Patholophysiology 2 (Aoma): Dr. Stewart, Exam 1

Front 1

What is pleural effusion?

Back 1

Abnormal collection of fluid in the pleural space of the lungs.

Front 2

T/F Giving O2 to pt with chronic bronchitis can decrease their respiratory drive.

Back 2

TRUE (if you want to hold your breath for a long time, hyperventalate first and get a respiratory alkalosis with really low C02 levels; high C02 levels are the normal primary trigger for taking a breath which also corrects hypoxia)

Front 3

What is the primary respiratory driver for people with emphasma and COPD?

Back 3

Hypoxia, which is different from normal function (which triggers when there is high C02). They inhale more than they exhale. So if you give them 02, you take away their primary driver for taking a breath!

Front 4

What does the term Emphasma refer to?

Back 4

Air in space [lungs].

It is a type of Chronic Obstructive Pulmonary Disorder (COPD). Due to destruction of alveoli there is less surface area avail for gas exchange, there is a loss of elasticity and the airway collapses. This impairs expiratory flow and air is trapped leading to a proportionate loss of ventilation-perfusion.

The "Pink Puffer": Is a descriptor for a Pt with COPD and severe emphysema, who has a pink complexion and dyspnea.

BTW: Most pt with COPD have elements of both emphysema and chronic bronchitis (inflammation of the major and small airways). In late stages can lead to hypoxia, pulmonary Htn and right-sided heart failure.

Front 5

Why are emphysema and COPD (chronic bronchitis) related?

Back 5

They are both an air trapping Dz's [what I wrote from class].?

Upon further analysis: They are also both COPD's and they both are disorders of ventilation (air to lungs)-perfusion (blood to lungs).

NOTE: Need to investigate this answer. Can anyone confirm? Both Emphasma and Chronic Bronchitis are types of COPDs. They both involve ventilation-perfusion Ds.

CLICK ON THE HINT for a cool link
Emphysema: "The Pink Puffers" Alveolia are enlarged and destroyed - air trapping.

Chronic Bronchitis: "The Blue Bloaters [b for bronchitis)", the bronchi are red, swollen and congested with mucous. These pt are blue from hypoxia and bloated (edema).

Hint 5

Picture that shows comparison btwn emphysema and chronic bronchitis. http://photos1.blogger.com/photoInclude/blogger/3930/1919/1600/COPD.0.jpg

Front 6

What causes hypercoagulability?

Back 6

1) Increase in platelet adhesiveness [fill in details], 2) Enhanced coagulation cascade [fill in details]; find the chart in the book

Thanks to Cynthia for this link: http://www.hopkinsmedicine.org/hematology/Coagulation.swf

Front 7

What are 5 of the 8 known risk factors for athlerosclerosis?

CLICK ON HINT

Back 7

STUDY TIP: ATHERO is no hero he is a 55 y/o smoking diabetic with medicated Htn and doesn't like avocados (HDL). His dad died from MI at 44 and his blood results showed CRP (proteins responding to FAT]. [sorry I know, dorky]

1) Age (men > 45, women > 55 or w/ premature menopause and no ERT),

2) Family Hx of Premature CHD (MI/Sudden death < 44 in father or 1st degree male relative) or <65 in mother or 1st degree FM relative),

3) Smoking (current),

4) Htn or on meds,

5) HDL < 40, [remember LDL is bad, HDL is good b/c it takes from tissues to LV where it is disposed]

6) Diabetes Mellitus,

7) Presence of C-reactive protein (CRP)

BTW: **PROTECTIVE (negative risk factor) HDL > 60

CRP is a protein found in the blood in response to inflammation (an acute-phase protein). It is synthesized by the liver in response to factors released by fat cells (adipocytes).

Hint 7

Atherosclerosis is the condition in which an artery wall thickens as the result of a build up of fatty materials such as cholesterol.

ATHLERO comes from a greek word meeting wax. ATH'a thick goop of wax and fat in your arteries.

Front 8

What are the 4 risk factors for essential Htn (Essential Htn is 2 or more elevated readings over 2 or more visits)?

CLICK ON HINT FOR MORE INFO

Back 8

STUDY TIP [apologies in advance]: ESSENTIALLY, this guy is a loser - BUBBA is an AGED, FAT guy who's papa died from eating too much tasty home-cookin', finds that SMOKIN, DRINKIN' a 40-oz and watchin' sports all day (INACTIVE) is still so STRESSED that he takes OCP to feel more like a women. YOU'd ESSENTIALLY have HTN TOO! [That's the point...it doesn't make sense so that you remember it!]

1) Family History (BIG ONE),

2) Age,

3) Race (blacks more often then whites),

4) Lifestyle factors (inc NaCl- intake, obestiy, inactivity, excess alcohol, increase K+ inake, smoking),

5) OCP (oral contraceptives),

6) Stress!!!!!!!!

Another pneumonic: FAR LOS

Hint 8

Hint: They are somewhat similar to athlerosclerosis.

Poor Choice, K+ Rich Foods
Salt substitutes (listed as KCl on labels)
Lite salts,
Coffee,
Sport drinks,
Iced tea sold in cans
Granola bars,
Ovaltine,
Chocolate and
Fig cookies
Molasses (Blackstrap) 1 tablespoon 498 mg

Front 9

What are the 3 causes of secondary Htn?

Back 9

BEWARE, Dr. may not have properly Dx Secondary Htn and be treating it as Essential. BE RIGOROUS, TAKE MORE TIME. ASK FOR MEDICAL RECORDS.

Htn can also be caused by:
1) Renal arery stenosis,
2) Coarctation of the aorta (narrowing of aortic arteries)
3) DRUGS (cocaine, caffeine, alcohol, licorice-tx HYPOtension...causes Na+ retention),
4) Obstructive sleep apnea,
5) Renal Dz,
6) Adrenal Dz,
7) Phenochromocytoma (adrenaline producing tumor).

Malignant Htn can be seen in renal and collagen Dz and IS LIFETHREATENING.

STUDY AID: Take a second to ID 2nd-ary Htn. This person is a snoring, adrenaline junkie (Adrenal Dz, Phenochromocytoma, Coke-head), with KI issues (renal artery stenosis, Renal Dz) with constricted aortic arteries.

Front 10

What are the 4 causes of congestive heart failure?

CLICK HINT FOR DEF

Back 10

1) Acute MI, hypertension,
2) cardiomyopathies,
3) Excessive work demands- hypermetabolic states (thyrotoxicosis), and
4) fluid overload (renal failure),
5) valvular stenosis,
6) regurg.
See Chapter 28

STUDY AID: Logically, why wouldn't your heart be able to send enough blood to other organs? HT-attack, HTN, body is too demanding (hypermetabolic), his buddy the KI's are falling down on the job (renal failure), HT valves are funky (too hard, thick, fused, clogged and/or regurg).

Cynthia's PNEUMONIC: MY Cat Elephant Fries Vasoline Regularly.

Hint 10

Congestive heart failure (CHF), or heart failure, is a condition in which the heart can't pump enough blood to the body's other organs,

Front 11

What are the 4 risk factors for lung cancer?

Back 11

1) Smoking,
2) Industrial Exposure-asbestos,
3) Familiar (large cell adenoma),
4) Diets deficient in fruits and veggies/antioxidants

STUDY AID: Smoking roofer, w/ fam history of lg cell adenoma is a FRUIT HATER!

Front 12

What are common areas for lung mestasises?

Back 12

BBLL (Brain, Bone, other Lung, Liver)

Front 13

A 22 y/o male, left sided chest pain; pain is worse with deep inspriation. On exam, they are shallow and rapid. You hear a friction rub. What is his problem?

Back 13

Pleuresy (ABRUPT onset, sharp, unilateral, lower lateral aspect of the chest; worse with movement, shallow and rapid respiratory)...FRICTION RUB;

For comparison:
Non-Pleural Chest Pain (musculoskelatal - coughing, barfing…worse with abdominal vs. chest contractions;
brochial-substernal, dull worse with coughing but NOT with deep inspiration...pleura not involved);
Myocardial (substernal, not affected by respiration).

Front 14

What are the symptoms for pneumothorax?

Back 14

Depends on the degree.
1) Ipsilateral chest pain,
2) Dyspnea
3) Tachypnea
4) Increased HR
5) Percussion: Resonate/hyper resonate
6) Auscultation: Absent or decreased breath sounds over the area
7) Tension pneumo - medastinal shift to the opposite side
8) Hypoxia

STUDY AID: Puncture a lung? Ipsi chest pain, diff and fast breathing, inc HT, DRUM (more air in pleural space), can't hear breath sounds, your damn medastium shifted to opp side, your hypoxic!

Front 15

BP 138/32, pulse is 110, breathing is shallow, lung sounds absent with resonnance to percussion.

Back 15

Pneumothorax (with pneumonia the content is fluid, so the sound will be dull)

Front 16

Pt with TB but intact cell-mediated immunity, the bacterial organism inside the granulomas are?

Back 16

With an intact cell-mediated immunity, the organism is contained within the granuloma and IS ALIVE but is NOT CONTAGIOUS.

Front 17

How is secondary TB initiated?

Back 17

1) bursting of granuloma due to immunity impairment or hypersensitive cellular immunity.

Signs / Sx’s: fever, night sweats, anorexia, weight loss, fatigue. “Consumption.” Cough: dry initially, then productive purulent, hemoptysis (late).

Front 18

Episodic increases in BP, taccycardia, tremor…is suggestive of?

Back 18

Pheochromocytoma, it's an adrenaline producing tumor *** ALSO ON EXIT EXAM*** (primary hypertension is the silent killer). These pt present WIRED!

Front 19

Pt comes in with pain in the calf on dorsiflexion of the foot, what is a possible cause?

Back 19

Description is Homan's Sign and indicates potential Deep Venous Thrombosis. Note can also mainfest as pain, swelling and muscle tenderness, if it is superficial you may be able to feel it. It may also be asymptommatic. Most common sites for DVT are soleus muscle and in the posterior tibial and peroneal veins.

Front 20

What is the Homan's Sign?

Back 20

Hyper dorsal flex their foot, briskly and it will sharply contract the gastrox and it will constrict the blood vessels and cause a sharp pain if there is thrombosis.

Front 21

Guy sitting in his chair and gets up and gets lightheaded?

Back 21

Orthostatic hypotension

Front 22

What are the symptoms of a small stroke or TIA (9 listed)?

Back 22

Transient Ischemic Attack (TIA) is a "warning stroke" or "mini-stroke" that produces stroke-like symptoms but no lasting damage. It is a temporary disturbance in the cerebral blood flow which reverses before infarction occurs (deficit less than 1 hour).

Symptoms:
1) SUDDEN,
2) FOCAL,
3) USU 1-sided, WEAKNESS of face and arm (most common) smtimes leg.
4) UNILATERAL NUMBNESS,
5) VISION LOSS (one-eye or to one-side),
6) APHASIA,
7) DYSARTHRIA (slurred speech) and
8) ATAXIA (sudden unexplained imbalance),
9) AGNOSIA (inability to recognize objects, etc.) and others.

[See pg. for more 1246-1247, old edition]

Front 23

What is a vaso-vagal episode?

Back 23

Fainting-like feeling, or actual fainting caused by bearing down really hard and it increases the vagal tone.

Front 24

24 y/o male, flu 2w ago, fatigue and anterior chest pain; abrupt onset and worse with deep inspiriation and **feels better when he bends forward**. Hear a friction rub listening to his chest.

Back 24

Acute pericarditis (you feel better when you bend forward and worse when he leans back)

Front 25

What is the difference between constrictive pericarditis and acute?

Back 25

Constrictive is chronic, scaring down vs. an acute episode.

ANYONE HAVE MORE INFO ON THIS?

Front 26

Coronary heart Dz becomes symptomatic after what percentage?

Back 26

70% occlusion

Front 27

Symptoms of Coronoary Heart Disease (CHD) do not become symptomatic before that because of what?

Back 27

Collateral circulation

Front 28

What is the most common cause of cardiogenic shock?

Back 28

Acute MI (myocardial infarction)

Front 29

Which of the major organs are least affective by Htn?

Back 29

Liver

Front 30

Which of the least likely to be most affective by Htn?

THINK THIS QUESTION MAY BE ERRONEOUS. Can anyone confirm?

Back 30

Heart

Front 31

What is the formula for cardiac output?

Back 31

Stroke volume x heart rate

Front 32

What are the warning signs of acute leukemia?

Back 32

Signs/Sx's related to def bone marrow function.

Manifestations:
1) Fatigue,
2) pallor,
3) weight loss,
4) fever, chills, night sweats,
5) infection,
6) easy bruising,
7) epistaxis -> lymphadenopathy, splenomegaly, hepatomegaly, CNS involvement (more often in ALL).

CNS involvement signs: cranial nerve palseys, headache, nausea, vomiting, papilledema and occasionally seizures and coma.

Front 33

What is the difference between Hodgkins and non-H. lymphoma?

Back 33

Hodgkin's spreads continuously from one lymph node to an adjacent; non-H is a Dz of B-lymph the spread is disseminated; both are called lymphadenopathy and called lymphomas

Front 34

A pt. presents with BP of 160/100, what is the systolic, diastolic, what is the pulse pressure, what is the mean arteriol pressure?

Back 34

"Pulse pressure is the difference between systolic and diastolic blood pressure, or the change in blood pressure seen during a contraction of the heart.

PULSE PRESSURE= Systole (1st#, QRS)-Diastole (2nd#heart filling with blood) .

MAP is considered to be the perfusion pressure seen by organs in the body. It is believed that a MAP that is greater than 60 mmHg is enough to sustain the organs of the average person. If the MAP falls significantly below this number for an appreciable time, the end organ will not get enough blood flow, and will become ischemic. [Source: Wiki]"

MAP~= Diastole + 1/3 (Dia-Sys)

Example:
Systole=160
Diastole=100 [diasole, distal, farther away, less pressure]

PP=SP-DP=160-100= 60

MAP = 100 + 1/3 (60) =120

Front 35

Which cardiac arrythmias are **best** tx by electrical shock?

Back 35

1) Ventricular Fibrillation (V-Fib)
2) Ventricular Tachycardia (V-TACH)

Atrial issues aren't typically serious. 1) V-Fib • This occurs b/c multiple focii evolves spontaneously and they can generate their own beat but b/c they are multiple and unsynchronized they interfere with each other and the heart quivers. There is not diastole or systole. BLOOD IS NOT MOVING and of course, this is lethal.
2) For V-TACH, Cardio version “the reset button” – is the way we treat ventricular taccycaria. The machine administers electrical shock but the machine is smart enough to submit the shock in synchrony with one of the beats in the heart. Then it depolarizes the heart and it stops beating completely and the idea is that it resumes beating at a slower rate. And then sometime it doesn’t work and then meds slow the hearbeat down – Ca+ channel blockers.

Front 36

Distruction of alveola is indicative of what?

Back 36

Emphysema

Front 37

Which is the most common cause of right heart failure?

Back 37

Left heart failure

Front 38

Know the circulation of the heart. Pulmonary edema is most likely caused by which valve failure?

Back 38

Mitral valve

Front 39

What is the manifestation TRIAD of Pericarditis?

Back 39

1) Chest pain (SHARP and intense; dull pain is more like HT attack),

2) Pericardial friction rub (oscultation sounds like sand paper heard each time the heart beats),

3) EKG changes (ST segment elevation - though you can also get this in an acute MI)

Front 40

What are the cardiac enzymes?

Back 40

1) Troponin (I &T) the most sensitive test for myocardial damage,
2) CPK/CK-MB (creatin kinease, relatively sensitive when muscle damage isn't present,
3) LDH (Lactate dehydrogenase)
4) AST (Aspartate transaminase...also tests for LV damage), 5) Myoglobin (Mb),n

Front 41

What is a potential result of venous thrombosis (sd)?

Back 41

1) Pulmonary embolism (blockage of pulmonary artery),
2) Recurrent episodes of DVT,
3) Chronic venous insufficency, stasis, ulceration.

Front 42

Which lipoprotein is associated with bad cholesterol (sd)?

Back 42

LDL (think low lifes are bad); they are "bad" b/c they are involved in the genesis of atherosclerosis.

They are removed from circulation by scavenger cells (monocytes & macrophages).

Front 43

What is the LDL mechanism (sd)?

Back 43

1) LDL level exceeds receptor availability,
2) LDL is removed by scavengers,
3) update of LDL by macrophages in arterial wall,
4) accumulation of cholesterol esters-> ATHEROSCLEROSIS;

** RECEPTOR dependent pathway

Front 44

What is the basic function of LDLs?

Back 44

Transports cholesterol and triglycerides from the liver to peripheral tissues. Like all lipoproteins, LDL enables fats and cholesterol to move within the water based solution of the blood stream. LDL also regulates cholesterol synthesis at these sites.

Front 45

If a young athlete dies from MI, what is it usually from? [BENCHMARK QUESTION]

Back 45

Hypertrophic Cardiomyopathy.

The HT muscle itself hypertrophied, the ventrical size is unchanged and the muscle gets thick. HT muscle, unlike skeletal muscle, only gets stronger up to a point after that the larger it gets the weaker it becomes. The ventrical size might also shrink if the heart muscle encroaches on it's space. WARNING: Family Hx risk.

Front 46

What type of cardiomyopathy occurs when we see chronic pericarditis or when something restrics the diastolic filler (i.e. heart can't fully expand)?

Back 46

Restricted cardiomyopathy

Front 47

Which protein regulates osmotic pressure?

Back 47

Albumen (osmotic pressure is the capacity for something that is in the blood stream to attract water, thus keeping water in the blood stream).

Front 48

Which formed elements are granulocytes (have cytoplasmic granules) and which are agranuloctyes?

Back 48

NLMEB (Never Let Monkeys Eat Bananas). Granualocytes: 1) Neutrophils (NON-STAINING but do have granules), 2) Eosinophils (VIOLET); Agran's: 1) Lymphocytes & 2) Monocytes.

Front 49

Name 4 naturally occuring anticoagulates?

Back 49

1) Antithrobin III (inactivates coagulation factors and neutralize thormbin),
2) Protein C (inactivates factors V & VIII),
3) Protein S (co-factor for Protein C),
4) Heparain (excellarates action of anti-throbin III).

STUDY AID: You'd "CASH" in without your anticoagulants. [Come-on, work with me, it's late.]

Front 50

What is thrombocytopenia?

Back 50

Deficiency platelet count, less than 100k (normal ranges are between 150-450k)

Front 51

What are the manifestations of thrombocytopenia?

Back 51

1) Easily bruising,
2) Nose bleeds (epistaxis),
3) Bleeding from the gums,
4) Heavy Menses.

NOTE: Clinically significant bleeding (typically does not occur until plateles are <50k.

Front 52

Name 3 Hereditary Blood Dz. [BENCHMARK]

Back 52

1) Hemophilia A - defectiive production of factor VIII; X-Linked (soft tissue bleeding, hemarthroses),

2) Hemophilia B- defective production of factor IX,

3) Von Willebrands (most commong, autosomal dominant, def of the carrier protein for factor VIII, often not diagnosed until surgery or dental work)

Front 53

Describe Sickle Cell Dz

Back 53

AUTOSOMAL Recessive affecting 10% of AfrAmericans; Single amino acid subsitution defect in the beta chain of hemoglobin (Hg). Sickled cells hold less O2, they also get gobbled by the SP and hemolyzed.

Front 54

Anemias of Def red blood cell production - KNOW THIS WELL

Back 54

1) Iron Deficiency (decrease prod of Hb. - microcytic, hypochomic),

2) Megaloblastic (B12, Folic Acid req for nucleic acid synthesis -MACROcytic, hypochromic),

3) Aplastic Anemia (decr prod of RBC in the marrow and dec WBC & platlets - causes include radiatio, chemo, drugs, toxic and can be idiopathic),

4) Anemia of Chronic Dz (microcytic, hypochromic - causes incl cancer, infection, HTN, renal failure, inflammation).

STUDY AID: Anemic IRON MAN (IRON def, Megaloblastic, Aplastic aNemia of chronic Dz)

Front 55

What is the diff btwn arteroslerosis and atheroslerosis?

Back 55

ARTEROsclerosis is hardening of the arteries, while ATHEROsclerosis is the thickening of artery walls as the result of a build up of fatty materials such as cholesterol.

Front 56

What is the most common cause of atherosclerosis?

Back 56

Arterosclerosis

Front 57

What is pleural effusion?

Back 57

Abnormal collection of fluid in the pleural space

Front 58

T/F Giving O2 to pt with chronic bronchitis can decrease their respiratory drive.

Back 58

TRUE (if you want to hold your breath for a long time, hyperventalate first and get a respiratory alkalosis with really low C02 levels; high C02 levels is the primary trigger for taking a breath which also corrects hypoxia)

Front 59

What is the primary respiratory driver for people with emphasma and COPD?

Back 59

Hypoxia, which is different from normal function (which triggers when there is high C02). They inhale more than they exhale. So if you give them 02, you take away their primary driver for taking a breath!

Front 60

What does the term Emphasma refer to?

Back 60

Air in space

Front 61

Why are emphasma and COPD (chronic bronchitis) related?

Back 61

They are both an air trapping Dz's

Front 62

What causes hypercoagulability?

Back 62

1) Increase in platelet adhesiveness [fill in details], 2) Enhanced coagulation cascade [fill in details]; find the chart in the book

Front 63

What are 5 of the 8 known risk factors for athlerosclerosis?

Back 63

1) Age (men > 45, women > 55 or w/ premature menopause and no ERT), 2) Family Hx of Premature CHD (MI/Sudden death < 44 in father or 1st degree male relative) or <65 in mother or 1st degree FM relative), 3) Smoking (current), 4) Htn or on meds, 5) HDL < 40, 6) Diabetes Mellitus, 7) Presence of C-reactive protein (CRP) **PROTECTIVE (negative risk factor) HDL > 60

Front 64

What are the 4 risk factors for essential Htn (Essential Htn is 2 or more elevated readings over 2 or more visits); risks are somewehat similar but not identical to athlerosclerosis)?

Back 64

1) Family History (BIG ONE), 2) Age, 3) Race (blacks more often then whites), 4) Lifestyle factors (inc NaCl- intake, obestiy, inactivity, excess alcohol, increase K+ inake, smoking), 5) OCP (oral contraceptives), 6) Stress

Front 65

What are the 3 causes of secondary Htn?

Back 65

BEWARE, Dr. may not have properly Dx Secondary Htn and be treating it as Essential. BE RIGOROUS, TAKE MORE TIME. ASK FOR MEDICAL RECORDS. Htn can also be caused by: 1) Renal arery stenosis, 2) Coartartion of the aorta, 3) DRUGS (cocaine, caffeine, alcohol, licorice-tx HYPOtension...causes Na+ retention), 4) Obstructive sleep apnea, 5) Renal Dz, 6) Adrenal Dz), 7) Phenochromocytoma (adrenaline producing tumor). Malignant Htn can be seen in renal and collagen Dz and IS LIFETHREATENING.

Front 66

What are the 4 causes of congestive heart failure?

Back 66

"1) Acute MI, hypertension, 2) cardiomyopathies.

Front 67

What are the 4 risk factors for lung cancer?

Back 67

1) Smoking, 2) Industrial Exposure-asbestos, 3) Familiar (large cell adenoma), 4) Diets deficient in fruits and veggies/antioxidants

Front 68

What are common areas for lung mestasises?

Back 68

BBLL (Brain, bone, other lung, liver)

Front 69

A 22 y/o male, left sided chest pain; pain is worse with deep inspriation. On exam, they are shallow and rapid. You hear a friction rub. What is his problem?

Back 69

Pleuresy (abrupt onset, sharp, unilateral, lower lateral aspect of the chest; worse with movement, shallow and rapid respiratory); For comparison: Non-Pleural Chest Pain (musculoskelatal - coughing, barfing…worse with abdominal vs. chest contractions; brochial-substernal, dull worse with coughing but NOT with deep inspiration...pleura not involved); Myocardial (substernal, not affected by respiration).

Front 70

What are the symptoms for pneumothorax?

Back 70

Pneumothorax

Front 71

BP 138/32, pulse is 110, breathing is shallow, lung sounds absent with resonnance to percussion.

Back 71

Pneumothorax (with pneumonia the content is fluid, so the sound will be dull)

Front 72

Pt with intake cell-mediated immunity, the organism is.

Back 72

The organism is contained within the granuloma, is alive but is not contageious.

Front 73

How is secondary TB initiated?

Back 73

1) bursting of granuloma…. [see slide]

Front 74

Episodic increases in BP, taccycardia, tremor…is suggestive of?

Back 74

Pheochromocytoma, it's an adrenaline producing tumor *** ALSO ON EXIT EXAM*** (primary hypertension is the silent killer). These pt present WIRED!

Front 75

Pt comes in with pain in the calf on dorsiflexion of the foot, what is a possible cause?

Back 75

Description is Homan's Sign and indicates potential Deep Venous Thrombosis. Note can also mainfest as pain, swelling and muscle tenderness, if it is superficial you may be able to feel it. It may also be asymptommatic. Most common sites for DVT are soleus muscle and in the posterior tibial and peroneal veins.

Front 76

What is the Homan's Sign?

Back 76

Hyper dorsal flex their foot, briskly and it will sharply contract the gastrox and it will constrict the blood vessels and cause a sharp pain if there is thrombosis.

Front 77

Guy sitting in his chair and gets up and gets lightheaded?

Back 77

Orthostatic hypotension

Front 78

What are the symptoms of a small stroke or TIA?

Back 78

Transient Ischemic Attack (TIA) is a "warning stroke" or "mini-stroke" that produces stroke-like symptoms but no lasting damage. It is a temporary disturbance in the cerebral blood flow which reverses before infarction occurs (deficit less than 1 hour). Symptoms: SUDDEN, FOCAL, USU 1-sided, WEAKNESS of face and arm (most common) smtimes leg. UNILATERAL NUMBNESS, VISION LOSS (one-eye or to one-side), APHASIA, DYSARTHRIA (slurred speech) and ATAXIA (sudden unexplained imbalance), AGNOSIA (inability to recognize objects, etc.) and others. [See pg. for more 1246-1247, old edition]

Front 79

What is a vaso-vagal episode?

Back 79

Fainting-like feeling, or actual fainting caused by bearing down really hard and it increases the vagal tone.

Front 80

24 y/o male, flu 2w ago, fatigue and anterior chest pain; abrupt onset and worse with deep inspiriation and **feels better when he bends forward**. Hear a friction rub listening to his chest.

Back 80

Acute pericarditis (you feel better when you bend forward and worse when he leans back)

Front 81

What is the difference between constrictive pericarditis and acute?

Back 81

Constrictive is chronic, scaring down vs. an acute episode.

Front 82

Coronary heart Dz becomes symptomatic after what percentage?

Back 82

70% occlusion

Front 83

Symptoms of Coronoary Heart Disease (CHD) do not become symptomatic before that because of what?

Back 83

Collateral circulation

Front 84

What is the most common cause of cardiogenic shock?

Back 84

Acute MI (myocardial infarction)

Front 85

Which of the major organs are least affective by Htn?

Back 85

Liver

Front 86

Which of the least likely to be most affective by Htn?

Back 86

Heart

Front 87

What is the formula for cardiac output?

Back 87

Stroke volume x heart rate

Front 88

What are the warning signs of acute leukemia

Back 88

Signs/Sx's related to def bone marrow function. Manifestations: Fatigure, pallor, weight loss, fever, chills, night sweats, infection, easy bruising, epistaxis -> lymphadenopathy, splenomegaly, hepatomegaly, CNS involvement (more often in ALL). CNS involvement signs: cranial nerve palseys, headache, nausea, vomiting, papilledema and occassionally seizures and coma.

Front 89

what is the difference between hodgkins and non-h. lymphoma

Back 89

Hodgkin's spreads continuously from one lymph node to an adjacent; non-h is a Dz of B-lymph the spread is disseminated; both are called lymphadenopathy and called lymphomas

Front 90

A pt. presents with BP of 160/100, what is the systolic, diastolic, what is the pulse pressure, what is the mean arteriol pressure?

Back 90

"Pulse pressure is the difference between systolic and diastolic blood pressure, or the change in blood pressure seen during a contraction of the heart. PULSE PRESSURE= Systole (1st#, QRS)-Diastole (2nd#heart filling with blood) . MAP is considered to be the perfusion pressure seen by organs in the body. It is believed that a MAP that is greater than 60 mmHg is enough to sustain the organs of the average person.

Front 91

Which cardiac arrythmias are **best** tx by electrical shock?

Back 91

V-Fib or E) 2 choses

Front 92

Distruction of alveola is indicative of what?

Back 92

Emphysema

Front 93

Which is the most common cause of right heart failure?

Back 93

Left heart failure

Front 94

Know the circulation of the heart. Pulmonary edema is most likely caused by which valve failure?

Back 94

Mitral valve

Front 95

What is the manifestation TRIAD of Pericarditis?

Back 95

1) Chest pain (SHARP and intense; dull pain is more like HT attack), 2) Pericardial friction rub (oscultation sounds like sound paper heard each time the heart beats), 3) EKG changes (ST segment elevation - though you can also get this in an acute MI)

Front 96

What are the cardiac enzymes?

Back 96

1) Troponin (I &T) the most sensitive test for myocardial damage, 2) CPK/CK-MB (creatin kinease, relatively sensitive when muscle damage isn't present, 3) LDH, 4) AST (also tests for LV damage), 5) Myoglobin (Mb),

Front 97

What is a potential result of venous thrombosis (sd)?

Back 97

1) Pulmonary embolism (blockage of pulmonary artery), 2) Recurrent episodes of DVT, 3) Chronic venous insufficency, stasis, ulceration.

Front 98

Which lipoprotein is associated with bad cholesterol (sd)?

Back 98

LDL (think low lifes are bad); they are "bad" b/c they are involved in the genesis of atherosclerosis. They are removed from circulation by scavenger cells (monocytes & macrophages).

Front 99

What is the LDL mechanism (sd)?

Back 99

1) LDL level exceeds receptor availability, 2) LDL is removed by scavengers, 3) update of LDL by macrophages in arterial wall, 4) accumulation of cholestorl esters-> ATHEROSCLEROSIS; ** RECEPTOR dependent pathway

Front 100

What is the basic function of LDLs?

Back 100

Transports cholesterol and triglycerides from the liver to peripheral tissues. Like all lipoproteins, LDL enables fats and cholesterol to move within the water based solution of the blood stream. LDL also regulates cholesterol synthesis at these sites.

Front 101

If a young athlete dies from MI, what is it usually from? [BENCHMARK QUESTION]

Back 101

Hypertrophic Cardiomyopathy. The HT muscle itself hypertrophied, the ventrical size is unchanged and the muscle gets thick. HT muscle, unlike skeletal muscle, only gets stronger up to a point after that the larger it gets the weaker it becomes. The ventrical size might also shrink if the heart muscle encroaches on it's space. WARNING: Family Hx risk.

Front 102

What type of cardiomyopathy occurs when we see chronic pericarditis or when something restrics the diastolic filler (i.e. heart can't fully expand)?

Back 102

Restricted cardiomyopathy

Front 103

Which protein regulates osmotic pressure?

Back 103

Albumen (osmotic pressure is the capacity for something that is in the blood stream to attract water, thus keeping water in the blood stream).

Front 104

Which formed elements are granulocytes (have cytoplasmic granules) and which are agranuloctyes?

Back 104

NLMEB (Never Let Monkeys Eat Bananas). Granualocytes: 1) Neutrophils (NON-STAINING but do have granules), 2) Eosinophils (VIOLET); Agran's: 1) Lymphocytes & 2) Monocytes.

Front 105

Name 4 naturally occuring anticoagulates?

Back 105

1) Antithrobin III (inactivates coagulation factors and neutralize thormbin), 2) Protein C (inactivates factors V & VIII), 3) Protein S (co-factor for Protein C), 4) Heparain (excellarates ation of antithrobin III).

Front 106

What is thrombocytopenia?

Back 106

Deficiency platelet count, less than 100k (normal ranges are between 150-450k)

Front 107

What are the manifestations of thrombocytopenia?

Back 107

1) Easily bruising, 2) Nose bleeds (epistaxis), 3) Bleeding from the gums, 4) Heavy Menses. NOTE: Clinically significant bleeding (typically does not occur until plateles are <50k.

Front 108

Name 3 Hereditary Blood Dz. [BENCHMARK]

Back 108

1) Hemophilia A - defectiive production of factor VIII; X-Linked (soft tissue bleeding, hemarthroses), 2) Hemophilia B- defective production of factor IX, 3) Von Willebrands (most commong, autosomal dominant, def of the carrier protein for factor VIII, often not diagnosed until surgery or dental work)

Front 109

Describe Sickle Cell Dz

Back 109

AUTOSOMAL Recessive affecting 10% of AfrAmericans; Single amino acid subsitution defect in the beta chain of hemoglobin (Hg). Sickled cells hold less O2, they also get gobbled by the SP and hemolyzed.

Front 110

Anemias of Def red blood cell production - KNOW THIS WELL

Back 110

1) Iron Deficiency (decrease prod of Hb. - microcytic, hypochomic), 2) Megaloblastic (B12, Folic Acid req for nucleic acid synthesis -MACROcytic, hypochromic), 3) Aplastic Anemia (decr prod of RBC in the marrow and dec WBC & platlets - causes include radiatio, chemo, drugs, toxic and can be idiopathic), 4) Anemia of Chronic Dz (microcytic, hypochromic - causes incl cancer, infection, HTN, renal failure, inflammation).

Front 111

What is the diff btwn arteroslerosis and atheroslerosis?

Back 111

ARTEROsclerosis is hardening of the arteries, while ATHEROsclerosis is the thickening of artery walls as the result of a build up of fatty materials such as cholesterol.

Front 112

What is the most common cause of atherosclerosis?

Back 112

Arterosclerosis

Front 113

According to Dr. Stewart, what is the ideal ratio of HDL to LDL?

Back 113

Ideally there would be a 1:1 ratio; however 1 HDL to 2 LDL is good; 1:1.5 is great.

Front 114

What is the difference between Raynoids phenomena and Raynoids Dz?

Back 114

Raynoids Dz is almost always a condition that happens in otherwise young, healthy women.

It's ideopathic can be caused by premenstral or b/c it's cold.

Raynoids PHENOMENA: occurs with other Dz, conditions; seen with previous vessel injury (trauma or frostbite), seen in collagen Dz and is often the first sign of a collagen Dz like scleroderma.

Front 115

How does a DVT form?

Back 115

Virchow's Triad describes 3 broad categories that contribute to the formation of DVT's.

1) Venous Stasis (bed rest, immobility, acute MI, CHF, shock, venous obstruction, spinal cord injury),

2) Hyperreactivity of Blood Coagulation (genetics, stress/trauma, pregnancy, childbirth, oral contraceptives, dehydration, cancer, antiphosphoipd syndrome, hyperhomocysteminemia),

3) Vascular Trauma (indwelling venous catheters, surgery, massive trauma/infection, fracture hip, orthopedic surgery).
[See pg. 496 in old book]

Remember: V in DVT for V in VIRchow's Triad.

Dr. VIR's got static, coagulatory trauma creatin' DVT.

Front 116

Describe the Sx's of Temporal Arteritis (VERY COMMON).

Back 116

A LACERATING on the temporal artery. If you push on the temporal area on someone with just a tension headache they may get a release but this pt it will hurt - they may even PUNCH you. This can be lifethreatening even though it can resolve itself. it may block a retinal artery and cause BLINDNESS OR STROKE.

Front 117

What does Renin do?

Back 117

It's a hormone made by the KI and ultimately promotes conversion of Angiotensinogen to Agniotension I. Result: INCREASE in BP via encouraging sodium retention.

STUDY AID: Retain water with Renin.

Front 118

According to NIH 2003, what are the normal BP ranges?

Back 118

1) NORMAL 120/80,
2) Pre-Htn 120-129/80-89 (diabetics goal is 130/80)
3) Htn 140/90,
4) Stage I 140-159/90-99,
5) Stage II > 160/100.

STUDY AID:
Normal (think 120/80 rule)
Pre within +9/+9 range
Htn Stg 1 >+20/+10 from normal
Htn Stg 2 >+40

Front 119

What are the signs and sx of artieral occlusion?

Back 119

THE 7 P's (mainly applies to extremeties, esp the legs):
1) PISTOL shot (sudden pain),
2) PALLOR,
3) POLAR (cold),
4) PULSElessness,
5) PAIN,
6) PARAsthesias,
7) PARALYSIS.
Tissue death occurs if circulation is not restored.

Front 120

What are the normal total cholesterol values (sd)?

Back 120

TOTAL CHOLESTEROL:
<200 (desirable),
200-239 (borderline high),
>= 240 (high)

STUDY AID: Just need to remember less than 200 good, more than 40 over high.

Front 121

What is the normal LDL values (sd)?

Back 121

<100 (optimal),
100-129 (near optimal),
130-159 (borderline),
160-189 (high),
>= 190 (very high)

STUDY AID: Just remember LDL is the biggest portion. Less than 100 optimal +60 is high, +90 very high.

Front 122

What are "normal" HDL values (sd)?

Back 122

<40 (low), >=60 (high)

Front 123

T/F Diastolic Htn (in absense of Systolic Htn) is not treated. (sd)

Back 123

TRUE, while we don't treat isolated systolic Htn, we do tx isolated Diastolic Htn.

Front 124

What is the primary way to keep maintain your vessel elasticity? (sd)

Back 124

EXERCISE

Front 125

What are some side effets of HTN medication? (sd)

Back 125

1) ACE-inhibitors (most popular) can cause people to cough (esp nighttime) in ~60% but are relatively safe, 2) Beta blockers erectile dys, depresion, libido losss, nausea and vomitting, 3) Ca+ channel blockers fluid retention and depression.

Front 126

Which ion can indicates a cardiac abnormality when defficient? (sd)

Back 126

K+ (diuretics causes KI to release sodium and thus more free water but the problem is that it also causes the release of K+, Mg and some minerals like Ca+, Cu and Mg), so long term use can lead to osteoporosis and cardiac abnormalities).

Front 127

What is the goal in Htn management? (sd)

Back 127

Reduce the end organ damage and arrest the process of arteriosclerosis.

Front 128

What is pregnancy induced Htn called? (sd)

Back 128

Pre-eclampsia

Front 129

What metal ion is an antispastic agent (for both blood vessesl and airways) and also a muscle relaxant? (sd)

Back 129

Mg+, both blood vessels and aireways are aligned with smooth muscle and smooth muscle responds to Mg; sometimes angina can be tx with Mg

Front 130

When would you start treating a high systolic BP? (sd)

Back 130

If pt presented with severe headaches or nosebleeds, would tx it, even if # was as low as 160. if asymptomatic, tx if it was 190.

Front 131

Why do infants sometimes receive Vit K shots? (sd)

Back 131

Vit K is necessary for clotting, synthesis of blood cogulation factors all require VitK. It's also part of an antidote for ingestion of too many blood thinners like coumadins (wafarin). Def is rare in adults, it is e: Vitamin is found chiefly in leafy green vegetables such as spinach, swiss chard, and Brassica (e.g. cabbage, kale, cauliflower, broccoli, and brussels sprouts); some fruits such as avocado and kiwifruit are also high in Vitamin K.

Front 132

What is pneumonia and what are the 3 types? (sd)

Back 132

Pneumonia is an inflammation illness of the lung. Frequently, it is described as lung parenchyma/alveolar inflammation and abnormal alveolar filling with fluid. 1) community-acquired, 2) hospital-acquired, 3) pneumonia in the immunocompromised