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126 Cards in this Set
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VHY***
What are each of the waves due to in JVP waveformL a, c, x and v? |
a-late diastole, atrial contraction
C-when blood hits the tricuspid valve during systole, ventricular contraction x -negative pressure by blood getting sucked up pulmonary artery V - filling of the right atrium, begining of diastole y - when atrium is emptying, but w/o contraction |
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patient has absent a wave and loses S4 if they had it, dx?
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A-fib
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if you had a huge a wave, dx?
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Tricuspid stenosis
called a giant a wave |
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If you had giant cv wave, DX?
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tricuspid regurgitation
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what produces turbitiy of plasma when you draw someones blood in a test tube?
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Tryglyceride not cholesterol
two fractions that carry Tryglycerides: chylomicrons diet derived TG's and VLDLs - liver derived |
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How do you get a true Tryglyceride level?
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Fast for at least 12 hrs because what you ate will screw it up...
But not for HDL cholesterol or Cholesterol itself. |
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which is more dens VLDLS or Chylomicrons?
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VLDLS because they have more protein
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most common lipid disorder?
Have high VLDL |
type IV hyperlipoproteinemia:
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patient w/ xathelasma (eyelids and achilles tendon) what causes it, DX?
what is the inheritance pattern what is the problem? |
increased cholsterol (need to check there level,
familial hypercholesterolemia (type II hyperlipoproteinemia) (xathelasma in achilles tendon is pathopneumonic) AD absent LDL receptor |
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what is the most common cause of Type IV hyperlipoproteinemia?
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alchol excess
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what was the first gene therapy that worked
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SCID gene replacement
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VHY***
How does atherosclerosis develop? |
endothelial damge of muscular and elastic areteries (e.g. HTN, smoking tobacco, homocysteine, LDL)
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what lesion is pathognomonic for atherosclerosis?
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Fibrous cap
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Atherosclarosis is the primary factor of many disease, list some examples
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AAA, coronary artery sclerosis, non-traumatic limb amuptation, mesenteric angina, small bowel infarction, reval vascular HTN...
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can small vessels get hardened?
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yes,
hyaline arteriolosclerosis (homongenous pink staining) |
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what is an exelent marker for disruption of fibrous plaques
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C-reactive protien
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what is the most common site for atherosclerosis, why?
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Abdominal aorta...because no vasovasorum(none after renal arteries)...only gets oxygen from blood in its lumen.
next is coronary artery |
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Diabetes and HTN produce what type of vessel damage
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hyaline arteriolosclerosis
non-enzymatic glycosylation |
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How diabetes causes damage to our body?
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Two mechanism and they both relate to excess glucose:
1.non-enzymatic glycosylation- (glucose attaching to AA and protein)...including capillaries in the kidneys...makes BM permeable to protiens...causing hyaline change and narrowing the lumen. 2.osmotic damage - aldose reductase is found in the following tissues: lens pericytes in the retina and schwann cell, they can convert glucose to sorbitol which sucks water into it away from the other tissues and those tissues die and causing (cataracts, micoanuersysm (pericytes die), peripheral nueropathies) |
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How does HTN
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Because diastolic blood pressure is so high it just pushes protiens through the BM of the vessels...once protein is there you get the hayline change and narrowing of the lumen...
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Onion skin appearnce of the arterioles
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vessel disease of malignant HTN, hyperplastic arteriosclerosis
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what is an aneurysm?
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area of out-pouching from weaking of the vessel wall... once it starts weaking it will contiune (law of law
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what is analagous to AAA in the lungs
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bronchiectasis - weaking and buldgin out, usually from cytstic fibrosis
diverticular disease |
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what is the most common complication of AAA?
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rupture
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sudden onset of left flank pain, pulsitile mass and hypotension, DX
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A.A - left flank pain because it is retroperitoneal
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Aotic arch aneurysm from vasculitis of vasovasorum...dx
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tertiary syphilis...weakening of vessel wall from necrosis of vasovasorum and aortic wall..this also causes aortic regurgitation because stretch of annular ring.
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what is the pathology of syphilis
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they infect small vessels...vasculitis - chanre as well (ischemic necrosis...also destroys nerves which are near by)
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most common complication of an aneurysm?
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rupture
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The key factor for causing a tear in the aorta, i.e. aortic dissection?
what is the most common location? |
HTN...elatic tissue fragmentation
proximal arch of the aorta...if it rupture out then they get cardiac tamponade |
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Patient presents w/ tearing retrosternal chest pain tha tgoes into the back, diminished pulse on the left compared to the right X-ray shows widening of the arotic nob?
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Aortic dissection
diminished pulse on the left is because the lumen of the left subclavian often becomes occluded as a result. |
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screening test of choice for Aortic dissection, what is the test to confirm this?
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chest x-ray showing proximal aortic nob widening.
prove w/ transesophageal echo |
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RIsk factors for Aortic dissection?
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1.HTN
2.Marfan syndrome (AD, chr.15, defect in fibrilin (component of elastic tissue, so it is weak) 3.ehlers-Danlos (EDS) - defect in collagen 4.pregnancy - from having twice the amount of plasma volume |
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what is the most common cause of death in Marfans syndrome?
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mitral valve prolapse
next is aortic dissection |
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What is the most common cause of death in Ehler danlos syndrome?
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Dissecting aortic anuerysm
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what is the most common cause of death in an aortic dissection?
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cardiac tamponade
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Patient w/ small cell carcinoma of the lungs and now complains of headache, retinal vein engorgment"puffiness" and blue to purple discoloration of the face, arms and shoulders, DX?
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Superior venal caval syndrome-knock of the supperior vena cava
back-up of blood into the venous system |
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VHY***
patient has a slightly raised purple lesion on cheek and near the eye(distrubition of the trigemnial nerve) that grows as they age (present since birth), they are slightly mentally retarded, DX what can also be seen in the brian in this person? what is the cause of the birthmark? |
sturge wever -vascular malformation an AV malformation may also be seen in the leptomeninges
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why do people w/ cirrhosis get spider angiomas
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becasue you can't metastasize estrogen
17-ketosteroids can't be metabolized by liver and are aromatized by adipose and get more estrogen |
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When is a spider angioma normal?
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In pregnant women from high levels of estrogen,
spider angioma is a AV fistula-pass capillaries, disspears when compressed they blanch unlike petechiae |
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capillary hemangiomas tx?
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leave them alone
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what is the mos common benigh tumor of the liver and spleen
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cavernous hemangioma..may rupture if large
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patient has red spots on the skin in the mouth and in the GI tract and they are iron deficient...they blanch, DX?
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Hereditary telangiectasias (AD)
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THis is a malignant tumor arising from endothelial cells, associated w/ human herpesvirus 8 DX?
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kaposis sarcoma
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VHY***WILL BE ON BOARDS
Lesion is noly seen in AIDS patients and it looks like kaposis but is caused by a bacteria, DX? Causative agent? how do you visualize it? treatment? |
Bascillary angiomatosis
bartonella hensalae seen w/ silver stain treat w/ a sulfer drug |
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Angiosarcoma of the liver is caused by what two main things, what type of people are exposed to these things?
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arsenic (contaminaed water and dipping your dog), vinyl chloride (people who work w/ plastic)
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Patient has palpable purpura what type of vasculitis is this?
what type of Hypersensitivity and necrosis is this? examples |
small vessel vasculitis (arterioles, venules and capillaries)
fibrinoid necrosis and they are all immune complexes so its Type III hypersensitivity Henoch-Schonlein purpura, microspcopic polyangitis |
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Thrombosis (results in an infarction) and aneurysm formation is what type of vasculaitis?
examples |
Medium vessel (muscular arteries)
Polyarteritis nodosa wegeners granumolatosis, kawasakis - coronary vasaculitis |
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most common cause of an MI in kids
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Kawasakis disease...coronoary artery vasculiits causing thrombosis and infarction
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absent pulse or stroke is what type of vasculitis
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large vessel vasculitis (elastic arteries) e.g. tayayasu arteritis, giant cell arteritis (temporal arteritis)
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why is purpura do to thrombocytopenia not papable?
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because it is associate w/ acute inflammation.
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what do antineutrophil cytoplasmic antiboides do?
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activate neutrophils causing the release of their enzymes...resulting in vessel damage
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c-ANCA is associated w/
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Wegeners granulomatosis...antibodies against protinease 3 in neutrophils
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p-ANCA is associated w/
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antibodies against myeloperoxidase and microscopic polyangitis and churg-strauss syndrome
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VHY***
Young asian women has presents w/ abscent pulse, visual field defects and ends up having a stroke, DX? pathogenesis |
Takayasus arteritis (pulseless disease)
large vessel vasculitis (granulomatous vasculitis involving the arch of the aorta) |
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patient has pain when they chew and, pain in the temporal artery and they have muscle aches and pain, they also say they are starting to have difficulty seeing.
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temporal arteritis, granulomatis artertitis, treat w/ corticosteroids for 1 yr starting immediatley
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only indication of SED rate is to screen for
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temporal arteritis...
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Patient that smokes he presents w/ raynauds, ulceration and digital vessel thrombosis, DX?
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Buegers disease
...medium vessel vasculitis |
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child less than 4 has adesquamating rash, swelling of hands and feet , vervical adenopathy
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Kawasaki disease
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VHY************
14 yr old boy had an upper respiratory tract infection one week ago, he then developed palpable purpura on the thigh and buttocks and lower extremeties, had polyarteritis and hematuria (w/ RBC casts) |
Henoch-schonlein purpura most common vasculitis of children, problems are from immune complex deposition...
hematuria is from glomerulonephritis (type III hypersensitivity) palpable purpura is only in the lower extremities |
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most common cause vasculitis in children
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henoch-schonlein purpura
IgA immune complex |
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VHY****
Patient presents w/ saddle nose deformity, sinus infections and upper respiraotroy, nodular masses and cresentic glomerulonephritis, DX and pathophysiology? what is the treatment of choice? what antibody is positive in this patient? |
Wegeners granulomatosis - granulomatosis inflammation and a vasculitis (involves the airways and kidneys)
c-ANCA (highly specific) cyclophosphamide |
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what are the side effects of cyclophosphamide?
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bladder cancer and hemorrhagic cystitis give mesna to prevent hemorrhagic cystitis
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IV drug abuse w/ chronic hepatits B nodular inflammed mass on the lower extremity and hematuria, DX?
what is antibody is positive in this patient? |
polyarteritis nodosa -inflammation of medium sized arteries so you see infarctions (e.g. hematuria, kidney infarct other orgnas can be involved) will also see skin involvement (ischemic ulcer) usually on the shin...assocaited w/ hepatits B.***
p-anca |
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VHY****
Polyarteritis nodosa is associated w/ what other disease? |
Hepatitis B surface antigen
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Presentation of rocky mountain spotted fever?
what is the vector and the bug that causes this? what cells do they infect? |
little red spots (petechiae) that start on extremities and goes to the trunk,
tick is the vector Rickettsia rickettsii (all start w/ R) endothelial cells-intranuclear microrganism*** |
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What is the other tick born disease that you get from bein out in the woods, and you get a bulls eye rash
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lyme disease - burrelia burgdorferi (spirochete)
recurrentis - spirochete but this causes relapsing fever... |
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VHY***
patient has diabetic kektoacidosis and develops a cerebral abscess of the brain what is the cause? |
mucormycosis-wide angled non-septated
diabetics commonly have this in their sinus and go crazy when there is lots of glucose around |
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Patient goes out side and gets raynauds in the cold and there nose turns blue what are the two likley causes?
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cryoglobulin C w/ hep C or IgM cold agluttinin
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this disease first presents w/ raynauds phenomenon and is caused by a vasculitis w/ eventual fibrosis, DX?
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progressive systemic sclerosis (CREST is the variation)
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VHY****
clacinosis and centromere (specific for this disease) antibody, raynauds, esophogeal dysmotility, sclerodactly and telangiectasias, DX? what is the cause of the raynauds phenomenon? |
CREST - digital vessel vasculitis
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Vasoconstriction diseases that can cause Raynauds phenomenon
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migrane headaches that take ergot derivatives
Buegers disease |
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what are the most common causes of death in HTN (1-3)?
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MI, Stroke and renal failure
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what racial group has the highest incidence of HTN (essential HTN, 95)
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Black (elderly as well)...polygenic inheritance (multifactorial inheritance), they retain salt (kidney dosn't get rid of it as well.
Affect disorder, congenital pyloric stenosis, type II diabetes, and gout are all also multifactorial |
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what does multifactorial mean
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some things you can't control but some things you can that can reduce your risk.
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how would you prevent gout?
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keep purines down - no meat or alcohol
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Why do you get and increase in systolic BP (leading to HTN) when you retain salt, called essential HTN?
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Retained salt in the ECF...causes plasma volume to be increasd... stroke volume increases (so systolic BP is UP)
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why does your diasatolic BP go up when you retain salt during essentail HTN?
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salt goes into your smooth muscle of your perihperal resistane arterioles...which allows alcium to go in and contracts the SM increasing TPR...increasing you diastolic BP
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Drug of choice for essential HTN
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hydrochlorathiazide- reduce plasma volume and salt
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IS essential HTN a low or high renin system?
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low renin
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Most common problem of HTN
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left ventricular hypertrophy...afterload problem (have to contract against increase resistance)
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What is systolic BP and diastolic BP?
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systolic - correlates w/ stroke volume - SV=CO*HR
diastolic - volume of blood in the arteries while the heart is filling up. (depends of TPR |
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Common causes of death form HTN
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MI, stoke and then renal failure
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what is the most common cause of secondary HTN?
What is the pathogenesis? |
renovascular HTN
Decreased renal arterial blood flow activates the RAAS system...angiotensin II vasoconstricts TPR...aldosterone increases sodium retention |
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pateint has uncontrolled severe HTN, increased plasma renin activity...involved kidney has increased renin levels whereas the univolved has decreased, DX?
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renovascular HTN
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what type of infarcts occur to the brain w/ HTN?
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lacunar infarcts
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Thick conentriacally dialted heart, what is the cause
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increased afterload***, aortic stenosis, or inc. TPR
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dilated and hypertrophied heart whati is the cause
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increased preload***, excess volume of blood, aortic regurgitation
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S1 and S2...what is the cause of the sounds.
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S1 -closing of the mitral (frist, more pressure)and tricuspid
S2 (can be split w/ inspiration because more blood comes in)- arotic and pulmonic (varitation w/ inspiration) |
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S3 what is the cause of the sound.
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blood in diastole that goes into a chamber that is overloaded...makes a turbulant sound (LHF, RHF...congested and get volume overload)
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S4
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Late diastole - when atrium is contracting and there is a problem w/ compliance (creating a vibration, from hypertrophy of left ventricle or all ready filled)
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So w/ HTN what type of heart sound might you hear?
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S4
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CHF what heart sounds would you hear?
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S3 and S4 gallop rythym
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How can you tell if the abnormal sound is from the left or the right?
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all right sided heart sounds increase in intensity on inspiration...more blood pulled in remember
On expiration if they get worse it is on the let side of the heart beacuse as the breath out pushes things out... |
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systolic ejection murmur, radiates into the carotids, increases on expiration and you hear an S4, what type of murmur is it?
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If its systolic and ejection who is opening on systolle...aortic an pulmonic valve)...worse on inspiration so it has to aortic stenosis (diamond shape) heard best at 2nd intercostal space on the left
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left side, ejection murmur increases on inspiration, DX?
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pulmonic stenosis
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you hear a murmur that is best heart at the apex it gets louder on expiration and has an opening snap and midiasolic rumbling during diastole.
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MITRAL regurgitation, (all that blood that build up behind the atrium and rushes in creates the rumble).
underfilling the left ventricle so no hypertrophy of the left ventricle*** |
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who closes during systole?
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mitral and tricuspid valve
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who is opening during diastole
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aortic and pulmonic valves
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Pancystolic or close to (straight line effect), apical murmur s3 and s4 increases in intensity on expiration.
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Mitral regurgitation
S3 from overfilling (each time blood goes back up into atrium and end up w/ to much blood trying to be put in the ventricle S4 - from atrium contracting and spilling out extra blood that was in it. |
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IV drug abuser w/ fever, had a pancystolic murmur, S3 S4 murmur and got worse on inspiration at the midsternal border on the right
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infectvie endocarditis creating tricuspid regurgitation.
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what happens to the atrium and the ventricle walls in mitral stenosis?
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atrium hypertrophies because it has to work hard against resistance
ventricle does not hypertrophy |
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what other common problem do you see in people who have mitral stenosis
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A-fib from left atrium dialtion and hypertrophy
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What clinal symptom might a patient complain of form dialtion of the left atrium?
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most posterior so it could compres the esophagus and cause dysphagia
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what is the most common cause of mitral stenosis
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recurrent attackes of rheumatic fever
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patient has a pansystolic murmur during sytole that radiates into the axilla, dyspnea and cough, DX?
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mitral regurgitation (hear the murmur the whole time during sytolle)
couph and dyspnea from LHF...fluid is backing up in the lungs will also see left ventricular hypertrophy (increased fillin of Left ventricle each time do to pushing extra blood back into the atrium) |
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what is the most common cause of mitral regurgitation?
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mitral valve prolapse-AD inheritance assocaiated w/ Marfans and Ehler danlos as well
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what is the consitency of the mitral valve from mitral valve prolapse?
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myxomatous degeneration of teh leaflets from excess production of dermatan sulfate
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Mid-systolic click is heard w/ a mid to late systolic murmur heard
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mitral valve prolapse
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what is the most comon cause of aortic stenosis
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dystrhophic calcification of normal and bicuspid valves
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what type of valvular lesion would most likley cause syncope and angina w/ excercise?
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Aortic stenosis - dec. blood flow throught the stenotic valves during excercise means less blood for the coronaires and the breina
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Patient has an early diastolic murmur (high "pitched blowing") and bounding pulses and a puslatin uvula, DX?
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aortic regurgitation...
occurs in diastole because thats when the valve normally closes |
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most common cause of infective endocarditis?
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streptococcus viridans (alpha hemolytic, no capsule (- quellung), optochin resistant and not bile soluble)
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most common cause of Infective endocarditis in IV drug abusers?
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Staph auerus
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Most common casue of infective endocarditis in prosthetic heart valves?
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staph epidermidis (catalase positive coagulse negative and novobiacin sensitive)
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what valvue is usually involved in infective endocarditis?
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mitral
tricuspid and aortic if IV drug abuser |
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how does staph A versus strep Viridans caus infective endocarditis
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Viridans effects damaged valves whereas Auerus effects normal valves
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what are the problems that are encounterd in infective endocarditis?
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1. friable vegetations embolize producing abscesses and infarction in distant orgna sites
2. valve destruction causing regurgitation |
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patient presents w/ a new onset murmur, red lines under the finger nails, hematuria, fever, splenomegaly, DX?
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infective endocarditis
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If you find sterile vegitations on the mitral valve, what is the diagnosis?
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SLE - called libman-Sacks endocarditis...can cause a murmur as well
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patient present for a well visit exam w/ his doctor during the Hx the patient says the only thing he had as kid was a couple recurrent episodes of sore throat w/ polyarthritis that required antibiotics...during the visit you notice a diastolic murmur that radiates into the axilla, DX?
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Endocarditis from rheuatic fever
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what is the pathogenesis of rheuatic fever?
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immune mediated type II hypersensitiviy rxn (cross rxn w/ step pyogenes (A) M protien w/ similar human proteins); cell-mediated immunity
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what would you see on the heart valve in rheumatic fever endocarditis?
how does an acute attack vs chronic disease effect the heart valve |
sterile, verrucoid-appearing vegetation that don't embolize.
Mitral reguritation in acute attack and mitral stenosis in chronic disease |
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what is the most common cause of death in acute rheumatic fever?
how would you make the diagnosis at atopsy |
myocarditis- aschoff bodies are present (fibrinoid necrosis surrounded by antischkow cells (reactive hisotiocytes))
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patient has friction rub, DX?
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pericarditis
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Fetal circulation?
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umbilical vein (most o2)...inferior vena cava drains into left atrium though the forem ovale...aorta shunts blood up to brain...superior vena cava drains into right atrium/ventricle... from pumonary artery most blood goes to the aorta throught the patent ductus arteriosus.
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what keeps the patent ductus arteriosus open?
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prostaglandin E2
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