Ptha 1321 - Human Diseases: A Systemic Approach - Zelman Book And Miele Lecture - Exam 2

Front 1

What is heredity? ***

Back 1

the innate capacity of an individual to develop traits and characteristics possessed by ancestors

Front 2

What attributes are included in heredity? ***

Back 2

among other things:
- mannerisms
- appearance
- intellect
- also includes diseases

Front 3

Upon what does heredity depend? ***

Back 3

upon the presence of genes in the chromosomes of the fertilized ovum from which the individual develops

Front 4

How many diseases are caused by genetic defects? ***

Back 4

between 2,400 and 5,000

Front 5

What are the different types of genetic defects? ***

Back 5

- single-gene mutation (environmental)
- multifactoral inheritance
- chromosomal aberrations

Front 6

Describe a chromosome. ***

Back 6

- rod-shaped organelles seen in dividing cells
- composed of tightly packed deoxyribonucleic acid (DNA)
- arranged in a series of individual units called genes

Front 7

Approximately how many genes are contained in one cell? ***

Back 7

100,000

Front 8

How are chromosomes arranged within the cell? ***

Back 8

each cell (except sperm/egg) contains 46 chromosomes divided into 23 pairs

half of the 46 chromosomes come from each parent (ovum = 23, sperm = 23)

22 of the chromosomes are called autosomes

X and Y are sex chromosomes

Front 9

Which is a cause of genetic defects? ***

a. single gene mutation
b. autosomes
c. traits and characteristics
d. organelles

Back 9

a. single gene mutation

Front 10

What sex chromosomes indicate a male? A female? ***

Back 10

XY = male

XX = female

Front 11

What is the karotype of a cell? ***

Back 11

the complete chromosomal composition of the nucleus of a cell

Front 12

The gene is the basic ______ ___ _________. ***

Back 12

unit of heredity

Front 13

Each gene occupies a certain _______ ___ ____ __________. ***

Back 13

locus on the chromosome

Front 14

Hereditary traits are controlled by ______ ___ ________. ***

Back 14

pairs of genes

Front 15

What are the three mechanisms of transmission of human traits (inheritance)? ***

Back 15

- autosomal dominant
- autosomal recessive
- sex-linked inheritance

Front 16

What is an autosomal dominant trait?

Back 16

a gene carried by one parent that is dominant over its paired gene from the other parent

Front 17

Each child has a ___% chance of inheritance if an autosomal dominant trait is passed on by only one parent. ***

Back 17

50 percent

Front 18

What are some examples of autosomal dominant traits? ***

Back 18

- brown eyes (over other colors)
- Huntington's chorea
- polydactylism
- achondroplasia/achondroplastic dwarfism
- Marfan syndrome
- familial hypercholesterolemia
- male pattern baldness

Front 19

What is Huntington's disease? ***

Back 19

autosomal dominant trait

a rare inherited disease that begins in middle life

characterized by progressive dementia and slow, writhing hand and arm movements

generally terminal within 10-15 years of diagnosis

Front 20

What is achondroplastic dwarfism? ***

Back 20

autosomal dominant trait

cartilage formation in the fetus is abnormal

long bones are shorter than normal, but trunk is normal, head is large and forehead is prominent

Front 21

What is polydactylism? ***

Back 21

autosomal dominant trait

having extra fingers or toes

Front 22

What is an autosomal recessive trait? ***

Back 22

a gene trait inherited from both parents

(parents do not exhibit trait)

Front 23

How are offspring affected by autosomal recessive genes? ***

Back 23

children of two parent carriers of autosomal recessive gene have:

- 25% chance of having the disease
- 50% chance of being a carrier of the disease
- 25% chance of being unaffected by the disease

Front 24

What are some examples of autosomal recessive disorders? ***

Back 24

- phenylketonuria (PKU)
- sickle cell anemia
- cystic fibrosis
- galactosemia
- Tay-Sachs
- albinism

Front 25

What is phenylketonuria? ***

Back 25

autosomal recessive disorder

lack of a specific enzyme which results in a high level of the amino acid phenylaline in the body

phenylaline is toxic to the brain and may cause mental retardation, convulsions, poor balance, tremors, hyperactivity

child presents with blonde hair and light skin, because the phenylalanine isn't converted to tyrosine, which is needed for melanin pigment production

Front 26

What is sickle-cell anemia? ***

Back 26

autosomal recessive disorder

a disease that is predominant in black families (1 in 12 are carriers!)

characterized by abnormal hemoglobin with deformed (sickle-shaped) red blood cells

these cells may become lodged in small arterioles and capillaries and block circulation, leading to necrosis and infarcts or death of tissue; the defective red blood cells are removed by the spleen, and this depletion can result in severe anemia

oddly, heterozygous carriers, although mildly anemic, have increased resistance to malaria because of the sickle cell trait

Front 27

What is cystic fibrosis? ***

Back 27

autosomal recessive disorder

a disease that affects the exocrine glands, resulting in thick mucus which obstructs intestinal glands, pancreas, and bronchi

sweat contains excessive sodium and chloride, which aids in diagnosis

Front 28

What is the cause of cystic fibrosis? ***

Back 28

a faulty chromosome number 7

Front 29

What is galactosemia? ***

Back 29

autosomal recessive disorder

inborn inability to utilize the sugar galactose, which accumulates in the blood and causes infant failure to thrive, cirrhosis of the liver, and mental retardation

treatment consists of eliminating galactose from the diet

Front 30

What is Tay-Sachs disease? ***

Back 30

autosomal recessive disorder

a disorder of lipid metabolism that causes excessive accumulation of lipids in the brain

leads to blindness, mental retardation, and infant death

primarily affects families of Eastern Jewish (Ashkenazi) origin

Front 31

Tay-Sachs disease, Cystic Fibrosis, Sickle Cell anemia, and Galctosemia are due to gene traits inherited from: ***

a. father
b. mother
c. grandparents
d. both parents

Back 31

d. both parents

Front 32

What is a sex-linked inheritance? ***

Back 32

a defective gene on the X chromosome (because Y chromosome is small and carries few genes)

typically the abnormalities are transmitted by the female, but affect the male offspring

recessive gene on the single X-chromosome of a male is unmasked and the trait is expressed (so, although it is recessive, in males it sort of acts dominant)

female XX generally negates the trait, but renders a 50% chance of being a carrier and passing on the trait; will only have the disease if she inherits two defective X chromosomes

male only transmits the disorder to daughters, because the Y chromosome is normal, and the male contributes only the Y chromosome to males

Front 33

What are some examples of sex-linked inheritance? ***

Back 33

- color blindness
- hemophilia
- Duchenne muscular dystrophy
- night blindness
- ichthyosis

Front 34

What is color blindness? ***

Back 34

sex-linked inheritance

cannot distinguish between colors, usually red-green

Front 35

What is hemophilia? ***

Back 35

sex-linked inheritance

disorder of the intrinsic coagulation mechanism

hemophilia a - absence of clotting factor viii

hemophilia b - absence of clotting factor ix; affects young males, who may have severe hemorrhage, or joint inflammation leading to arthritic destruction of joints

Front 36

What is Duchenne muscular dystrophy? ***

Back 36

sex-linked inheritance

affects almost exclusively boys (1 in 3,500) and appears between the ages of 3 and 5

characterized by lack of dystrophyn in sarcolemma; progressive skeletal muscle deterioration (very rapid)

Gower's sign--walking up thighs to stand--a sign of potential Duchenne's MD

Front 37

What is ichthyosis? ***

Back 37

sex-linked inheritance

problem with keratinization

results in scaly, lizard-like skin

Front 38

How do gross chomosomal abnormalities occur? ***

Back 38

- either in structure or number of chromosomes

- cells may fail to separate properly during cell division, causing one deficient daughter cell and one daughter cell with an extra chromsosome

- loss of autosomal chromosome is usually incompatible with life

- loss of a sex chromosome or presence of an extra one is less serious, but still produces abnormalities

Front 39

What are some examples of gross chromosomal abnormalities? ***

Back 39

- Down's syndrome
- Fragile X syndrome
- Cri du chat syndrome

Front 40

What are the characteristics of Down's syndrome? ***

Back 40

gross chomosomal abnormality

three chromosomes 21 (trisomy), because of the failure of two chromosomes to separate as gametes are being formed (nondisjunction)

children have wide-set eyes with epicanthic folds, a course protruding tongue, a straight crease across the palm and a shortened 5th finger

mental retardation, and may have congenital heart disease and frequent respiratory infections

Front 41

What are the characteristics of Fragile X syndrome? ***

Back 41

gross chomosomal abnormality carried by females

abnormality of X chromosome causes physical and mental disability

Fragile X chromosome appears to have broken end and affects connections in the brain

similar to autism, child presents with eye avoidance, unexplained temper tantrums, flapping hands and arms, large head with long face and pronounced ears, hyperactivity, distractability, and impulsivity as well as sensory integration dysfunctions

Front 42

What is Cri du chat syndrome? ***

Back 42

gross chomosomal abnormality caused by deletion of part of the short arm of chromosome 5

child presents with abnormally small head and deficiency in cerebral brain tissue, widely spaced yes and mental retardation

makes cat-like crying sounds

Front 43

What are some sex anomalies? ***

Back 43

- Turner syndrome - missing sex chromosome (XO)
- Klinefelter syndrome - extra sex chromosome

- hermaphrodite - has both testes and ovaries
- pseudohermaphrodite - has either testes or ovaries, but rest of anatomy is mixed (a.k.a. sex reversal since the chromosomal sex differs from anatomical sex)

Front 44

What is the complete, detailed family history drawn up by a genetic counselor called? ***

Back 44

pedigree

Front 45

How are pedigrees used? ***

Back 45

to determine patterns of inheritance of a genetic disease within the family

can assist a couple in deciding if the risks of having genetically abnormal offspring are significant enough for them to decide against having children

Front 46

When is amniocentesis done? ***

Back 46

after the 14th week of pregnancy

Front 47

How many genetic diseases can amniocentesis detect? ***

Back 47

approximately 200

Front 48

Are the results of amniocentesis always accurate? ***

Back 48

no, false positives are not uncommon

Front 49

What is chorionic villus sampling? ***

Back 49

removal of cells from the villi through the cervix

gives embryonic or fetal results (gender and chromosomal information) earlier in the pregnancy

Front 50

What is gene therapy (a.k.a. genetic engineering)? ***

Back 50

a procedure that involves identification, manipulation, and transference of genetic segments into a host to replace defective genes and to perform desired genetic activities

it may be cultured in a microbe and delivered in a viral package or by injection

(a la "bubble boy")

Front 51

What are congenital diseases? ***

Back 51

diseases which appear at birth or shortly thereafter, but are NOT caused by genetic or chromosomal abnormalities

congenital defects usually result from some failure in development during the embryonic stage, or in the first 2 months of pregnancy

CONGENITAL DISEASES CANNOT BE TRANSMITTED TO OFFSPRING!

Front 52

Can congenital diseases be transmitted to offspring? ***

Back 52

no

Front 53

What is the function of deoxyribonucleic acid (DNA)?

Back 53

it is the blueprint for directing all cell activities, especially protein synthesis within the cell

Front 54

All genes are made from:

Back 54

segments of four chemical bases (A,T,G,C), arranged in different orders and in different lengths

Front 55

Within the nucleus of cells, DNA is assembled into stranded units called _________.

Back 55

chromosomes

Front 56

Describe meiosis.

Back 56

Within each primary sex organ (ovary or testis), "parent" sex cells contain 46 chromosomes and divide to produce gametes (egg and sperm) that each contain 23 chromosomes

Front 57

44 of 46 chromosomes are called

Back 57

autosomes

Front 58

Two of the 46 chromosomes are called:

Back 58

X and Y (or sex) chromosomes

Front 59

What is the Human Genome Project?

Back 59

a 13-year project begun in 1990 that set out to

-identify all of the approximate 30,000 genes in human DNA,

- determine the sequences of the 3 billion chemical base pairs that make up human DNA, and

- store this information in databases

Front 60

Who sponsored the Human Genome Project?

Back 60

the US Department of Energy and

the National Institutes of Health

Front 61

Genes for a particular trait occupy:

Back 61

a particular site on a chromosome

Front 62

Each person has ___ sites or ___ copies of each gene.

Back 62

two, two

one copy from each parent

Front 63

What are alleles?

Back 63

alleles are alternative forms of a gene

(e.g., for brown eyes, for blue eyes, for green eyes--they are all eye-color genes, but in different forms/with different characteristics)

Front 64

Define homozygous.

Back 64

the pair of alleles for a particular trait are the same

(e.g., offspring has BB for brown eyes or bb for blue eyes)

Front 65

Define heterozygous.

Back 65

the pair of alleles for a particular trait are different

(e.g., offspring has Bb alleles, one for brown eyes and one for blue eyes)

Front 66

Which alleles always produce their trait when inherited?

Back 66

dominant alleles

Front 67

How does a dominant allele (B-brown eyes) express itself when the offspring is:

- homozygous (e.g., BB for brown eyes)

- heterozygous (e.g., Bb--alleles for both brown eyes and blue eyes)?

Back 67

whether homozygous or heterozygous, the dominant allele will be the one expressed

this offspring will have brown eyes

Front 68

When do recessive alleles express themselves?

Back 68

only when the offspring is homozygous for the trait

(e.g., only bb will have blue eyes)

Front 69

What are codominant alleles? Give an example.

Back 69

alleles that, when both are inherited, both traits express themselves

(e.g., AB blood type, A inherited from one parent and B from the other)

Front 70

What is reduced penetrance?
Give an example.

Back 70

when a dominant allele is not fully expressed

(e.g., syndactyly)

Front 71

What factors can modify expression of genes?

Back 71

- other genes
- environmental conditions
- gender

Front 72

How does an autosomal dominant allele express with respect to:
- different generations
- affecting male or female offspring?

Back 72

the autosomal dominant disease will appear in every generation

it will affect male and female offspring equally

Front 73

What is the cause of hereditary or familial diseases?

Back 73

they are generally the result of metabolic breakdown caused by a lack of direction from a missing or compromised gene or chromosomal segment

often the gene responsible for the production of a particular protein (e.g., enzyme or structural type) is missing or defective, and this interrupts the chain of events required to ensure proper metabolic activities

Front 74

What is the most common genetic disorder in the US?

Back 74

hemochromatosis

(affects 1 in 200 to 1 in 400 people)

Front 75

How are hereditary or familial genes passed on?

Back 75

when offspring inherits:

- a single autosomal dominant allele
- a pair of autosomal recessive alleles (one from each parent)
- a defective allele on the X chromosome

Front 76

What is Marfan syndrome?

Back 76

autosomal dominant trait

dysfunction of gene that codes for connective tissue protein fibrillin

lack of fibrillin weakens connective tissue, including tendons, heart valves, and blood vessels, thus it's a multisystemic disease

affects 1 in 10,000; detected by lack of fibrillin in blood test

Front 77

What is familial hypercholesterolemia?

Back 77

autosomal (incomplete) dominant trait

common cause of cardiovascular disease (affects 1 in 500)

mutation in gene encoding receptor for low-density lipoprotein (LDL); results in lipid deposits in arteries and atherosclerosis

incomplete dominant, thus varying outcomes
- if both genes are mutated - death in childhood
- if only one gene is mutated (heterozygous) - death as young adult

Front 78

Autosomal recessive diseases manifest themselves only when:

Back 78

a person is homozygous for the defective allele

requires both parents to be carriers (heterozygous)

offspring have 25% chance of having the disease

Front 79

The chance for inheriting two recessive alleles increases in:

Back 79

close intermarriage

Front 80

What is albinism?

Back 80

autosomal recessive disorder

manifests with very white skin and hair; increased risk of skin cancer

often visual problems (nearsightedness and abnormally high light sensitivity)

Front 81

What is the most commonly inherited cause of mental retardation?

Back 81

Fragile X syndrome

Front 82

What are familial diseases?

Give some examples

Back 82

some diseases appear in families, but means of inheritance is not understood

(e.g., diabetes, epilepsy, allergies, cardiovascular problems, familial polyposis)

Front 83

What seems to be the cause of familial diseases?

Back 83

they do not seem to be the result of a single gene, but effect of several genes working together, known as a multifactorial trait

some familial diseases may not be inherited at all, but instead result form unique environmental conditions or behaviors that are shared by family members

Front 84

When is chorionic villus sampling done?

Back 84

in early pregnancy, between the 8th and 10th week

Front 85

What is atresia?

Back 85

the absence of a normal opening in an organ

Front 86

A permanent change in the genetic code of DNA is:

Back 86

a mutation

Front 87

If the two members of a pair of genes are alike, they are said to be:

Back 87

homozygous

Front 88

Mutations can result from:

a. viral activity
b. radiation
c. chemical action
d. all three answers are correct

Back 88

d. all three answers are correct

Front 89

The carrier of a genetic disease is someone who has a defective gene and:

Back 89

apparently normal health

Front 90

The carrier of a genetic disease is:

Back 90

heterozygous

Front 91

Congenital diseases are those that are:

Back 91

present at birth or shortly thereafter

Front 92

A genetic disease that always appears in the children of one affected parent must be:

Back 92

an autosomal dominant trait

Front 93

An individual who is heterozygous for a genetic disease but is not him/herself affected is a carrier for a:

a. dominant autosomal trait
b. recessive autosomal trait
c. recessive sex-linked trait
d. answers 2 and 3 are both correct

Back 93

d. answers 2 and 3 are both correct

Front 94

Typical characteristics seen in a Down syndrome child include:

a. mental retardation
b. slanted eyes
c. coarse and protruding tongue
d. all of the above

Back 94

d. all of the above

Front 95

Marfan syndrome is:

a. XXY chromosomes
b. sterile male
c. dominant trait
d. codominant trait

Back 95

a dominant trait

Front 96

DNA provides a blueprint for protein synthesis. (T/F)

Back 96

true

Front 97

The karyotype of a cell describes the chromosomes present. (T/F)

Back 97

true

Front 98

Autosomes are the chromosomes that determine the sex of an individual (T/F)

Back 98

false

Front 99

Inborn errors of metabolism can result from lack of a particular enzyme. (T/F)

Back 99

true

Front 100

Sex-linked genes are carried on the X and the Y chromosomes. (T/F)

Back 100

false

Front 101

Girls do not develop sex-linked genetic disorders. (T/F)

Back 101

false

Front 102

Lactaid may reduce symptoms of galactosemia. (T/F)

Back 102

true

Front 103

In males, the Y chromosome is shorter than the X but carries the same number of genes. (T/F)

Back 103

false

Front 104

Color blindness is a sex-linked trait found only in males. (T/F)

Back 104

false

Front 105

Fathers only contribute the Y sex chromosome to their sons. (T/F)

Back 105

true

Front 106

If everyone who inherits one copy of a defective allele develops the related disorder, that allele is ________________.

Back 106

dominant

Front 107

Huntington's chorea is inherited as a ______________ trait.

Back 107

dominant, autosomal

Front 108

Phenylketonuria is a genetic disorder resulting from the failure of an afflicted individual to produce ___________.

Back 108

an enzyme

Front 109

The inheritance of __________ may decrease the likelihood of a person's catching malaria.

Back 109

sickle cell trait

Front 110

People with Turner's syndrome or Klinefelter's syndrome will be __________.

Back 110

sterile

Front 111

From two color blind parents, there is ______ chance for a normal visioned offspring?

Back 111

0%

Front 112

The gene for achondroplasia affects development of the fetal __________.

Back 112

cartilage

Front 113

The lack of control of salt and mucus secretion is indication of __________________.

Back 113

cystic fibrosis

Front 114

An autosomal recessive condition causing abnormal lipid metabolism in the brain, with progressive mental and physical retardation, and death by the age of 4 is ___________.

Back 114

Tay-Sachs

Front 115

The incidence of __________ is higher in mothers over the age of 35.

Back 115

Down syndrome

Front 116

What is malnutrition? ***

Back 116

- any disease or disorder concerning nutrition

- may result from unbalanced, insufficient or excessive diet

- may be the result of impaired absorption, assimilation, or use of foods

Front 117

What are the causes of malnutrition? ***

Back 117

- ignorance and poverty
- gastrointestinal disorders
- chronic alcoholism
- psychoneurotic disorders

Front 118

What are the basic purposes for nutrients? ***

Back 118

- form body structure
- provide energy
- serve as regulators of body processes

Front 119

Body structure is determined by: ***

Back 119

genetics

Front 120

For the genetic blueprint of the body structure to be fulfilled, an individual must have adequate: ***

Back 120

nutrition

Front 121

What is energy? ***

Back 121

vital function/fuel that nutrients provide the body

Front 122

How is energy measured? ***

Back 122

it is measured in calories

Front 123

How many calories do most adults use daily? ***

Back 123

between 1500 and 3000

Front 124

What are the nutrients that provide energy? ***

Back 124

- carbohydrates
- lipids
- proteins

Front 125

What is another term for regulation? ***

Back 125

metabolism

Front 126

What are the primary nutrient regulators? ***

Back 126

- proteins
- vitamins
- minerals

Front 127

What are the symptoms of Vitamin C deficiency?

How is it treated/prevented? ***

Back 127

- bleeding gums and hemorrhages into tissues

- citrus fruits and greens

Front 128

What are the symptoms of Vitamin A deficiency?

How is it treated/prevented? ***

Back 128

- results in poor vision in dim light; also dry, cracked mucous membranes

- diets including dairy products and vegetables

Front 129

What are the symptoms of Vitamin D deficiency?

How is it treated/prevented? ***

Back 129

- weak, deformed bones

- Vitamin D supplements, fortified milk, and exposure to sunlight

Front 130

What are the symptoms of Vitamin K deficiency?

How is it treated/prevented? ***

Back 130

- results in tendency to hemorrhage

- normal diet

Front 131

What are the signs and symptoms of Vitamin A hypervitaminosis, both acute and chronic? ***

Back 131

- acute toxicity: headache, vertigo, diarrhea

- chronic toxicity: cirrhotic-like liver, hypercalcemia, and or generalized edema

Front 132

Which are the fat-soluble vitamins? ***

Back 132

- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin K

Front 133

What are the signs and symptoms of Vitamin D hypervitaminosis, both acute and chronic? ***

Back 133

- acute toxicity: hypercalcemia, weakness, vomiting, diarrhea, nausea

- chronic toxicity: renal impairment, polydipsia, or excessive thirst

Front 134

What are the signs and symptoms of Vitamin E hypervitaminosis? ***

Back 134

- very minimal in humans

Front 135

What are the signs and symptoms of Vitamin K hypervitaminosis? ***

Back 135

hemolysis--destruction of RBCs with the release of hemoglobin

Front 136

Which are the water-soluble vitamins? ***

Back 136

- niacin
- vitamin B6
- vitamin C

Front 137

What are the signs and symptoms of niacin toxicity? ***

Back 137

- flushing
- severe twitching
- rash
- jaundice
- heartburn, nausea, vomiting
- hypotension, syncope

Front 138

What are the signs and symptoms of vitamin B6 toxicity? ***

Back 138

convulsive disorders

Front 139

What are the signs and symptoms of vitamin C toxicity? ***

Back 139

- diarrhea
- urinary acidification
- neuropathies

Front 140

What are the principal functions of calcium? ***

Back 140

- muscle contraction
- bone formation
- blood clotting

Front 141

What is the principal function of iodine? ***

Back 141

thyroid hormone regulation

Front 142

What are the principal functions of potassium? ***

Back 142

- nerve activity
- heart and muscle functioning

Front 143

What is the principal function of iron? ***

Back 143

hemoglobin formation

Front 144

What are the principal functions of sodium? ***

Back 144

- water balance
- nerve and muscle activity

Front 145

What is the etiology of anorexia nervosa? ***

Back 145

- a disease of psychoneurotic origin

- aversion to food leads to emaciation and malnutrition

- patient is obsessed with food, but desires to be thinner

Front 146

What is the incidence of anorexia nervosa? ***

Back 146

- most common among teenage females
- greatly increased in recent years
- rare in males and older population

Front 147

What are the signs and symptoms of anorexia nervosa? ***

Back 147

- patient has misconception of body image and size
- denies problem, but perceives herself as fat
- becomes emaciated with gaunt face and protruding bones

Front 148

What personality changes are associated with anorexia nervosa? ***

Back 148

- irritability
- anxiousness
- depression
- hostility
- obsessed with food
- exercises strenuously

Front 149

What does a medical exam of an anorexia nervosa patient generally reveal? ***

Back 149

- low blood pressure
- decreased heart rate
- anemia
- dehydration
- depletion of potassium
- muscle weakness
- heart abnormalities
- lowered immune response

Front 150

What is the treatment for anorexia nervosa? ***

Back 150

hospitalization to correct malnutrition and psychological problems

Front 151

What is the prognosis for anorexia nervosa patient? ***

Back 151

- frequent relapses
- depression leading to suicide
- starvation leading to death with a high mortality rate

Front 152

What is the etiology of bulimia? ***

Back 152

an eating disorder of psychoneurotic origin with a gorge-purge syndrome

similar to anorexia, but the goal is to avoid weight gain, not lose weight

Front 153

Who are the primary bulimia patients? ***

Back 153

females in their teens and early 20s

Front 154

What are the signs and symptoms of bulimia? ***

Back 154

- usually of average weight or slightly overweight, making it hard to detect
- eating binges followed by self-induced vomiting
- excessive use of laxatives and diuretics
- constant sore throat
- swollen salivary glands
- dehydration
- electrolyte imbalance
- liver damage is common

Front 155

What is the treatment for bulimia? ***

Back 155

may include antidepressants and psychological counseling

management rather than cure is the treatment goal

Front 156

What is the prognosis for bulimia? ***

Back 156

can lead to sudden death from heart failure or ruptured stomach

Front 157

Bulimia may persist: ***

Back 157

throughout life

Front 158

What is obesity? ***

Back 158

a nutritional disorder that occurs when an abnormal amount of fat accumulates in adipose tissue

Front 159

What causes obesity? ***

Back 159

it occurs when an excess of calories is consumed compared to energy expended

the rate of fat synthesis is faster than mobilization of fat to muscles for use as energy

Front 160

What may be said about the underlying cause of obesity? ***

Back 160

it may be complex and difficult to treat

Front 161

At what point is a person considered obese? ***

Back 161

if the individual is 20% heavier than the upper limit of ideal weight for his/her sex, age, and height
(AT LEAST THAT'S WHAT I THINK THE SLIDE IS TRYING TO SAY--CHECK ON THIS!)

Front 162

What are some of the causes of obesity? ***

Back 162

- overeating (high calorie) foods combined with insufficient exercise
- genetic factors; increased number of adipose cells may be inherited trait
- culture and environment; encouraging excessive food intake and using food as a reward set the regulatory system of the hypothalamus at a level that maintains the habit of overeating
- emotional dependency on food as a reward to self when depressed or lacking positive feelings
- hypothalamus dysfunction and hypoactive thyroid are rarely a cause of obesity
- psychological factors: reaction to stress, substitute for other desires, learned behavior as a result of environment

Front 163

What are some of the complications of obesity? ***

Back 163

- hypertension
- hypoventilation
- maturity-onset diabetes
- diaphragmatic hernia
- enlarged heart
- atherosclerosis
- varicose veins
- gallbladder disease
- fatty liver
- psychological disorders
- sleep apnea

Front 164

What is the treatment for obesity? ***

Back 164

- diet
- exercise
- drugs
- surgery

Front 165

What aspects of a diet can help reduce obesity? ***

Back 165

- it is the most effective method of overcoming obesity
- change eating habits (choice and volume)
- balanced diet of protein, some unsaturated fat, and adequate carbohydrates to provide glucose to cell (minimizes feeling of hunger)
- reduce intake of sodium and table salt
- increase daily intake of water
- weight reduction programs
- provide support for difficult process

Front 166

What is an optimal weekly weight loss goal for lasting results? ***

Back 166

loss of 1-3 pounds

Front 167

At what calorie levels does weight loss occur for:
men?
women? ***

Back 167

men - 1500-2000 calories per day
women - 500-1000 calories per day

Front 168

How does an exercise program facilitate weight loss? ***

Back 168

- daily exercise will facilitate weight loss by expending calories
- exercise releases endorphins which will help you feel better
- exercise tends to help suppress habitual feelings of hunger

Front 169

What types of drugs are used to assist weight loss? ***

Back 169

- appetite suppressants (depressants) and amphetamines initially assist with new eating habits, but may cause nervousness, restlessness, insomnia, dry mouth, and constipation
- mild antidepressant drugs used if depression is a contributing factor to obesity

Front 170

How can surgery be used to facilitate weight loss? ***

Back 170

- decrease size of intestines
- decrease size of stomach (pouch procedure/gastric bypass)
- lap band

Front 171

What are some positive effects of weight loss? ***

Back 171

- decreased blood pressure
- lower levels of circulating lipids that may contribute to atherosclerosis
- distress of osteoarthritis is reduced (decreased joint pain, increased mobility)
- more effective, efficient control of diabetes
- decreased cardiovascular and respiratory problems
- increased activity level which helps maintain weight loss
- increased self-image
- less stressed and greater life satisfaction
- increased longevity
- sleep apnea reduced

Front 172

What is alcoholism? ***

Back 172

illness characterized by significant impairment that is directly associated with persistent and excessive use of alcohol

Front 173

What types of impairment are associated with alcoholism? ***

Back 173

impairment may involve physiological, psychological, or social dysfunction

Front 174

What percentage of alcohol consumers are considered alcoholics? ***

Back 174

in 1995, 10% of alcohol consumers were considered alcoholics, number has increased annually

Front 175

What psychological problems are noted with alcoholism? ***

Back 175

- emotional disturbances during childhood or past
- feelings of insecurity, inadequacy, or loneliness
- hostility
- depression

Front 176

What sociological problems are noted with alcoholism? ***

Back 176

- sanctioned behavior - heavy drinking is socially acceptable in some professions or cultures
- peer pressure: social groups consider drinking "adult behavior"
- teens and young adults engage in alcohol binges
- socially promoted as relaxing and forgetting troubles by having a few drinks

Front 177

What causes alcoholism-related malnutrition? ***

Back 177

- unavailability of required nutrients or skipping meals
- eating unbalanced meals
- diseases that prevent the utilization of ingested foods
- psychoneurotic disorders

Front 178

What treatment options are available for alcoholism? ***

Back 178

- best controlled by early intervention and continuing attention
- treatment directed toward enabling patient to develop better problem-solving strategies
- mental and physical health of alcoholic determines best treatment approach
- personal physician, psychotherapist, group therapy, or AA or behavior modification are options
- detoxification centers are available for the acutely intoxicated
- general and psychiatric hospitals may be required for treatment of DT, hepatic comas, and other medical emergencies
- halfway houses and recovery houses are helpful in assisting the recovering alcoholic with adjusting and transitioning to life without alcohol

Front 179

Upon what body systems does alcohol have a negative effect? ***

Back 179

- central nervous system
- digestive system
- cardiovascular system

Front 180

What specific effects does chronic alcoholism have on the digestive system? ***

Back 180

- gastritis
- liver disease
- pancreatitis
- gynecomastia
- blood clotting disturbances
- ascites (abnormal accumulation of fluid in the abdomen)
- ecchymoses (bruising)
- epistaxis (nosebleeds)

Front 181

What specific effects does chronic alcoholism have on the cardiovascular system? ***

Back 181

- fatty infiltration of the heart
- coronary thrombi
- enlargement of the heart
- progressive cardiac failure

Front 182

What specific effects does chronic alcoholism have on the nervous system? ***

Back 182

- impaired judgment
- poor powers of concentration
- delirium tremens
- hepatic coma

Front 183

What is fetal alcohol syndrome? ***

Back 183

- caused by babies being born to alcoholic mothers
- most likely to occur if mother has a 5-10 year history of drinking problems
- incidence is increasing along with the increase in alcoholism among young females

Front 184

What are the signs and symptoms of fetal alcohol syndrome? ***

Back 184

- mental retardation
- delayed physical growth
- limb and joint abnormalities
- heads are smaller than normal
- eye slits smaller and with epicanthal folds
- flat midface
- nose short and upturned
- smooth philtrum and thin upper lip
- jaws underdeveloped
- born with withdrawal symptoms, stiffness, and irritability

Front 185

What is the treatment for fetal alcohol syndrome? ***

Back 185

detoxification and life support

Front 186

What is the prognosis for fetal alcohol syndrome? ***

Back 186

good, if near full term or normal birth weight with no other physical abnormalities

Front 187

What membranes does the heart contain? ***

Back 187

- myocardium - cardiac muscle
- endocardium - smooth membrane lining heart chambers
- pericardium - double-membrane sac enclosing heart
- epicardium - inner layer of pericardial sac

Front 188

What is the septum of the heart? ***

Back 188

the structure that separates the right and left sides of the heart

(there is an interatrial septum and interventricular septum)

Front 189

List the chambers of the heart. ***

Back 189

2 atria, 2 ventricles
- atria - receiving chambers
- ventricles - pumping stations

Front 190

What are the functions of the 2 atria? ***

Back 190

right atrium receives blood from the body (deoxygenated - CO2)

left atrium receives blood from the body (oxygenated - O2)

Front 191

What are the functions of the 2 ventricles? ***

Back 191

right ventricle - pumps blood to lungs (CO2)

left ventricle - pumps blood to the body and brain (O2)

Front 192

What do the heart valves do? ***

Back 192

they assure one-way flow of blood

(the lub-dub sound is their opening and closing)

Front 193

What two types of valves are contained in the human heart? ***

Back 193

- atrioventricular valves
- semilunar valves

Front 194

What are the atrioventricular valves? ***

Back 194

valves between atria and ventricles (duh!)

- bicuspid (mitral) valve is between the left atrium and ventricle

- tricuspid valve is between the right atrium and ventricle

Front 195

What is another name for the bicuspid valve? ***

Back 195

mitral valve

Front 196

What are the semilunar valves? ***

Back 196

- pulmonary valve - between right ventricle and pulmonary artery

- aortic valve - between left ventricle and aorta

Front 197

What is the function of the coronary arteries? ***

Back 197

they supply blood to the muscles of the heart

if the coronary arteries become blocked, the result is heart attack

Front 198

What is the primary function of the human heart? ***

Back 198

- muscular pump
- keeps blood flowing to all cells and tissues

Front 199

Trace the flow of blood through the human heart. ***

Back 199

- deoxygenated blood from inferior and superior vena cava enters right atrium
- flows through tricuspid valve into right ventricle
- pumped through pulmonary valve into pulmonary artery, which branches to the left and right lungs
- CO2 is exchanged for O2
- oxygenated blood is pumped through pulmonary veins to left atrium
- flows through mitral/bicuspid valve into left ventricle
- pumped through aortic valve into aorta for distribution to brain and rest of body

Front 200

What is the cardiac cycle? ***

Back 200

alternating contraction and relaxation of atria and ventricles

Front 201

How many phases are there in the cardiac cycle? What are they? ***

Back 201

two phases

- systole - active, contracting phase
- diastole - relaxing, filling with blood period

Front 202

What is the typical speed of the cardiac cycle? (Each cycle and cycles per minute) ***

Back 202

- each cycle takes approximately 0.85 seconds

- roughly 72 cycles per minute

Front 203

How do the ventricles and atria function together? ***

Back 203

when ventricles are alternately contracting, the atria are alternately relaxing and filling

Front 204

What does blood pressure express? ***

Back 204

ventricular systole/diastole

(contraction/relaxation)

BLOOD PRESSURE IS VENTRICULAR!!!

Front 205

The human heart can contract continuously and rhythmically without: ***

Back 205

nerve stimulation

Front 206

By what mechanism does the heart beat? ***

Back 206

sinoatrial node - specialized patch of tissue on right atrial wall acts as a pacemaker, initiating a beat

impulse travels over right and left atria and causes atrial contraction

stimulates atrioventricular node near septum

special bundle of fibers (Bundle of His) rapidly spreads impulses from atria to ventricles

impulses terminate in Purkinjie fibers which branch throughout ventricles

contraction of ventricles occurs

Front 207

Which portion of the nervous system influences heart rate? ***

Back 207

autonomic nervous system

Front 208

How does the autonomic nervous system influence heart rate? ***

Back 208

via innervation to the heart (cardiac nerves for acceleration, vagus nerve for slowing)

(sinoatrial and atrioventricular nodes)

Front 209

What does the vagus nerve do? ***

Back 209

- causes release of neurotransmitter acetylcholine (ACh) which slows contraction during sleep or rest (parasympathetic nervous system)

- right vagus innervates sinoatrial node

Front 210

What does the cardiac accelerator nerve do? ***

Back 210

causes release of neurotransmitter epinephrine, which speeds up contractions for strenuous physical activity, when excited, or when body needs more blood flow (sympathetic nervous system)

Front 211

What are some common heart diseases and defects? ***

Back 211

- coronary artery disease (CAD)
- hypertensive disease (HTN)
- cor pulmonale
- congestive heart failure
- congenital heart defects
- valvular disorders
- rheumatic heart disease
- infectious endocarditis
- abnormalities of heart action

Front 212

What is coronary artery disease? ***

Back 212

- coronary arteries supplying O2 blood to heart muscles become occluded due to coronary thrombosis (clot) or narrowing of the lumen (atherosclerosis)

- ischemia (deficiency of blood supply) develops, resulting in heart attack

- sudden deprivation of blood to myocardium causes tissue death

- infarct is the dead muscle tissue, repairs as scar tissue and is no longer functional

Front 213

Another name for a heart attack. ***

Back 213

myocardial infarction

Front 214

What is the prognosis for a patient suffering a myocardial infarction? ***

Back 214

depends on:

- speed of medical attention/CPR
- size of coronary artery occluded
- how much heart muscle is damaged
- if collateral blood vessels to area are sufficient to lessen damage

Front 215

What are some signs of impending MI? ***

Back 215

- severe chest pain
- heartburn, nausea
- clammy feeling
- shortness of breath (SOB)
- referred pain into left side of neck and/or shoulder, down left upper extremity (LUE)
- can also be right-sided pain

Front 216

What are some treatments for a myocardial infarction? ***

Back 216

- thrombolytic drugs and anticoagulants (Coumadin, Heparin, aspirin)
- CABG - LE saphenous vein to replace occluded area
- angioplasty to break up plaque
- lasers to break up plaque

Front 217

What is angina pectoris? ***

Back 217

temporary O2 deficiency to heart (not > 30 minutes)

Front 218

What causes angina pectoris? ***

Back 218

- stress
- overexcitation
- heavy meals
- strenuous exercise

Front 219

What are the signs of angina pectoris? ***

Back 219

severe, sharp chest pains which may radiate to neck, jaw, and left arm, and/or

feeling of tightness or suffocation

Front 220

What is the treatment for angina pectoris? ***

Back 220

nitroglycerin pills to dilate arteries

Front 221

What is hypertensive heart disease? ***

Back 221

the heart is overworked due to pumping against great resistance (narrowed vessels) because of a history of uncontrolled high blood pressure (150/90 or higher)

the hypertensive heart is enlarged (hypertrophy and dilation)

the left ventricle becomes exhausted and the heart fails

Front 222

What are the signs and symptoms of hypertensive heart disease? ***

Back 222

- often asymptomatic for months to years
- vague symptoms of lightheadedness, tinnitus, fatigue, heart palpitations

Front 223

What is the treatment for hypertensive heart disease? ***

Back 223

- minimize risk factors
- diet and moderate exercise
- decrease stress
- vasodilators and diuretic medications

Front 224

What is cor pulmonale? ***

Back 224

caused by right-sided heart failure due to chronic lung disease

right ventricle works against too much resistance, with resultant dilation and hypertrophy

Front 225

What is the treatment for cor pulmonale? ***

Back 225

relieving causative lung disease by bronchodilators and ventilation

Front 226

What is the main function of the circulatory system?

Back 226

transport

Front 227

The circulatory system carries:

Back 227

- oxygen and nutrients needed for metabolism to the tissues
- waste products from cellular metabolism to kidneys and other excretory organs for elimination
- electrolytes and hormones needed to regulate various body functions

Front 228

What is considered the pacemaker of the heart?

Back 228

the sinoatrial node (SA node)

Front 229

What are the two circulatory routes?

Back 229

- systemic circulation
- pulmonary circulation

Front 230

What is the smallest artery called?

Back 230

arteriole

Front 231

What are capillaries?

What do they do?

Back 231

they connect arteries (arterioles) and veins (venules)

deliver oxygen and nutrients to tissues

Front 232

Composition of veins:

Back 232

- thinner walls than companion arteries
- lumens are larger, however
- less muscle and elasticity makes them more likely to collapse when empty
- have valves to return blood to heart against pull of gravity (esp in legs)

Front 233

What are some diseases of arterial circulation?

Back 233

- hyperlipidemia
- hypercholesterolemia
- arteriosclerosis
- atherosclerosis
- peripheral artery disease
- Raynaud's disease
- aortic aneurysm

Front 234

What are some diseases of arterial pressure?

Back 234

- arterial hypertension
- pulmonary arterial hypertension

Front 235

What are some diseases of venous circulation?

Back 235

- venous circulation of the lower extremities
- varicose veins
- chronic venous insufficiency
- venous thrombosis

Front 236

What are some diseases of cardiac function?

Back 236

- coronary heart disease

Front 237

What are some myocardial and endocardial diseases?

Back 237

- myocarditis
- cardiomyopathy

Front 238

What are some diseases of the endocardium?

Back 238

- infective endocarditis
- rheumatic heart disease

Front 239

What are some valvular heart diseases?

Back 239

- mitral stenosis
- mitral regurgitation
- aortic stenosis
- aortic regurgitation

Front 240

What are some cardiac conduction disorders?

Back 240

- cardiac arrhythmias

Front 241

What is congestive heart failure?

Back 241

a condition in which the heart cannot pump enough blood to meet the blood and oxygen needs of other body organs

it is a complication of most forms of heart disease, including coronary and peripheral atherosclerosis

Front 242

What are some heart diseases noted in infants and children?

Back 242

congenital heart disease consisting of:
- cyanotic heart disease (tetrology of fallot, transposition of the great arteries)
- non-cyanotic congenital heart disease (septal defects, patent ductus arteriosus, coarctation of the aorta)

Front 243

What general disorders cause heart disease?

Back 243

disorders of

- blood flow
- blood pressure
- cardiac function

Front 244

What is hyperlipidemia?

Back 244

generic term for elevated lipids or fats in the blood

Front 245

What are lipids?

Back 245

- cholesterol
- cholesterol esters
- phospholipids
- triglycerides

Front 246

Cholesterol is transported throughout the system by:

Back 246

transport proteins called lipoproteins

Front 247

Why is LDL the "bad" cholesterol?

Back 247

accumulations of it form a plaque or thick hard deposit that narrows the arteries and impedes blood flow

Front 248

Why is high-density lipoprotein (HDL) the "good" cholesterol?

Back 248

it carries about 1/4 to 1/3 of the cholesterol

it carries cholesterol away from the arteries and to the liver, where it is eliminated from the body

Front 249

What are triglycerides?

Back 249

the form that fat exists in the human body

Front 250

What are the two classifications of hypercholesterolemia?

Back 250

primary - develops independent of other causes

secondary - associated with other health problems or lifestyle

Front 251

Many types of hypercholesterolemia have _____

Back 251

a genetic basis

Front 252

A cause of primary hypercholesterolemia:

Back 252

familial hypercholesterolemia (an autosomal dominant genetic disorder)

Front 253

Causes of secondary hypercholesterolemia:

Back 253

- obesity
- diabetes mellitus

Front 254

What does arteriosclerosis lead to? Why?

Back 254

hypertension

because affected arteries cannot stretch and rebound in response to pressure of blood forced through them

Front 255

What is the most common cause of arteriosclerosis?

Back 255

atherosclerosis

Front 256

What are some risk factors for atherosclerosis?

Back 256

- hypercholesterolemia
- smoking
- hypertension
- diabetes

Front 257

What are the three types of lesions associated with atherosclerosis?

Back 257

- fatty streak
- fibrous atheromatous plaque
- complicated lesion

Front 258

What are fatty streaks?

Back 258

thin, flat discolorations in the vasculature that progressively enlarge and thicken

Front 259

How do fatty streaks evolve?

Back 259

they are present in children and increase in number to about age 20, then they either remain static or regress

Front 260

What is the basic lesion of clinical atherosclerosis?

Back 260

the fibrous atheromatous plaque

Front 261

How is the fibrous atheromatous plaque characterized?

Back 261

by accumulation of intracellular and extracellular lipids and formation of scar tissue

Front 262

How does fibrous atheromatous plaque begin?

Back 262

as a whitish gray lesion thickening of the vessel intima (inner coat of the vessel) that contains a lipid core covered by a fibrous plaque

as the lesion increases in size, it may cause an occlusion

Front 263

What are complicated lesions?

Back 263

more advanced than fatty streaks or fibrous atheromatous plaque

characterized by hemorrhage, ulceration, and scar tissue deposits

Front 264

How is a thrombosis formed?

Back 264

the clot within a blood vessel is formed by turbulent blood flow in the region of the plaque and ulceration of the plaque

Front 265

When are symptoms of atherosclerosis felt?

Back 265

not usually until the interior of the artery is extensively occluded

Front 266

On what do symptoms of atherosclerosis depend?

Back 266

location and severity of occlusion

Front 267

Occlusion of the coronary arteries may result in:

Back 267

chest pain and shortness of breath

Front 268

Blockage of the carotid arteries can cause:

Back 268

reduced blood supply to the brain and a stroke

Front 269

Blockage or hardening of arteries in the leg is known as:

Back 269

peripheral artery disease
(peripheral vascular disease)

Front 270

Peripheral artery disease (peripheral vascular disease) can lead to:

Back 270

pain in the muscles of the leg

in severe cases, ulceration or gangrene of the extremities

Front 271

What medications are used to treat atherosclerosis?

Back 271

- antihypertensive medications
- cholesterol-lowering medications

Front 272

What is peripheral arterial disease?

Back 272

similar diseases as affect coronary or carotid arteries, but in the peripheral arteries of the body

Front 273

What are the symptoms of peripheral artery disease?

Back 273

- ischemia (lack of blood and oxygen supply); foot will feel cool to touch and pulse will be faint or absent
- pain (esp. with walking - a.k.a. intermittent claudication)
- impaired function
- infarction
- tissue necrosis (ulceration and gangrene)
- thinning of skin and subcutaneous tissues of lower leg

Front 274

What arteries are most commonly affected by peripheral artery disease?

Back 274

- femoral
- popliteal

Front 275

What are the signs of ischemia?

Back 275

- subcutaneous atrophy
- pallor
- coolness
- absent pulse

Front 276

Treatment for peripheral artery disease:

Back 276

- prevention of further damage
- walking slowly
- avoiding injury to areas with compromised circulation
- blood thinners
- surgical bypass/removal

Front 277

Symptoms of Raynaud's disease? ***

Back 277

- skin change from pallor to cyanosis
- cold, numbness, tingling, pain
- may lead to arthritis, ulceration, or rarely gangrene

Front 278

How are aneurysms classified?

Back 278

- location
- size
- morphology (configuration and structure; e.g., fusiform, saccular)
- origin

Front 279

Where do aneurysms usually occur?

Back 279

- abdomen below the kidneys (abdominal aortic aneurysm)
- chest cavity (thoracic aneurysm)
- cerebral or brain aneurysms are less common

Front 280

Causes of aneurysms? ***

Back 280

- atherosclerosis (most common for abdominal aneurysms)
- connective tissue disease
- congenital defect
- infection
- inflammation
- trauma

Front 281

Treatment of aneurysms? ***

Back 281

possibly surgical repair, depending on size and location

Front 282

Arterial blood pressure is a measure of:

Back 282

the force of blood against arterial walls

systolic <120 mm Hg
diastolic <80 mm Hg

Front 283

What is the cause of congestive heart failure? ***

Back 283

inadequate pumping of the heart

Front 284

What is chronic congestive heart failure? ***

Back 284

the result of many cardiac and pulmonary pathologies

Front 285

What is acute congestive heart failure? ***

Back 285

results from myocardial infarction

Front 286

What becomes congested in congestive heart failure? ***

Back 286

either
- systemic veins or
- pulmonary veins

pressure builds up in either vascular system

Front 287

What happens in right-sided congestive heart failure? ***

Back 287

- peripheral edema
- pitting edema of ankles
- distended neck veins
- enlarged liver/spleen

because blood is backing up in the vena cava to the rest of the body

Front 288

What happens in left-sided congestive heart failure? ***

Back 288

- pulmonary edema
- shortness of breath

because blood is backing up into the lungs

Front 289

What is the treatment for congestive heart failure? ***

Back 289

- diuretics to decrease edema
- reduction of salt and water intake
- medications to improve cardiac output
- antihypertensives
- antiarrhythmics
- medications to slow heart rate and allow heart muscle to relax and fill with blood
- bed rest in severe cases

Front 290

What are congenital heart defects? ***

Back 290

caused by abnormalities of birth due to failure of normal heart development in utero

Front 291

What is the most common congenital heart defect? ***

Back 291

most are septal defects--abnormal openings in the septum

Front 292

What is an ASD? ***

Back 292

atrial septal defect

a defect (opening) in the septum between the two atria

Front 293

What is a VSD? ***

Back 293

ventricular septal defect

a defect (opening) in the septum between the two ventricles

Front 294

What is a PDA? ***

Back 294

patent ductus arteriosis

a defect (opening) connecting the pulmonary artery and aorta

Front 295

What is the Tetralogy of Fallot? ***

Back 295

a collection of four heart abnormalities

Front 296

How does a ventricular septal defect produce cyanosis? ***

Back 296

- initially the pressure gradient is higher in the left ventricle, so the oxygenated blood flows to the right ventricle (lower pressure)
- pressure in right ventricle increases and deoxygenated blood begins to flow back to left ventricle
- deoxygenated blood is pumped out the aorta and to the body, producing cyanosis

Front 297

What abnormalities occur in Tetralogy of Fallot? ***

Back 297

- narrowing of pulmonary artery (decreased size or by valvular stenosis)
- large ventricular septal defect (VSD)
- thicker (hypertrophied) right ventricle
- displaced aorta that crosses interventricular septum (allows blood from both ventricles into systemic circulation)

one of the most serious congenital heart defects

Front 298

What is coarctation of the aorta? ***

Back 298

narrowing or stricture of the aorta, and decreased blood flow to the lower body

Front 299

What is the usual treatment for congenital heart defects? ***

Back 299

surgical correction

Front 300

What occurs in patent ductus arteriosis? ***

Back 300

the ductus arteriosis connecting the pulmonary artery and aorta fails to close after birth

higher blood pressure in aorta causes blood to flow backwards into pulmonary artery (lower pressure)

Front 301

What are some types of valvular disorders? ***

Back 301

- stenosis
- valvular insufficiency
- malfunctions/defects

Front 302

What is valvular stenosis? ***

Back 302

the opening is too small for sufficient blood flow

(e.g., mitral stenosis due to rheumatic fever--mitral valve cusps become rigid and fuse)

Front 303

What can cause mitral stenosis? ***

Back 303

Rheumatic fever is the predominant cause

blood clots deposit on inflamed mitral valve cusps and they become rigid and fuse, causing stenosis

Front 304

What is valvular insufficiency? ***

Back 304

the valvular opening is too large

e.g., mitral insufficiency - mitral valve cannot close completely due to poor or weak papillary muscle contractions and cusps flutter open (allow backflow)

Front 305

What do valvular disorders result in? ***

Back 305

- decreased blood flow, circulation
- cyanosis
- blood backs up and leads to hypertrophy and CHF
- thrombus formation leads to emboli to brain or organs

Front 306

What other minor issue can valvular disorders cause? ***

Back 306

a heart murmur, which may be asymptomatic if not a serious problem

Front 307

How are valvular disorders corrected? ***

Back 307

- surgical reconstruction
- valve replacements

Front 308

What is the cause of rheumatic heart disease? ***

Back 308

- rheumatic fever (a systemic disease)
- sequela of infection by a Group A hemolytic streptococci
- autoimmune reaction with antibodies attacking body's tissue, especially the heart/mitral valve

Front 309

What organs/tissues are affected by rheumatic fever? ***

Back 309

- joints
- CNS
- skin
- heart
- mitral valves primarily involved with mitral stenosis and mitral insufficiency

Front 310

Who is primarily affected by rheumatic fever? ***

Back 310

usually children, teens, and young adults

it's uncommon today because of antibiotics

Front 311

What are the signs and symptoms of rheumatic fever? ***

Back 311

- begins with sore throat and ears
- progresses to fever, inflamed and painful joints
- sometimes a rash

(shiny red swelling of joints -- associated with rheumatic conditions)

Front 312

What is infectious carditis/infective endocarditis? ***

Back 312

- microbial infection affecting endocardial endothelium and heart valves

- bacteria and fungi cause it, and in acute cases form nodules or vegetations in a fibrous clot

Front 313

What are the symptoms of infective endocarditis?

Back 313

- fever
- chills
- change in sound or character of an existing heart murmur
- evidence for embolization of the vegetative lesions

Front 314

How does infectious carditis/infective endocarditis occur? ***

Back 314

caused by streptococcus bacterium entering bloodstream due to UTI, skin infection or tooth infection, etc.

bacteria migrate to heart already damaged by congenital defect and/or rheumatic heart lesions

form bacteria-filled nodules which are friable (break apart easily) and enter bloodstream as emboli to brain/organs

Front 315

What is the treatment and prognosis for infectious carditis/infective endocarditis? ***

Back 315

- blood test for causative organism
- EKG to detect valve disease and vegetations

- treatment with antimicrobials
- surgical interventions when heart is severely damaged

prognosis is good (was fatal prior to antibiotics)

Front 316

What is an arrhythmia? ***

Back 316

loss or irregularity of normal heart rhythm

irregularity in impulse generation and impulse conduction

Front 317

What is a normal heart rate? ***

Back 317

- adults - 72-78 bpm

infants - 110-150 bpm

normal rate slows with age

Front 318

What are four types of arrhythmias? ***

Back 318

- heart block
- excitation
- atrial fibrillation
- ventricular fibrillation

Front 319

What is a heart block? ***

Back 319

failure of SA node or AV node impulse conduction due to scar formation

(usually sequela of MI)

Front 320

What is excitation? ***

Back 320

firing of impulses is slowed or irregular

(can be corrected by pacemaker)

Front 321

What are fibrillations? ***

Back 321

chronic twitching of the heart with or without regular contractions

result of disorganized current flow within the atria or ventricles that interrupts normal contractions

Front 322

What are atrial fibrillations? ***

Back 322

most common cardiac arrhythmia

atria twitch and ventricles receive irregular input and do not fill properly

Front 323

What are ventricular fibrillations? ***

Back 323

more serious

ventricles "twitch" and blood is not pumped

leads to cardiac arrest, permanent damage to brain, heart, organs, and death within minutes

Front 324

What are premature ventricular contractions (PVC)? ***

Back 324

ventricles skip a beat or beat too soon, causing irregular rhythms or beats that are out of synchronization

Front 325

What is tachycardia? ***

Back 325

heart rate increases rapidly (greater than 100 bpm)

Front 326

What is bradycardia? ***

Back 326

heart rate is abnormally slow (< 60 BPM) (book says < 50 BPM)

Front 327

What is auscultation? ***

Back 327

listening through a stethoscope for abnormal sounds

Front 328

What is an ECG? ***

Back 328

electrocardiogram

non-invasive procedure to check electrical activity of heart

Front 329

What are P waves?
QRS waves?
T waves? ***

Back 329

- atrial contraction

- ventricular contraction

- repolarization of ventricles

Front 330

What does an ECG help diagnose? ***

Back 330

- coronary artery disease
- myocardial infarction
- valvular heart disease
- congenital heart disease
- arrhythmias
- heart blockages

Front 331

What is an echocardiogram? ***

Back 331

a non-invasive procedure that uses ultrasound waves to examine the

- size, shape, and motion of heart structures,
- heart valve movements,
- measurements of chambers, and
- changes of chambers during cardiac cycle

Front 332

What is color Doppler echocardiography? ***

Back 332

explores blood flow patterns and changes in velocity, and allows evaluation of valvular stenosis or insufficiency

Front 333

What is coronary arteriography? ***

Back 333

selective injection of contrast dyes into coronary artery with X-rays showing blood vessel action/blockages

Front 334

What are some treatment procedures for cardiac disease/defects? ***

Back 334

- drug therapy
- angioplasty
- lasers
- pacemaker implants
- open-heart surgeries

Front 335

What are some available drug treatments for cardiac disease? ***

Back 335

- vasodilators - Capoten (Captopril), Vasotec (Enalapril), Corgard (Nadolol)

- anticoagulants (or thinners), Persantine (Diprydiamole), Coumadin (Warfin Sodium), Calciparine (Heparin)

- antibiotics – penicillin or any of a number

- diuretics – Lasix, Furomide (Furosemide)

- antiarrhythmics – Lanoxin (Digoxin)

- antidepressants or antianxiety medications – Xanax (Alprazolam), BusSpar (Buspirone Hydrochloride)

Front 336

What are some surgical treatments for cardiac disease? ***

Back 336

- angioplasty - balloon catheterization and stent increase internal vessel diameter, thereby allowing increased blood flow rate

lasers - improves circulation by dissolving blockages

- pacemaker implants – provides regularity of stimulation to SA and AV nodes

- open heart surgeries: CABG, reconstruction/replacement, transplant

Front 337

What are some open heart surgeries? ***

Back 337

- CABG – coronary artery bypass graft using LE saphenous vein as replacement

- reconstruction/replacement – repair and replacement with synthetic materials

- transplant – implantation of donor heart

Front 338

What elements comprise the arterial system? ***

Back 338

- arteries
- arterioles
- capillaries

Front 339

Describe an artery. ***

Back 339

- muscular and thick walls
- strong
- considerable elastic tissue
- several layers
- lined with endothelium (intima)

Front 340

Describe an arteriole. ***

Back 340

- smaller lumen than artery
- thinner walls, mostly of smooth muscle fiber arranged circularly
- lined with endothelium
- constrict/dilate via ANS to SNS, which alters blood flow to tissues

Front 341

Describe capillaries. ***

Back 341

- minute vessels, about 1/2 to 1 mm long
- lumen as wide as RBC
- walls consist of a layer of endothelium only

Front 342

How do veins compare to arteries? ***

Back 342

- thinner walls
- larger lumen
- less elastic (collapse easily)
- most superficial of the blood vessels
- contain one-way valves to help return blood upward to heart against gravity
- skeletal muscle contractions greatly assist blood movement as well
- deeper veins are located parallel with arteries

Front 343

What are some diseases of the arteries? ***

Back 343

- arteriosclerosis
- atherosclerosis
- thrombosis/embolism
- aneurysm
- hemorrhagia
- Raynaud's disease

Front 344

What is arteriosclerosis? ***

Back 344

"hardening" of the arteries

- affects small arteries/arterioles
- degenerative (aging) process
- vessels become brittle and lose elasticity; can rupture
- leads to hypertension
- progressive thickening/roughening of intima makes vessels susceptible to thrombus (blood clot) formation
- clot formation can result in decreased blood flow to tissue distal to thrombus (= ischemia)
- partly due to calcium deposition

Front 345

What is atherosclerosis? ***

Back 345

fatty hardening of the arteries

- affects medium and large arteries; a form of arteriosclerosis
- lipid plaque (fatty deposit) build up on intima
- lumen narrows and may become occluded
- occlusion can result in decreased/absent blood flow to tissue distally (= ischemia)

Front 346

In what arteries is atherosclerosis of the most concern? ***

Back 346

- coronary artery (MI)
- cerebral artery (CVA)

Front 347

What is a thrombus? ***

Back 347

formation of blood clots on blood vessel walls due to adherence of platelets on roughened surfaces

occlusion can cause infarct (tissue necrosis)

Front 348

Where do thrombi typically form? ***

Back 348

- in areas of slower blood flow (veins)
- in areas of turbulence (scarred/diseased heart valves)
- on roughened vessel walls (atherosclerosis and rheumatic heart disease)
- can form when blood's platelet count is too high (increased viscosity)

Front 349

What is the typical treatment for thrombi? ***

Back 349

anticoagulants

sometimes surgery to remove the thrombus or embolism

Front 350

What is an embolism? ***

Back 350

a traveling mass of undissolved matter present in a vessel

can be comprised of fibrin, bits of tissue, blood clots, tumor cells, fat globules, air bubbles, clumps of bacteria, any foreign bodies

occlusion of vessel can cause infarct

Front 351

When do emboli occur in vessels? ***

Back 351

- when a thrombus breaks loose
- entry of bacteria due to lack of sterile techniques (septic embolism)
- entry of air bubbles during surgery
- entry of fat globules with fracture
- entry of foreign body with injury

Front 352

Emboli can travel in vessels and cause: ***

Back 352

occlusion
ischemia
infarct (MI, CVA, blockage in an organ)

Front 353

What happens to tissues after an infarct? ***

Back 353

tissue death allows bacteria to enter
gangrene follows
gangrene can infect viable tissue
leads to possible amputation or death

Front 354

What is coagulation necrosis? ***

Back 354

localized tissue death distal to the clot

Front 355

What is an aneurysm? ***

Back 355

localized dilation (fusiform) or sac-like (saccular) formation in arterial wall (lumen)

can enlarge and rupture, resulting in hemorrhaging which can be life-threatening, especially in the brain, aorta, heart, etc.

Front 356

How are aneurysms treated? ***

Back 356

if detected early enough can sometimes be surgically repaired with grafts

depends on location and size

Front 357

What is hemorrhagia? ***

Back 357

- a large loss of blood internally or externally

- often caused by aneurysms, head injuries, and bleeding diseases

Front 358

What is Raynaud's disease? ***

Back 358

- functional disorder of the arteries caused by vasospasms

- poor blood flow to the fingers or toes causing numbness, discoloration, and intermittent pain

- vasospasm in fingers/toes that cuts off circulation

- brought on by exposure to cold or by stressful events

Front 359

What are some diseases of the veins? ***

Back 359

- phlebitis
- varicose veins

Front 360

What is phlebitis? ***

Back 360

inflammation of a vein, usually of the lower extremities

Front 361

What causes phlebitis? ***

Back 361

- injury
- infection
- obesity
- poor circulation

it is a serious problem if in deep veins because it can lead to DVT (thrombophlebitis)

Front 362

What are the symptoms of phlebitis? ***

Back 362

- warmth
- pain
- edema
- erythema to area of DVT
- thrombus can dislodge and cause embolism

Front 363

What is the treatment for phlebitis? ***

Back 363

- anticoagulants
- occasionally surgery to remove clot

Front 364

What are varicose veins? ***

Back 364

enlarged, swollen knotty superficial veins, usually in the lower leg (saphenous vein)

caused by stagnation and pooling of blood in veins

often painful

Front 365

How do varicose veins form? ***

Back 365

the veins become dilated due to

- poor milking action of muscles to enhance venous return; blood pools
- increased back pressure of blood (due to some sort of obstruction)

Front 366

Stagnating blood causes ______ on veins and results in dilation of veins.

Back 366

pressure

leads to incompetent valves and pooling of blood

Front 367

What are some causes of varicose veins? ***

Back 367

- history of prolonged standing/sitting
- pregnancy or uterine tumor (increased pressure on veins in pelvic region resulting in backup or pooling of blood)
- heredity
- obesity
- can result in venostasis (slowed venous blood flow leading to ulcers due to poor circulation)

Front 368

What is the treatment for varicose veins? ***

Back 368

- elastic wraps
- support stockings
- walking
- elevating legs when sitting
- stripping and ligation
- laser

Front 369

What is hypertension (HTN)? ***

Back 369

- persistently high arterial blood pressure (150/90); (book says 140/90 mm Hg)
- caused by persistent peripheral resistance to blood flow (atherosclerosis)
- often called the "silent killer" as it is the leading cause of CVA, CHF

Front 370

What are some causes of/risk factors for hypertension? ***

Back 370

- prehypertension
- heredity (esp. African Americans)
- advancing age
- smoking
- obesity
- excessive salt, fat, and/or alcohol intake
- lack of exercise

Front 371

How does the nervous system attempt to control blood pressure? ***

Back 371

if low, nervous system vasoconstricts vessels to increase peripheral pressure

if excessively high, nervous system causes dilation of arterioles in kidney resulting in increased blood flow to kidneys and increased urine output, which lowers blood volume and thus blood pressure

Front 372

With what other disease/organ is hypertension linked? ***

Back 372

hypertension can cause kidney failure

kidney disease can cause hypertension

decreased kidney function leads to water retention, increased blood volume, and elevated blood pressure

long-standing hypertension causes arteriosclerosis of renal artery that reduces blood flow to kidneys and causes damage to them

Front 373

What are the two types of hypertension? ***

Back 373

- primary (essential) - develops for idiopathic reasons, may be asymptomatic for months/years; 90-95% of cases

- secondary - results from another pathology/disease (e.g., kidney disease, tumor of adrenal gland which regulates salt retention)

Front 374

What are the effects of hypertension? ***

Back 374

- overworks heart, leading to CHF or MI

- vessels become sclerotic, resulting in thrombus formation, embolus, or ruptures (CVA, MI)

- affects kidneys, heart, eyes, blood vessels

Front 375

What is the treatment for hypertension? ***

Back 375

- diuretics (decrease fluid volume)
- vasodilators (decrease peripheral resistance)
- decrease salt intake (decrease fluid retention)
- weight reduction
- cessation or decrease of smoking
- increase exercise (increase circulation)

Front 376

What is shock? ***

Back 376

a life-threatening vascular change resulting from assault or injury in which blood flow/pressure is inadequate to sustain life

condition that reduces heart's ability to pump effectively or decreases venous return

Front 377

Name four types of shock. ***

Back 377

- hypovelemic shock
- neurogenic shock
- cardiogenic shock
- anaphylactic shock
- septic shock

Front 378

What is hypovolemic shock? ***

Back 378

results from decreased blood volume due to excessive loss of fluid (hemorrhaging causing blood loss, severe burns causing plasma loss)

Front 379

What is neurogenic shock? ***

Back 379

results from decreased vasomotor tone/damage to central nervous system (poor venous return) due to SCI, spinal anesthesia, drugs

Front 380

What is cardiogenic shock? ***

Back 380

results from extensive MI or arrhythmia which causes inadequate oxygen

Front 381

What is anaphylactic shock? ***

Back 381

severe allergic reaction (insect bite, drug, food, etc.)

results in vasodilation throughout vessels causing a decreased blood flow to vital organs

Front 382

What are some diagnostic procedures for vascular diseases? ***

Back 382

- auscultation
- electrocardiogram (ECG/EKG)
- echocardiography
- Doppler echocardiography
- exercise tolerance test
- cardiac catheterization
- angiocardiography
- coronary arteriography
- carotid phonoangiography
- ultrasound arteriography
- angiography

Front 383

What is an electrocardiogram?

Back 383

ECG/EKG

electrical recording of heart action to aid in diagnosis of coronary artery disease, myocardial infarction, valve disorders, and some congenital heart diseases, as well as arrhythmias and heart block

Front 384

What is echocardiography?

Back 384

ultrasound cardiography

noninvasive procedure that uses high-frequency sound waves to examine the size, shape, and motion of heart structures

it gives a time-motion study of the heart, which permits direct recordings of heart valve movement, measurements of the heart chambers, and changes that occur in the heart chambers during the cardiac cycle

Front 385

What is an exercise tolerance test?

Back 385

used to diagnose coronary artery disease and other heart disorders

it monitors the ECG and blood pressure during exercise, and problems that do not normally occur at rest are revealed

Front 386

What is cardiac catheterization? ***

Back 386

procedure in which a catheter is passed into the heart through blood vessels to sample the blood in each chamber for oxygen content and pressure

findings can indicate valve disorders or abnormal shunting of blood and aid in determining cardiac output

Front 387

What is angiocardiography?

Back 387

a contrast indicator (dye) is injected into the cardiovascular system

in conjuction with X-rays of the heart and great vessels, the aorta, and pulmonary artery to detect blockage in vessels

Front 388

What is carotid phonoangiography? ***

Back 388

- non-invasive procedure

- special microphones over abnormal sounds heard with stethoscope (areas of carotid arteries); sound reproduced on oscilloscope to locate carotid stenosis

Front 389

What is ultrasound arteriography? ***

Back 389

- non-invasive procedure

- (a.k.a. Doppler imaging) -- special ultrasound equipment uses echoes of moving blood to produce images of vessel wall outline, measures velocity of blood and degree of arterial stenosis

Front 390

What is angiography? ***

Back 390

- invasive procedure

- examination of blood vessels by X-ray, vessels made visible by injection of radioactive substances (e.g., arteriograms and venograms)

Front 391

The cardiovascular system pumps blood through approximately _______ miles of blood vessels? ***

Back 391

60,000

Front 392

Disorders of what functions are directly and indirectly responsible for many of the diseases that affect pulmonary and systemic circulation?

Back 392

disorders of:
- blood flow
- blood pressure
- cardiac function

Front 393

Disorders of blood flow and blood pressure include:

Back 393

the diseases of
- arterial and
- venous circulation

Front 394

Disorders of cardiac function consist of diseases of:

Back 394

- pericardium
- coronary heart disease
- myocardial disease
- endocardial disease
- heart valve disease
- cardiac conduction disturbance
- heart failure
- heart disease in infants and children

Front 395

What are the transport proteins that carry cholesterol throughout the body called?

Back 395

lipoproteins

Front 396

Which is the major cholesterol carrier in the blood?

Back 396

low-density lipoproteins (LDL)

Front 397

What are risk factors for peripheral artery disease?

Back 397

- male
- age 70-80
- heredity
- environmental risks

Front 398

Treatment of Raynaud's disease includes:

Back 398

- reducing triggers
- protecting hands from trauma and cold
- avoiding emotional stress
- sometimes medications that prevent vasospasm

Front 399

What is a fusiform aneurysm?

Back 399

a uniform shape with symmetrical dilation around the entire circumference of the artery

Front 400

What is a saccular aneurysm?

Back 400

an outpouching of only one portion of the aortic wall

Front 401

Blood pressure ranges

Back 401

below 120/80 - healthy
120/80 to 139/89 - prehypertension
- 140/90 - 159/99 - stage 1 HTN
- 160/100 and up - stage 2 HTN

Front 402

What is the most common cardiovascular disorder?

Back 402

hypertension

affects about 20% of adult population worldwide

Front 403

What is pulmonary arterial hypertension?

Back 403

idiopathic or secondary high blood pressure in the pulmonary artery that causes the following changes :

- vasoconstriction
- endothelial and/or smooth muscle proliferation
- intimal fibrosis and thrombosis of the pulmonary capillaries or arterioles

Front 404

Symptoms of pulmonary arterial hypertension?

Back 404

- dyspnea (shortness of breath)
- syncope (loss of consciousness)

as the disease advances, pumping ability of heart weakens and symptoms occur at rest

Front 405

Treatment for pulmonary arterial hypertension?

Back 405

- medication
- oxygen therapy
- lung transplant

without treatment, prognosis is poor with median survival rate less than 3 years

Front 406

How is blood returned to the heart from the lower extremities?

Back 406

blood flows from superficial (saphenous) veins to deeper venous channels for return

valves along the deeper veins and skeletal leg muscles assist in moving the blood

Front 407

What are spider veins?

Back 407

small, dense networks that appear as red or blue discolorations on the skin

Front 408

Cause of spider veins?

Back 408

unknown

may be genetic, hormonal (puberty, birth control pills, pregnancy, HRT)

Front 409

Treatment of spider veins?

Back 409

laser treatment or saline injection to scar them shut

followed by continuous compression for several weeks, and walking to activate leg muscle venous pumps

Front 410

What is chronic venous insufficiency (CVI)?

Back 410

condition of poor venous blood return to the heart

Front 411

What are the most common causes of chronic venous insufficiency (CVI)?

Back 411

- deep vein thrombosis
- incompetence of venous valves and muscles that aid in blood return

Front 412

What are the signs and symptoms of chronic venous insufficiency (CVI)?

Back 412

- tissue congestion
- edema
- necrosis or skin atrophy
- pain on walking
- venous stasis ulcers in advanced cases

Front 413

What are the risk factors for chronic venous insufficiency (CVI)?

Back 413

- advancing age
- family history of deep vein thrombosis (DVT)
- sedentary lifestyle
- obesity
- smoking

Front 414

When is the peak incidence of chronic venous insufficiency (CVI)?

Back 414

- men in their 70s
- women in their 40s

Front 415

What is the treatment for chronic venous insufficiency (CVI)?

Back 415

- mild cases - diet, exercise, and compression stockings

- more severe - surgical repair of valves, vein bypass/stripping

Front 416

What are some signs and symptoms of venous thrombosis?

Back 416

- asymptomatic in 50% of cases
- similar to inflammation with pain, swelling, deep muscle tenderness

Front 417

Why is early detection and prevention of venous thrombosis important?

Back 417

to prevent potentially fatal complications such as emboli

Front 418

What is the most common cause of coronary heart disease?

Back 418

atherosclerosis (90% of cases)

Front 419

What is the leading cause of death worldwide?

Back 419

coronary heart disease

Front 420

What are the symptoms of coronary heart disease?

Back 420

- chest pain/angina pectoris
- palpitations
- dizziness/fainting
- weakness
- shortness of breath
- nausea
- pallor
- cardiac arrest/MI

Front 421

How is coronary heart disease treated?

Back 421

- blood pressure-lowering agents
- blood thinners
- diuretics
- nitrates to stop chest pain
- lipid-lowering medications
- lifestyle changes (diet/exercise)

Front 422

What is myocarditis and what causes it?

Back 422

inflammatory disease of the heart muscle

caused by virus (e.g., HIV, Coxsackie, adenovirus, echovirus) or bacteria

Front 423

How is myocarditis diagnosed?

Back 423

- EKG detects conduction disturbances
- echocardiogram may show enlargement/inflammation of heart
- blood culture test to show infection, detect certain heart muscle enzymes

Front 424

What are the symptoms of myocarditis?

Back 424

- it's often asymptomatic

- history of viral illness
- fever
- chest pain that feels like heart attack
- shortness of breath
- tachycardia

Front 425

How is myocarditis treated?

Back 425

- prevention of further damage with bed rest

- antibiotics if bacterial infection

Front 426

What is cardiomyopathy and what are the 3 types?

Back 426

functional disease of the myocardium

- dilated cardiomyopathy
- hypertrophic cardiomyopathy
- restrictive cardiomyopathy

Front 427

What is dilated cardiomyopathy and how is it treated?

Back 427

- most common form

- dilation of the ventricle, contractile dysfunction, symptoms of CHF

- treated with medications, rest, and surgical transplant in severe cases

Front 428

What are the causes and signs/symptoms of dilated cardiomyopathy?

Back 428

may result from:
- infections
- myocarditis
- toxic agents
- metabolic disorders
- genetic disorders
- immune disorders
- often idiopathic

symptoms include:
- dyspnea on exertion
- orthopnea
- weakness
- fatigue
- ascites
- peripheral edema

Front 429

What is hypertrophic cardiomyopathy and how is it treated?

Back 429

- characterized by ventricular hypertrophy/excessive ventricular growth
- most common cause of sudden cardiac death in the young

- treatment includes medications and surgery

Front 430

What are the causes and signs/symptoms of hypertrophic cardiomyopathy?

Back 430

- etiology often unknown, but some genetic mutations found

- may be asymptomatic

Front 431

What is restrictive cardiomyopathy?

Back 431

- least common form of cardiomyopathy

- associated with reduced heart-filling pressures and endocardial scarring/rigidity in the ventricle

- endemic in parts of Africa, India, Asia, and South/Central America

Front 432

What are the cause and signs/symptoms of restrictive cardiomyopathy?

Back 432

- most common cause is amyloidosis, a group of diseases in which one or more organ systems accumulates abnormal protein deposits

- symptoms include dyspnea, orthopnea, peripheral edema, ascites, weakness, and fatigue

Front 433

How does mitral stenosis manifest?

Back 433

- mitral valve opening is narrowed by rigidity in the cusps, which often fuse together (most often due to sequela of rheumatic fever)
- blood flow from left atrium to left ventricle meets resistance and atrial wall hypertrophies
- resistance leads to back pressure into pulmonary veins causing pulmonary congestion
- backed up fluid leaks into tissues causing edema
- poor circulation causes cyanosis because left ventricle doesn't have time to fill before it beats
- backup of blood and congestion cause heart to become exhausted and may lead to CHF

Front 434

What is another risk of mitral stenosis?

Back 434

increased risk for a thrombus to form on the valve, become detached, and become an embolus

Front 435

How is mitral stenosis remedied?

Back 435

- surgical valvuloplasty (similar to angioplasty)
- may lead to complications such as leaky valve, in which case it will be replaced with metal alloy or a pig valve

Front 436

How does mitral insufficiency/regurgitation manifest?

Back 436

- valve is unable to close completely (often due to failure of papillary muscles/chordae tendinae)
- blood leaks back into atrium with each ventricle contraction
- causes lung congestion

Front 437

What is mitral valve prolapse (MVP)?

Back 437

papillary muscles and chordae tendinae are unable to prevent mitral valve cusps from opening upward under force of expelled ventricular blood

Front 438

How is mitral valve prolapse (MVP) treated?

Back 438

- most people are asymptomatic and lead normal lives
- those with moderate to severe cases may take antibiotics to prevent bacteria from colonizing in the defective valves
- in most severe cases, surgical reconstruction or replacement

Front 439

What is aortic stenosis and what causes it?

Back 439

- aortic semilunar valve narrows

- may be sequela of rheumatic fever,
- congenital defect, or
- arteriosclerosis

- most common in men over 50

Front 440

What are the symptoms of aortic stenosis and how is it treated?

Back 440

symptoms include:
- left ventricular hypertrophy
- syncope

- can be corrected surgically

Front 441

What is aortic insufficiency/regurgitation and what causes it?

Back 441

- aortic semilunar valve doesn't close properly and blood flows back into left ventricle from aorta

- can result from endocarditis or a dilated aorta

Front 442

What are the symptoms of aortic insufficiency/regurgitation?

Back 442

- gradual onset; asymptomatic for a number of years; only sign may be a heart murmur
- diastolic BP drops
- left ventricle hypertrophies, becomes exhausted, and fails
- dyspnea, even at rest
- syncope

Front 443

Two categories of cardiac arrhythmias

Back 443

supraventricular arrhythmias--those generated by electrical abnormalities in the:
- sinoatrial (SA) node
- atria
- atrioventricular (AV) node
- and junctional tissue in the heart

ventricular arrhythmias generated in the ventricular conduction system and in the ventricle

Front 444

Which are the most serious arrhythmias?

Back 444

ventricular arrhythmias, since the ventricles are the pumping chambers, these arrhythmias can be life-threatening

Front 445

What are two disorders of cardiac rhythm (arrhythmia)?

Back 445

- tachycardia (sustained > 100 BPM)

- bradycardia (sustained < 50 BPM) (she says < 60 BPM)

Front 446

What can interruption of the flow of impulses through the conduction system of the heart lead to?

Back 446

heart block

Front 447

What does heart block cause the atria and ventricles to do?

Back 447

contract independently of one another

Front 448

What is the most serious consequence of a heart block?

Back 448

circulation to vital organs is cut off

Front 449

What is an ectopic pacemaker?

Back 449

an excitable focus outside the pacemaker of the heart (SA node) that can cause additional beats or take over normal pacemaker activity

Front 450

What are some symptoms of cardiac arrhythmias?

Back 450

- palpitations
- syncope
- edema
- shortness of breath

Front 451

What are some causes of cardiac arrhythmias?

Back 451

- history of coronary heart disease
- heart valve disease
- myocardial infarction
- hypertension
- atherosclerosis
- metabolic diseases
- smoking, drug abuse, etc.

Front 452

How are cardiac arrhythmias treated?

Back 452

- electrocardioversion with an external (AED) or surgically placed internal pacemaker/defibrillator
- catheter ablation - nonsurgical procedure of inserting catheter into heart to direct energy to sever pathway of abnormal rhythm
- antiarrhythmic medications to alter physiological properties of heart's conduction system

Front 453

What is septic shock?

Back 453

shock caused by toxins released by bacterial infection

Front 454

What puts a baby at increased risk of congenital heart disease?

Back 454

- born to parents with a history of congenital heart disease
- born with chromosomal abnormalities such as Down syndrome
- maternal diabetes, rubella infection, maternal alcoholism,, and treatment with anticonvulsant drugs
- maternal age over 40

Front 455

How is congenital heart disease classified?

Back 455

- etiologies that do not cause cyanosis

- etiologies that cause cyanosis (by allowing deoxygenated blood to bypass the lungs and return to systemic circulation)

Front 456

Symptoms of Tetrology of Fallot

Back 456

- difficulty feeding/gaining weight
- poor development
- cyanosis, especially with strain (feeding, crying, defecation)
- fainting
- sudden death
- clubbing of fingers
- squatting during episodes of cyanosis

Front 457

Treatment for Tetrology of Fallot

Back 457

numerous corrective surgeries

Front 458

What is transposition of the great arteries?

Back 458

the aorta and pulmonary artery are transposed

aorta is connected to right ventricle and pulmonary artery to left ventricle

Front 459

How is transposition of the great arteries treated?

Back 459

- if found prenatally, prostaglandin administration to keep patent ductus arteriosus open

- surgery within first 2-3 weeks of life to correct

Front 460

Symptoms of coarctation of the aorta

Back 460

- dizziness
- shortness of breath
- cold legs
- harsh murmur

Front 461

How is coarctation of the aorta treated?

Back 461

surgical correction

Front 462

In a normal heart, blood flows from the left atrium into the:

Back 462

left ventricle

Front 463

What does an EKG record?

a. blood flow to the heart
b. pulmonary trunk and pulmonary circulation
c. electrical events of the heart
d. blood pressure

Back 463

c. electrical events of the heart

Front 464

The bicuspid valve normally maintains one-way blood flow into the:

Back 464

left ventricle

Front 465

The rate of contraction of the heart can be increased by increased activity in the:

a. sinoatrial node
b. sympathetic nerves
c. parasympathetic nerves
d. a and b are correct

Back 465

d. a and b are correct

Front 466

The primary cause for hypertension is:

Back 466

atherosclerosis

Front 467

Hypertrophy of the myocardium due to excess work in pumping against high blood pressure produces what type of heart disease?

a. hypertensive heart disease
b. myocardial infarction
c. congestive heart failure
d. congenital disease

Back 467

a. hypertensive heart disease

Front 468

In a heart attack caused by blood clots blocking the coronary arteries, circulation can be quickly restored by administration of:

a. nitroglycerin
b. thrombolytic drugs
c. CPR
d. angioplasty

Back 468

b. thrombolytic drugs

Front 469

The tetralogy of Fallot involved four defects in the structure of the heart, including:

a. pulmonary stenosis
b. atrial septal defect
c. open foramen ovale
d. patent ductus arteriosis

Back 469

a. pulmonary stenosis

Front 470

Blood can flow back into the atrium and cause pulmonary hypertension in what type of valvular disease?

Back 470

mitral insufficiency

Front 471

Failure of the ventricle to contract when heart block occurs is caused by an abnormal

a. valve action
b. contraction of the cardiac muscle
c. conduction system
d. tachycardia

Back 471

c. conduction system

Front 472

Diuretics help with congestive heart failure. (T/F)

Back 472

true

Front 473

Left heart congestive failure produces edema in the ankles, liver and spleen, with enlargement of the neck veins. (T/F)

Back 473

false

left side causes lung congestion

Front 474

The parasympathetic nerve impulses act as a braking system to slow heart rate. (T/F)

Back 474

true

Front 475

Highly oxygenated blood is found in the right side of the heart (T/F)

Back 475

false

Front 476

Cardiomyopathy tends to result in congestive heart failure. (T/F)

Back 476

true

Front 477

Strokes may be hemorrhagic or ischemic. (T/F)

Back 477

true

Front 478

Diastolic pressure is the pressure in the venous blood. (T/F)

Back 478

false

Front 479

Heart murmurs are sounds that indicate abnormality of valves. (T/F)

Back 479

true

Front 480

Rheumatic heart disease is an infection of the endocardium and valves by Group A hemolytic streptococci. (T/F)

Back 480

false

Front 481

Stasis of blood flow frequently causes vegetations to form on the valve cusps. (T/F)

Back 481

false

Front 482

Contraction of the ventricles is called ________.

Back 482

systole

Front 483

Syncope is caused by a _________ of blood to the brain.

Back 483

lack

Front 484

________________ is a temporary chest pain from lack of oxygen to heart.

Back 484

angina pectoris

Front 485

The heart requires stimulation from the _________ to regulate the rate of contraction.

Back 485

sinoatrial node

Front 486

__________ disease is caused by constriction of arteries in fingers and toes.

Back 486

Raynaud's

Front 487

As a result of hypertension, the left ventricle develops __________ as it constantly pumps against high resistance in the arterial system, and eventually develops __________ as it weakens from the overload.

Back 487

hypertrophy; dilation

Front 488

Left-sided congestive heart failure produces ___________ in the patient.

Back 488

pulmonary edema

Front 489

In a child with a ventricular septal defect, ____________ indicates blood is shunting from left to right.

Back 489

cyanosis

Front 490

The ________ is a fetal vessel used to bypass the non-functioning fetal lungs.

Back 490

patent ductus arteriosus

Front 491

______________ stems from pulmonary hypertension and causes right-side heart failure.

Back 491

cor pulmonale

Front 492

Back 492

1.1 Tricuspid valve E.
1.2 Bicuspid (mitral) valve M.
1.3 Left pulmonary artery (to lung) I.
1.4 Right atrium D.
1.5 Left atrium L.
1.6 Right ventricle P.
1.7 Left ventricle O.
1.8 Aorta H.
1.9 Right pulmonary veins (from lung) C.
1.10 Left pulmonary veins (from lung) K.
1.11 Chordae tendineae F.
1.12 Inferior vena cava (from trunk and legs) G.
1.13 Superior vena cava (from head and arms) A.
1.14 Pulmonary semilunar valve J.
1.15 Right pulmonary artery (to lung) B.
1.16 Aortic valve N.

Front 493

tachycardia

Back 493

excessively rapid heart rate, > 100 BPM

Front 494

major congenital heart anomaly

Back 494

tetrology of Fallot

Front 495

phlebitis

Back 495

inflamed veins

Front 496

ischemia

Back 496

deficient blood supply

Front 497

infarct

Back 497

area of dead tissue

Front 498

myocardial infarction

Back 498

heart attack

Front 499

blood test for MI

Back 499

serum enzymes

Front 500

stasis

Back 500

slowed blood flow

Front 501

sclerotic

Back 501

hardened, scarred

Front 502

fibrillation

Back 502

uncoordinated, inefficient contraction

Front 503

What are the primary purposes of blood? ***

Back 503

- transportation
- defense

Front 504

What are the prime elements of blood? ***

Back 504

formed elements
- erythrocytes (RBCs)
- leukocytes (WBCs)
- thrombocytes (platelets or cell fragments; clotting cells)

nonformed elements
- plasma

Front 505

What elements does blood transport? ***

Back 505

- O2/CO2
- water
- nutrients
- salts
- proteins
- hormones
- waste products
- bloodborne diseases

Front 506

What does blood defend against? ***

Back 506

- diseases
- infections
- toxins
- antigens
- other foreign elements

Front 507

What are the formed elements of blood? ***

How much of the blood do they account for? ***

Back 507

- erythrocytes
- leukocytes
- thrombocytes/platelets

account for 45% of blood

Front 508

What is plasma? ***

How much of blood does it account for? ***

Back 508

- liquid element (everything else)

- accounts for 55% of blood

Front 509

Where do erythrocytes come from? ***

Back 509

- cells formed only in red bone marrow of flat bones (e.g., sternum, iliac crest, ribs)

- process is called erythropoeisis

Front 510

What are some properties of erythrocytes? ***

Back 510

- mature cells are biconcave, have no nucleus and few organelles

- prime component is hemoglobin, a chromoprotein of red color that carries oxygen

- most abundant cell in human body

- RBCs outnumber WBCs 700 to 1

Front 511

Where are leukocytes formed? ***

Back 511

in red bone marrow and lymph tissue

Front 512

What WBCs comprise the granulocytes, and what are their functions? ***

Back 512

- neutrophils (65%) - ingest bacteria
- eosinophils (2-4%) - function unknown
- basophils (0.5%) - function unknown

Front 513

What WBCs comprise the agranulocytes, and what are their functions? ***

Back 513

- lymphocytes (25%) - large and small, non-phagocytic, likely source of serum protein and immune bodies

- monocytes (5%) - ingest larger particles

Front 514

What condition(s) is indicated by an elevated number of neutrophils? ***

Back 514

- acute bacterial infections
- inflammatory disorders
- certain drugs
- stress

Front 515

What condition(s) is indicated by an elevated number of eosinophils? ***

Back 515

- allergies
- parasitic infestations

Front 516

What condition(s) is indicated by an elevated number of lymphocytes? ***

Back 516

viral infections

Front 517

What condition(s) is indicated by an elevated number of monocytes? ***

Back 517

chronic severe infections when controlled

(what the hell does this even mean?)

Front 518

What are platelets? ***

Back 518

- cell fragments
- formed in red bone marrow
- a.k.a. thrombocytes
- essential for blood clotting; form knots to which fibrin adheres, liberating thromboblastin and facilitating the blood clot
- stimulate the phagocytic action of leukocytes

Front 519

Trace the (re)-development of red blood cells ***

Back 519

- proerythroblast - red bone marrow
- erythroblasts - nuclei shrink as hemoglobin develops
- reticulocytes - nuclei digested but endoplasmic reticulum remains; emerge from marrow at this stage
- mature erythrocytes

Front 520

What are some common blood disorders? ***

Back 520

- anemias - reduced hemoglobin or HGB hg
- polycythemias - excessive amount of RBCs
- neoplastic diseases - cancers of WBCs, bone marrow, and/or lymph tissue
- infectious mononucleosis - viral infection

Front 521

What are some causes of anemias? ***

Back 521

- prolonged bleeding (e.g., GI ulcers, surgical procedures, menstruation)
- hemolysis - rupture of cells, sickle cell anemia
- disturbances of RBC formation - inhibition, loss, or failure of bone marrow
- deficiencies of iron or B12
- chronic disease

Front 522

What are some signs and symptoms of anemia? ***

Back 522

- pallor - decreased color of skin, mucous membranes, and nail beds due to decreased hemoglobin
- fatigue and muscle weakness due to decreased oxygen
- dyspnea and tachycardia - shortness of breath, increased heart rate, increased respiratory rate (body's attempt to get more O2 to tissues)
- heart palpitations - reflex from coronary arteries
- jaundice and enlarged spleen (with hemolytic anemia)

Front 523

What are some types of anemia? ***

Back 523

- pernicious anemia (B12 deficiency)
- hemolytic anemia (sickle cell, spheroidal)
- hypochromic anemia

also
- iron deficiency anemia (same as hypochromic????)
- anemia of chronic disease (RA, TB deplete iron stores)
- anemia of renal disease (fail to produce erythropoietin)
- megaloblastic anemia (impaired DNA synthesis due to deficiency in B12 and/or folic acid)
- folic acid deficiency anemia

Front 524

Characteristics of pernicious anemia ***

Back 524

- a.k.a. Vitamin B12 deficiency anemia
- RBCs cannot develop, few in number, membranes rupture easily
- more common in anglos, rare before age 30
- intrinsic factor in gastric juice not secreted
- normally intrinsic factor enables extrinsic factor of vitamin B12 to be absorbed from small intestines into the blood
- vitamin B12 cannot be absorbed and RBCs cannot develop

Front 525

What are the signs and symptoms of pernicious anemia? ***

Back 525

- numbness and tingling of hands and feet
- diarrhea
- vomiting
- nausea
- sore tongue with smooth, glazed appearance
- responds well to IM injection of vitamin B12

Front 526

Characteristics of hypochromic anemia ***

(Is this also run-of-the-mill iron-deficiency anemia?)

Back 526

- iron deficiency due to chronic blood loss from bleeding ulcers, malignant tumor, or excessive menstrual bleeding

- results in decreased amount of hemoglobin per cell, but number of RBCs is adequate (the cells are pale = hypo + chromic)

- responds well to large doses of iron

Front 527

Characteristics of hemolytic anemia ***

Back 527

- malformed RBCs rupture prematurely (before 90-120 day average lifespan)

- hemoglobin breaks down, yielding bilirubin (pigment formed is orange/yellow and accumulates in plasma, causing yellow appearance in skin, sclera, etc.)

- can be caused by malarial parasites, immune disorders, or as an allergic reaction to drugs such as sulfonamides

Front 528

Characteristics of sickle cell anemia ***

Back 528

- red cell deficiency, cells are crescent shaped and tend to rupture
- RBCs contain abnormal form of hemoglobin (hemoglobin S)
- pain in arms, legs, abdomen
- recurrent fever, jaundice of sclera
- crisis period with headache, paralysis and convulsions as well as tissue and eventual organ death
- no cure; only able to treat symptoms

Front 529

Characteristics of spherodoidal anemia ***

Back 529

- cells are spherical rather than biconcave
- cell ruptures due to fragility
- results in jaundice and splenomegaly
- treatment may be removal of spleen, resulting in increased susceptibility to infection

Front 530

Characteristics of erythroblastosis fetalis ***

Back 530

- disease of newborns
- anemia, jaundice, enlarged liver and spleen
- Rh- mother develops antibodies against Rh+ blood factor fetus inherits from father
- severity: mild anemia to death
- treated by vaccine of Rh immunoglobulin (RhoGam) within 24 hours of delivery of Rh- infant
- next fetus will not have condition
- blood testing as part of prenatal care can prevent disease

Front 531

Characteristics of aplastic anemia ***

Back 531

- bone marrow stops producing RBCs, WBCs, and platelets
- pt is anemic, cannot fight infection, has tendency to bleed
- caused by excessive radiation, certain drugs, and industrial poisons
- treatment is blood transfusion and bone marrow transplants

Front 532

What is secondary anemia? ***

Back 532

- accompanies another disease
- chronic kidney disease
- leukemia
- cancer
- number of cells is normal, but Hgb is low
- treated with administration of iron

Front 533

Characteristics of polycythemias/excessive RBCs ***

Back 533

- primary polycythemia myeloproliferative or excessive RBC count

caused by:
- hyperactivity of red bone marrow, usually secondary to tumor
- elevated RBC count increases blood volume, raises blood pressure, increased work load on heart
- blood flow is reduced due to increased viscosity and tendency to clot

Front 534

What are some signs and symptoms of polycythemia? ***

Back 534

- purplish skin
- red mucous membranes
- bloodshot eyes
- enlarged spleen
- elevated RBC, WBC, and platelet count

- dizziness
- headaches
- visual disturbances
- itching
- pain in fingers and toes
- thromboembolism resulting in death

Front 535

Treatment for polycythemia ***

Back 535

- purpose is to reduce RBC count and blood volume
- phlebotomy: periodic blood letting
- radiation therapy to decrease red cell production
- chemotherapy to suppress production of all blood cells by bone marrow

Front 536

Characteristics of secondary polycythemia ***

Back 536

- erythrocytosis or high RBC count

causes
- any inadequate O2 supply to the body results in production of excessive RBCs as compensation
- high altitudes have low O2 in air
- muscles of elite athletes have increased need for O2
- increased O2 needs for patients with congenital heart disease, CHF, and emphysema

Front 537

How are primary and secondary polycythemia differentiated? ***

Back 537

- primary - all blood cell types produced in bone marrow are affected

- secondary - only RBC count is elevated

Front 538

What is hemophilia? ***

Back 538

- defective or absent clotting mechanism
- mother-to-son inherited genetic disorder
- caused by absence of clotting factor due to lack of plasma protein for coagulation, although blood platelets are normal
- treatment is transfusion or administration of clotting protein concentrates

Front 539

Characteristics of purpura (idiopathic thrombocytopenic purpura--ITP) ***

Back 539

- thrombocytopenia or deficiency in number/excess destruction of platelets needed for blood clotting mechanism

- results in spontaneous hemorrhaging in skin, mucous membranes of mouth and internal organs

- often follows viral infection in children under 5, and resolves in a few weeks; chronic condition and not associated with viral infection in adults

caused by
- impaired platelet production (bone marrow),
- ratio of antibodies to platelets (immune system),
- allergic response to drugs

Front 540

Signs and symptoms of purpura (idiopathic thrombocytopenic purpura--ITP) ***

Back 540

- petechia - small, flat, red spots on the skin
- ecchymoses - large, irregularly-shaped hemorrhagic areas of the skin
- gastrointestinal and urogenital hemorrhages
- severe nosebleeds and bleeding from mucous membranes of the mouth
- treatment is corticosteroids or splenectomy

Front 541

Neoplastic diseases ***

Back 541

- cancers of WBCs, bone marrow, and/or lymph tissue

- leukemia - uncontrolled production of (immature?) WBCs
- cause - malignancy of WBCs affecting bone marrow and lymph tissue

Front 542

Signs and symptoms of leukemia ***

Back 542

- anemia, pallor, fever, bone/joint pain
- enlarged spleen (splenomegaly)
- swollen lymph nodes (lymphadenopathy)
- enlarged liver (heptamegaly)
- abnormal bleeding and tendency to bruise easily
- unexplained weight loss
- general weakness, shortness of breath, heart palpitations
- susceptible to infection since immature WBCs cannot fight off infection

Front 543

Types of leukemia ***

Back 543

- myelogenous
- lymphatic

Front 544

Characteristics of myelogenous leukemia ***

Back 544

- cancer of the bone marrow
- acute myelogenous leukemia is more common in adults and males
- chronic myelogenous leukemia has a prolonged course affecting mature cells

Front 545

Characteristics of lymphatic leukemia ***

Back 545

- cancer of the lymph nodes
- acute lymphatic leukemia is more common in children with an abrupt onset and rapid progression
- chronic lymphatic leukemia has a prolonged course affecting mature cells

Front 546

What is the treatment for leukemia? ***

Back 546

- often fatal, but some respond well to chemotherapy
- three stages: induction, consolidation, and maintenance
- 50-90% complete remission possible depending on type of leukemia

Front 547

Characteristics of malignant lymphomas ***

Back 547

- malignancies of lymphoid tissue (phagocytic cells - histocytes and macrophages)

- thought to be caused by virus that interferes with normal lymphocyte production

- Hodgkin's disease is most common

Front 548

Signs and symptoms of malignant lymphomas ***

Back 548

- swelling in one lymph node
- fever
- weight loss

Front 549

Treatment for malignant lymphomas ***

Back 549

- responds well to radiation and chemotherapy if localized to one or two areas

- cure rate good if treated early

Front 550

Characteristics of infectious mononucleosis ***

Back 550

- viral infection common in children and young adults

- caused by Epstein-Barr herpes virus

Front 551

Signs and symptoms of infectious mononucleosis ***

Back 551

- mild fever
- marked fatigue
- sore throat
- swollen lymph nodes
- elevated WBCs
- high percentage of atypical lymphocytes that resemble monocytes
- tender, enlarged spleen

Front 552

Treatment of infectious mononucleosis ***

Back 552

- antibiotics not effective vs. viruses
- bed rest if fever present
- avoid contact sports to protect spleen

Front 553

Composition of hemoglobin

Back 553

globulin - a protein
heme - a molecule which binds to iron

Front 554

How does hemoglobin function?

Back 554

- in lungs, binds to O2 in exchange for CO2

- O2 RBCs travel to tissues and release O2 in exchange for CO2

Front 555

How long do RBCs live, and how are they disposed of afterward?

Back 555

about 120 days

removed from body by liver and spleen

Front 556

Does anemia typically develop slowly or quickly?

With symptoms or asymptomatic?

Back 556

typically slowly and asymptomatically

Front 557

How does the body control iron balance?

Back 557

- it is conserved for reuse
- no excretory pathway
- only means of iron loss from the body are blood loss and loss of epidermal cells from the skin and gut

Front 558

How much iron is required daily and how much do we typically ingest?

Back 558

1.0 - 1.4 mg/day

average 15 mg/day (males) and 11 mg/day (females)

Front 559

Where does iron absorption take place?

Back 559

in the small intestine

Front 560

How does iron-deficiency anemia progress?

Back 560

- first stage - negative iron balance (anemia may not yet be present)
- second stage - iron stores in body are depleted; syntheis of hemoglobin impaired and RBCs become pencil-shaped

Front 561

What is the leading cause of anemia worldwide?

Whom does it chiefly affect?

Back 561

iron-deficiency anemia

preschool children and adolescent/adult females

Front 562

Characteristics of folic acid deficiency anemia

Back 562

caused by
- low intake of folic acid,
- malabsorption due to bowel inflammation (e.g., Crohn's disease),
- excessive demand, as during pregnancy, or
- side effect of some medications

treated with oral supplementation

Front 563

How is hemolytic anemia treated?

Back 563

depends on underlying etiology

- splenectomy (decreases risk of gallstones, hemolytic crises and pathological changes to bone marrow)
- blood transfusion (in cases of severe blood loss)
- antibiotics for infectious causes
- immunosuppressants for immune disorders
- cease taking offending medications

Front 564

What are hemoglobinopathies?

Back 564

- disorders affecting structure, function, or production of hemoglobin
- usually inherited
- mutations that result from synthesis of abnormal hemoglobin

Front 565

Name the two most common hemoglobinopathies.

Back 565

- sickle cell anemia
- thalassemia

Front 566

By what mechanism do cells assume the sickled shape in sickle cell anemia?

Back 566

when the RBC deoxygenates, hemoglobin S forms cross-links with other hemoglobin S molecules and long crystals develop, pulling the cell into the characteristic shape

Front 567

Treatment of sickle cell anemia

Back 567

- no cure
- aim is to prevent crisis, control anemia, and relieve pain
- blood transfusions

Front 568

What are the most common genetic disorders in the world

Back 568

thalassemias

Front 569

Symptoms of thalassemia

Back 569

in most severe form:
- severe, life-threatening anemia
- bone marrow hyperactivity
- enlargement of spleen
- growth retardation
- bone deformities

due to deficient synthesis of alpha or beta chains required for proper formation and performance of hemoglobin

Front 570

Treatment of thalassemia

Back 570

blood transfusions required to sustain life, and life expectancy reduced

Front 571

What causes bleeding disorders (poor clotting/continuous bleeding)?

Back 571

- platelet dysfunction/deficiency
- vitamin K deficiency
- clotting factor deficiency

Front 572

Where are platelets produced?

Where are clotting factors produced?

Back 572

in the bone marrow

in the liver

Front 573

What elements are critical to hemostasis?

Back 573

- platelets
- prothrombin
- thrombin
- vitamin K
- calcium

Front 574

What is thrombocytopenia?

What causes it?

Back 574

abnormally small number of circulating platelets

conditions that
- impair production
- increase destruction, or
- cause sequestration of platelets

Front 575

What is the most common bleeding problem among hospitalized patients?

Back 575

thrombocytopenia

Front 576

What is disseminated intravascular coagulation?

Back 576

- condition involving destruction of platelets and consumption of clotting factors

- thrombin released into systemic circulation causing systemic coagulation and suppression of normal physiological anticoagulation mechanisms

- causes extensive ischemia, organ damage, and depletion of platelets and clotting factors

Front 577

Occurrence of disseminated intravascular coagulation

Treatment of disseminated intravascular coagulation

Back 577

occurs in conjunction with:
- sepsis/blood infection
- endothelial damage as in shock, OB complications or neoplasms (cancer)

treatment includes platelet transfusions, coagulation inhibitors, IV anticoagulants when needed

Front 578

What is neutropenia?

Back 578

reduction in circulating neutrophils that increases risk for bacterial and fungal infections

Front 579

Causes of neutropenia

Back 579

- cancer chemotherapy
- using immunosuppressive drugs
- immune destruction of neutrophils with RA

Front 580

Treatment of neutropenia

Back 580

- growth factors/colony-stimulating factors
- corticosteroids if immune destruction is the cause