Metabolism And Homeostasis 2012

Front 1

What are the two components of blood pressure?

Back 1

Cardiac output and peripheral resistance

Front 2

What are the two components of cardiac output?

Back 2

Heart rate and cardiac stroke volume

Front 3

What are the three components of stroke volume?

Back 3

Cardiac contracility, venous return to the heart and resistance the left ventricle must overcome to inject blood into the aorta (aortic pressure)

Front 4

What are the four components of peripheral resistance?

Back 4

Circulating regulators, direct innervation, local regulators, and blood viscosity

Front 5

As you increase in age, cardiac output plays a more dominant role in determining blood pressure (T/F)

Back 5

False

Front 6

Total peripheral resistance increases with age (T/F)

Back 6

True (e.g. due to increased atherosclerosis)

Front 7

What are the four systems directly responsible for blood pressure regulation?

Back 7

Heart (supplies pumping pressure), blood vessel tone (determines systemic resistance), kidney (regulates intravascular volume), and hormones (modulate the function of the other systems)

Front 8

Atherosclerosis associated with hypertension results in plaque formation and narrowing throughout the arterial vasculature (T/F)

Back 8

True

Front 9

Name the five common sites for atherosclerotic lesions to appear?

Back 9

Coronary arteries, aorta, major arteries of the lower limb, neck and brain.

Front 10

Name five problematic processes of peripheral vascular disease?

Back 10

1) Narrowing of the vessels by plaque formation
2) Plaque ulceration or rupture
3) Intraplaque hemorrhage
4) Peripheral emboli
5) Weaking of the vessel wall (aneurysms)

Front 11

Write the formula governing vascular resistance?

Back 11

Vessel length/vessel radius^4

Front 12

The significance of a stenotic vessel lesion depends mainly on vessel length (T/F)

Back 12

False: the degree of vessel narrowing is far more important

Front 13

Name the three portions of the arterial wall?

Back 13

1) Intima: innermost layer
2) Media: muscular layer
3) Adventiva: contains mast cells

Front 14

Contraction of the smooth muscle layer in the media results in decreased resistance of the artery (T/F)

Back 14

False

Front 15

What is the main symoptomatic manifestation of increased peripheral resistance?

Back 15

Decreased exercise/activity tolerance

Front 16

What is the term for smooth and silent blood flow in a vessel?

Back 16

Laminar flow

Front 17

What is the term for turbulent flow found on physical exam?

Back 17

Bruit

Front 18

What are the common sites which should be checked for Bruits?

Back 18

Carotid vessels and over the kidneys

Front 19

Structural or hormonal changes are the most common cause for hypertension (T/F)

Back 19

False: essential hypertension is the most common cause

Front 20

The blockage of calmodulin binding with calcium results in lower blood pressure (T/F)

Back 20

True

Front 21

Atherosclerosis increases aggregation of platelets at the affected site (T/F)

Back 21

False: it inhibits platelet aggregation

Front 22

Name the five most commonly used classes of antihypertensive drugs?

Back 22

1) Diuretics
2) ACE inhibitors
3) Angiotensin receptor blockers
4) Long acting calcium channel blockers
5) Beta-blockers

Front 23

Name 5 important causes of hypertension?

Back 23

1) Essential hypertension
2) Chronic renal disease
3) Primary aldosteronism
4) Renovascular causes
5) Other: pheochromocytoma, coarctation of the aorta and Cushings syndrome

Front 24

Name one of the most important regulators of blood pressure?

Back 24

Angiotensin 2

Front 25

Name six negative consequences of hypertension?

Back 25

1) Heart failure
2) Myocardial ischemia and infarction
3) Aortic aneurysm and dissection
4) Stroke
5) Nephrolsclerosis and renal failure
6) Retinopathy

Front 26

List three non-modifiable risk factors for heart and vascular disease?

Back 26

1) Age: Males >45, females >55
2) Family History: 1st degree relative with early heart disease (M<45. F<55)
3) Male sex

Front 27

List 5 modifiable risk factors for heart and vascular disease?

Back 27

1) Smoking
2) Hypertension
3) High cholesterol
4) Low HDL cholesterol
5) Diabetes Mellitus

Front 28

A stable plaque has a thin fibrous cap (T/F)

Back 28

False: unstable plaques have a thin cap

Front 29

List 4 clinical manifestations of atherosclerotic disease?

Back 29

1) CAD: coronary artery disease
2) PAD: peripheral artery disease
3) CVD: cerebral vascular disease
4) CKD: chronic kidney disease

Front 30

What percentage of patients over age 40 develop cardiovascular disease?

Back 30

60%

Front 31

Cardiovascular disease reduces life expectancy by 11-12 years for patients aged >50 (T/F)

Back 31

True

Front 32

At what percentage of occlusion will flow through a vessel be sufficient to cause angina?

Back 32

70%

Front 33

What will the majority of patients with significant stenosis present with?

Back 33

Acute myocardial infarction

Front 34

List the signs and symptoms of angina

Back 34

Usually central pain and discomfort. Can radiate to one or both arms. Can be associated with nausea, fatigue, shortness of breath, sweating, light headedness or weakness

Front 35

List the characteristics of stable angina

Back 35

Occurs during physical exertion, short time course (5-15 minutes), is relieved by rest/medications

Front 36

List the characteristics of unstable angina

Back 36

Occurs at rest, comes as a surprise, more severe and lasts longer ( can be 30 mins), not resolved by rest or medication and may get worse over time (crescendo)

Front 37

List the four functional classifications of angina

Back 37

1) FC-1: provoked with exertion
2) FC-2: provoked walking >2 blocks or 1 flight of stairs
3) FC-3: provoked walking <2 blocks or < 1 flight of stairs
4) FC-4: provoked with minimal activity or at rest

Front 38

What are the characteristics of variant angina?

Back 38

Usually occurs at rest/night, tends to be severe, caused by vasospasm, and is relieved by nitroglycerine or caclium channel blockers

Front 39

What is claudication?

Back 39

Claudication, literally 'limping' (Latin), is a medical term usually referring to impairment in walking, or pain, discomfort or tiredness in the legs that occurs during walking and is relieved by rest

Front 40

What are the two major categories of stroke?

Back 40

Ischemic and Hemorrhagic

Front 41

Name the three findings most likely to lead to the correct identification of a stroke?

Back 41

1) Sudden onset facial weakness/visual disturbance
2) Arm drift and/or leg weakness
3) Abnormal speech

Front 42

Most cases of ischemic stroke typically start suddenly (sec to min) and progress further (T/F)

Back 42

False: ischemic stroke will not progress further

Front 43

Which stroke types are associated with headache?

Back 43

Subarachnoid hemorrhage, cerebral venous thrombosis and occasionally intracerebral hemorrhage

Front 44

Name the two main subtypes of brain hemorrhage?

Back 44

1) Intracerebral hemorrhage: bleeding in brain parenchyma
2) Subarachnoid hemorrhage: bleeding in subarachnoid space

Front 45

What are the most common causes of intracerebral hemorrhage?

Back 45

Hypertension, trauma, bleeding diathesis, amyloid angiopathy, illicit drug use and vascular malformation

Front 46

What are the two major causes of subarachnoid hemorrhage?

Back 46

Rupture of arterial aneurysm and bleeding from vascular malformations

Front 47

In a person presenting with hypertension under the age of 35, what is the most likely cause?

Back 47

Secondary hypertension

Front 48

Name five symptoms in stage three Chronic Kidney Disease.

Back 48

1) Hypertension
2) Edema: peripheral or general
3) Congestive heart failure
4) Pericarditis
5) Arrhythmia

Front 49

Define Mitrial Stenosis and list its most common cause?

Back 49

Mitrial stenosis is narrowing of the mitiral valve which limits the flow of blood from the left atrium to the left ventricle. Its most common cause is rheumatic fever

Front 50

Describe the Jones criteria for diagnosis of acute rheumatic fever?

Back 50

Requires two major manifestations or one major and two minor manifestations along with evidence of preceding Streptococcus pyogens infection.
Major criteria: carditis, polyarthritis, chorea, erythema marginatum or subcutaneous nodules
Minor criteria: arthralgia, fever, elevated ESR or CRP, EKG evidence of prolonged QT interval

Front 51

How is acute rheumatic fever treated?

Back 51

anti-inflammatory and penicillin

Front 52

What is the pathology of mitrial stenosis?

Back 52

Acute and recurrent inflammation producing fibrous thickening and calcification causing comissural fusion and chordal thickening/foreshortening

Front 53

Describe the pathopysiology of mitrial stenosis?

Back 53

With mitrial stenosis, pressure builds in the left atrium. Hemodynamically significant stenosis seen when mitrial valve area is less than 2 cm^2

Front 54

What is the clinical presentation with mild mitrial stenosis?

Back 54

1) Dyspnea with exertion
2) Reduced exercise capacity

Front 55

What is the clinical presentation with severe mitrial stenosis?

Back 55

1) Pulmonary congestion at rest: orthopnea and paroxysmal nocturnal dyspnea
2) Right heart failure
3) can cause compression of the recurrent laryngeal nerve

Front 56

Name four complications from mitrial stenosis?

Back 56

1) Endocarditis
2) Atrial fibrillation
3) Hemoptysis from rupture of small vessels (due to high pressure)
4) Thrombus formation (stroke)

Front 57

What are the findings on ECG, CXR and echocardiogram for mitrial stenosis?

Back 57

ECG: Left atrial enlargement +/- right ventricular hypertrophy or afibrillation
CXR: Left atrial enlargement, pulmonary vascular redistrobution, edema, Kerley B lines
Echo: velocity of blood across valve is low and turbulent

Front 58

What are the valve areas and mean pressure gradients in mild, moderate and severe mitrial stenosis?

Back 58

Mild:
valve area: >1.5 cm^2
Mean grad: < 5 mm Hg
Moderate:
valve area: 1.0-1.5 cm^2
Mean grad: 5-10 mm Hg
Severe:
valve area: <1.0 cm^2
Mean grad: >10 mm Hg

Front 59

Describe the treatment of mitrial stenosis?

Back 59

1) Diuretics to treat symptoms of vascular congestion
2) Medication to slow heart rates
3) Anticoagulation with warfarin if they are in afibrillation
4) Percutaneous valvuloplasty or surgery

Front 60

Describe mitrial regurgitation and a common cause of this condition?

Back 60

A portion of the left ventricular volume is ejected backwards into the left atrium during systole. A common cause is mitrial prolapse.

Front 61

What is the physical finding for someone with mitrial prolapse?

Back 61

Mid systolic click followed by a murmur (if mitiral regurgitation is present)

Front 62

In mitrial regurgitation, what five factors are the severity and backward flow dependent on?

Back 62

1) Size of the regurgitant oriface
2) Pressure difference between left ventricle and left atrium
3) Systemic vascular resistance (afterload)
4) Compliance of the left atrium
5) Duration of regurgitation with each systole

Front 63

List a factor which improves and worsens mitrial regurgitation?

Back 63

1) Worsens: increased afterload (e.g. hypertension, aortic stenosis)
2) Improves: decreased afterload (e.g. medical intervention)

Front 64

Describe the pathophysiology of acute vs chronic mitrial regurgitation.

Back 64

Acute: LA pressure increases quickly and they have a prominent V wave (on JVP). presents with pulmonary edema as PA pressure and right heart pressure increases

Chronic: LA dilates and becomes more compliant. LV dilates and high SV maintained. Leads to eventual LV failure

Front 65

What are the clinical presentations of acute vs chronic mitrial regurgitation?

Back 65

Acute: pulmonary edema with possible dyspnea, orthopnea and PND

Chronic: symptoms of low cardiac output including fatigue, weakness and shortness of breath with exertion. Once they start to decompensate, they will experience symptoms of right heart failure

Front 66

What are 5 physical finding on exam with mitrial reguritation?

Back 66

1) Pansystolic murmur at the apex radiating to axilla
2) S1 may be soft (depending on etiology)
3) S3 sound (in chronic MR)
4) Displaced apex (in chronic MR)
5) Signs of right heart failure (if acute or decompensated chronic MR

Front 67

What are the findings on CXR, ECG and Echocardiogram investigation?

Back 67

CXR: pulmonary edema (if acute) and LA/LV enlargement (if chronic)
ECG: LA enlargment, Left venticle hypertrophy (if chronic)
ECHO: enlarged left ventricle and poor function depending on the degree of MR

Front 68

What are the treatments for acute vs chronic mitrial regurgitation?

Back 68

Acute: diuretics, vasodilators, mechanical support and possible emergency surgery
Chronic: some evidence for use of ACE-1 (reduce afterload) if hypertensive or LV dysfunction and surgery for repair/replacement of MV

Front 69

Define aortic valve stenosis and list its clinical findings.

Back 69

Aortic valve stenosis is AV thickening