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Oral Cancer I – Flashcards 351 terms

Brenda Gannon

351 terms

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Oral Cancer I – Flashcards

question

What types of cancer can be called oral cancer?

answer

Throat, mouth, larynx, sinuses, salivary glands, and skin.

question

What is unique to oral cancer?

answer

Often difficult to treat and high rate of recurrence

question

What are the treatment options for oral cancer?

answer

Surgery, Chemo, Radiation, and Novel approaches.

question

What are the scary stats for oral cancer?

answer

Over 40k will be diagnosed each year and over 50% will die of the disease.

question

How are oral cancers classified clinically?

answer

Through TNM Staging and differentiation of tumor histology or grading.

question

What does TNM refer to?

answer

T is based on size and extent of Tumor, N is whether it has reached the lymph nodes and then M refers to whether it has metastasized or not.

question

What are some diagnostic aids to diagnose cancer and pre cancer?

answer

Oral exam, Brush cytology, Toluidine Blue or TB staining, Visualization adjuncts (light based) and Scalpel Biopsy (gold standard).

question

What are some oral carcinogens?

answer

Tobacco, Infectious agents (viruses), Alcohol, GERD, Diet, Radiation

question

What does oral cancer epidemiology refer to?

answer

Factors affecting the non-random distribution of cancer in a population....like cancer rates, mobidity vs. mortality, Survival.

question

What are the anatomical site for oral cancer?

answer

Oral cavity, Pharynx, Tongue, and Esophagus.

question

What are some common tumors?

answer

Benign connective tissue growths of hard or soft tissues, Benign epithelial surface growths like papillomas or Nevi (moles), benign salivary gland tumors, malignant epithelial surface growths, Metastatic lesions, and salivary gland malignancies.

question

What are some malignant epithelial surface growths?

answer

Squamous cell carcinoma, Basal cell carcinoma, and Melanocarcinoma.

question

What are some uncommon tumors?

answer

Ones with hereditary association, Lymphomas, Malignant CT growths, melanocarcinomas, and odontogenic tumors.

question

What is Myeloma?

answer

It is an uncommon tumor, a lymphoma that is a plasma cell tumor.

question

What are 3 types of surgical intervention for oral cancer?

answer

Ablative surgery, Mohs microsurgery, Radical neck dissection.

question

What is a Trojan peptide?

answer

It is a type of novel vaccine for oral cancer in testing to treat squamous cell carcinoma. It is made from HPV 16, MAGE-A3...it is very large and a chaperone cell aids it entry into the cells. It is thought that larger peptide might trigger a stronger response from the body.

question

What is oncology?

answer

The study and treatment of cancer that usually includes a multidisciplinary approach.

question

How does a regular cell become a renegade cell?

answer

A mutational event that begins a malignant transformation.

question

What is carcinogenisis?

answer

A multi-step process where cells propagate to a threatening phenotype where aberrant proteins produce aberrant genes.

question

What are the six hallmarks of Cancer?

answer

Growth signal autonomy, Evasion of growth inhibitory signals, Evasion of apoptosis, Unlimited replicative potential, Angiogenesis (new blood vessels), Invasion and Metastasis.

question

How does Cancer Kill?

answer

Organ Failure, Obstruction of GI tract, ducts and hollow organs, Cachexia, and infection.

question

What is cachexia?

answer

Extreme weight loss or wasting.

question

Is there a cure for oral cancer?

answer

Yes by understanding biology, current treatments, new treatments, screening, and prevention.

question

Lecture 2:

answer

...

question

How are staging and grading related?

answer

Staging is clinical and grading is histological.

question

What is staging?

answer

It is a way to describe how much the cancer has spread and takes into account size, depth, invasion of adjacent organs, if lymph nodes have metastasized, and spread to distant organs.

question

What is the most powerful predictor of survival?

answer

The stage diagnosis, Treatments are changed based on stage.

question

What is the TNM system?

answer

It is a clinical staging system where T stands for tumor, N stands for nodes, and M stands for metasteses. Every tumor has a unique TNM classification. Once TNM classification is determined then you can divide tumors into stages I-IV

question

How is T determined in the TNM system?

answer

Size of tumor. TX-can't be assessed, TO no evident primary tumor, T1-2cm or less, T2-from 2-4 cm, T3-tumor greater than 4 cm, T4 tumor invades adjacent structures.

question

What are the general names for epithelial and CT tumors?

answer

Epithelial origin are carcinomas and CT tumors are called sarcomas.

question

How is N denoted within the TNM staging system?

answer

It indicates size and number of involved nodes. N=regional lymph nodes, NX= no regional lymph node metastasis. N1= metastisis to a single ipsilateral lymph node, N2= from 3-6 cm or bilateral, N3=greater than 6 cm.

question

How is the M noted in the TNM system?

answer

The M is M0 or M1....either it has metastasized or no

question

What is the TNM staging system used for?

answer

Asses prognosis, determine treatment, and compare results from different protocols and centers worldwide.

question

What is the weakness of the TNM classification system?

answer

It is empiric in nature until you can do a histologic evaluation....it might then be restaged.

question

What are the treatments for Stage I and II oral cancer?

answer

Surgery alone or radiation alone for both

question

What are the treatments for stage III and IV oral cancer?

answer

Surgery 1st and then radiation or radiation 1st and then surgery.

question

What are the leading causes of Cancer?

answer

Most to least....Tobacco, diet and obesity, sedentary lifestyle, family history of cancer, occupational factors, viruses and other biological agents, alcohol, pollution, UV radiation. Alcohol and tobacco are synergistic.

question

What is the difference between leukemia and lymphoma?

answer

Leukemia proceeds from the bone marrow and lymphoma starts in lymph nodes and goes from there.

question

What do you do if you detect lymph node enlargement?

answer

Determine the mobility and consistency of the nodes. Neoplasias and chronic granulomatous conditions they will be endurated and immobile.

question

What is recommended with respect to order of the extraoral/intraoral exam?

answer

Be systematic

question

Can you draw the locations of the lymph nodes based on the roman numerals?

answer

Maybe...

question

Which area is the crossroads/spaghetti bowl for the head and neck lymph nodes?

answer

Level II. This drains area from lateral tongue bilaterally and so if you have oral cancer here it is much more likely to spread bilaterally than a cancer on the lip.

question

Where are the level two lymph nodes located?

answer

At the division of the internal and external carotid arteries.

question

How do epithelial tumors (carcinomas) generally spread?

answer

Through the lymphatics

question

How do CT tumors (sarcomas) generally spread?

answer

Through the blood vessels.

question

What does a mass on the midline of the neck usually indicate?

answer

A problem with the thyroid. You can tell by having the patient swallow. If the mass moves while swallowing then it is thyroid associated.

question

What should we look for in the lips in the I/E oral exam?

answer

A distinct border, nodules, soft tissue swellings,

question

What objective findings can help rule out a malignancy with the tissues?

answer

Color, Symmetry, texture, size, and contour.

question

What should we do if we find something abnormal?

answer

Assess invasiveness by palpating and when possible documentation w/photos is useful for follow-up comparisons.

question

What is the most common abnormality in oral cavity?

answer

Fibroma

question

What does the ending "oma" usually indicate?

answer

That a tumor is benign except with lymphoma and melanoma.

question

How can you tell if the buccal mucosa is discolored due to leukedema?

answer

Stretch it to see if goes away.

question

What does smooth, red gingival indicate in kids?

answer

Nothing, but in adults it is pathologic.

question

Is bleeding on probing normal?

answer

No, it is common, but it is always pathologic.

question

In what area are oral cancers most common?

answer

Where the saliva pools under the tonge and on the lingual side of dentition. These tissues are also more susceptible because they are unkeratinized.

question

Etiology part I

answer

...

question

Adjunctive tests fall under what part of SOAP?

answer

Objective information

question

What objective information is collected for soft tissue lesions?

answer

Color, Size, Location, and Surface

question

What is the order of severity (least to greatest) by site for oral cancer?

answer

Oral cavity, Tongue, Tonsil, Pharynx and Esophagus

question

What is the most common malignancy in the head and neck?

answer

Lip SCC. Lower lip >85%, 5 yr survival 90%, presents as persistent non-healing ulcer of exophtic tumor

question

Where are 75% of all tongue cancers located?

answer

Anterior 2/3 of tongue, 55% 2 yr survival

question

What % of pt with SCC at the base of the tongue have cervical lymph node involvement at diagnosis?

answer

50-75%, 1/3 of all tongue cancers, ulcerative infiltrative and aggressive

question

Where is the most common intra-oral malignancy located?

answer

The tongue. Metastasizes to ipsilateral submandibular of jugulodigastric nodes

question

What is the most aggressive SCC in the oral cavity?

answer

Floor of the mouth SCC, most aggressive and potentially fatal, more common in men

question

In palatal SCC is the hard or soft palate affect more often?

answer

Soft palate 75% and hard palate 25%

question

Is gingival SCC more common in the maxilla or mandible?

answer

70% arise in mandibular gingiva

question

What is buccal mucosal SCC associated with?

answer

Smokeless tobacco and leukoplakia, has a high rate of recurrence

question

Which virus is associated with tonsilar SCC?

answer

HPV. Those with HPV related tumors who are non-smokers have better survival rates

question

what are the best diagnostic tools available?

answer

Your eyes, ears and fingers. Observe the lesion, palpate it and listen to the pt

question

why is the health history important?

answer

Provides a pattern of pt health status and mode of life, it is a barometer of physical conditioning and resistance to disease

question

what are early signs of oral cancer?

answer

Persistent red and/ or white patch, non-healing ulcer, progressive swelling, unusual surface changes, sudden tooth mobility w/out apparent cause, unusual bleeding or epistaxis, and prolonged harseness

question

what are late signs of oral cancer?

answer

Paresthesia/ dysesthesia of tongue or lips, persistent pain or referred pain, chronic earache, altered vision, dysphagia, trismus, cervical lymphadenopathy indurated area

question

what is the gold standard for determining oral cancer?

answer

Scalpel biopsy

question

when screening oral cancer what does the sensitivity of a test refer to?

answer

The probability that someone who has a target disease will generate a positive result

question

what does specificity refer to in screening tests?

answer

The probability that someone who does not have cancer will generate a negative finding

question

what is positive predictive value?

answer

The probability that someone w/ positive test results actually has cancer

question

what is negative predictive value?

answer

The probability that a person w/ negative test results does not have the disease

question

when might brush cytology have a place in diagnosis?

answer

In diagnosing red lesions. Observe lesion for 2-3 wks if still present carry out brush cytology if report is suspicious or positive the biopsy must be done

question

What does the research say about the effectiveness of adjunctive cancer screening techniques?

answer

There is a lack of data to support or refute their effectiveness so clinicians must rely on a thourough oral mucosa exam.

question

What are Toluidine Blue tests based on?

answer

It selectively binds to DNA that is more acidic (neoplastic)

question

How to Toluidine Blue tests fair with respect to sensitivity and specificity?

answer

It is over 90% in sensitivity and between 70 and 90% in specificity. Specificity in the 70's isn't that great. There is a risk of a false negative.

question

How do tissue reflectance tests work?

answer

Irregular cells take on a different color, but these tests just help identify the need for further testing. Why waste time with this....You might have just wasted two weeks in observation when you could have known for sure with a biopsy.

question

Which test helps ensure to not get a false positive for oral cancer?

answer

A biopsy gives a definitive Diagnosis

question

What are the 4 common types of biopsy?

answer

Excisional (removed in its entirety), Incisional (a slice of tissue), Needle (cores a deep mass), and Punch (used to remove surface lesions like pigmented nevi)

question

How does the prognosis of a white lesion compare to that of a red lesion?

answer

In a white lesion the cells are still producing keratin and it has a much better prognosis. About ¼ of oral white lesions will be cancerous.

question

How should clinicians approach oral cancer?

answer

We need to learn to HATE the disease and hunt it down relentlessly. Always assume it is cancer unless proven otherwise. Keep a high index of suspicion.

question

How can early diagnosis affect the outcome of oral cancer?

answer

As many as 80% can be saved vs. the 50% without early detection.

question

Epidemiology

answer

...

question

What is the cornerstone of public health research?

answer

Epidemiology

question

What is cancer epidemiology?

answer

Study of the factors affecting cancer, as a way to infer possible trends and causes

question

What are the two phases of cancer progression?

answer

Compensated - tumor does not cause any damage or distress. De-compensated - when the pt suffers

question

Where does cancer rank on the leading causes of death in the us?

answer

#2 behind heart disease

question

What is the ancient historical perspective on cancer?

answer

Hippocrates used Carcinos and carcinoma to describe tumors. Ancient Egypt details documenting 8 cases of tumors occurring on the breast

question

When was tobacco recognized as a carcinogen?

answer

Observational studies published as early as the 1700s. 1960s the surgeon general published the dangers of smoking

question

When were Diet/ BMI/ and physical activity tied to chronic diseases and cancer?

answer

British sailors and limes. 70s and 80s linked specific dietary factors to risks for cancers,

question

What are risk factors for oral cancer?

answer

Tobacco use #1, Alcohol consumption #1 for non-smokers, diet low in fruits and vegetables, surgeries/ medication, lifestyle, HPV, Sun exposure

question

What is the 5 yr survival rate for oral cancer?

answer

57%

question

Where do most cancers on the larynx begin?

answer

On the vocal cords

question

What are symptoms of laryngeal cancer?

answer

Hoarseness or other changes in the voice, lump on the neck, sore throat, earache

question

How high is the risk for pts, who overcome laryngeal cancer, to develop a second cancer?

answer

20X

question

What are the 3 ways to speak after a laryngectomy?

answer

Esophageal speech, Artificial larynx, and tracheoesophageal Puncture (voice prosthesis)

question

Where does oral cancer fit in the most common cancer list?

answer

Sixth most common cancer about 2.4% of all cancers in US

question

What % of people with oropharyngeal cancer have no risk factors at all?

answer

25%

question

Does Tongue or lip cancer have a better 5 year survival rate?

answer

Lip cancer by 10-20% across all 4 stages.

question

Which area of oral cancer has the lowest 5 year survival rates?

answer

Oropharynx and tonsil followed by The Floor of the mouth.

question

Molecular Biology of Cancer:

answer

...

question

What is allows you to metabolize alcohol?

answer

Alcohol dehydrogenase or ADH

question

Which ADH variant increase RR of oral cancer by 5X over ADH1 and ADH2?

answer

ADH3

question

How does alcohol affect the cell membrane?

answer

It increases the fluidity of the membrane which exacerbates the actions of smoking

question

What is the RR of smoking and alcohol together?

answer

It is 195 in stead of the mere sum of the two on their own which would be 28.

question

Who is at higher risk for oral cancer in Nevada?

answer

Males 50 and older.

question

What group is the exception to incidence and mortality of Oral cancer?

answer

Black Females are an increased risk and the risk for all other groups has decreased.

question

How does cigarette smoke affect growth factor receptor activation?

answer

It can cause ligand-independent phosphorylation of these receptors. 80-100% of oral cancers show EGFR activation and over-expression.

question

How do EGF mutations compare between non-smokers and smokers?

answer

They occur in 51% of non-smokers vs. 4% of smokers....which implies a protective effect, but that is bologna.

question

What happens when you have EGFR activation?

answer

You get TGF alpha transcription and activated matrix metalloproteases which instigates autocrine signaling.

question

What does cyclin D1 do?

answer

It phosphorylates Rb, allowing G1/S progression in the cell cycle.

question

Where is Cyclin D1 over expression seen?

answer

25-70% of all oral cancers

question

Which two constituents of tobacco smoke enhance DNA methylation?

answer

Polycyclic aromatic hydrocarbons PAH and Nicotine-derived nitrosamines (NDN)

question

Which two enzyme are directly affected by PAH and NDN?

answer

DNA methylase activation and DNA methyltransferase activation.

question

What is a common site for DNA methylation?

answer

P53, at codons 248 and 273, CpG rich exons

question

What doe DNA methylation affect?

answer

Transcriptional down regulation or mutations during replication.

question

What type of DNA replication errors are common at the methylated CpG sites?

answer

G to T transversions

question

How do rate of p53 mutations compare between smokers and non-smokers?

answer

300% more likely in smokers.

question

What molecular transformations is one of the first detectible genetic events?

answer

9P21:p16 and 3p12: FHIT

question

What is the most commonly deleted gene in Hean and Neck Squamous Cell Carcinoma?

answer

9p21, removal inactivates p16 the inhibitor of cyclin CDK that leads to progression through the cell cycle.

question

How common is a 3p allelic imbalance?

answer

Occurs in 60% of HNSCC where Fragil Histidine Triad Gene FHIT is methylated. FHIT has tumor suppressor functions.

question

What molecular transformation events occur at 8p?

answer

p14/p19 simultaneous deletion in many oral cases

question

What is the last molecular transformation seen?

answer

17p and 14q: p53....p53 alters Rb phosphorylation removing the block from G1 to S progression.

question

What signal is important in angiogenisis?

answer

VEFG Vascular Endothelial Growth Factor has a similar transduction pathway as EGFR it is just further down stream.

question

How do Fruits and Veggies affect oral cancer?

answer

Consuption lowers oral cancer risk even among smokers and drinkers...more servings = lower risk.

question

How does folate supplementation affect rates of oral cancer growth in vitro?

answer

It increased the rate.

question

What is the most important oncovirus?

answer

HPV

question

What do E6 and E7 of HPV do regarding oral cancer?

answer

They are the early genes that act to block p53 activity which leads to cell growth and proliferation.

question

How do folate and HPV interact?

answer

Folate helps methylate HPV sequences because the HPV genome is CpG rich.

question

Carcinogens:

answer

...

question

What are carcinogens?

answer

Any substance, radionuclide or radiation which is directly involved in the promotion of cancer or facilitation of its propagation.

question

What are two common examples of carcinogens?

answer

Inhaled asbestos (mesothelioma) and tobacco smoke.

question

What are two broad classifications of carcinogens?

answer

Genotoxic that cause genetic damage by mutation or DNA binding, and Nongenotoxins promote growth via hormones or other organic compounds.

question

What might serve as a genotoxic carcinogen?

answer

Chemical agents like MNu, non chemical agents like UV light or viruses..

question

How does the Internation Agency for Research on Cancer classify carcinogens?

answer

Group 1 (definitely carcinogenic) Group 2A (probable carcinogen), 2B (possible carcinogen), group 3 (not carcinogenic), and group 4 (probably not carcinogenic)

question

What are 3 viruses that are associated with cancer as possible carcinogens?

answer

EBV, HPV, and Helio pylori

question

What are other possible risk factor for oral cancer besides smoking?

answer

Poor hygiene, Diet, Environmental contaminants, Marijuana.

question

When was a conclusive link presented between tobacco, lung cancer and premature death?

answer

1964 by the surgeon general.

question

How many different carcinogens are in tobacco?

answer

60 in smoke and 16 in unburned tobacco.

question

What are the strong carcinogens in tobacco?

answer

Cause tumors with low doses of PAH, Nitrosamins, and Aromatic amines

question

What are weak carcinogens in tabacoo?

answer

Cause tumors after high dose exposure. Acetaldehyde

question

What is the relationship of dose and response to tobacco?

answer

There is a positive linear relationship. As dose increases so does response. Duration of exposure is more important than intensity

question

What are two main carcinogens of tobacco that exposure might result from occupational exposure?

answer

BaP and PAH, both derived from incomplete combustion of coal-derived sources.

question

What are the tobacco-specific nitrosamines that are carcinogens?

answer

NNK and NNN...can induce local and systemic tumors. In combination they induce oral cavity tumors.

question

How much NNK and NNN are found in tobacco?

answer

Enough to be similar to the amounts in total doses required to produce cancer in lab animals.

question

Do tobacco specific nitrosamines cause cancer?

answer

Several lines of evidence strongly indicate that nitrosamines have a major role especially in the causation of snuff-dippers.

question

What do epidemiologic studies demonstrated about snuff-dipping?

answer

It causes oral cancer. NNK and NNN are quantitatively the most prevalent known carcinogens in snuff

question

Why does NNK play a role in the induction of lung cancer by tobacco smoke?

answer

Its organo-specificity for the lung

question

What are used as ideal bio-markers for assessing human exposure to and metabolic activation of tobacco smoke carcinogens?

answer

Adducts of tobacco-specific nitrosamines

question

What is a DNA adduct?

answer

An abnormal piece of DNA covalently bonded to a cancer causing chemical

question

What six carcinogens form DNA adducts?

answer

BaP, NNK, NDMA, NNN, Ethylene Oxide, and 4-ABP

question

What is the main active chemical in Marijuana?

answer

THC (delta-9-tetrahydrocannabinol)

question

How does marijuana effect the brain?

answer

THC changes the way in which sensory information gets inot and is acted on by the hippocampus

question

What similarities do marijuana smokers and tobacco smokers have?

answer

May have many of the same respiratory problems. Marijuana smoke causes abnormal functioning of lung tissue because of injury by smoke

question

What is the effect of marijuana on the lungs?

answer

Regardless of THC content: amount of tar inhaled and level of CO absorbed is 3-5Xs greater than tobacco smoke. 4Xs higher TAR burden

question

What are short term effects of mamrijuana?

answer

Dry mouth/ throat, increased heart rate, and anxiety also so lack of coordination and lower cognitive ability

question

What are the long term effects of marijuana?

answer

1-3 joints per day produces the same lung damage and potential cancer risk as smoking 5-15 cigarettes per day

question

What is the cancer risk factor for those who drink or smoke?

answer

3-9Xs for drinking or smoking. Together they produce a 100Xs risk factor

question

What cancers are alcoholic beverages causally related to?

answer

Oral cavity, pharynx, larynx, and esophagus

question

What are the 6 pathways through which drinking alcohol may cause cancer?

answer

1. Alcohol's contact-related local effects 2. The solvent effects on tobacco and other carcinogens 3. Induction of microsomal enzymes involved in carcinogen metabolism 4. Formation of oxygen radicals and lipid peroxidation products 5. Nutritional deficiency especially vit and mineral deficiencies 6. Suppressed immune function

question

What is the major carcinogen in alcohol?

answer

Acetaldehyde which interacts w/ DNA to form DNA adducts

question

What are 2 infectious agents of oral cancer?

answer

EBV and HPV

question

Of the 100+ types of HPV which is most notable?

answer

Cervical cancer

question

In the mouth which cancer is HPV often seen in?

answer

tonsillar squamous cell carcinoma

question

What do HPV 1 and 2 cause?

answer

Warts on soles of feet or palms of the hands, respectively

question

What do HPV 6 and 11 cause?

answer

Irregular warts known as condyloma accuminata on the genitals

question

Are HPV 1,2,6,and 11 cancer causing?

answer

Not generally associated w/ an increased risk of cancer

question

Which HPV strains are cancer causing?

answer

HPV types 16 and 18 may cause head/ neck and other cancers

question

Where does papillomaviruse replicate?

answer

Exclusively in kerativocytes: skin and mucosal surfaces like the oral mucosa and vagina

question

Where is the release of free radials etiologically significant to ulcers?

answer

Stomach ulcers

question

Why do duodenal ulcers form?

answer

90% of pts have H. pylori infections in the stomach and acid is still important too (without acid in stomach pts never get duodenal ulcers)

question

What disorder related to GERD gives an elevated risk for laryngeal and pharyngeal carcinoma?

answer

Barrett's esophagus

question

What is barrett's esophagus?

answer

Normal squamous epithelial cells that line the esophagus turn to specialized columnar cells. 5-10% of pts develop cancer of distal esophagus

question

What type of diet increases cancer risk?

answer

High in saturated animal fats and low in fruits and vegetables

question

How does over cooking food cause a cancer risk?

answer

Charred residue on BBQ meats is identified as a carcinogen along w/ many other tars

question

Dr. Woo

answer

...

question

What is the parotid papilla and where is it located?

answer

It is the opening to stensen's duct and it is located in the buccal mucosa opposite the 1st molar

question

How might the labial mucosa feel on palpation?

answer

Slightly pebbly

question

What is the posterior demarcation of the soft palate?

answer

Uvula, anterior tonsillar pillars

question

What structures are located on either side of the lingual frenum?

answer

Sublingual caruncles and Wharton's ducts

question

What are the histologic features of the buccal and labial mucosa, soft palate and floor of the mouth?

answer

Epithelium: stratified squamous, shallow rete pegs, nonkeratinized surface. Connective tissues: minor salivary gland lobules, striated muscle, blood vessels, nerves and losse fibroadipose connective tissue

question

What demarcates the division between attached gingiva and alveolar mucosa?

answer

The mucogingival junction

question

What are the histologic features of attached gingiva?

answer

Epithelium: paraderatinized surface, elongated pointed rete ridges, stratified squamous Connective tissue: NO salivary gland lobules, dense, fibrous connective tissue

question

What does alveolar mucosa look like histologically?

answer

Similar to the buccal/ labial mucosa, FOM and soft palate. Nonkeratinized surface with shallow rete pegs

question

What does hard palate look like histologically?

answer

Epithelium: thin orthokeratinized surface, elongated pointed rete pegs. Connective tissue: prominent blood vessels and nerves, minor salivary gland lobules

question

What are the 4 types of papillae on the dorsum of the tongue?

answer

Filiform, fungiform, circumvallate, and foliate

question

What does the ventral/ lateral tongue look like histologically?

answer

Similar to buccal/ labial mucosa, FOM and soft palate. Rare minor salivary gland lobules in the CT

question

What histologic features does the dorsum of the tongue have?

answer

Epithelium: rough, parakeratinized surface, taste buds, prominent rounded rete pegs Connective Tissue: striated muscle, rare minor salivary gland lobules

question

What 9 categories are used to describe oral lesions?

answer

Location, Color, Surface architecture, Size, Consistency, Surface texture, Base characteristics, Growth pattern, and Specific characteristics

question

What is a macule?

answer

Focal color change, neither raised nor depressed

question

What is a plaque: a slightly elevated patch (usually epithelial)

answer

...

question

What is a papule?

answer

Solid, round, raised, usually <5mm in diameter (usually epithelial)

question

What is a nodule?

answer

Solid, round, raised, >5mm (usually submucosal)

question

What is amass?

answer

Solid, mostly raised, larger than nodule (epithelial or submucosal)

question

If none of the above apply how might surface architecture be described?

answer

Growth or lesion

question

What do pedunculated and sessile mean?

answer

Pedunculated - narrow base, sessile - Broad base

question

What are the specific characteristics to note?

answer

Vesicle, bulla, pustule, erosion, and ulcer

question

What is the difference between a vesicle and a bulla?

answer

Vesicles are <5mm and bulla are larger than 5mm

question

When describing radiographic pathology what 8 categories are used?

answer

Location, Density, Borders, Size, Shape, Internal architecture, Effect on adjacent structures and symmetry

question

When describing the location of a radiographic lesion?

answer

Site, relationship to other structures, and relationship to teeth

question

What are the options for describing density?

answer

Radiolucent, radiopaque and mixed

question

How are borders defined?

answer

Well-defined (corticated or non corticated) and ill-defined (irregular, ragged, and moth-eaten)

question

What is acanthosis?

answer

Increase in epithelial thickness due to intercellular edema in spinous layer

question

What is metaplasia?

answer

Reversible alteration from one mature cell line to another

question

What is pseudoepitheliomatous hyperplasia?

answer

Benign, reactive overgrowth of squamous epithelium, can mimic squamous cell carcinoma

question

Common and Uncommon Tumors I

answer

...

question

What is the definition of leukoplakia?

answer

A white, plaque-like lesion which cannot be wiped off AND cannot be clinically diagnosed as any other disease entity. This is a clinical term that is not associated with a specific histologic diagnosis

question

What is the short list of clinically distinct entities that must be exclude before diagnosing a leukoplakia?

answer

Frictional hyperkeratosis (morsicatio), Leukoedema, Linea alba, Nicotine stomatitis, Smokeless tobacco keratosis, Lichen planus, and others

question

What are the results after microscopic examination of leukoplakias?

answer

5-25 % are epithelial dysplasia (pre-cancer), 4% SSC. True leukoplakias are considered to be potentially premalignant lesions

question

What is the #1 proposed etiologic cause of leukoplakia?

answer

Tobacco, > 80% of leukoplakias occur in smokers. Alcohol has not yet been associated on its own but has synergistic effects with tobacco

question

What is sanguinaria?

answer

AKA blood root, contained in Viadent products, causes leukoplakia in the mazillary vestibule, maxillary alveolar mucosa and may cause epithelial dysplasia

question

Who gets ultraviolet radiation associated leukoplakia?

answer

Immunocompromise pts especially transplant pts

question

What microorganisms are proposed etiologies of leukoplakia?

answer

Treponema pallidum on the dorsal tongue in tertiary syphilis and HPV types 16 and 18

question

What trauma events are proposed etiologies of leukoplakia?

answer

Heat eg nicotine stomatitis in response to heat of smoking, and mechanical eg frictional hyperkeratosis, response to low grade trauma. These have no malignant potential and are not true leukoplakias.

question

What is the most common oral premalignancy?

answer

Leukoplakia. M>>F, high risk sites for dysplasia and SSC include lip vermillion, lateral-ventral tongue, floor of mouth and soft palate

question

What does a leukoplakia look like clinically?

answer

Gray to white, plaques, well-defined borders, Early - soft thin, translucent. Late - firm, thickened, opaque

question

What is proliferative verrucous leukoplakia (PVL)?

answer

Multifocal leukoplakias. Female predilection, little assoc. with smoking, typically develops dysplastic changes, SCC

question

What is Erythroleukoplakia, speckled leukoplakia?

answer

Leukoplakia admixed with erythroplakia typically exhibits dysplastic changes

question

What does thick fissured leukoplakia suggest?

answer

Dysplasia (mild/moderate)

question

What does granular verruciform leukoplakia suggest?

answer

Moderate/ severe dysplasia

question

What does erythroleukoplakia (speckled leukoplakia) suggest?

answer

Severe dysplasia or carcinoma in situ

question

What changes are pr-malignant?

answer

Dysplasia and carcinoma in situ(CIS). SCC is malignant

question

What are typical features of epithelial dysplasia?

answer

Enlarged nuclei and cells, Increased nuclear to cytoplamic (N:C) ratio, Hyperchromatic nuclei, Pleomorphic nuclei and cells, Increased mitotic activity and Abnormal mitotic figures, Bulbous tear dropped rete ridges, and loss of polarity

question

What is mild/ moderate/ severe dysplasia?

answer

Mild Dysplasia involving the lower 1/3 of epithelium, Moderate involves lower 2/3, Severe estending to upper 1/3

question

What is carcinoma in situ?

answer

Dysplasia involving the entire thickness of the epithelium

question

What is important to remember when removing leukoplakias?

answer

Preserve specimen for histological exam

question

How do you treat leukoplakia?

answer

Surgical removal, careful long-term follow up and cessation of contributing factors

question

What is the risk for leukoplakia transforming to SCC?

answer

Moderate dysplasia 4-11% chance, Severe dysplasia 20-35% chance

question

Common tumors II

answer

...

question

What is squamous cell carcinoma?

answer

Malignant neoplasm of squamous cells

question

Who gets SCC?

answer

Caucasian males >65 yrs and middle aged AA males

question

What % of oral cancers are SCC?

answer

94% of oral cancers are SCC

question

What are the extrinsic and intrinsic factors that play a role in SCC?

answer

Extrinsic - tobacco, alcohol etc. Intrinsic factors - systemic diseases, immunocomprommise. Most SCC is preceded by a premalignat lesion such as leukoplakia

question

What are 11 etiologic agents of oral SCC?

answer

Tobacco smoking, Smokeless tobacco, Betel quid, Alcohol, Radiation, Iron deficiency, Vit-A deficiency, Syphilis, Oncogenic viruses, Immunosuppression, and Oncogenes and tumor suppressor genes

question

Which type of smokeless tobacco imposes the greatest risk for SCC?

answer

Dry snuff> moist snuff> chewing tobacco. Over all RR of smokeless tobacco is 2 to 26

question

What type of radiation causes oral SCC?

answer

Any type, UV, x-irradiation to head and neck. Risk is dose dependent. Common cause of lip SCC

question

What are the characteristic of Iron deficiency SCC?

answer

Develops at a younger age, SCC of esophagus, oropharynx, and posterior mouth. Syndromes such as plummer-Vinson syndrome cause sever iron deficiency

question

What do those with a vitamin-A deficiency present with?

answer

Low serum retinol and dietary betacarotene placing them at greater risk of SCC

question

Which syphilis causes increased risk for SCC?

answer

Tertiary syphilis, dorsal tongue SCC RR of 4

question

Which strains of HPV are high risk strains for oral SCC?

answer

HPV - 16, 18, 31, and 33

question

What increases the already high risk for immunosuppressed pts (AIDS/ transplant pts)?

answer

Use of tobacco and alcohol

question

How do oncogenes and tumor suppressor genes cause cancer?

answer

Activation of oncogenes (ras, myc, EGFR) and inactivation of tumor suppressor genes( p53,pRb, p16, E-cadherin)

question

What are the high risk sites for SCC?

answer

Tongue (lateral border, ventral), FOM, and Softpalate. FOM SCC - high risk of second primary malignancy

question

How does oropharyngeal SCC present?

answer

In tonsil, posterior soft palate, or base of tongue. Usually large tumor size, cervical and distant metastasis at presentation because of delays in diagnosis

question

Which lip in affected more?

answer

Lower lip 90%, preceded by actinic cheilitis

question

What does SCC look like radiographicly?

answer

May cause destruction of underlying bone, radiolucency ill-defined (moth eaten) borders and can mimic periodontal disease

question

What does SCC look like histologically?

answer

Invasive islands of dysplastic (atypical, anaplastic) squamous cells

question

When is SCC said to have regional metastasis?

answer

When metastasis is to ipsilateral cervical lymph nodes and nodes are non-tender, firm, hard +or- fixation. 21% pt have cervical mets at presentation

question

What is distant metastasis?

answer

Mets to distant organs: lungs, liver bones. 2% of pts at presentation

question

To which nodes do tumors of the oropharynx mets to?

answer

Jugulo-digastric and retropharyngeal

question

To which nodes do tumors of the posterior oral cavity mets to?

answer

High jugular digastrics nodes

question

To which nodes do tumors of the lip vermilion and FOM mets to?

answer

Submental nodes

question

What is the treatment for intraoral SCC?

answer

Surgical resection is #1 other additional treatments include radiation, chemo, and neck dissection

question

What can molecular markers be useful for?

answer

Predictors of malignant transformation and prognostic indicators

question

What is chemoprevention used for?

answer

Oral dysplasias and pts at risk for second primary recurrences

question

What is a fibroma?

answer

The most common benign soft tissue lesion of the mouth, likely caused by reactive hyperplasia to local irritation. Most often seen in buccal mucosa along occlusal line

question

What are the clinical features of fibroma?

answer

Normal mucosal colored or white, smooth surface, nodule or mass, Firm

question

What do fibroms look like histologically?

answer

Proliferation of dense fibrous CT, intact or ulcerated stratified squamous epithelium

question

How are fibromas treated?

answer

Conservative surgical excision then submit for histologic examination to rule out other entities. If gingival scale adjacent teeth to remove local irritants

question

What causes pyogenic granuloma formation?

answer

Likely reactive hyperplasia to a local irritations. It is neither pyogenic nor granulomatous in nature

question

Where do pyogenic granulomas usually form?

answer

On the gingiva

question

Who gets Pyogenic franulomas?

answer

F>M, children and young adults

question

What are the clinical features?

answer

Pink, red, purple, often lobulated, nodule or mass, may initially grow rapidly, may bleed on palpitation

question

What is a pregnancy tumor?

answer

PG during pregnancy that typically occurs in 1st trimester increase in frequency to 7th month, due to estrogen and progesterone levels

question

What is Epulis granulomatosum?

answer

PG that occurs in healing extraction socket, response to foreign bony, bone spicule in socket

question

What is granulation tissue?

answer

Inflamed and well-vascularized fibrous connective tissue

question

What happens to long standing PG?

answer

fibrous maturation PG turns into a fibroma

question

What is the treatment for PG?

answer

conservative surgical excision with histologic examination, if gingival scale adjacent teeth. Defer treatment with pregnancy tumor may resolve after pregnancy

question

What is a pleomorphic adenoma?

answer

Benign neoplasm of ductal epithelial and myoepithelial cells. The most common salivary gland tumor and the most common salivary gland tumor of childhood

question

Who gets pleomorphic adenoma?

answer

F slightly> M, 30-60 yr but really any age

question

Where are pleomorphic adenomas seen the most?

answer

Parotid gland: superficial lobe > deep lobe, Minor salivary glands: palate> upper lip > bu mucosa

question

What are the clinical features for a parotid PA?

answer

swelling over ramus anterior to ear, angle of mn if it's the superficial lobe for the deep lobe mass of lateral pharyngeal wall/ soft palate, slowly growing, mostly movable, can become very large, usually asymptomatic.

question

What are the clinical features of a minor salivary gland PA?

answer

slowly growing, mucosal colored, smooth surfaced dome shaped, mass, +/- secondary ulceration, movable if involving lips and bu mucosa

question

What histologic finding are seen with PA?

answer

well circumscribed, mostly encapsulated, containing - ductal 1. epithelial cells, 2. myoepithelial cells, and 3. chondromyxiod stroma

question

How are PAs treated?

answer

Superficial parotid PA - superficial parotidectomy w/ preservation of CN VII. Deep lobe Pas - total parotidectomy w/ preservation of CN VII. Submandibular - excision of tumor and gland. Minor glands - excision of tumor.

question

What % of PAs will under go malignant transformation if not removed?

answer

5% called carcinoma ex PA

question

What is the most common odontogenic tumor?

answer

Ameloblastoma

question

What is an ameloblastoma?

answer

Benign but locally aggressive neoplasm of odontogenic epithelium

question

What are the 3 subtypes of ameloblastomas?

answer

1. Solid or multicystic 86% 2. Unicystic 13% 3. Peripheral 1%

question

Where are ameloblastomas usually located?

answer

Mandible 85% usually in the posterior (molar, ascending ramus area)

question

What are the clinical features of ameloblastoma?

answer

Usually asymptomatic/ painless, swelling, bone expansion, buccal and lingual cortical expansion, can become very large

question

What are the radiographic features of ameloblastoma?

answer

Shape: multilocular, Density: radiolucent, Borders: well defined/ scalloped borders, Internal architecture: soap bubble/ honeycomb, Location: may be associated w/ unerupted tooth, Effect on adj. structures: +/- root resorption/ tooth displacement

question

What are ameloblasitc features?

answer

Palisaded peripheral cells, reversed polarity, and stellate reticulum cells

question

What is the histology of ameloblastoma?

answer

Islands of odontogenic epithelium with ameloblastic features

question

How is ameloblastoma treated?

answer

Treatment is controversial: enucleation vs. resection. Curettage has a 50-90% recurrence. Long term clinical and radiographic follow up is needed

question

HIV and Oral Path:

answer

...

question

What are the general characteristics of HIV?

answer

It is a lentivirus with a prolonged latency period. It infecs CD4+ Helper T lymphocytes and ultimately reduces the number of T cells and sets up an immunocompromised state.

question

What are the common modes of transmission of HIV?

answer

Sexual Contact and parenteral exposure, contaminated blood, and maternal transmission....other modes rare.

question

What are the most common exposure categories for HIV?

answer

MSM and IDU

question

What is the Course of HIV?

answer

Acute viral syndrome (symptoms like mono/IM), prolonged asymptomatic stage (persistant neck lymphadenopathy 70%), and Symptomatic stage (AIDS related complex and over AIDS)

question

What is AIDS related complex?

answer

ARC is part of the symptomatic stage of HIV where you might see chronic fever, weight loss, diarrhea, oral candidiasis, herpes zoster, or oral hairy leukoplakia (OHL).

question

What is considered to be over AIDS?

answer

Part of the symptomatic stage of HIV in which you get multisystem involvement (respiratory, musculoskeletal, GI, oral, and others), and CNS involvement with neurologic and psychiatric symptoms.

question

What are the EC-clearinghouse classifications for oral manifestations of HIV?

answer

Group 1: strongly associated with HIV—candidiasis, OHL, KS, NHL, and PD, Group 2: Less commonly associated—Bacterial infections, hyperpigmentation, necrotizing ulcerative stomatitis, Viral infections, oral ulcerations Group 3: Seen in HIV: Other bacterial infections, drug rxn, fungal infections, neurologic disturbances, apthous ulcers.

question

How many aids pts get candidiasis?

answer

33% of HIV and over 90% of AIDS patients

question

What are the 4 types of clinical presentations of Candidiasis?

answer

Pseudomembranous, Erythematous, Chronic hyperplastic, and mucocutaneous. (the first 3 are common with HIV)

question

What are the 5 types of Erythematous Candidiasis?

answer

Acute atrophic, Central papillary atrophy, chronic multifocal, Angular cheilitis, and Denture stomatitis

question

At what CD4 counts is it common to see pseudomembranous and erythematous type candidiasis?

answer

Pseudomembranous <200, and Erythematous < 400.

question

What are the characteristics of pseudomembranous Candidiasis?

answer

Adherent white plaques on buccal mucosa, palate and dorsal tongue that can be wiped off. Mucosal erythema. Commonly seen in those taking broad spectrum antibiotics like immunocompromised. Usually CD4+ less than 200.

question

What are is characteristic of Erythematous candidiasis?

answer

Mucosal erythema (bald appearance) 3 most common types with HIV...are central papillary atrophy, angular cheilitis, and chronic multifocal variants. Usually seen with CD4+ less than 400.

question

What is central papillary atrophy?

answer

A type of erythematous candidiasis. Aka median rhomboid glossitis. Seen at the mid dorsal tongue with a well-defined bald area/loss of filiform papillae. RX: antifungals

question

What is angular Cheilitis?

answer

A type of erythematous candidiasis. Aka perleche. Common in immunocompromised and with loss of vertical dimension. Erythemal, fissuring, and scaling of the coners of the mouth. Common coinfection with candida and Staph Aureus.

question

What does the histology of candidiasis look like?

answer

You will see candidal hyphae in the parakeratin layer, also PMN in epithelium and elongated rete pegs seen under the staining of a Periodic Acid Schiff (PAS), GMS, or KOH stain.

question

How do you diagnose Candida?

answer

Clinical features and a fungal culture (Sabourad's agar), cytology smear, and tissue biopsy.

question

What is the treatment for Candidiasis?

answer

We always do a med consult before prescribing anything to an HIV/AIDS patient, but usually it is treated with antifungal therapy.

question

When do you do systemic antifungal treatment for candidiasis?

answer

If CD4's are under 50 or pt is not on antiretrovirals tx then Fluconazole is the drug of choice as azoles are synergistic with antiretrovirals

question

What are the 3 type of antifungal medications?

answer

Polyenes (amphotericin B), Imidazoles (clotrimazole), or Triazoles (fliconazole) dentists might prescribe the imidazoles or triazoles but usually not polyenes.

question

What is LGE?

answer

Common in HIV. A red band of free gingival margin. Responds to fluconazole.

question

What are the characteristics of NUG?

answer

Ulceration and necrosis or 1 or more interdental papilla with no loss of attachment. Features ulceration, necrosis of papilla, bleeding, pain, and halitosis.

question

What is NUP?

answer

Gingival ulceration and necrosis with rapid loss of attachment and alveolar bone, tooth mobility, and in multiple isolated sites, bleeding, pain, edema, and halitosis.

question

What is the treatment for NUP and NUG?

answer

Debridement—frequent and often until stable, Antimocrobials—CHK rinses or systemic metronidazole, Long term maintenance by quitting contributing habits.

question

What is Herpes Simplex Virus?

answer

DNA virus part of HHV family, two types HSV-1 (affects above the waiste) and HSV-2 (affects the skin below the waist. There is some cross reactivity between HSV1 and HSV2. If you have had one type you have reduced chance of getting the other.

question

What is the normal course of HSV infections?

answer

You get a primary infection that is taken up by sensory nerves, into the ganglia and remains latent until reactivated to give a secondary infection. The trigeminal ganglion is the most common site for latency of HSV-1.

question

What can trigger a reactivation of a primary infection?

answer

UV light exposure.

question

Are secondary herpes infections symptomatic?

answer

Most are, but not all and the virus can be shed without any active lesions.

question

What are the two main presentations of primary HSV infections?

answer

Acute herpetic gingivostomitis or pharyngotonsillitis.

question

What are the two most common presentations of secondary/recurrent HSV infections?

answer

Herpes labialis and Intraoral recurrent herpes.

question

What are the characteristics of herpes labialis?

answer

A cold sore, UV light trigger, occurs in young adults and throughout life at the vermillion border and adjacent skin. Usually preceded by a prodrome and then presents as a cluster of vesicles then crusts then ulcers.

question

When is herpes labialis most contagious?

answer

During the vesicular stage (1st 48 hrs) as there is active viral replication occurring.

question

How does secondary intraoral recurrent herpes present?

answer

Young adults with recurrences throughout life, on the keratinized mucosa, seen as vesicles, then red macules, then ulcerations that coalesce and then heal in 7-10 days.

question

What are HSV infections like for the immunocompromised?

answer

Frequent recurrence due to loss of host immune response, can be life threatening with continued spreading until treated with antivirals, it has atypical characteristics: seen in Keratinized and NK mucosa, you see necrosis, large ulcers with raised, yellow border. Maybe coninfection with CMV....send persistant ulcer tissue to biopsy for HIV patients.

question

What does the histology of HSV look like?

answer

Free floating cells in vesicles (Tzanck cells) and then the 3 m's of herpes infected cells: Multinucleation, Chromatin Margination, and Nuclear Molding with ballooning degeneration....(these features also common in VZV infections)

question

How do you Dx HSV?

answer

Clinical presentation and viral culture, cytologic smear/tissue biopsy, or serologic tests.

question

What is the Tx for HSV in HIV patients?

answer

Oral antivirals for prevention, IV antivirals if active HIV infection (acyclovir). Gancyclovir if coinfection with HSV and CMV.

question

What is OHL?

answer

Oral Hairy Leukoplakia?; Caused by EBV (HHV-4), reduced with HAART, on the lateral border of tongue. Seen as a white plaque with vertical corrugations that can become shaggy and doesn't wipe off.

question

What is the histology of OHL?

answer

Hyperparakeratinosis with epithelial hyperplasia, surface corrugations, and balloon cells (perinuclear halo with chromatin beading) in the upper epithelial layer. EBV can be isolated with in situ hybridization and PCR...

question

What is the DX for OHL?

answer

Clinical and EBV identification in tissue biopsy

question

What is the TX for OHL?

answer

Not tx necessary will resolve with antivirals with common recurrences.

question

What is HPV associated with in the immunocompetent?

answer

Oral lesions like squamous papilloma, verruca vulgaris, and condyloma acuminatum.

question

What are the features of HPV in the immunocompromised?

answer

On most surfaces of oral cavity, cauliflower like surface, multifocal blunt or sharp projections.

question

What does the histology of HPV look like?

answer

Papillary stratified epithelium with hyperpara or hyperorthokeratosis, epithelial hyperplasia with Koilocytes in upper epithelial layer. HPV can be located in situ via PCR.

question

What are koilocytes?

answer

Vacuolated cells with shrunken nuclei that are HPV + and found in the upper epithelial layer.

question

How do you dx HPV?

answer

Clinically and HPV identification on tissue biopsy

question

What are the tx's for HPV?

answer

Surgical excision but recurrence is common, long term observation especially if dysplastic.

question

What is KS?

answer

Malignant neoplasm of vascular endothelial cells. Associated with KSHV. Most common malignancy in HIV pts, Seen in skin of upper body or on the oral mucosa, hard palate, gingival, and tongue.

question

What does KS look like?

answer

Flat, brown-red areas (macules, pathches) that don't blanch with diascopy and later they are raised plaques or nodules, with bleeding, pain, and necrosis. Can invade bone.

question

What does the histology of KS look like?

answer

Vascular proliferation, Small, slit-like blood vessels with spindled endothelial cells, with RBC's within and outside the vessels.

question

What are lymphomas?

answer

Malignant neoplasms of the lymphoreticular cells. Most are NHL's, many associated with EBV. 2nd most common neoplasm in HIV. More common in extranodal sites.

question

What are the clinical features of lymphoma?

answer

Red to purple, boggy swellings in soft tissues, swelling and bone expansion with possible tooth mobility and nerve parasthesia and an ill-defined radiolucency.

question

What does the histology of lymphoma look like?

answer

A sheet of atypical lymphocytes

question

What is the treatment for lymphoma?

answer

Chemo and radiation with a poor prognosis.

question

How do you dx HIV?

answer

Viral culture with enzyme immunoassay (EIA) good for screening but possible false positives occur. Usually done with a western blot.

question

What is the TX for HIV?

answer

HAART. Combo of nucleoside reverse transcriptase inhibitors and non nucleoside reverse transcriptase inhibitor and a protease inhibitor.

question

At what level is it AIDS?

answer

Less than 200 cells or less than 14% of total lymphocites.

question

What are some common diseases which are used as indicator diseases for dx of AIDS?

answer

Candidiasis, Cervical cancer, KS, Lymphoma, HSV with chronic ulcers and soar throat, and Pneumocystis carini pneumonia.

question

What are the clinical features of AIDS?

answer

Opportunistic infections, Multisystem involvement, and Neurologic dysfunction.

question

What is in store for the future of HIV and AIDS?

answer

Public Health interventions, New therapeutic agents, and HIV vaccine.

STUDY

End Stage Liver Disease Endocrinology Long Chain Fatty Acids Nursing Pharmaceutical Sciences

Hypercalcemia and Hypocalcemia Drugs 2-12 – Flashcards 64 terms

James Storer

64 terms

Preview

Hypercalcemia and Hypocalcemia Drugs 2-12 – Flashcards

question

Explain the regulation of parathyroid hormone release

answer

Ca binds to Ca sensing receptor (CaSR) on PT gland which inhibits secretion of PTH

question

Explain the role of the following in calcium and phosphate homeostasis: 1. parathyroid hormone

answer

1. increases bone resorption, kidney reabsorption *causing increased Ca, decreased P*

question

Explain the role of the following in calcium and phosphate homeostasis: 1. Vitamin D

answer

1. increases intestinal absorption of Ca *increasing Ca*

question

Explain the role of the following in calcium and phosphate homeostasis: 1. Calcitonin

answer

1. inhibits osteoclasts *decreasing serum Ca, P*

question

Explain the control of osteoclast and osteoblast activity: 1. osteoclast 2. osteoblast

answer

1. PTH stimulates it, calcitonin inhibits it 2. exogenous PTH stimulates it

question

Differentiate between Vitamin D3 (cholecalciferol) and 1,25(OH)2D3 (calcitriol) and where activation occurs: 1. Vit D3

answer

1. stored form (made from UV exposure to skin or obtained from diet)

question

Differentiate between Vitamin D3 (cholecalciferol) and 1,25(OH)2D3 (calcitriol) and where activation occurs: 1. 1,25-OH-D3

answer

1. made in the kidney from action of 1a hydroxylase which activates it

question

Identify the main causes and symptoms of hypercalcemia

answer

PT gland tumor makes too much PTH Malignant tumor produces PTH-related protein (PTHrP) Too much vitamin D Cancer that metastasizes to bone, stimulates osteoclast formation and activation, and causes bone resorption

question

Identify the main causes and symptoms of hypocalcemia

answer

hypoparathyroidism vit D deficiency pseudohypoparathyroidism

question

Explain the main causes of vitamin D deficiency

answer

-chronic kidney disease b/c there is a lack of 1a hydroxylase which can cause increased PTH (b/c low calcitriol) which will cause high Phosphate levels and possibly normal Ca levels if enough PTH -nutritional deficiency -lack of sunlight exposure -malabsorption

question

Differentiate between osteoporosis and osteomalacia: 1. osteoporosis

answer

1. excessive bone remodeling leading to porous bone b/c of excessive osteoclast activity

question

Differentiate between osteoporosis and osteomalacia: 1. osteomalacia

answer

1. decreased bone mineralization (loss of hydroxyapatate crystals - soft bone)

question

List the different agents used to treat: the following from either primary hyperparathyroidism or hypercalcemia of malignancy. 1. acute, symptomatic/severe hypercalcemia how soon they are effective and how long they last

answer

1. volume expansion with isotonic saline - only acute setting add loop diuretic if pt has renal or heart failure - long time calcitonin- 48hrs bisphosphonate (pamidronate)- w/in 48hrs and then long time

question

Explain the rationale for using IV saline to treat acute, severe and/or symptomatic hypercalcemia

answer

this will dilute Ca in the blood and facilitate urinary Ca excretion via increased diuresis

question

Explain the advantages/disadvantages of using a loop diuretic in treating acute, severe and/or symptomatic hypercalcemia

answer

advantages - inhibits NKCC in TAL, blocking K secretion into tubule diminishing (+) lumen voltage leading to less driving force to push Ca across tight junction into interstitium.. useful for pt w/edema, renal failure, heart failure & hypercalcemia DON'T give if pt has normal hydration status/dehydrated, b/c increases diuresis

question

Compare the mechanism of the bisphosphonates and calcitonin in treating hypercalcemia (acute or chronic therapy), osteoporosis, and Paget's disease: 1. calcitonin 2. bisphosphonate

answer

1. directly binds to osteoclasts and inhibits them 2. binds to remodeling site and prevents attachment of osteoclasts to bone and taken up by osteoclasts, inhibiting its activity and can cause apoptosis .. prevents breakdown of bone, increased bone mineral density but do not form new bone ..

question

Compare and explain the ability of the first and second generation bisphosphonates to cause osteomalacia, esophagitis, bone/muscle pain, atypical femur fracture and osteonecrosis of the jaw 1. Etidronate, Tiludronate 2. Pamidronate, Alendronate, Risedronate 3. 1st & 2nd gen

answer

1. osteomalacia - b/c it inhibits bone mineralization (decreased osteoblast activity b/c it inhibits osteoclasts .. osteoblasts fill in what clasts tear up), 2. atypical femur fracture, esophagitis, bone/muscle pain, osteonecrosis of jaw 3. both types can cause esophagitis b/c pill can stick to esophagus, bone, muscle pain, atypical femur fracture (b/c less remodeling), osteonecrosis of the jaw (b/c of trauma to bone along w/continual stress from chewing)

question

Explain the mechanism of action of cinacalcet in treating hypercalcemia associated with parathyroid carcinoma, and primary hyperparathyroidism, and why it is not useful in hypercalcemia of malignancy or vitamin D intoxication

answer

it enhances sensitivity of Ca sensing receptors in parathyroid to Ca, lowering the [Ca] at which PTH is suppressed, decreases PTH, decreasing serum Ca.. but not useful w/malignancy or Vit. D intoxification b/c they are not related to hyperparathyroidism

question

Identify and explain the main side effect of cinacalcet

answer

hypocalcemia

question

Compare and explain the use of calcium, Vitamin D (cholecalciferol) and calcitriol in the treatment of Rickets, osteomalacia, & hypoparathyroidism: 1. Rickets/osteomalacia 2. Hypoparathyroidism

answer

1. there is a deficiency in vit. D thus administering it will correct the pathology.. 2. with hypoparathyroidism, there are low levels of serum Ca, thus giving Ca and vit D will increase serum Ca (vit D will increase reabsorption of Ca from gut) .. calcitriol is better choice than cholecalciferol b/c of the decreased PTH there will be less 1a hydroxylase activity

question

Explain the mechanism of action of teriparatide in the treatment of osteoporosis

answer

the exogenous PTH stimulates osteoblasts thru a different receptor than endogenous PTH which increases osteoblast activity

question

What are some causes of hypercalcemia?

answer

-PT gland tumor makes too much PTH -Malignant tumor produces PTH-related protein (PTHrP) -Too much vitamin D -Cancer that metastasizes to bone, stimulates osteoclast formation and activation, and causes bone resorption

question

Is hypercalcemia always symptomatic?

answer

no, depends on degree of hypercalcemia and rate of rise of serum [Ca]

question

How can you approach treating severe and/or symptomatic hypercalcemia?

answer

increase urinary Ca excretion inhibit bone resorption decrease Ca absorption

question

A 63-year-old female has lost her appetite with weight loss, and is constipated. She has been urinating alot and complains of thirst. Her blood pressure is 110/70 mm Hg, heart rate is 80 bpm. Her mucus membranes are somewhat dry and sticky. Serum creatinine is 2.1 mg/dL (normal 0.6-1.2 mg/dL), with normal electrolytes and glucose levels, but serum calcium is 14.1 mg/dL (normal 9.0-11.0 mg/dL). What would be the best treatment?

answer

IV normal saline

question

The patient has symptomatic hypercalcemia and is dehydrated with presumed prerenal azotemia. What would be the best treatment?

answer

IV normal saline (restores volume status, dilutes Ca in blood, facilitates urinary Ca excretion)

question

What diuretic will increase Ca excretion by the kidney?

answer

loop diuretic

question

when might you use a loop diuretic to treat hypercalcemia?

answer

-if they develop edema after IV saline -in a pt with symptomatic hypercalcemia and heart failure

question

What happens to bone with primary hyperparathyroidism and hypercalcemia of malignancy?

answer

bone resorption (releases Ca2+ into blood)

question

What hormone decreases osteoclast activity?

answer

calcitonin

question

How does calcitonin lower serum Ca levels in a patient with primary hyperparathyroidism?

answer

decrease bone resorption (b/c it inhibits osteoclasts)

question

What will produce a more sustained lowering of serum Ca than calcitonin?

answer

bisphosphonates

question

what will pamidronate do to bone resorption?

answer

decrease it

question

Which agent would be most useful in preventing hypercalcemia and adverse skeletal events in a patient with metastatic cancer to bone.

answer

bisphosphonate

question

what is a side effect of the 1st gen bisphosphonates (Etidronate, Tiludronate)?

answer

osteomalacia

question

how do bisphosphonates cause osteonecrosis of the jaw?

answer

trauma to bone along w/continual stress from chewing. Bone has a limited capacity for healing due to the effects of bisphosphonate therapy (no bone remodeling)

question

how can PTH secretion be reduced?

answer

raise serum levels of Ca sensitize CaSR to Ca

question

Why would you not use Cinacalcet to treat hypercalcemia of malignancy (not referring to parathyroid carcinoma)?

answer

there is low PTH, thus not helpful b/c PTH-independent

question

What can contribute to a vitamin D deficiency?

answer

nutritional deficiency lack of sunlight exposure malabsorption chronic kidney disease

question

what does Vit D deficiency cause in: 1. children 2. adults

answer

1. rickets 2. osteomalacia

question

What is the primary cause of hypocalcemia from a vitamin D deficiency?

answer

decreased intestinal absorption of Ca

question

An elderly black female was admitted to the hospital from a nursing home because of progressive weakness. Her labs revealed a serum total calcium level of 8.2 mg/dL (normal 9.0-11.0 mg/dL), serum phosphorus of 2.6 mg/dL (normal 3.0-4.5 mg/dL) 25-hydroxyvitamin D level was 4 pg/dL (normal: 10-55 pg/dL), and her iPTH level was 161 pg/dL (normal: 14-72 pg/dL). What will you use to treat her?

answer

calcium & Vit D

question

What usually happens to phosphorus and PTH with chronic kidney disease?

answer

phosphorus is elevated PTH is elevated

question

What can happen to Ca levels if a patient with either a vitamin D deficiency or chronic kidney disease has high enough PTH levels?

answer

normal serum Ca

question

What contributes to hypocalcemia from hypoparathyroidism?

answer

decreased PTH

question

what happens to Ca in hypoparathyroidism?

answer

hypocalcemia occurs

question

what happens to P in hypoparathyroidism?

answer

possibly normal or hyperphosphatation (b/c low PTH, thus not action on kidney to excrete P)

question

What would you use to treat hypoparathyroidism?

answer

vitamin D calcitriol Calcium supplement

question

How can you treat osteoporosis?

answer

inhibit osteoclasts enhance osteoblast activity

question

Which agents will work on bone to inhibit osteoclast activity?

answer

bisphosphonates calcitonin

question

What agent will work on bone to selectively increase osteoblast activity?

answer

exogenous PTH

question

what is Paget's disease?

answer

Disorder of increased skeletal remodeling Uncontrolled osteoclastic bone resorption with secondary increases in bone formation New bone is poorly organized

question

what would you use to treat Paget's disease?

answer

inhibit osteoclasts (calcitonin, bisphosphonates, plicamycin [last resort])

question

Predict the effect of the following on serum calcium, phosphorus and PTH levels: 1. primary hyperparathyroidism

answer

1. high PTH causing high Ca, low P

question

Predict the effect of the following on serum calcium, phosphorus and PTH levels: 1. secondary hyperparathyroidism due to vit D deficiency 2. secondary hyperparathyroidism due to chronic kidney disease

answer

1. increased PTH, possibly normal Ca, low phosphate 2. increased PTH, possibly normal Ca, high phosphate (can't excrete P)

question

Predict the effect of the following on serum calcium, phosphorus and PTH levels: 1. hypercalcemia of malignancy

answer

1. high Ca, high P, low PTH

question

Predict the effect of the following on serum calcium, phosphorus and PTH levels: 1. vit D intoxification

answer

1. high Ca, normal to high P, low PTH

question

Predict the effect of the following on serum calcium, phosphorus and PTH levels: 1. hypoparathyroidism

answer

reduced serum Ca and PTH Possibly normal or elevated b/c PTH is not acting on kidney to excrete P

question

Predict the effect of the following on serum calcium, phosphorus and PTH levels: 1. secondary hypoparathyroidism

answer

1. low Ca, normal to high P, low PTH .. due to surgical misadventure?

question

What is the underlying factor in all high altitude diseases?

answer

hypoxia

question

What effect will a decrease in arterial PO2 have on ventilation

answer

increase it

question

What effect will hyperventilation have on blood pH?

answer

respiratory alkalosis

question

What effect does high blood pH have on the hyperventilatory response to a reduced PO2?

answer

decrease

question

What effect will acetazolamide have on blood pH?

answer

more acidic

STUDY

End Stage Liver Disease Nursing Patient-Family Centered Care: Maternal/Child Nursing Surgery

Nursing – Care of Nasogastric (Decompression) Tubes – Flashcards 6 terms

Ann Ricker

6 terms

Preview

Nursing – Care of Nasogastric (Decompression) Tubes – Flashcards

question

You are caring for a client with a nasogastric tube. Which task can be delegated to an experienced UAP?

answer

Disconnecting the suction to allow ambulation to the toilet.

question

The client has a nasogastric tube connected to intermittent wall suction. The student nurse asks why the client's respiratory rate has decreased. What is your best response?

answer

"The client may have a metabolic alkalosis due to the NG suctioning, and the decreased respiratory rate is a compensatory mechanism."

question

A client is to have gastric lavage. In which position should the nurse place the client when the nasogastric tube is being inserted?

answer

High-Fowler

question

Two hours after a subtotal gastrectomy, the nurse identifies that the drainage from the client's nasogastric tube is a bright red. What should the nurse do FIRST?

answer

Determine that this is an expected finding.

question

A client is admitted to the surgical unit from the postanesthesia care unit with a Salem sump nasogastric tube that is to be attached to wall suction. Which nursing action should the nurse implement when caring for this client?

answer

Use normal saline to irrigate the tube.

question

After a partial gastrectomy is performed, a client is returned from the postanesthesia care unit to the surgical unit with an IV solution infusing and a nasogastric tube in place. The nurse identifies that there is no nasogastric drainage for 30 minutes. There is an order for instillation of the nasogastri tube prn. The nurse should instill.

answer

30 mL of normal saline and continue the suction.

STUDY

End Stage Liver Disease Nursing

ATI – Leadership – Flashcards 21 terms

Sonia Kelly

21 terms

Preview

ATI – Leadership – Flashcards

question

Can be delegated to LPN

answer

-Monitoring client findings; -Reinforcement of client teaching; -Trach care; -Suctioning; -Checking NG tube patency; -Admin of enteral feedings; -Insertion of urinary catheter; -Med admin [excluding IV meds]

question

Can be delegated to AP (CNA)

answer

Activities of daily living [ADLs]: -Bathing, Grooming, Dressing; -Toileting, Ambulating; -Feeding [*without* swallowing precautions] -Positioning, Bed making; Specimen collection; Intake and output (I&O); Vital signs [on *stable* clients] Can document stuff like vitals

question

5 Rights of delegation

answer

*Task* - Identify what tasks are appropriate to delegate for each specific client; *Circumstance* - Assess health status and complexity of care required by client; *Person* - Assess and verify competency of team member; Communication; Supervision

question

Right supervision - delegating nurse must

answer

-Provide supervision, either directly or indirectly (by assigning supervision to another licensed nurse); -Provide clear directions and understandable expectations; -Monitor performance; -Provide feedback; -Intervene if necessary; -Evaluate client to determine if client outcomes met; -Identify needs for quality improvement activities and/or additional resources

question

Leadership styles

answer

Authoritative - makes decision for the group; Democratic - includes group when decisions are made; Laissez-faire - makes very few decisions and does little planning

question

Client w/terminal illness scheduled to be discharged to nursing home states that he wants to go home to die

answer

contact the case manager first

question

Negligence

answer

conduct that falls below the standard of care [e.g., med errors, failure to monitor a client's condition, failure to report changes in client's condition to HCP, falls that occur as result of failure to provide safety to client, failure to check equipment for proper functioning]

question

Malpractice [aka Professional Negligence]

answer

failure of a person with professional training to act in a reasonable and prudent manner [i.e., using average judgment, foresight, intelligence, and skill that would be expected of a person w/similar training and experience]

question

Client's rights in a healthcare setting per the American Hospital Association's Patient Care Partnership

answer

-high quality of care; -protection of client privacy; -involvement in care; -help when leaving hospital (preparation for discharge); -help w/billing and filing insurance claims

question

If nurse receives an inappropriate assignment

answer

-Bring assignment to attention of charge nurse and negotiate new assignment; -If no resolution is arrived at, take concern up chain of command; -If no satisfactory resolution after reporting to charge nurse, file an unsafe staffing complaint w/the appropriate personnel.

question

emergent triage category - implies that a condition exists that poses an immediate threat to life or limb

answer

Shortness of breath

question

urgent triage category - implies that the client should be treated quickly

answer

-High fever and productive cough (possibly new onset pneumonia); -possible fractured tibia

question

non-urgent triage category - client can generally wait for several hours without a significant risk of clinical deterioration

answer

swollen and bruised ankle

question

Audit Process

answer

-*structure audit* - evaluates the setting and resources available to provide care; -*outcome audit* - evaluates results of nursing care provided; -*root cause analysis* - indicated when a sentinel event occurs; -*retrospective audit* - conducted when client is no longer receiving care; -*process indicators* - measure nursing actions that are used to facilitate expected and desired outcomes in clients; -benchmark is set at beginning of process and then compared to the data after collection is completed

question

Informed consent - provider must give the client:

answer

-Complete description of treatment/procedure; -Description of professionals who will be performing/participating in the treatment; -Description of potential harm, pain, and/or discomfort that might occur; -Options for other treatments; -Right to refuse treatment; -Risk involved if client chooses no treatment

question

Examples of when an incident report should be filed

answer

Med errors; Procedure/treatment errors; Equipment-related injuries/errors; Needlestick injuries; Client falls/injuries; Visitor/volunteer injuries; Threat made to client or staff; Loss of property (dentures, jewelry, personal wheelchair); Discovery that a preop client has eaten breakfast

question

Incident reports:

answer

Should be completed as soon as possible and within 24 hr of the incident; Are are not shared with client, nor is it acknowledged to client that one was completed; -Are not placed nor mentioned in client's health care record [However, a description of the incident itself should be documented factually in client's record]; -Include an objective description of incident and actions taken to safeguard client, and assessment and treatment of any injuries sustained; Are forwarded to the risk mgmt department, possibly after being reviewed by the nurse manager

question

Nurse should include the following in an incident report

answer

-Client's name and hospital number, and date, time, and location of incident; -Factual description of incident and injuries incurred -avoid assumptions as to cause of incident; -Names of any witnesses to incident and any client or witness comments regarding incident; -Corrective actions that were taken, including notification of HCP and any referrals; -Name and dose of any meds or ID number of any equipment involved in incident

question

charge nurse delegates task to RN and then finds out an error was made that could cause the client harm

answer

the RN performing the task remains accountable for his actions; the charge nurse is accountable for supervision, follow-up, intervention to safeguard client, and any corrective action

question

Can a nurse witness a client's signature on a living will?

answer

Yep

question

For the purposes of organ donation, the Uniform Determination of Death Act (UDDA) states that death is determined by one of two criteria:

answer

1) An irreversible cessation of circulatory and respiratory functions; 2) Irreversible cessation of all functions of the entire brain, including the brain stem

STUDY

End Stage Liver Disease First And Last Name Nursing Nursing-LPN

4/30 – Flashcard 137 terms

Mary Moore

137 terms

Preview

4/30 – Flashcard

question

The nurse receives a report from the previous shift. Which of the following patients should the nurse see FIRST? 1)A patient who had a lobectomy 24 hours ago and has a chest tube. 2)A patient who had a laryngectomy 12 hours ago. 3)A patient complaining of a headache. 4)A patient in Buck''s traction for a fracture of the R femur.

answer

question

Epigiotomy 후 care (M) ① pain 줄여주기 위해 warm or cold water로 bath ② daily soap and water로 clean ③ 의자에 앉기 전에 muscle을 relax한다. ➃ ice pack apply ⑤ perineal area를 ~~~한다.(모르는단어)

answer

1,3

question

소아과 간호사, 가장 먼저 봐야 할 환자 ① 3yrs barking sound ② 4mon fever 38.6

answer

question

신규간호사가 하는 행동중 잘하고 있는 것? 멀티 ① 환자 log rolling시 side rail ~~~ ② 환자 가까이에 서서 care ③ Knee bending~~

answer

1,3

question

간호하는 사람 건강 다치지 않게 하는 바른자세. 멀티. ①standing시 한쪽 다리를 올린다 ②무릎 구부려서 물체잡기 ③ 앉을 때 무릎이랑 엉덩이를 어쩌고~~ ④ 물건을 향해 설 때는 ~~ ⑤설 때 ~~

answer

1,2

question

mechanical body 멀티 ①다리 어깨너비벌리고...~ ②환자가까이서 작업하고..~ ③11.3키로일때는 동료에게 도움받지않아도된다.

answer

1,2

question

Metformine에 관한 내용 맞는것? ① 보통 아침, 자기전 복용한다. ② dye 사용하는 검사할때 의사에게 말하고 stop한다. ③ urine Keton검사한다.

answer

question

Alcohol abuse patient, effective? ①I told my friends I won't drink when I go to bar ② I Attended all alcohol support group meeting for 2 weeks ③ My spouse attends support group every week ④ I would stay sober if my spouse agrees to divorce me

answer

question

Migraine H/A 으로 ~riptan 먹는 환자이다. 맞는 것은?(멀티) ① 예방적으로 복용하는 약이다. ② wine, cheese 와 같이 먹지 않겠어요. ③ 한번 복용 후에 두통이 지속되는 경우 2 시간 뒤에 재복용 한다. ④ 임산부도 복용할 수 있다.

answer

1,2

question

Kideny Bx 후 우선 봐야할 증상은? ① voiding시 burning sense ② shouler & back pain

answer

question

TPN에 대해 맞는 것 ① change catheter tubing q24hr ② change IV cath q24hr ③ change cath dressing q24hr ④ check BST q8hr ⑤ semi folwer's position

answer

question

condom catheter사용 환자가 설명한 내용중 틀린것? ① penis 끝이 tube 끝에 닿게 해야 해요. ② 알맞는 사이즈 알기위해 사이즈 재야해요. ③ 낮에 다닐때는 bag을 다리에 고정 할거에요.

answer

question

condom cath 틀린 것? ①condom 땅에 떨어뜨렸으면 새걸로 한다 ②tip 끝에 공간을 둔다

answer

다른답

question

Hypertropic cardiomyopathy에 대한 설명중 맞는것은? ① hypertention이 원인이다. ② degenerative change에 의한 것.. ③ 치료(근본적치료?..)는 심장이식이다.

answer

다른답

question

Bipolar pt. took medicine and undergoing treatment. proper improvement? ①having good relation ship with other clients ② decrease of manipulation ③ well sociailised

answer

question

Scarlet fever client care시 옳은 것은 ? ① Take off gloves after leaving client's room ② Wear surgical mask when taking client's blood pressure ③ Wear gown when 뭐 할 때.... (contact precaution) ④ 환자를 negative pressure 방에 둔다

answer

question

CAD patient serum homocystein ① MI진단위해 ② 심장내 압력이 60mmhg일때..아리송

answer

question

아기 낳은 7일된 산모가 말하기를 'I'm bad mother. 아기가 새벽에 깨서 울면 나도 울고 싶다.' 간호사의 적합한 response? ① 그런 감정은 정상적이다. ② child abuse 예방 위해 미리 치료를 받아야겠다. ③ I suggest 너의 남편에게 도와달라고 말해라.

answer

question

Cancer 예방 conference. Multi ① 하루에 fruit & vegetable at least 5 serving 먹어야한다. ② 담배 피우지 말아야한다. ③ avoid alcohol and red meat ④

answer

1,2,3

question

primi 산모 분만직후에 자궁수축이 잘되고있는지확인하려고한다. require follow이 필요하지 않은 상태는? ① soft, umbilical level ② firm, umbilical level ③ soft, above umbilical2finger level ④ firm, above umbilical2finger level

answer

question

PPE 제거 순서 ① Remove glove ② Untie gown's strip ③ 목 부분 잡고 내려트려라 ④ 팔 부분 중앙으로 접으면서 벗어라 ⑤ 손 씻는다

answer

1-2-3-4-5

question

24hr 전에 vaginal delivery 한 환자 perineal care 맞는 것은?(multi) ① swelling 경감위해 얼음 데어준다. ② pad 뒤에서 앞으로 제거 하겠다. ③ Tub bath 하겠다 ④ spray 이용해서 cleansing 하겠다.

answer

1,3

question

BP.P, R증가.anorexia. cyanosis. incontinance.U/O감소. coughing. swallowing difficult.

answer

MG ; myasthenial crisis

question

apprehension. restlessness. dyspnea. disphagia.increased lacrimation. increased slivation. diaphoresis

answer

mixed crisis(MG+cholinergic)

question

n/v. diarrhea. abd cramping, blurred vision. pallor.

answer

cholinergic crisis

question

The inability to speak or understand phrases

answer

Aphrasia:

question

.The nurse surveys patients midway through the evening shift. It is MOST important for the nurse to intervene in which of the following situations? 1)A patient diagnosed with emphysema and a smoker''s cough is watching television with a visitor who is wearing a mask and gloves. 2)A patient diagnosed with gastroesophageal reflux disease (GERD) is sitting in a chair sipping a can of ginger ale after eating dinner. 3)A patient diagnosed with peripheral arterial disease (PAD) is sitting on the side of the bed with legs crossed. 4)A patient diagnosed with myasthenia gravis is being assisted with dinner by the nursing assistant, who is cutting the food into small pieces.

answer

question

The middle of the evening shift on the inpatient psychiatric unit is unusually hectic,(열광) with a large census, high acuity level, three admissions in two hours, and a fourth admission on the way. The unit secretary goes down to the emergency department to get some needed paperwork for one patient. When she gets back to the unit, she angrily and repeatedly exclaims about the ongoing rudeness of the emergency department staff, including their not providing the necessary documents. She states, "I am going home!" and starts to go toward the coatroom. What is the BEST response by the charge nurse? 1)"Take a deep breath. Give it some thought and let me know what you decide." 2)"You must stay here and do your job. If you leave, that will be insubordination."(불순종) 3)"Calm down. Overreacting does not do you or anyone else any good." 4)"We are not the ones who were rude to you. Do not leave us, because we need you."

answer

question

간호사가 환자에게 약을주려고 한다. 환자를 확인하는 방법?(multi) ① 환자의 ID band 를 확인한다. ②환자에게 이름을 말해보도록 한다. ③환자의 등록번호를 확인한다. ④환자의 룸넘버를 확인한다. ⑤환자 방에 들어가면서 이름을부른다.

answer

1,2

question

투약error줄이기 위한 conference multi ① 주기 전 minimum 3회 check ② 환자와 함께 약 개수 센다. ③ 용량계산은 2명의 간호사와 double check한다.

answer

1,3

question

약물 error 컨퍼런스 .전화 처방 받을때 select all ①spell 이 틀릴수 있으니 다시 확인 한다. ②닥터 오더를 repeat 한다. ③환자의 진단명 이름을 우선 말한다. ④근무가 끝나기 전에 의사의 사인을 ensure 한다.

answer

1,2,3,4

question

ACE inhibitor indication? multi ① HTN ② Heart failure ③ DM ④ infective endocarditis ⑤

answer

1,2,3

question

Stich out 순서 드레그 문자 ① suture remove set 준비하기 ②glove wear and aseptic technique ③ forcep and curved scissor hoding ④scissor level -시져를 슈쳐위 어느정도?위치에두고 자른다. beneath the suture ⑤ partial suture remove 6. povidone dressing 7. sterile gauze

answer

1,2,3,4,5,6,7,

question

Somogyi effect (DM환자 2-3AM경 hypoglycemia예방위해,먹이는 것이 중요, insulin usual dose 7A,19PM sq..) 할 일? ①밤에 스낵을 제한하고 어쩌고 저쩌고 ② SMBG 4시간마다하고 어쩌고 저쩌고 ③protein,버터바른 샌드위치 을 섭취하도록

answer

question

Clarify with Dr. the medication order. ① Glargine 30unit in the evening for type 1 DM patient. - 너무 적다, 100unit

answer

question

Increased anxiety 를 나타내는 sx ① declining meal ② frequent urination ③ write several page of journal ④ increase sexual desire ⑤ pacing decrease ; perception ability , learning skill, solving problem,

answer

1,2,5

question

최근 입원한 환자 more confuse and anxiety(?) yelling to nurse station correct documentation? or 맞는 것?, multi ① anxiety related to new environment ② more confuse,,yelling

answer

1,2

question

.fat embolism(multi)? ①Restlessness(anxiety) ② P 68 ③ hypotension ④ rales(crackle) sound Sx : BP↓,PR↑,BT↑, Gum bleeding, chest pain, irritable, JVD, dyspnea, SOB, hematuria Tx:HFP, ROM exercise, EB, O2, heparin

answer

1,3,4

question

colon ca 로 fluorouracil-5FU 치료 중일때 봐주어야 할 것은? ① mouth soreness ② ? ③ ?④ notify to HCP alopecia -대머리,ES *chemo:cytoxan,cisplatine- cistitis *5Fu,6MP,methotrexate - dermatitis ; psoriasis avoid *Adriamycin : ototoxicity, nephroxicity, neuromusclar blockage *vincristine ; nerve/necrosis

answer

question

우선순위? ①Heart failure 환자, ② CRF 환자가 5시간 동안 urine 하나도 안 나오고 pruritis 있다, ③5일전 head injury 로 입원 계속 decelebrate position 유지

answer

question

halovest traction 환자 간호 multi? ① vest 적용부위 skin assess ② pin 삽입부위에 drainage 유무 관찰 (감염이나 징후를 본다는 얘기) ③ headache 있다면 pin을 loose 하게 할 것이다. ④ muscle function ,skin sensation assess

answer

1,2,4

question

Halo vest traction 간호로 맞는 것은? (multi) ① 2시간마다 position change 하겠다 ② 다리를 들어 올릴 때 halo ring 사용하지 않겠다 ③ 잘 때 벗고 자겠다.. ④ 샤워하겠다.

answer

1,2

question

disaster 있어 퇴원가능한 환자는 ? ① 입원한지 얼마안된 MI 환자 ② ? ③ cholecystectomy 8시간전 시행하고 4시간전부터 tolerate liquid diet ④ asthma axacerbation으로 24시간전에 입원한환자로 추가적으로 스테로이드 흡입제 사용에 관해 교육이 필요한 환자

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question

Four patients arrive in the emergency department within minutes of one another. Which patient should the nurse see FIRST? 1)A patient, pale and diaphoretic, who is complaining of sudden and severe pain radiating from the flank to the scrotum. 2)A patient with right lower quadrant (RLQ) abdominal pain of 24 hours'' duration and which is relieved by drawing the legs up and remaining still. 3)A patient, jaundiced and nauseated, who is complaining of pain in the right shoulder and has a temperature of 100°F (37.8°C). 4)A patient with sudden epigastric pain and nausea who reports vomiting blood and has an odor of alcohol on the breath

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.The nurse cares for clients in the outpatient surgical center. Four clients scheduled for surgery present to the surgical center at the same time. Which of the following clients should the nurse see FIRST? 1)A 19-year-old scheduled for a tonsillectomy. 2)A 25-year-old scheduled for an inguinal hernia repair. 3)A 32-year-old scheduled for a mastoidectomy. 4)A 39-year-old scheduled for removal of nasal polyps.

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The nurse cares for clients on an acute pulmonary unit. The nurse prepares a written report for the next shift. It is critical to communicate which of the following to the next shift? 1)Laboratory work drawn on the client, arterial blood gas reports, nutritional intake, and vital signs for the shift. 2)Any respiratory difficulty client has experienced, activity tolerance, sputum production, and significant variances in vital signs during the shift. 3)Name of client''s physician, date client was admitted, dietary intake, and client''s general condition. 4)Urinary output, fluid intake, visits by the attending physician, vital signs, any respiratory problems encountered.

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The nursing team consists of an RN, an LPN, and two nursing assistants. The RN should care for which of the following clients? 1)A child recovering from surgical repair of a hypospadias. 2)A client recovering from excision of a malignant melanoma. 3)A client diagnosed with a myocardial infarction requiring assistance to the bathroom. 4)A client diagnosed with urolithiasis recovering from lithotripsy.

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low molecular weight heparin therapy 중이다 교육에 들어갈 내용은? ① ? ② SC로 주사줄때 흡인하지 않는다. ③gum bleeding 이 있다면 vit K 함유 vegetable 같은거 먹을 것이다. ④ check partial thromboplastin time weekly Heparin : PT/PTT, OB, Hwt/Wt check

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OA multi ①Wt bearing 한다 ②rest ③NASAID 가 내 통증을 줄여줄 것이며 OTC에서 사먹겠다 ④CAL를 OTC에서 사먹겠다 ⑤ ice massage ⑥운동..체중감소 위해 헬스 끊는다

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1,2,5

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Osteo malacia discharge education, 환자 잘 이해한것.(multi) ① will do weight bearing exercise ② will do swimming ③.will take prescribed pain med ④will get calcium supplements from OTC ⑤ will use cane (?) 연골연화증; ca↑, vit↑, fat↓, vit D위해 sun expose- morning, evening 5-15분 노출이 효과적 ,strengthen exercise, device, splint쓴다

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1,2,5

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multi) Laparscopy cholecystitis op 예정인 환자가 있는데 post op complication risk 높은 pt는? ① Enoxaparin 최근 처방 받아 투여중 ② 어렸을때 asthma hx ③ 최근 처방된 Bumex 복용중 ④ Hb 14 ⑤ Bun 17

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1,2

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ventilator malfunction 으로 볼수있는 것은? ① water in tube ② tube pressure 20mmHg ③ high pressure alarm when client HFP position ④ low pressure alarm when suctioning

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백내장 op후 간호기록 잘된 것을 골라라 (어느쪽 눈인지 제시x)—마지막문제 ① MSO4 투여. Pt complains pain 4 in 0-10 scale ② OS eyepatch apply ③ 240ml pale yellow urine voiding *Accurately document : OS ; Lt eye, OD: Rt eye, OU : both eye 대광반사affected eye shining→unaffected shining

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infantile colic 부모에게 교육할 내용? ① pain phase 에 carseat를 사용한다. ② 아기에 배에 directly warm pack을 적용한다 ③ 공기를 삼키는것을 줄이기위해 모유수유보다는 bottle feeding with diposable bag ④ wait 15minute before picking up the baby when baby crying pain phase

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priority ① HCV pt dark urine ② Rt Mastectomy pt Rt arm edema

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ECT 검사후에, 널스가 incident report 를 작성해야 되는 경우는 언제인가? 맞는거 다 골라라. ①Nurse found a patient on the floor and side rail was upright. ②A patient is out of bed and cover off other patient's linen who is crying on the bed. 환자가 침대 밖으로 나와 울고있는 다른환자의 침대 커버를 벗겨버린다. ③Nurse found out that a consent form was not signed. ④A patient complains of a headache and asked a medication ⑤ECT 결과에서 seizure의 움직임이 2분동안 포착됬다.

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1,3

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32주 perg 몇일 전부터 heavy bleeding fluid lekage 느낀다. first? ①리트머스 종이 갖다대어 양수인지 확인한다. ②extra fetal monitoring한다. gush fluid ; litnos paper test, asses PH ; green color - alkaline

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Living will 맞는 것 (multi) ① 2년마다 내용을 바꿀 수 있다 ② 환자가 원할 때 내용을 바꿀 수 있다 ③ 치료지속 여부를 결정할 수 있다 ④ 대리인이 must be review 해야 한다 ⑤ 가족들이 내용을 바꿀 수 있다

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2,3,4,5

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living will multi. ①terminal care에대한 환자의 wish ②환자가 원하면 내용을 alter할 수 있다 ③환자가 2년마다 내용을 update한다 ④Attorney가 반드시 review해야한다 ⑤환자가 의사결정을 못할 시에는 family member가 대신한다

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1,2,4,5

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Advance directive refuse giving antibiotic to pt. MD ordered antibiotic for 7days. Nurse action? ① notify nurse manger. ② incident report. ③ ask pt if he is aware of the antibiotic.

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약물 ① haldol 쓰고 bath 한다. ② prozac 쓰고 카페인 제한한다. ③ prolixine se 보고 한다. ④ lithium 물 제한한다. *manic; tegretol, lamotigen, lithium

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Consent form 에 들어가야 할것? multi. ① Altenative treatment ② diagnosis ③ procedure ④ 수술시 응급상황이 발생할경우 어떻게 조치를 취할것인지에관한 내용 ⑤ all heathcare provider's name

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2,3,4

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The patient will have a surgery after 4 hrs. What should the nurse prepare?(M) ① V/S ② Informed consent. ③ Oriented the surgery room ④ Health assess history.

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1,2,3,4

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barium enema 했고, occult boold 검사할 때 ? M ① 최소 3일전은 철분제제 끊는다 ② 소변은 포함시키지 않는다. ③ red meat 은 피한다. ④ barium 포함되어도 상관 없다.

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1,2,3,4

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Cardiac catheterization 후 중재 (multi) ① bed rest and compression ② peripheral pulse check affected site ③ hematoma bleeding check

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1,2,3

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모성 우선 순위 ① 34주 전치 태반 소변에서 brawn color ② 36주 PROM 흐르는 양이 점차 증가함. ② 몸무게 변화

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ADHD 환아 ~~해서 더이상 학교를 다니기가 어렵고 이환자의 경우 어떤것을 봐주어야하나? ① 식욕, Wt loss ②? ③ social ,physical development ④? 문제내용 지문자체가 기억이 잘 안나요

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Fentanyl patch 맞는것? ① bath 한다 ② heat pad 댄다. ①pt chest에 hand palm으로 firmly 하게 붙인다.

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spiroaldacton ① K섭취한다. ② 아침에 복용한다 ③ green leaf 먹는다

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Adenovirus precaution? ① droplet ② airborne ③ contact ④ neutrogenic?

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간호사가16세 veitnamese을 assess하고 있는데 그의 아버지가 나타나 질문하고 있다 그때 간호사는? ①아버지를 무시하고 계속 사정한다 ②아버지에게 나가달라고 부탁하고 사정하기 시작한다 ③아버지를 옆에 두고 그녀에게 직접적으로 질문한다

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다음 중 간호사가 문화에 대해 잘 이해하고 있는 것을 모두 골라라. ①이슬람교 하루 4번 메카를 향해 기도한다. ②유대교 토요일은 모든 치료를 거부할 것이다. ③동양인은 질병에 대해서 자신의 죄로 인해 발생했다고 믿는다. ④크리스트교,로마카톨릭 자신의 운명에 최선을 다한다.

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background가 다른 간호사가 pt care 할 때? ① 간호에만 focus on 한다 ② religion에 대한 information을 얻는다

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Anorexia nervosa priority? ① 우리엄마아빠는 내가 학교갔다오면 매일 체중을 잰다 ② It's not my fault my parents arguing ③ 체중계 숫자를 확인하는게 난 너무 힘들다 ④ 학교일을 너무 열심히 하지 않아도 된다는걸 알겠어요

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Lactulose malabsorption conference multi ① constipation, N/V 이 주 증상이다. ② pancreatitis pt 에게 나타날 수 있다. ③

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1,2

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client with Radiation therapy , suddenly decrease urine output and~ (electrolyte imbalance중 하나 였는지 기억이 안나요 urine output 감소와 함께 같이 주어진게있었어요) 무엇때문인지? ① SIADH ② Tumolysis syndrome ③

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macular degeneration pt. 나의 life, hobby 등 모든 것이 끝이다. Miserable. 이라 말했을 때 nurse? ① tell pt 부정적인 생각은 치료에 좋지 않아요. ② 시력장애 group 에 가게 한다. ③ 의사와 OTx 에 대해 의논한다. ④ 같은 unit에 있는 같은 진단받은 환자와 이야기할 수 있게 한다.

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Lt tympanoplasty 방금 수술한 환자 퇴원교육중 포함해야 할 것은? ① expected pain for first day ② notify to HCP if you hear left ear popping sound ③ Lt side lying for drainage ④ when you sneezing ,close your mouth

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grief와 loss에 관한 교육중 맞는것은? grief의 종류에 관한 ① complicated grief는 long term care 필요한 사람 주로 cancer 환자 ② distorted grief는 denial 로 schooler child 에게 주로보여짐 ③ delayed grief 는 빨리 잊고사는 사람에게 나타난다 ④ grief 중 하나에 관한 내용 *complicated grief복합슬픔 : delayed, chronic,pathologic-Ca환자 disorder, abnormal grief *disorted grief 왜곡된 슬픔: converted전환 grief, chronic grief, extremely supression, irriational expression비이성적 표현

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inhalation anthrax 시 사용하는 약? ①lamivudine ② ciprofloxacin ③ cefazolin ④ penicilline

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Nephrotic syndrome 환자 퇴원 예정이고 steroid tapering 중이다. 퇴원교육으로 맞는 것은? ① Urine albumin check ② Diet ③ Activity 제한 ④ 기억안남 *Glomurulonephritis : Streptococcal infection, 우선hematuria, protein uria, fever, U/O↓, BP↑, headache, orbital edema Tx : rest, IV, 1000cc↓, Diet : water↓, Na↓, K↓, P↓, Mg↓, protein↓ *Chr. Renal failure : M.acidosis, Cr↑, puritis ☞: azotemia sign * Nephrotic syndrome : immune↓, proteinuria, Low albumin, 전신 edema Life long steroid, SE: 4S↑ : sugar↓, sodium↓, protein↑,k↑diet 필요

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*patients management priority Rheumatoid Arthritis / PVC5↑ Pharyngitis / K↓ or K↑ ; electro unbalance Pakinson's /CABG, MI 우선 Sickel cell anemia / Encephalopathy, mental↓ Burn /Cholecystectomy after some op Bone marrow / Transplantation, rejection sign ##pharyngitis symptom-Sore throat Red throat .Lump in throat feeling .Fever .Headache Swollen glands .Swollen neck lymph glands Tender neck lymph glands .Difficulty swallowing Pain swallowing .Breathing difficulty

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priority1

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-meningitis neck stiffness # -thyroidectomy respiration difficult # -신생아 diaper 4개/24hr # -cisplantin 하루전에 맞고 N/V # -MS drooling #

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priority2

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.It is MOST important for the nurse to consider which of the following concepts when planning nursing care for a client from a culture other than the United States? 1)The distance from the United States and the duration of time the client has been in the United States. 2)The climate and topography of the client''s native country. 3)The concept of time and the organization of society in the client''s native country. 4)The client''s financial status and physical characteristics.

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The nurse returns to the desk in the prenatal clinic and finds four phone messages. Which of the following messages should the nurse return FIRST? 1)A multigravida at 12 weeks'' gestation experiencing heavy white vaginal discharge. 2)A primigravida at 17 weeks'' gestation states that she has not felt the baby move. 3)A primigravida at 22 weeks'' gestation complains of feeling dizzy and clammy when lying on her back. 4)A multigravida at 32 weeks'' gestation experiencing malaise and bilateral dependent and facial edema.

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The nurse manager of the psychiatric unit plans the biweekly unit-wide multidisciplinary team case conference focused on one particular patient. Which of the following patients is MOST important for the manager to select for discussion? 1)A patient who was admitted after a second serious suicide attempt and refuses to talk. 2)A patient toward whom the staff have sharply conflicting attitudes and actions. 3)A patient who talks to invisible beings, takes possessions from other patients, and paces continually. 4)A patient, well known and well liked by staff, whose diagnostic testing reveals a brain tumor.

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The nurse on the medical/surgical unit prepares several clients for discharge today. Which of the following statements, if said by one of the clients to the nurse, indicates the need for further teaching? 1)"Because my colostomy is pink and moist, I can take a relaxing bath." 2)"Now that I''ve had this old hip replaced, I can get back on the tennis court." 3)"In about a week, I''ll need to have the stitches removed from my head. Perhaps I should wear a hat while I''m outdoors." 4)"I can''t wait to go for a walk in the park. My knee feels so much better with the new joint in place." *우선:hip replacement, immobilization, abduction,extension

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multidiscipline ① 12yr SCA + neutropenia ② 14yr 18week 임신, GDM ③ 19yr homeless, active TB + anemia

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hital hernia 시 주의점 ① 허리에 binder 한다 ② 변비 주의한다 *hital hernia원인: obese, heavy lifter, GERD, - samll freq.먹기 ; Wt loss, avoid - lifting, binder⁴

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병원에서 가장 많이 옮는 병원균 원인은 ① 벤틸레이션 하고 있는 환자 ② self urination 하는 환자

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smoking을 멈추기를 원하는 환자에게 간호사가 할수 있는 말은? ① "늦었다고 생각하지 마세요" ② "support group을 만들어라" ③ "psychotheraphy를 받아라" ④ "원래 끊기가 쉽지않다."

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thyroxin crisis ① beta bloker 쓴다. ② EKG 12 lead 처방 받는다. ③ Tylenol ④ ASA

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1,2,3

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Thyroxin crisis 환자에게 해줘야할것 다골라라. ① ASA ② Cool blanket ③ Beta adrenergic blocker ④ (Acetaminophen) Tyrenol ⑤ O2

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2,3,4,5

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HIV Pt 가족이랑 생활시 주의해야할 것 ①손자를 허그 하면 안된다 ②그릇을 따로 쓴다 ③~

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34주 preterm labor 처방 clarify ① MgSo4 2mg 1시간 마다 인퓨전 펌프 ② MgSo4 10mg 20분 동안 인퓨전 펌프 ③ Ca channel bloker nifedipine po. ④ 스테로이드 IM *PIH toxicity봐준다 R12↓,U/O 30cc/hr↓, DTR +2→+1

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streptococcus B vaginal 32주 산모 ① 남편 치료해야한다. ② 분만후 아기 예방적 치료해야한다. ③ 임신기간 동안 산모 예방적 치료해야한다. seqently pregnancy 라고 있었는데 옵션에.. 무슨 뜻인지..

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Hepatitis A 일 때 Concern ? ① Wear off glove after get out of the room ② share the room Hepatitis A and Hepatitis B * Hepa A, E(contact p) ; Oral, fecal secretion, 후진국 여행, 종업원(daycare center,restaurent), water -bottle water=Evian water, utensil- disposable, worker's : Havix #1, hand -washing, oral excretion feces : contact precaution,private, harrivix vaccine (hepatabrixB, racombi)1#, cured, 치료시 donner가능, acute cure *Hepa B,C,D,G(standard p) ;Unknoen of virus, Blood, drug, utensil, hemodialysis,sex ,Liver cirrhosis, cancer ,치료시 donner불가능, Not cure

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Tb 환자 진단하는데 도움이되는 증상 멀티 ① night sweat ② 충분히 잤는데도 피곤하다. ③ blood-tinged suputum 나온다. ④ 식욕이 없는데 살이 찐다. ⑤ 1년동안 약먹기 ⑥plastic bag에 버리기 ⑦식기를 따로 쓴다.

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1,2,3

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abuse 당하는 여성의 탈출 방법 중 옳은 것(multi) ① 폭력이 시작되려고 할 때 집 근처의 safe house, shelter로 피해라 ② 비상시 필요한 돈과 차 키를 집 안에 숨겨놓아라 ③ 경찰에 신고를 해야 할 경우 이웃과 암호의 단어를 미리 정해놓아라 ④ 도망치는 방법에 대해 자주 연습하여라 ⑤ 상대가 abuse 시작한 것 같으면 바로 도망쳐라 ⑥ 제일 가까운 피난처 혹은 safe house 같은 곳을 확보하고 가는 교통수단도 확보해라

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1,3,5,6

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partner abuse 틀린 것은(multi) ① postpartum, pregnancy 일 때 decrease 된다 ② 문화적으로 여자의 역할이 남자보다 적은 나라에서 많이 발생한다 ③ urban의 low socioeconomic 가정에서 많이 발생한다

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다틀림

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indiffernciated schizophrenia goal? ① express felling ② 입원이유 알게한다.

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anhedomia무감각, alogia무언증, avolition무관심, asocialization, blunted affected

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Schizo. Negative Sx

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Hallucination-jumping sound, high way walk, delusion, bizzare behavior- poor hygiene

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Schizo. Positive Sx

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-MED : ~zine, Haldol, Zyprexa, -Clozaril(agranocytosis, WBC check), -Olanzepine(SE : blurred vision, neck stiff, wt gain, constipation), Serogueal, prolixine *ES : photosensitivity, orthostatic hypotension, dizziness, constipation, blurred vision, breast milk, Wt gain *Sx: Anticholinergic -Dry symptoms(sugarless gum, silps of water), dry eyes, blurred vision, constipation, urinary retention. *TE: Increase fluids, increase fiber, increase exercise. Can cause blood dyscrasia혈액질환-sore throat, fever, malaise, bleeding. *AE:Photosensitivity, GI disturbance, dizziness, dry mouth, Wt gain(low calories, high fiber), blurred vision, Galactorrhea( breast milk) i. clozarile ; agranulaytosis과립구감소증, WBC↓ ii. prolxine : BP↑, saliva↑ iii, Serogueal : Photosensitivity↑- 긴팔, 긴옷 iv. haloperidol - EPS sign↓

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Schizo Tx

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PIH에 관한 것으로 correct? ① 자간전증, 자간증으로 발전 할 수 있다. ② 원인은 unknown ③ mild 자간전증은 urine protein 과 edema가 없다 ④ 자간전증은 출산 후 24wks까지 영향을 미친다. ⑤ multiple 산모는 위험요인다.

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HBV 진단증상 ①atralgias ②confusion ③ headache ④ESR 상승 *Sx : atrexis, encephalopathy,hand tremor,Mental↓ 예방접종 : 12hr , 1,1,5

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DKA (multi)? ① pH 3.0 ② ketonuria ③ diaphoresis ④ slurred speech & dizziness ⑤ BP 98/54 ⑥ PH 저하 *DKA(diabetic ketoacidosis 350↑,polyuria다뇨, polydipsia다갈, polyphagia다식),Keton urin(+) - maintain dose :100-220☞IV, N/S replaced, RI, SMBG, 쥬스; 우선 60↓, control - self care ; alone

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1,2,5,6

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CVA apasia (M) ①speech ~~ ②express apasia ③receptive apasia

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1,2,3

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receptive aphasia 시 간호? ① face 보고 speak slowly ② yes no 대답 할 질문 ③큰 소리로 말한다 ④writing

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receptive aphasia pt와의 의사소통을 위해서? ① loud 하게 이야기 한다 ② repeat해서 이야기 한다 ③gesture를 사용한다

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Hemisphare, pyramidal반구현상 : agnosia-name X, apraxia, disphraxia -spoon, release cloth, aphagia-연하곤란,soft thicken food, aphasia - 언어곤란, anopsia-반맹증, aphrasia-문장못쓴다, asthria☞ normal tone, low tone. Man's voice Small frequently soft, thicken food, avoid liquid-juice, milk 예방 : NSAIDS, ASA, Heparine, coumadine

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CVA + dysphasia실어증

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*Expressive disorder -표현실어 : speaking,writing,intelligent Broca's aphasia : behavior change X X O Picture or communication board쓴다 *Receptive disorder -수용실어 : Werniker's X X X gesture Tx : Normal tone, low tone, men's tone, facing with lip reading, light, shining, yes, no reply *Global aphgia : 둘다, Yes, NO simple closed *aphasia : less or impaired of the power to use or comprehend words

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CVA + dysphasia

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hypophysectomy 수술은 아니고 비슷한 질병? 증상에서 rhinorrhea과 otomosis가 나오는 상황에서 옳은 중재는? ① ②Trendelenburg Position 취한다. ③ 귀에서 흐르는 drainge를 pressure dressing 한다. ④ ecchymosis부위에 cool compression 한다

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다른답

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알콜리즘 환자 2시 30분에 ER로 왔다. 다음번 간호사에게 말해 주어야할 DATA? ①마지막 술을 먹었을 때가 2일전이다. ②하루에 ~?병 마신다. ③전에 ~attack(crisis) 겪을 적이 있다. ④그는 liver cirrhosis가 있다.

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abuse ①이전 hx ② 카운 셀링 받도록 한다.

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The nurse manager of the oncology unit is planning an inservice to address confidentiality issues. Which of the following measures should the nurse manager stress as being BEST to prevent confidentiality violations? 1)Keep ambulatory patients and visitors away from the nursing station as much as possible. 2)Call patients and one another by first names only. 3)Answer the telephone by saying the type of unit, but not the floor number. 4)Accompany the physicians doing walking rounds at the bedside.

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question

.The nurse cares for clients on a medical/surgical unit in a large metropolitan hospital. The family of a client diagnosed with end stage liver disease has been consistently dissatisfied with the nursing care. Early one morning, the nurse discovers the client has died. The charge nurse notifies the family, who come to the hospital. Prior to the family arriving, the staff expresses concern about having to interact with the client''s family. Which of the following responses by the charge nurse is MOST appropriate? 1)""The nursing supervisor will be here when the family arrives."" 2)""I will notify the legal department about the family''s complaints."" 3)""Please wash the client and place pads under the client''s perineum."" 4)""The chaplain will greet the family.""

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question

The clinic nurse anticipates the arrival of a Navajo Native American patient for follow-up care regarding type 2 diabetes. When planning care for the client, the nurse should expect which of the following behaviors? 1)The patient will not arrive at the appointed time. 2)The patient will be noncompliant with medication. 3)The patient will complain much about dietary restrictions. 4)The patient will offer a firm handshake.

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수술전 간호사가 마지막으로 채concern 해야 할 것은? ① concent 받기 ② 수술 check list 작성 하기

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chicken pox 틀린 것 ①surgical mask patient wear when transfer ②keep open the door when pt check V/S

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노인 중재 중 틀린 것 multi 헷갈렸던 보기 ①get out of bath tube 시 towel bar를 hold한다 =타올 바는 안되는걸로 공부해서.. ②shower water 120F(48.9도) ; 45.6F↓정상√ ③rug 제거 ④my spouse installed low-watt fre...(모르는 단어) in the kicken

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1,4

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NIDDM 환자에 대해 맞는 것은? ① alcohol은 hypoglycemia를 유발한다. ④ milk 대신에 scrambled eggs 먹는다. ⑤ CHO를 50% 이상 늘린다. Alcohol/drug abuse ; hypoglyemia

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allopurinol에 대해 맞는 설명은? ① gout의 acute stage에 쓴다. ② inhibit product uric acid Gout Tx ; uric acid↓, metabolic acidosis↓

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ileostomy ①포비돈 소독한뒤에 appliance 한다 ②applience 3~4일마다 바꾼다 ③6개월 후부터 high fiber, vegitable 섭취 증가한다

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atenolol 주기 전 concern 할 것? ①BP ②BUN ③newly reported ankle edema

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contact 고르기 ①HIV ②parvious B19 ③MRSA ④parainfluenza virus

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3,4

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HIV (+) 환자 교육내용중 컨선할것 ① i know must use it but my girl friend latex allergy so i will use natral membrane 콘돔 ② 끝을 잡고 Air를 뺀 후 착용할 것이다. ③ 나머지 내용은 틀린 내용이었어요.

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cobena..??(베타네콜아니고 처음 보는 약이었으나 BPH약:proscar,zoladex, oxybutine) 처방했는데 환자 기록보고 requsest해야할 것? ①small angle glaucoma (Med:pilocapine,zolathine,piamox,timobone, tetolot)

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다른답

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3시간 전에 thoracostomy를 받은 환자에게 갔는데 chest tube가 lying되어 있었다. 간호사가 가장 먼저 해야 할 일은? ① PRN O2를 준다. ② 환자의 자세를 SFP으로 취해준다. ③ tube가 빠진 자리에 petrollium gauze를 대어준다. ④ coughing & deep breathing을 하게 한다.

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CATARACT 예방교육 후 효과로 볼수있는 것 ① 썬글라스 예방적으로 착용 ② 고혈압이 원인이다.

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EKG 말로 풀어서 옳은것? ① QRS는 ventricular depolization. ② P는 atrial depolization ③ S는 ventricul depolization ④ T는 ventricul repolization

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1,2,3,4

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6M otitis media 걸린 환자의 부모가 teaching 받은 후 하는말 중 옳은 것은? ①우리는 비행기 여행 안 하겠다 ②~~~먹지 않겠다 ③lemon piece ④ shampoo시 ear plug쓴다

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K낮은 Pt에게 KCL 주는 방법 다 고르시오. ①U/O 봐주기 ② ③K iv push ④k electric device로 주기(electric device ; slowly infusion pump) ⑤dilute해서주기(희석해서)

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1,4,5

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burn 환자 급성기때 증상: ① hyperkalemia ② hypokalemia U/O↓, IV electro imbalance check ; *Acute (Oliguria stage); 24~48hr : U/O↓, USG↑, K↓, Na↓, Ca↑ → IV우선, LSX 1~2회/일, dehydration Diuretic stage ; 48hr ↑ U/O↑, USG↓, K↓, Na↓, Ca↑→U/O우선으로 봐준다

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집에서 enema할 때, 환자의 옳은 진술을 골라라 ① ~inch를 inser 하겠다. (12.x~13.x로 기억나요) ② Rt. lateral position 할 거에요 ④ enema tip이 insertion될 때, 입으로 gently breath out 할 거에요. Cathter ; 4inch(2.2cm;8-9cm), Lt side lying,open mouth, waiting 30-60cm

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.prostate Ca pt seald chemo f/u 할 것? ①임산부 만나지 않는다 ②너는 therapy 끝날 때 까지 어떤 가족도 만나지 않겠다

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herb 항우울제 복용하고 있는 환자가 kavakava 먹고 있다. ① 의사와 상의 후 먹어라 ②안전을 위해 먹어라 ③panic 상태에서 먹지 마라 ④ 간독성으로 복용하지 마라 *liver toxicity로 8wks ↓ 쓴다

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STUDY

Comes And Goes Complete Blood Cell Count End Stage Liver Disease Fat Soluble Vitamin Gastric Outlet Obstruction Hepatology Herpes Zoster Shingles

Hepatitis A,B,C – Flashcards 67 terms

Sam Arent

67 terms

Preview

Hepatitis A,B,C – Flashcards

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Hepatitisinflammation of the liver: causes

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drugs toxins alcohol viral infections (A, B, C, D, E) other infections (parasites, bacteria) physical damage

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Liver Functions:

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Stores sugar needed for energy Absorbs good nutrients Breaks down poisons (toxins) and drugs Makes important proteins that help build new tissue and repair broken tissue Produces bile, which helps remove waste from the body

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Acute Hepatitis:

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Short-term hepatitis. Body's immune system clears the virus from the body within 6 months

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Chronic Hepatitis:

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Long-term hepatitis. Infection lasts longer than 6 months because the body's immune system cannot clear the virus from the body

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Hepatitis A: Incubation period

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30 days on average (range 15-50 days) infectious latter half of incubation period while asymptomatic through 1 week after having jaundice.

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Hepatitis A: Symptoms

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A person may have all, some or none of these: Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain

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Hepatitis A: How do you get it?

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Feces (stool) on hands that gets on food or in water Contaminated shellfish Sex A person is most contagious 2 weeks before they feel sick Not spread by kissing, sneezing, saliva

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Hepatitis A: Diagnosis and Treatment

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Blood test No medicine or treatment to make it go away Rest, fluids, treatment of symptoms Most people recover completely and become immune to reinfection

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Hepatitis A: Prevention

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Shot of immune globulin up to 2 weeks after exposure Good hand washing Cook food well Good diaper hygiene Only drink clean water VACCINE!!!

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Hepatitis A: Who needs immune globulin?

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Living with someone with Hep A Eaten food handled by someone with Hep A Sexual contact with person with Hep A Traveling to an area where Hep A is common Child or employee at a child care program where someone else has Hep A

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Hepatitis B: What is it?

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Hep B is a serious disease caused by a virus that infects the liver Can cause lifelong infection, cirrhosis (liver scarring), liver cancer, liver failure and death

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Hepatitis B: Pathogenesis

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HBV carried in liver Mechanism of liver damage unknown Damage most likely results from immune response Virus replicates via reverse transcriptase Viral DNA transported to host nucleus Host mRNA makes RNA copy RNA copy transcribed by viral reverse transcriptase New DNA copy is genome for new virus New viruses bud from host cell

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Hepatitis B: Incubation period

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60-90 days on average (range 45-180 days) infectious weeks before getting ill and for variable period after acute infection chronic carriers remain infectious

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Hepatitis B: Symptoms

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Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain A person may have all, some or none of these

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Hepatitis B: Who is at risk?

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Anyone can get it In the USA, 200,000 people get Hep B every year 5,000 people die every year of Hep B If you have had other kinds of Hepatitis, you can still get Hep B

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Hepatitis B: Who is at highest risk?

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Injection drug users Sex partners of those with Hep B Sex with more than one partner Men who have sex with men Living with someone with chronic Hep B Contact with blood Transfusions, travel, dialysis

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Hepatitis B: How do you get it?

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Direct contact with blood or body fluids of an infected person sharing injection equipment sex baby from infected mother during childbirth Hepatitis B is not spread by food, water or casual contact

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Hepatitis B: Who is a carrier of Hep B virus?

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Some people with Hep B never fully recover from the infection (chronic infection) They still carry the virus and can infect others for the rest of their lives There are about 1 million carriers of Hep B in the USA

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Hepatitis B: Diagnosis and Treatment

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Blood test There is no cure Interferon/Ribaviron

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Hepatitis B: What about Hep B and pregnancy?

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A woman with Hep B can give it to her baby at birth Babies with Hep B can get very sick, can develop chronic infection and spread Hep B, can get cirrhosis or liver cancer Pregnant women should be tested for Hep B Babies should get Hep B vaccine at birth

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Hepatitis B: Who should get Hepatitis B vaccine?

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All babies, at birth All children 11-12 who have not had vaccine People at risk MSM Multiple sex partners Injection drug users People with jobs where exposure to blood might happen

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Hepatitis C: Pathogenesis

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Few details known Infection transmitted via contact with infected blood Incubation period average 6 weeks Over 80% develop chronic infections Virus infects the liver Incites inflammatory and immune responses Cell-mediated immunopathology Disease comes and goes Individuals have times of near normalcy 10% to 20% will develop cirrhosis or liver cancer

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Hepatitis C: Incubation period

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6-7 weeks on average (range 2-6months) infectious one or more weeks before getting ill chronic carriers remain infectious

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Hepatitis C: Symptoms

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Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain 3 out of 4 persons have no symptoms and can infect others without knowing it

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Hepatitis C: Who is at risk?

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About 35,000 people get Hep C every year down from 180,000 in the 1980s About 3.9 million people in the USA are infected with Hep C. It can cause liver failure, cirrhosis, liver cancer Responsible for 8,000 to 10,000 deaths/year.

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Hepatitis C: Who is at highest risk?

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Injection drug users Estimated that over 75% of injectors nationwide have Hep C In Seattle/King County, 86%

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Hepatitis C: How do you get it?

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Shared injection equipment (60% of new infections) Blood transfusion before May, 1992 (now only 1 in 100,000 chance of transmission) Blood transfer (HCW, tattoo, piercing ...) Sex? (HCV in semen and vf but only 1.5% rate of transmission for long-term partners) Mother to child (<5%) 10-20% of infections have no identifiable risk factors

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Hepatitis C: Diagnosis

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There is a blood test that screens for Hep C antibodies (ELISA or RIBA) Antibodies usually develop within 3 months HIV+ persons may not develop detectable antibodies There is a PCR test (detects parts of actual virus) for Hep C but it is not yet FDA approved If infected, liver enzyme tests or a liver biopsy can check liver function

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Hepatitis C: What happens when you have Hepatitis C ?

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85% of people develop chronic infection (infected for the rest of their life) Rapid progression, slow progression, no progression HCV subtype Alcohol consumption (alcoholics 3 times more likely to develop cirrhosis after 20 years) age (older at time of infection more rapid) gender (men faster progression than women)

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Hepatitis C: Long term pathogenesis

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Over time progressive liver damage may occur 20 -30 % of those infected will develop cirrhosis over 10 - 30 years Of those with cirrhosis 25-30% (5% of overall) will develop end-stage liver disease or liver cancer Many live without symptoms for decades Others experience mild symptoms --intermittent fatigue, nausea, and muscle aches

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Hepatitis C: Treatment

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Interferon/Ribaviron (suggest 40% "cure" rate) Peginterferon Alfa-2a (still in studies - not yet FDA approved)

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Hepatitis C: What should a person do who has Hep C?

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Get regular medical care--tell doctor about ALL drugs (including herbs)!!! Have a healthy diet (no iron supplements, reduce salt intake, no large doses of vitamin A) Get needed rest No alcohol or Tylenol, cut back on other drug use Avoid chemical fumes and other environmental toxins Get vaccinated for A and B!!! Do not share injection equipment. Do not donate blood or plasma, organs or sperm Do not share toothbrushes, razors Cover areas of open skin Use safer sex?

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Hepatitis C and HIV

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30 - 40% of HIV+ people in US also infected with Hep C More rapid progression of Hep C (twice as fast) Little to no affect on HIV progression (still inconclusive) Complications of medication regimens Increases risk of perinatal transmission

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Hep A, B, & C breakdown

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Hep A Structure: Picture

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Hep B Pathogenesis: Picture

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Hep B Structure: Picture

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Unique Features of Herpesviruses

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• Herpesviruses have large, enveloped icosadeltahedral capsids containing double-stranded DNA genomes. • Herpesviruses encode many proteins that manipulate the host cell and immune response. • Herpesviruses encode enzymes (DNA polymerase) that promote viral DNA replication and are good targets for antiviral drugs. • DNA replication and capsid assembly occurs in the nucleus. • Virus is released by exocytosis, cell lysis, and through cell-cell bridges. • Herpesviruses can cause lytic, persistent, latent, and (for Epstein-Barr virus) immortalizing infections. • Herpesviruses are ubiquitous. • Cell-mediated immunity is required for control.

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Disease Mechanisms for Herpes Simplex Viruses

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• Disease is initiated by direct contact and depends on infected tissue (e.g., oral, genital, brain). • Virus causes direct cytopathologic effects. • Virus avoids antibody by cell-to-cell spread and syncytia. • Virus establishes latency in neurons (hides from immune response). • Virus is reactivated from latency by stress or immune suppression. • Cell-mediated immunity is required for resolution, with limited role for antibody. • Cell-mediated immunopathologic effects contribute to symptoms.

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Epidemiology of Herpes Simplex Virus (HSV): Disease/Viral Factors

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• Virus causes lifelong infection • Recurrent disease is a source of contagion • Virus may cause asymptomatic shedding

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Epidemiology of Herpes Simplex Virus (HSV): Transmission

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• Virus is transmitted in saliva, in vaginal secretions, and by contact with lesion fluid (mixing and matching of mucous membranes) • Virus is transmitted orally and sexually and by placement into eyes and breaks in skin • HSV-1 is generally transmitted orally; HSV-2 is generally transmitted sexually

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Epidemiology of Herpes Simplex Virus (HSV): Who Is at Risk?

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• Children and sexually active people are at risk for classic presentations of HSV-1 and HSV-2, respectively • Physicians, nurses, dentists, and others in contact with oral and genital secretions are at risk for infections of fingers (herpetic whitlow) • Immunocompromised people and neonates are at risk for disseminated, life-threatening disease

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Epidemiology of Herpes Simplex Virus (HSV): Modes of Control

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• Antiviral drugs are available • No vaccine is available • Health care workers should wear gloves to prevent herpetic whitlow • People with active genital lesions should refrain from intercourse until lesions are completely reepithelialized

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Disease Mechanisms of Varicella-Zoster Virus (VZV)

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• Initial replication is in the respiratory tract. • VZV infects epithelial cells, fibroblasts, T cells, and neurons. • VZV can form syncytia and spread directly from cell to cell. • Virus is spread by viremia to skin and causes lesions in successive crops. • VZV can escape antibody clearance, and cell-mediated immune response is essential to control infection. Disseminated, life-threatening disease can occur in immunocompromised people. • Virus establishes latent infection of neurons, usually dorsal root and cranial nerve ganglia. • Herpes zoster is a recurrent disease; it results from virus replication along the entire dermatome. • Herpes zoster may result from depression of cell-mediated immunity and other mechanisms of viral activation.

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Epidemiology of Varicella-Zoster Virus: Disease/Viral Factors

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• Virus causes lifelong infection. • Recurrent disease is a source of contagion.

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Epidemiology of Varicella-Zoster Virus: Transmission

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• Virus is transmitted mainly by respiratory droplets but also by direct contact.

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Epidemiology of Varicella-Zoster Virus: Who Is at Risk?

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• Children (ages 5 to 9) experience mild classic disease. • Teens and adults are at risk for more severe disease with potential pneumonia. • Immunocompromised people and newborns are at risk for life-threatening pneumonia, encephalitis, and progressive disseminated varicella. • Elderly and immunocompromised people are at risk for recurrent disease (herpes zoster [shingles]).

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Epidemiology of Varicella-Zoster Virus: Modes of Control

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• Antiviral drugs are available. • Immunity may wane in the elderly population. • Varicella-zoster immunoglobulin is available for immunocompromised people and staff exposed to virus, as well as newborns of mothers showing symptoms within 5 days of birth. • Live vaccine (Oka strain) is available for children.

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Disease Mechanisms of Epstein-Barr Virus

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• Virus in saliva initiates infection of oral epithelia and spreads to B cells in lymphatic tissue. • There is productive infection of epithelial and B cells. • Virus promotes growth of B cells (immortalizes). • T cells kill and limit B-cell outgrowth. T cells are required for controlling infection. Antibody role is limited. • EBV establishes latency in memory B cells and is reactivated when the B cell is activated. • T-cell response (lymphocytosis) contributes to symptoms of infectious mononucleosis. • There is causative association with lymphoma in immunosuppressed people and African children living in malarial regions (African Burkitt lymphoma) and with nasopharyngeal carcinoma in China.

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Epidemiology of Epstein-Barr Virus: Disease/Viral Factors

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• Virus causes lifelong infection. • Recurrent disease is cause of contagion. • Virus may cause asymptomatic shedding.

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Epidemiology of Epstein-Barr Virus: Transmission

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• Transmission occurs via saliva, close oral contact ("kissing disease"), or sharing of items such as toothbrushes and cups.

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Epidemiology of Epstein-Barr Virus: Who Is at Risk?

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• Children experience asymptomatic disease or mild symptoms. • Teenagers and adults are at risk for infectious mononucleosis. • Immunocompromised people are at highest risk for life-threatening neoplastic disease.

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Diagnosis of Epstein-Barr Virus

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1. Symptoms a. Mild headache, fatigue, fever b. Triad: lymphadenopathy, splenomegaly, exudative pharyngitis c. Other: hepatitis, ampicillin-induced rash 2. Complete blood cell count a. Hyperplasia b. Atypical lymphocytes (Downey cells) (T cells) 3. Heterophile antibody (transient) 4. EBV-antigen specific antibody

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Disease Mechanisms of Cytomegalovirus (CMV):

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• CMV is acquired from blood, tissue, and most body secretions. • CMV causes productive infection of epithelial and other cells. • CMV establishes latency in T cells, macrophages, and other cells. • Cell-mediated immunity is required for resolution and contributes to symptoms; role of antibody is limited. • Suppression of cell-mediated immunity allows recurrence and severe presentation. • CMV generally causes subclinical infection.

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Epidemiology of Cytomegalovirus Infection: Disease/Viral Factors

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• Virus causes lifelong infection • Recurrent disease is source of contagion • Virus may cause asymptomatic shedding

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Epidemiology of Cytomegalovirus Infection: Transmission

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• Transmission occurs via blood, organ transplants, and all secretions (urine, saliva, semen, cervical secretions, breast milk, and tears) • Virus is transmitted orally and sexually, in blood transfusions, in tissue transplants, in utero, at birth, and by nursing

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Epidemiology of Cytomegalovirus Infection: Who Is at Risk?

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• Babies • Babies of mothers who experience seroconversion during term are at high risk for congenital defects • Sexually active people • Blood and organ recipients • Burn victims • Immunocompromised people: symptomatic and recurrent disease

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Epidemiology of Cytomegalovirus Infection: Modes of Control

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• Antiviral drugs are available for patients with acquired immune deficiency syndrome. • Screening potential blood and organ donors for cytomegalovirus reduces transmission of virus.

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HAV=

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~unenveloped-naked ssRNA virus ~food-borne/ fecal oral ~green onions, lettuce, spinach, raw dish

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HAV main symptoms

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~Jaundice ~clay-like feces ~pale stools

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HAV- route in body

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intestines--> liver--> bile--> stool Ingestion--> 10 day incubation--> increased feces viral load (contagious)--> symptoms by 3-6 weeks

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our antibodies vs HAV

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we can quickly make antibodies (2 types) to destroy HAV antibodies can also be used for Tx

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HBV transmission

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through sex or blood

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HBV similar to HIV?

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~uses reverse transcriptase ~you can live with it for a long time

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what is the main immunogenic factor in HBV?

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as budding, release the protein (HBsAg)-on surface of virion is released as well

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What is Hep D? and what is its relationship to Hep B?

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Hep D= delta agent its a small co-virus w/ Hep B and produces the most severe chronic form

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what type of virus is HCV?

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ssRNA

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End Stage Liver Disease Nursing Psychology

Chapter 16 Human Sexuality 46 terms

Edwin Holland

46 terms

Preview

Chapter 16 Human Sexuality

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STI - Sexually Transmitted Infection

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Infections that can be communicated through sexual contact.

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HPV - Human Papilloma Virus

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The organism that causes genital warts. It is estimated to be in at least 20% of Americans over the age of 12 and in more than 50% of some populations of college women. Also linked to cervical cancer.

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Chlamydia

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a sexually transmitted disease, the most common STI - more common than gonorrhea and syphilis. Caused by the bacterium Chlamydia trachomatis, a parasitic organism that can only survive within cells. Often producing no symptoms, it can cause pelvic inflammation, infertility, chronic pain, or a tubal pregnancy if left untreated. Infections are high among female teenagers and college students. Causes other types if infections: (NGU) Nongonococcal Urethritis in men and women, Epididymitis (infection of the epididymis) in men, Endometritis (infection of the endometrium), Cervitis (infection of the cervix) and PID in women.

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STI - How are they transmitted

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They are transmitted through sexual means, such as vaginal, anal and oral sex. Some STIs can be spread through nonsexual contact. HIV/AIDS and viral hepatitis my be spread by sharing contaminated hypodermic syringes. \"Crabs\" can be picked up from bedding or other objects, such as moist towels that harbor the infectious organisms that cause these STIs.

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(WHO)

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World Health Organization - Estimates that at least 333 million people around the world are infected with curable STIs every year. US is believed to have the highest rate of infection in the industrial world.

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Bacteria

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One-celled microorganisms that have no chlorophyll and can give rise to many illnesses. Some bacteria are needed for human life and some of which are harmful. Bacteria causes: pneumonia, tuberculosis, meningitis, STIs - gonorrhea, syphilis and chlamydia.

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Gonorrhea - \"Clap\" or \"The Drip\"

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A STI caused by the gonococcus bacterium / Neisseria gonorrhoeae and characterized by a discharge and burning urination. Was the most widespread bacterial STI in the US but it has been replaced by Chlamydia. About 355,000 new cases of gonorrhea are reported each year. Most new cases are contracted by people between the ages of 20 & 24. Highly contagious. Women stand nearly a 50% chance of contracting gonorrhea after one exposure. Men have a 25% risk of infection. Risk is higher for women because they retain infected semen in the vagina. Risk of infection increases with repeated exposure.

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Gonorrhea - Symptoms

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Men- Experience symptoms within 2-5 day after infection. Clear at first then changing to a yellowish, thick penile discharge, urethra becomes inflamed and burning urination, swelling and tenderness in lymph glands of the groin. Women - Primary sight of infection is the cervix. Increases vaginal discharge, burning urination, irregular menstrual bleeding (80% of women show no early symptoms) When left untreated it may spread through the urogenital system in both genders and strike the internal reproductive organs. Diagnosis - Clinical inspection, culture of sample discharge Treatment - Antibiotics: Injection of Ceftriaxone, ciprofloaxin, cefixime, ofloxacin

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Pharyngeal gonorrheal

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A gonorrheal infection that is characterized by a sore throat.

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Ophthalmia Neonatorum

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A gonorheal infection of the eyes of newborn children who contract the disease by passing through an infected birth canal. This disorder may cause blindness but has become rare because the eyes of a newborn are treated routinely with silver nitrate or penicillin ointment, which are toxic to gonococcal bacteria.

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Cervicitis

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The inflammation of the cervix. May cause a yellowish to yellow-green puslike discharge that irritates the vulva.

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Epididymitis

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Inflammation of the epididymis. Tenderness or pain in the scrotum are the main symptoms. Fever may be present. Could possibly effect the kidneys. Can cause fertility problems.

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Pelvic Inflammatory Diesease - PID

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Gonorrhea infection. The spread of bacterium through the cervix to the uterus, fallopian tubes, ovaries and other parts of the abdominal cavity. Symptoms - cramps, abdominal pain and tenderness, cervical tenderness and discharge, irregular menstrual cycles, sex pain,fever nausea and vomiting. Could occur without any symptoms. Can cause scarring that blocks the fallopian tubes, leading to infertility. Very serious illness that required aggressive treatment. Surgery may be needed to remove the infected tissue. Usually will clear up rapidly in over 90% of cases if caught early and treated early, but women usually do not show early signs.

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Syphilis

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A STI that is caused by Treponema pallidum bacterium, which may progress through several stages of development from a chancre to a rash to damage to vital body systems. Name means \"faintly colored (pallid) turning thread\" describing the corkscrew shape of the microscopic organism. It is also called a \"spirochete\" - meaning spiral and hair. It is treated with penicillin. Can cause heart disease, blindness, confusion and death. Syphilis killed the painter Paul Gauquin.

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Congenital Syphilis

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A syphilis infection that is present at birth. May impair vision and hearing, or deform bones and teeth.

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Syphilis - Origin

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The Columbus theory - Christopher Columbus returned from Spain with syphilis. He showed symptoms of advanced syphilis when he died in 1506. \"Pre-Columbian Theory\" - the theory that said that syphilis existed in Europe prior to voyages of Columbus.

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Syphilis - Transmission

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Is most often transmitted by vaginal or anal intercourse, or oral-genital or oral-anal contact with an infected person or by touching an infectious chancre (sore). Can't be caught from a toilet seat that was used by an infected person. Pregnant women my transmit syphilis to the fetuses because the spirochete can cross the placental membrane. This may cause miscarriage, stillbirth or congential syphilis. The fetus may not be harmed if the mother is treated before the 4th month of pregnancy.

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Chancre

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A sore or ulcer

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Syphilis - Primary Stage

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Primary Stage - 2-4 weeks after infection painless chancre appear at site of infection. (hard round ulcer like lesion with raised edges) Women - usually form on the vaginal wall or cervix, but can also form on the external genitalia most often forming on the labia. Men- the chancre forms on the penile glans or on the scrotum or penile shaft. If oral sex is performed on an infected person the chancre may form on lips or tongue. Anal - the rectum may serve as the site of the chancre. The sores usually disappear in a few weeks, but if the infection remains untreated the syphilis will continue to work withing the body.

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Syphilis - Secondary Stage

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Begins a few weeks to a few months later. A skin rash develops, consisting of painless, reddish, raised bumps that darken after a while and burst. Sores in the mouth, painful swelling of joints, sore throat, headaches and fever. Resembles flu like symptoms. These symptoms will disappear but the infection continue to do damage to the body.

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Syphilis - Latent Stage (3rd)

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It may lay dormant for 1-40 years. Spirochetes continue to multiply and burrow into the circulatory system, central nervous system (brain and spinal cord) and bones. After several years of the latent stage they may not be contagious to sex partners,but pregnant mothers can pass along the infection to her newborn at any time during birth.

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Syphilis - Tertiary Stage (4th)

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A large ulcer may form on the skin, muscle tissue, digestive organs, lungs, liver or other organs. The ulcer can be treated,but serious damage may occur when it attacks the central nervous system or cardiovascular system (the heart and major blood vessels) either outcome may be fatal.

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Neurosyphilis

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Syphilitic infection of the central nervous system,which can cause brain damage resulting in paralysis or the mental illness called general paresis. Can cause death.

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Syphilis - Diagnosis & Treatment

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Diagnosis is by clinical examination. If chancre is found, fluid is drawn out and examined under a microscope. Blood test are not definitive until the second stage begins. Penicillin is the treatment of choice for syphilis. Doxycycline and other antibiotics can be used if someone has an allergy to penicillin. Sex partners need to be examined.

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General Paresis

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A progressive form of mental illness caused by neurosyphilis and characterized by gross confusion.

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VDRL - Veneral Disease Research Laboratory

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Blood test used for detection of antibodies to Treponema pallidum.

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Antibodies

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Specialized proteins which are produced by the white blood cells of the immune system in response to the disease organisms and other toxic substances, and which recognize and attack the organisms or substances.

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Chlamydia Trachomatis - Transmission

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Usually transmitted through vaginal or anal sexual intercourse. May cause an eye infection if the person touches their eye after handing genitals of an infected partner. Oral sex can infect the throat. Newborns can acquire after passing through the cervix of an infected mother. Babies delivered through c-section can be infected if the amniotic sac breaks before delivery.

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Chlamydia - Symptoms

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Symptoms are similar to the symptoms of gonorrhea, but are more mild. Most often appear with gonorrhea

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Chlamydia in Men - Nongonococcal Urethritis

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It is an inflammation of the urethra. May produce a thin, whitish discharge from the penis and some burning or other pain during urination. These contrast with the yellow-green discharge and intense pain of gonorrhea. There may be soreness in scrotum an feeling of heaviness in testes. Young male adults are at highest risk. Untreated infections can damage reproductive organs in men.

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Chlamydia in Women

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Usually and infection in the urethra or cervix. May experience burning when they urinate, genital irritation and a mild vaginal discharge, pelvic pain and irregular menstrual cycles. Cervix may look swollen and inflamed.25% of men and 75% of women have no noticeable symptoms. \"the silent disease\" Can lead to PID, scarring the fallopian tubes, resulting in infertility. Have a greater chance of ectopic pregnancy.

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Chlamydia - Diagnosis and Treatment

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Various test are used to verify a diagnosis of chlamydia in women. The test analyze a cervical smear are highly reliable. In men a swab may be inserted through the penile opening to extract fluid that can be analyzed. Many doctors screen young women during regular treatment do to the way this disease is symptom-free many times. Treatment: Antibiotics other than penicillin are highly effective against chlamydia. Azithromycin, Doxycycline, Ofloxacin and Amoxicillin are the antibiotics used.

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Chancroid - \"soft chancre\"

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A STI caused by the bacterium Hemophilus ducreyi. It is found in the tropics and Eastern nations. The sore consists of a cluster of small bumps or pimples on the genitals, perineum or the anus. The lesions appear within 7 days of infection. In a few days the lesion ruptures producing an open sore or ulcer. Several ulcers may merge with others forming giant ulcers. There is usually swelling of a near by lymph node. It is different from the syphilis chancre because it has a soft rim and is painful in men. Women don't usually have pain and may be unaware of being infected. Transmitted through sexual or bodily contact with the lesion or its discharge. Confirmed by culturing the bacterium (found in pus). Antibiotics are usually effective in treating the disease.

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Young People & Risky Behavior

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Perceived low risk of infection - Heterosexuals perceive a low risk of contracting HIV. Negative attitudes toward condom use - seen as too much fuss and decreases sexual sensations. Myth of personal invulnerability - they believe that they are somehow immune to HIV/AIDS and other diseases.

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Safer Sex - How?

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Abstinence or Monogamy, be knowledgeable about risk, remain sober,inspect yourself and your partner,use latex condoms,use barrier devices when practicing oral sex, avoid high risk sexual behavior,wash the genitals before and after sex, have regular medical checkups, possibly undergoing testing before sexual relations, engage in non sexual activities,

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Outercourse

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Forms of sexual expression such as massage, hugging, caressing, mutual masturbation and rubbing bodies together that do not involve the exchange of bodily fluids.

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Scabies - Sarcoptes Scabiei

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A parasitic infestation caused by a tiny mite that may be transmitted through sexual contact or contact with infested clothing, bed linens, towel and other fabrics. The mites attach themselves to the base of pubic hair and burrow into the skin where they lay eggs and subsist for the duration of their 30 day life span. Often found in the genital region and cause itching and discomfort. Signs red lines, sores,welts or blisters on the skin. Most often found on hands, wrists, can be found on genitals, buttocks, armpits, and feet.

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Scabies - Treatment

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May be treated effectively with 1% lindane (Kwell). The whole body from the neck down needs to be covered with a thin layer of medication, needs to stay on for 8 hours. Lindane should not be used by pregnant or nursing woman. Partner needs to be treated, clothing and bedding needs to be washed in hot water or dry cleaned. Sexual contact needs to be avoided until infestation is cleared.

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Pediculosis - (pubic lice) \"crabs\"

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Infestation of a parasite pubic lice. They belong to a family called biting lice. When they are in the adult stage they are able to be seen with the naked eye. They are spread sexually, can also be spread by using an infested towel, sheet or toilet seat. They can survive for only about 24 hours without a human host, but may deposit eggs that can take up to seven days to hatch in bedding or towels. Bedding,towels and clothing has to be washed in hot water and dried on a hot cycle or dry cleaned. Fingers can transfer them to other parts of the body with hair. Symptoms - Itching. The itching is caused by the crabs attaching themselves to the pubic hair and piercing the skin to feed on blood. Lifespan is 1 month can lay lots of eggs before they die. Can be treated with 1% solution of lindane (is a prescription Kwell - brand name). Come in cream, lotion and shampoo. Non prescription - medications containing pyrethrins or piperonyl butoxide (RID, Triple X and others.) Kwell can not be used by pregnant or nursing mothers.

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Ectoparasites

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Parasites that live on the outside of the host body. Pubic Lice and Scabies.

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Molluscum Contagiosum

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An STI that is caused by a pox virus that causes painless raised lesions to appear on the genitals, buttocks, thighs and lower abdomen. Lesions with pinkish appearance with a waxy or pearly top. They appear after 2-3 months from infection. People usually have 10-20 lesions, but could have up to 100. They disappear in about 6 months, are not associated with any serious complications. Solutions of podophyllin, Trichloroacetic Acid TCA or silver nitrate are used. Freezing with liquid nitrogen (cryotherapy). Needs to be treated by doctor.

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Shigellosis

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Caused by the Shigella bacterium. Symptoms are fever, severe abdominal symptoms, diarrhea and inflammation of the large intestine. Can be a result from food poisoning, but often caused by oral contact with infected fecal material, which may stem from oral-anal sex. Usually resolves itself, severe cases are treated with antibiotics. Person may become dehydrated from the diarrhea.

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Granuloma Inguinale

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It is cause by the bacterium calymmatobacterium granulomatous and is not contagious. Rare in the US usually found in tropical areas. Symptoms - painless red bumps or sores in the groin area that ulcerate and spread. Spread by sexual contact or contact with the lesion or discharge. Diagnosed by looking at sample of tissue from the rim of the sore under a microscope. Treated with antibiotics, but left untreated could develop fistulas (holes) in the rectum, or bladder, destruction of infected tissues or organs, scarring or skin tissue that results in a condition call elephantiasis. This is what afflicted the so called elephant man.

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Elephantiasis

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A disease characterized by enlargement of parts of the body, especially legs and genitals, and by hardening and ulceration of the surrounding skin.

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Lymphogranuloma Venereum (LGV)

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Another tropical STI. Rarely in US or Canada. Caused by several strains of Chlamydia Trachomatis bacterium. Enters body through vulva, penis,or cervix where a painless sore may develop. Sore may not be noticed but the lymph gland in the groin swells and becomes tender. Other symptom are flu like. Possible backache (more so in women) and arthritic complaints) painful joints. If it is not treated, growths and fistulas in the genitals and elephantiasis of legs and genitals may occur. Diagnosis made by skin & blood test. Antibiotics are used for treatment.

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Vaginitis

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Any type of vaginal infection or inflammation. Symptoms are usually - genital irritation, itching, burning while urinating, but most common is a discharge with an odor. Caused by organisms that reside in the vagina or by sexually transmitted organisms.

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