and usually originate from a _____ or deeper brain focus and consciousness is always lost or impaired | subcortical |
| Partial seizures involve neurons only UNILATERALLY often have a local (focal) onset, and usually originate from ___ brain tissue (superficial focus). | cortical |
| ____ ____ is the experience of a 2nd, a 3rd and often subsequent Sz before the person has fully regained consciousness from the preceding Sz (postictal state) or a single Sz Lasting MORE THAN 5 MINS. | Status epilepticus |
| An EPILEPTOGENIC FOCUS appears to be a group of neurons that evidence a ____ ______ shift and sudden changes in the usual membrane potential, making them more permeable and therefore more easily activated by the known factors. | Paroxysmal depolarization |
| The firing of involved epileptogenic neurons reaches a threshold point, the discharge spreads to adjacent normal neurons & if uninhibited @ this point, the cortical excitation progresses to the ______, to the _____ of the basal ganglia, thalamus, & stem | contraleteral cortex, subcortical areas |
| Define Tonic phase | muscle contraction with increase muscle tone, associated with loss of consciousness |
| Define the Clonic phase | alteration contraction and relaxation of muscle. |
| As corticol excitation is projected downward to the spinal cord neurons and the clonic phase begins as inhibitory neurons in the ____, ____, and _____ begin to inhibit the cortical excitation, interrupting the Sz discharge. (clonic) | cortex, anterior thalamus, and basal ganglia |
| Maintenance of Sz activity demands a ___% increase in ATP and cerebral O2 consumptiom is increased by __% and although cerebral blood flow also increases ___%, availlable glucose and O2 are depleted | 250, 60, 250 |
| As the combined deficiency of ATP, O2 and glucose occurs, ____ accumulates in the brain tissues. | Lactate |
| Severe Sz thus may produce secondary hypoxia, acidosis, and ____ all of which are imbalances that may result in progressive brain tissue injury and destruction | lactate accumulation |
| ____, a partial Sz experienced as a peculiar sensation preceding the onset of a generalized Sz that may take the form of gustatory, visual, or auditory experiences; a feeling of dizziness, numbness, or funny feeling. | Aura |
| ___, early clinical manifestations, such as malaise, h/a, or a sense of depression that may occur hours to a few days before the onset of a Sz | Prodroma |
| _______ is the most critical aspect in diagnosing a Sz disorder and establishing the cause | health history |
| The ___ is useful in assessing the type of seizure and may help to determine its focus | EEG |
| Treatment of Sz include antiSz medications, a ____ diet, biofeedback, and surgery. | ketogenic |
| Severe Sz thus may produce secondary hypoxia, acidosis, and ____ all of which are imbalances that may result in progressive brain tissue injury and destruction | lactate accumulation |
| ____, a partial Sz experienced as a peculiar sensation preceding the onset of a generalized Sz that may take the form of gustatory, visual, or auditory experiences; a feeling of dizziness, numbness, or funny feeling. | Aura |
| ___, early clinical manifestations, such as malaise, h/a, or a sense of depression that may occur hours to a few days before the onset of a Sz | Prodroma |
| CVA are classified according to ____ as thrombotic, global hypoperfusion (shock), embolic, or hemorrhagic. | pathophysiology |
| _______ is the most critical aspect in diagnosing a Sz disorder and establishing the cause | health history |
| The ___ is useful in assessing the type of seizure and may help to determine its focus | EEG |
| Treatment of Sz include antiSz medications, a ____ diet, biofeedback, and surgery. | ketogenic |
| Thrombotic strokes may be further subdivided on the basis of CLINICAL MANIFESTATION into: | TIA, strokes in evolution, and completed strokes. |
| _______ is the most frequently occurring neurologic disorder ( >50%) consisting on any abnormality of the brain caused by a pathologic process in the blood vessels | cerebrovascular disease |
| The common clinical occurrence of cerebrovascular disease is a _____. | Cerebrovascular accident/ stroke |
| _____, a sudden non-convulsive focal neurologic deficit which in its mildest form, is so minimal as to be almost unnoticed, and in its most severe state, hemiplegia, coma, and death result | cerebrovascular accident |
| CVA are classified according to ____ as thrombotic, global hypoperfusion (shock), embolic, or hemorrhagic. | pathophysiology |
| Thrombotic strokes arise from arterial occlusions caused by thrombi formed in the arteries supplying the brain with risk factors like: | arteriosclerosis, hypothyroidism, oral contraceptives, SSD, Polycythemia vera, arteritis, subclavian steal syndrome, chronic hypoxia, dehydration |
| Thrombotic strokes may be further subdivided on the basis of CLINICAL MANIFESTATION into: | TIA, strokes in evolution, and completed strokes. |
| In a true Transient Ischemic attack (TIA), all the neurologic deficits must be completely clear within _____, leaving no residual dysfunction | 24 hours |
| ____ are neurologic deficits that persist over 24 hrs but eventually disappear completely. | Reversible ischemic neurologic defects (RINDS) |
| The Sx of thrombotic strokes occasionally have an Abrupt onset but tend to be slowly progressive, evolving in a step by step fashion over mins. to hours. The typical development of a thrombotic stroke causes the clinical syndrome ____. | stroke in evolution (progressive stroke) |
| The ____ is a CVA that has produced neurologic deficits, although cerebral edema may not have reached its maximum. | completed stroke |
| An _____ ( usually in the distribution of the MIDDLE cerebral artery) involves fragments that break from a thrombus formed outside the brain, usually involvoving small vessels and obstructing them at a bifurcation or narrowing, causing ischemia | embolic stroke |
| Conditions associated with onset of ___ strokes include; A. fib, M.I, endocarditis, RHD, valvular prostheses, ASD's, and disorders of the aorta, carotids, or vertebral-basilar circulation. | embolic |
| ____ strokes (intracranial hemorrhage) mostly result from HTN,, ruptured aneurysms or AVM, bleeding tumor, and hemorrhage associated with bleeding disorders | Hemorrhagic |
| Cerebral hemorrhages are described as ____ (several cm in diameter), ____ (1-2 cm), _____(lies in the subcortical area) or ____ ( the size of a pinhead). | massive, small, slit, petechial |
| The most common sites for HTN hemorrhages are in the ______ (55%), the thalamus (10%), the cortex and subcortex (15%), the pons (10%) and the cerebellar hemisphere (10%). | putamen of the basal ganglia |
| _______ results when an area of the brain loses blood supply because of vascular occlusion, either abruptly (embolus, hemorrhage) or gradually (thrombosis, atheroma). | Cerebral infarction |
| Cerebral edema reaches its maximum in about ___ hrs and takes about ___weeks to subsided. Most pt survive initial hemispheric ischemic stroke unless massive cerebral edema develops. | 72 hours, 2weeks |
| Massive brain stem infarcts caused by basilar thrombosis or embolism are almost always ____ | FATAL |
| Individuals experiencing intracranial hemorrhage from a ruptured or leaking aneurysm have one of three sets of symptoms: | 1. onset of an excruciating h/a, w/ almost immediate lapse into an unresponsive state. 2. h/a but with consciousness 3. sudden lapse into unconsciousness |
| if a hemorrhage is confined to the _____ space, there may be no local signs. If bleeding spreads into the brain tissue, hemiparesis/paralysis, dysphasia, or homonymous hemianopia may be present | subarachnoid |
| warning signs of an impeding aneurysm rupture include: | headache, transient unilateral weakness, transient numbness, and tingling, and transient speech disturbances. |
| Treatment of a stroke needs to be initiated in ___ hrs of symptom ONSET and included the adm. of agents for metabolic intervention by paramedics in the field, followed by perfusion therapy AFTER ER evaluation and brain scanning. | 6 hrs |
| In ___ strokes treatment is directed at supportive management to control cerebral edema and increased ICP. | thrombotic |
| ASA effectively reduces death and dependency at 6 mths when started within 48hrs of ischemic strokes as it's the case with systemic anticoags as long as there is a low risk of ____. Same for thrombolysis when given w/in 3hr. | intra-extra cranial hemorrhage |
| In ____ strokes, treatment in directed at preventing further embolization by instituting anticoagulation therapy and correcting the primary problem | Embolic |
| Clinical manifestations of aneurysms may arise from cranial nerve compression (__,__,__,__), but the signs vary depending on location and size | III, IV, V, VI |
| The most common 1st indicator of an aneurysm is an acute ____, intracerebral or combined hemorrhage | subarachnoid |
| Diagnosis of an aneurysm BEFORE bleeding episode is made through ____. but after a bleed, a tentative diagnosis of an aneurysm is based on clinical manifest., hx, CT and MRI | ateriography |
| Treatment of choice for an aneurysm is | surgical management |
| An ____ is a tangled mass of dilated blood vessels creating abnormal channels between the arterial and venous systems. | Arteriovenous malformation (AVM) |
| AVM do not have a normal blood vessel structure, are abnormally thin and may be fed by one or several arteries which become | dilated |
| _____ refers to a variety of conditions characterized by an excess of fluid within the cranial vault, subarachnoid space, or both . | hydrocephalus |
| hydrocephalus occurs because of ____, _____, or _____. | increase fluid production, obstruction within the ventricular system, or defective reabsorption of the fluid |
| Obstruction within the ventricular system called, _____ or internal hydrocephalus may result from congenital abnormalities in the ventricular system or mass lesions that compresses structures of the ventricular system. | non-communicating hydrocephalus |
| Impaired absorption of CSF from the sub-arachnoid space occurs when and obstructive process disrupts the flow of CSF thru the subarachnoid space preventing it from reaching the CONVEX portion of the cerebrum, where the ____ are located | arachnoid granulations |
| hydrocephalus from impaired absorption is termed ___ (extraventricular) hydrocephalus | communicating |
| hydrocephalus from impaired absorption may be caused by: adhesions from inflammation, and compression of the subarachnoid space by a mass, congenital abnormalities of the subarachnoid space, or high venous pressure within the ______. | sagittal sinus |
| The most common cause of communicating (extraventricular) hydrocephalus are: (four answers0 | subarachnoid hemorrhage, developmental malformation, head injury, neoplasm. |
| one form of communicating (extraventricular) hydrocephalus is ____ which arises from cerebral atrophy and CSF fills the unoccupied space. The amount of CSF is increased but the fluid is NOT under pressure. | Hydrocephalus ex vacuo |
| Another form of communicating hydroceph is ______ (low press, adult, or occult hydroceph) which occurs mostly in late MIDDLE AGE. Caused by arachnoid adhesions that obstruct the SAS as a complication of head injury and subarachnoid hemorrhage | normal-pressure hydrocephalus |
| congenital hydroceph. is rare. Non-communicating hydorceph is more commonly seen in ___. and communicating hydroceph is commonly seen in ___. | non-communicating common in KIDs. communicating common in ADults. |
| Acute hydroceph. contributes significantly to increased ____ | ICP |
| The obstruction of CSF flow associated with hydrocephalus produces dilation of the ventricles ___ to the obstruction. | proximal |
| Obstructed CSF IS under Pressure, causing atrophy of the cerebral cortex and degeneration of the ___ ____ ____. | white matter tracts |
| There is a SELECTIVE preservation of gray matter. When excess CSF a defect caused by ___, ___, or a surgical incision, this fluid is NOT under pressure; therefore atrophy and degenerative changes are NOT induced | atrophy, degenerative disorders |
| Clinical manifestations of acute hydrocep is one of rapidly devoloping ___ ___ ___ with the person deteriorating rapidly into a deep coma if not promptly treated | increased intracranial pressure |
| ____ hydroceph. had a long-term presentation and develops slowly over time with the individual of family complaining of declining memory and cognitive function | normal -pressure |
| A ____ _____ may be performed to diagnosed normal-pressure hydrocephalus | radioisotopic cisternogram |
| In normal pressure hydroceph., excision or coagulation of teh choroid plexus is needed occasionally when a ____ is present | papilloma |
| Hydrocephalus can be treated with: (2 answers) | 1. surgery- to resect cyst, neoplasms, or hematomas 2. Ventricular bypass into the normal intracranial channel or into an extracranial compartment using a shunt |
| In normal -pressure hydroceph. reduction of CSF through a ____ regimen is often used | diuresis |
| An early clinical manifestation such as malaise, h/a, or a sense of depression, that may occur hours to a few days before the onset of a Sz. | Prodroma |
| a degenerative disorder of the basal ganglia (corpus striatum) involving the dopaminergic nigrostiatal pathway producing a syndrome of abnormal movements | Parkinson's Disease |
| Primary or idiopathic Parkinson disease is described as | loss of pigmented neurons in the substantia nigra |
| Secondary Parkinson's disease or secondary Parkinsonism is due to | trauma, inflection, neoplasm, atherosclerosis, toxins, drug intoxication |
| ____ parkinsonism caused by neuroleptics, antiemetics, and antiHTN is the MOST COMMON cause of the secondary form and is usually REVERSIBLE | Drug induced |
| Parkinson disease DOES NOT show a hereditary pattern or familial tendency and epidemiologic data suggest genetic, ___, and envrionmental toxins as possible causes. | viral |
| an acute form of peptic ulcer that tends to accompany severe illness, systemic trauma, or neural injury. Usually multiple sites of ulceration are distributed within the stomach or duodenum. | a stress ulcer |
| The primary clinical manifestion of a stress ulcer is? | Bleeding; and they rarely become chronic |
| The most common indications for ulcer surgery is? | bleeding and or perforation |
| chronic inflammatory disease causing ulceration of the colonic mucosa, usually in the rectum and sigmoid segments. The lesions appear in susceptible individuals between 20 and 40 years of age | ulcerative colitis |
| The course of ulcerative colitis consists of | intermettent periods of remission and exacerbation and the |
| The risk of left-side colon cancer increases significantly after many years of which digestive disease? | ulcerative colitis |
| TREATMENT of ulcerative colitis depends on the severity of symptoms and the extent of mucosal involvement. The disease is often treated with ? | sulfasalazine, steroids and salicylates. Broad-spectrum antibiotics may be prescribed if bacterial infection is suggested. |
| For unknown reasons ___may have a protective effect against ulcerative colitis | nicotine |
| a type of diaphragmatic hernia, is the protrusion (herniation) of the upper part of the stomach through the diaphragm and into the thorax. | hiatal hernia |
| sliding hiatal hernia (direct) is associated with gastroesophageal reflux and esophagitis because the hernia diminishes the resting pressure of the ____.. | LES |
| presents herniation of the greater curvature of the stomach through a secondary opening in the diaphragm. | Paraesophageal (rolling) |
| Reflux is ____ in paraesophageal hernia | uncommon |
| _____ drugs are contraindicated because they relax the LES and delay gastric emptying. | Anticholinergic |
| Surgery that may be performed if medical management fails to control symptoms of hiatal hernias | fundoplication |
| __ or ___l pain is the cardinal symptom of acute pancreatitis. It may radiate to the back and is caused by edema, chemical irritation and inflammation of the peritoneum; and irritation or obstruction of the biliary tract. | epigastric or midabdominal |
Created by:
Bvaleris
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