Alt. Phys. Final Flashcards
1
Q
What is an atherosclerotic plaque?
A
Hardening of the blood vessels caused by the plaque which is made up of lipids, cholesterol, calcium
2
Q
Is atherosclerosis a chronic condition?
A
Yes
3
Q
HDL vs LDL
A
HDL is good cholesterol and carries fats from periphery to the liver to be discarded. LDL contains less proteins and increases cholesterol in the blood
4
Q
What is the proper order of development for atherosclerosis?
A
- endothelial damage and inflammation
- high levels of LDLs in the blood. Some enter the tunica intima
- LDL in the t.intima is oxidized into proinflammatory lipids. Attracts inflammatory cells+phagocytes into the endothelium
- LDLs will be engulfed by macrophages forming FOAM cells. FOAM cells collect to form fatty streak
- FOAM cells release cytokines and growth factors to stimulate proliferation and production of collagen
- formation of atherosclerotic plaque. Collagen fibers harden the blood vessel walls to form fibrous plaque
5
Q
Arterial Disease is most commonly caused by______
A
Atherosclerosis
6
Q
What is the most serious location for blockage in CAD?
A
left ventricle
7
Q
CAD can lead to ______
A
LHF
8
Q
PAD is especially present in___
A
smokers and those with diabetes
9
Q
Stage 1 of CAD_______
A
absent, weak pulse in arteries supplying the legs and feet
10
Q
stage 2 of CAD___-
A
intermittent claudication upon physical exertion
11
Q
stage 3 of CAD_______
A
claudication without physical exertion. coldness in 1 leg//foot compared to the other
12
Q
Primary Hypertension
A
most common; influenced by genetic and environmental factors
13
Q
Secondary hypertension
A
Secondary hypertension: caused by a systemic disease process that raises peripheral vascular resistance or cardiac output. Often renal
14
Q
Isolated systolic hypertension
A
Elevation of only systolic pressure
15
Q
Primary hypertension is caused by
A
genetics +environment
16
Q
Which type of hypertension can be caused by hormone imbalances
A
Secondary
17
Q
Asymptomatic aneurysms can also be called
A
congenital
18
Q
Which of the following is not a complication of an aneurysm?
Blood leaking
Hemorrhage
Ischemia
Infarction
A
infarction
19
Q
Thrombus_____
A
blood clot that remains attached to vessel wall
20
Q
What are the steps to hemostasis?
A
Vasoconstriction, platelet plug, coagulation
21
Q
Thrombosis _______
A
intravascular activation of coagulation cascade with blood vessel wall damage
22
Q
Thrombophlebitis_______
A
thrombosis and inflammation in the veins
23
Q
Thromboembolus______
A
detached blood clot
24
Q
Causes of arterial thrombosis include all except
Vasculitis
Shock
Blood thickening
endothelial wall infection
A
blood thickening
25
Which type of embolism can be caused by post-femoral (“hip”) fracture?
Fat-emoblism
26
Which two types of embolism can be caused by an IV?
Air embolism and foreign substance
27
Explain the sequences of events from atherosclerosis to thrombosis to myocardial infarction
atherosclerosis = most common cause of thrombus formation. Forces, inflammation, apoptosis or enzymes to the plaque will cause it to rupture leading to increased inflammation with release of multiple cytokines platelet activation, production of thrombin and vasoconstriction. This will cause decrease in lumen size, O2 which will lead to MI
28
Ischemia =
reduction of blood supply to tissues
29
Hypoxia =
low O2 in blood (inadequate supply to an area)
30
Hypoxemia =
low O2 in blood
31
Infarction=
tissue death due to lack of O2
32
Necrosis =
cell death due to pathophysiology changes in cells
33
Most common cause of transient myocardial ischemia is
atherosclerosis
34
cause of unstable angina (sudden onset) =
Reversible myocardial ischemia: presence of a complicated plaque, thrombus formation, vessel occlusion, vasoconstriction
35
Treatment for unstable angina (sudden onset) =
immediate: oxygen, aspirin, vasodilators, pain relief
intermediate: bypass, drugs, clot dissolving drugs
long term: cholesterol lowering agents, lifestyle changes
36
Modifiable risk factors for atherosclerosis include ALL except
age, hypertension, smoking, diabetes mellitus type 2, lack of physical activity
37
Temporary loss of contractile function lasting hours - days =
myocardial stunning
38
Tissue is persistently ischemic and metabolic adaptation which prolong myocyte survival until perfusion is restored
hibernating myocardium
39
leads to myocyte hypertrophy and loss of contractility distal to site
myocardial remodeling
40
Which one of the acute coronary syndromes can be caused by necrosis?
myocardial stunning
hibernating myocardium
myocardial remodeling
transient ischemia
myocardial remodeling
41
Which one of the following cardiac complications of MI is due to necrosis of the conducting system?
Valve dysfunction
Pericarditis
Aneurysms
Dysrhythmias
Dysrhythmias
42
The T wave on the ECG is_____
ventricular repolarization, ventricular relaxation
43
The P wave on the ECG is______
Atrial depolarization and atrial contraction
44
The QRS segment of the ECG is_____
atrial repolarization, atrial relaxation, ventricular depolarization, ventricular contraction
45
Subendocardial MI is____
in b/w the endocardium and myocardium non STEMI
46
Transmural MI________
STEMI. MI is across the wall of the heart
47
Preload _____
volume of blood at the end of diastole (filling stage)
48
Afterload____
resistance in the that the left ventricles must overcome to pump blood out of the aorta.
49
Preload is increased in all of the following conditions EXCEPT
hypervolemia
hypertension
heart failure
regurgitation of valves
hypertension
50
RHF is most commonly caused by____
lung disease
51
LHF is most commonly caused by_______
ischemic heart disease
52
Which is more common RHF or LHF
LHF
53
Primary pulmonary hypertension is caused by_____
Idiopathic: imbalance in production of vasocontrictors & vasodilators
54
Secondary pulmonary hypertension is caused by_____
scar tissue or emphysema (COPD)
55
The end result of RHF is
pulmonary hypertension
pulmonary edema
peripheral edema
pitting edema
peripheral edema
56
Which of the following complications in not seen with RHF
pulmonary edema
jugular vein distention
dependent edema
ascites
pulmonary edema
57
Jugular venous distention
accumulation of fluid in the jugular vein, which returns blood from the head to the heart
58
Edema
excessive accumulation of fluid within interstitial spaces between tissue cells
59
Dependent edema
occurs in the feet & legs while standing and in the sacral regions and buttocks when lying down (supine). Dependent on gravity
60
Ascites
accumulation of fluid in the peritoneal
cavity. body fluid is trapped in the peritoneal
space from which it cannot escape
61
Pitting edema
occurs when a “pit” or indentation
is seen when pressure is applied
62
Which of the following is NOT a functional
change expected from acute myocardial
infarction?
A. Decreased contractility
B. Decreased stroke volume
C. Increased ejection fraction
D. Disordered heart rhythms
C. Increased ejection fraction
63
What is a possible consequence of thrombosis that occurs within the myocardium?
A. Aneurysm
B. Atherosclerosis
C. Ischemia
D. Hypertension
A. Aneurysm
64
Pericardial disease can be caused by_______
infection, trauma or surgery, neoplasm; disorders such as
uremia, rheumatoid arthritis, systemic lupus
65
Clinical manifestations of pericardial disease mimic those of ______
RHF
66
Acute pericarditis is a common CV complication of which disease?
HIV
67
Acute pericarditis =
Roughening and/or inflammation of pericardial membranes
can lead to pericardial effusion/tamponade or constrictive pericarditis
68
constrictive (restrictive pericarditis)_
Fibrous tissue scarring with calcification
Pericardium becomes a hardened shell encasing the heart
69
Pericardial effusion=
Accumulation of fluid in the pericardial cavity; fluid is usually an exudate; develops suddenly
Can occur as a result of pericarditis and can lead to cardiac compression (called: tamponade)
70
Pericardial tamponade
Unable to accommodate more than a small volume of fluid
Accumulation of fluid in the pericardial cavity Restricts contractile ability of heart
71
Which cardiomyopathy can mimic restrictive pericarditis?
restrictive cardiomyopathy
72
In which cardiomyopathy is contractility normal?
hypertrophic cardiomyopathy
73
valvular dysfunction most commonly occurs in the ____
aortic and bicuspid/mitral valve
74
Rheumatic heart disease occurs from ___________infection
pharyngeal
75
Aschoff bodies are seen in ____
Rheumatic heart disease: myocarditis
76
Myocardium vibrating or twitching is seen with which dysrythmia
atrial or ventricular fibrillation
77
slowing of postural reflexes as part of the aging process; neurologic diseases such as Parkinson’s Disease are causes of which orthostatic hypotension?
primary/neurogenic orthostatic hypotension
78
Triad of Virchow
venous stasis, venous endothelial damage, hypercoaguable states
79
Delivers nutrient rich oxygenated blood from placenta to fetal heart with some of this blood going to the liver
umbilical vein
80
Delivers wastes and deoxygenated fetal blood to placenta
umbilical artery
81
Extension of umbilical vein which drains into inferior vena cava
Ductus venosus
82
Opening in the septum between right and left atria which diverts most of blood in RA to LA (right-to-left shunt)
Foramen ovale
83
Connects pulmonary trunk with aortic arch: allows blood to flow from pulmonary artery to aorta (systemic circulation) without going through the lungs (right-to-left shunt)
Ductus arteriosus
84
after birth
umbilical vein becomes____
umbilical artery becomes______
formamen ovale becomes _____
ductus venosus becomes___
ductus arteriosus becomes___
round ligament of liver
umbilical ligaments
fossa ovalis and functionally closes
ligamentum venosum of the liver
ligamentum arteriosum
85
more sever congenital heart defects are
cyanotic
86
Acyanotic defects include
ASD, VSD, patent ductus arteriosus, AV canal defect
87
cyanotic defect include
tetrology of fallot and transposition of the great arteries
88
the most common type of congenital heart lesion is
ventricular septal defect
89
Which defect causes a machine like mumrmer
paten ductus arteriosus
90
Tetralogy of fallot
1. VSD
2. Pulmonary valve stenosis
3. Right ventricle hypertrophy
4. overriding aorta
91
Hypoxia
low oxygen in cells or tissue
92
Hypoxemia
low oxygen in the blood
93
Hypercapnia
high levels of CO2 in the blood
94
Hypocapnia
very low levels of CO2 in the blood
95
Pain receptors are only located in the ____ of the lungs
pleura
96
Atelactasis
Total collapse of lungs leading to no alveoli ventilation
97
Bronchiectasis
Persistent abnormal dilation of the pockets of bronchi
Bacterial infection can remain in affected bronchioles
common in smokers
98
Aspiration
Passage of fluid and solid particles into the lungs (even bronchioles) to cause blockage
Fluid can cause chemical damage, e.g. bile & gastric juice burns the lungs
99
Bronchiolitis:
Inflammation of the bronchioles which leads to bronchoconstriction
Most common in children
100
Pneumoconiosis can be caused by
silica, asbestos, coal, fiberglass, aluminum
101
T/F pneumoconiosis increases the risk of cancer
true
102
The main event of surfactant deficiency disorder is
atelectasis
103
Mesothelioma is most likely caused by
asbestos
104
What is red hepatization
accumulation of so much inflammatory cells & debris that the lungs look like liver
105
Most common cause of pulmonary thromboembolism is
DVT in thigh
106
The unifying sign and symptom of obstructive lung diseases is
sign: wheezing symptom: dyspnea
107
Asthma is a
type 1 hypersensitivity reaction
108
Centri-acinar emphysema affects
smokers with chronic bronchitis
109
Pan-acinar emphysema affects
older adults
deficiency in alpha1 antitrypsin
all structures are affected
110
what is the first indication of lung damage
hypersecretion of mucus and productive cough
111
What stores the hormones secreted by the hypothalamus?
Neurohypophysis
112
What can bind to receptors and act like hormones?
Antibodies
113
What causes low ADH secretion?
HPA tumor, infection or receptor resistance
114
What causes high ADH secretion?
Tumors, head trauma, Sheehan Syndrome
115
Autoimmune cause of hypothyroidism?
Hasimoto's
116
Autoimmune cause of hyperthyroidism?
Grave's Disease
117
What is the most common cause of thyroid cancer?
Ionizing radiation esp. in childhood
118
What causes hyperparathyroidism?
Primary: adenomas or hyperplasia
Secondary: chronic hypocalcemia, low dietary calcium, malabsorption syndromes
119
What is diabetes Insipidus?
Central: A reduction in ADH
Nephrogenic: Nephrons do not recognize ADH
120
What is diabetes mellitus and explain the different types?
Type 1, type 2, gestational
121
Explain the mechanisms of DKA
Severe manifestation of insulin deficiency that evolves quickly. Increased production in ketones with ketone smell in breath and urine.
122
Explain the mechanisms for HHNKS
Large amounts of glucose is excreted in urine causing dehydration, increased blood concentration leading to blood becoming thick/sluggish. This can lead to coma, death and seizures. Evolves slowly
123
Explain the effects of microvascular disease
Neuropathy, nephropathy, retinopathy
124
Explain the effects of macrovascular disease
Attachment of advanced glycation end products to their receptor which promotes oxidative stress, inflammation, hyperlipidemia
125
Why does hyperglycemia lead to increase infections? Explain
Loss of senses, glycosylated Hb leads to hypoxia and increases risk of infection, increased glucose for pathogens, reduced blood flow (reduced phagocytosis)
126
What is a open fracture?
Break through intact skin, bone marrow is exposed to external environment
127
What is a pathologic fracture?
occurs in bone which is weakened by a disease
128
What is a comminuted fracture?
Fracture with 2 or more pieces of bone
129
What is a impacted fracture?
Pressure/weight that causes breaks
130
What is a greenstick fracture?
Break in only the cortex of the bone
131
What is an avulsion fracture?
Fragment of bone connected to a ligament or tendon breaks off the main bone
132
Dislocation
total loss of contact between articular cartilage
133
Subluxation
Partial loss of contact between articular cartilage and surface of bone
134
Strain
Injury or tear in a tendon/muscle
135
Sprain
Injury or tear in a ligament
136
Most common fractures in osteoporosis?
Compression fractures
137
Most common location of fractures in osteoporosis?
Thoracic vertebrae
138
Osteoporosis is more obvious in ____
trabeculae bone
139
Explain the mechanisms of OPG, RANKL, RANK
Osteoblasts produce OPG and RANKL
Osteoclasts have RANK receptors
OPG is increased by the presence of estrogen
140
Explain DMD
Loss of dystrophin which leads to slow motor development, progressive weakness, muscle wasting. X-linked recessive disease
141
Explain DDH
Congenital abnormality of the femoral head, acetabulum or both. Risk factors include: female, oligohydramnios. Barlow vs Ortolani test. Treatment includes Pavlik harness
142
Where does OA occur more frequently?
hips, knees, lower lumbar +cervical vertebrae, CMC, TMT joints
143
In RA activation of CD4 helper cells leads to what?
stimulation of macrophages, fibroblasts, RANKL and osteoclasts which leads to pannus formation and joint destruction
144
What is the chronic form of gout called?
Tophaceous gout
145
Which bacteria causes osteomyelitis?
Staph. aureus
146
What are the secondary causes of bone cancer?
Prostrate cancer, breast cancer, kidney cancer, lung cancer, thyroid cancer
147
Osteosarcoma is located where?
Metaphysis region of long bone
148
Chondrosarcoma presents itself where?
Joint space and can expand to surrounding tissue
149
Where does Ewing Sarcoma presents itself?
Diaphysis of long or flat bones
150
Cardiogenic shock
caused my MI, LHF, VFIB
151
Hypovolemic shock
insufficient intravascular fluid volume due to hemorrhage, burns or diarrhea
152
Neurogenic shock
alterations of the CNS from SC injury
153
Anaphylactic Shock
type of hypersensitivity reaction(type 1) caused by bees, peanuts latex etc.
154
Compensation for cardiogenic shock
RAAS, ADH, catecholamine release
155
Massive vasodilation is seen in which type of shock?
neurogenic
156
Bleeding from venipuncture sites due to simultaneous clotting and hemorrhage is known as what?
DIC
157
What is an ectopic source of a hormone?
Nonendocrine source independent of biological controls
158
What is the primary cause of kidney failure?
Diabetes mellitus
159
What is allergic contact dermatitis?
Type 4 T-cell/ delayed hypersensitivity reaction. Due to metals, poison ivy, latex
160
What is irritant contact dermatitis?
Non-immunological, non-specific irritants such as acids, detergents and water
161
Where does seborrheic dermatitis develop?
sebaceous glands of scalp, eyebrows, eyelids,
162
What is koebner phenomenon?
plaque and papule formation at the site of trauma
163
Where are the bumps most likely to form in herpes-zoster?
dermatomes along the thoracic and lumbar back region
164
Which ringworm infection is resistant to topical anti-fungals?
Tinea capititis
165
Where is candidiasis most likely to form?
Mucous membranes and skin folds
166
Seborrheic keratosis is___
benign proliferation of basal cells. No increased cancer risk but worsens with UV exposure
167
Actinic keratosis ______
proliferation of keratinocytes due to prolonged UV exposure. Premalignant condition
168
Keratoacanthoma
Growth of squamous cells arising from hair follicles. Pre-malignant condition
169
Risk of cancer with nevi is ___-
possible
170
Which pre-malignant conditions will lead to squamous cell carcinoma?
Actinic keratosis and keratoacanthoma
171
Chovestk sign is seen in
hypoparathyroidism
172
In which thyroid disorder is there an increased metabolic rate and weight loss?
hyperthyroidism
173
What is addisonian crisis?
vascular collapse and shock
174
Large amounts of glucose excreted in blood is seen in which endocrine disorder?
Hypoglycemia aka diabetes mellitus, HHNKS
175
Overglycosylation of glycoproteins on
basement membrane of endothelium is seen in which endocrine disorder?
diabetes mellitus, hyperglycemia, microvascular disease
176
Duchenne muscular dystrophy is
1. More commonly diagnosed in females
2. An autosomal recessive gene disorder
3. The most common form of muscular dystrophy
4. A disease of the skeletal system
the most common form of muscular dystrophy
177
What are the risk factors for DDH?
Female sex, breech position, family history, oligohydramnios
178
What is the most common joint disease?
osteoarthritis
179
Eric had low levels in which hormones?
all HPA hormones (testosterone) except for oxytocin and prolactin
180
Which hormone released by the hypothalamus is inhibitory
prolactin inhibitory factor
181
How did doctors cure Eric's pituitary tumor?
transphenoid surgery and radiation
182
Eric's aneurysm could have been caused by
radiation
183
Eric's stroke could have been caused by
radiation, high BP (multifactorial)
184
Why is Eric prone to infections?
because he is deficient in cortisol
185
Eric's polyuria indicated that
he has diabetes insipidus
186
Cellular edema due to shock causes a _____ in K+ and _________ in Na and H2O
efflux, infflux
187
Cystic fibrosis effects the _______ on ________
Cystic Fibrosis transmembrane
conductance regulator (CFTR) GENE found on
chromosome 7
188
The most common gene mutation of cystic fibrosis causes
protein processing mutations
189
What happens without adequate CFTR protein?
chloride and water have problems LEAVING the cell
190
Purplish brown macules that can develop into plaques and nodules and can be a cardinal sign of AIDS is known as
kaposi sarcoma
191
The most common cause of pulmonary edema is
LHF
192
Adrenal tumor that secretes catecholamines is called
pheochromocythoma
193
decrease in LH, FSH, TSH AND ACTH are clinical conditions of
hypopituitarism
194
glycosylated Hb leads to
hypoxia, increased risk of infection,
195
resembles RHF, exercise intolerance, dyspnea, fatigue, anorexia, edema, jugular vein distention, hepatic congestion, hypoxia
pericardial disease
196
Herberden's and Bouchard's nodes is characteristic of which disease?
Osteoarthritis
197
exophthalmos, dermopathy, pretibial myxedema is characteristic of which endocrine disorder?
hyperthyroidsm
198
Stephanie's experience with trikafta was
succesful
199
stephanie was diagnosed at 30 for cystic fibrosis
false
200
Where is pressure higher in a fetus
pressure is higher in the right atrium and pulmonary artery
