exam 2

Question 1

Hypoxemia

Answer 1

low oxygen content in the blood

Low O2 Saturation

Question 2

Hypoxia

Answer 2

a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level

Question 3

ACS

Answer 3

an umbrella term for a range of symptoms associated with sudden, reduced blood flow to the heart

Question 4

ISCHEMIC HEART DISEASE (IHD)

Answer 4

Also referred to as Coronary heart disease (CHD) or coronary artery disease (CAD),atherosclerotic heart disease (ASHD)
Includes:
Heart attacks/Myocardial infarction
Angina: Stable and unstable

Question 5

what causes IHD?

Answer 5

Atherosclerosis of the coronary arteries (most common)
A progressive inflammatory disorder of the arterial wall characterized by localized lipid deposits
Coronary thrombus or emboli
Coronary spasm
Complications of connective tissue disorders

Question 6

Ischemic Cardiomyopathy

Answer 6

ischemic
Disease of the heart muscle, reduced contractility
chronic narrowing of the coronary arteries which, in turns, diminishes blood supply to the heart

Question 7

Causes of Ischemic Cardiomyopathy

Answer 7

Caused by CAD which causes an insufficient blood flow/ to the heart resulting myocyte ischemia

Question 8

constant cardiac ischemia results?

Answer 8

irreversible myocyte damage
This damage results in cardiac remodeling
Myocardial fibrosis
Arrhythmias
Possible cardiac conduction system impairments
Cell death
Ultimately these patients develop clinical congestive heart failure

Question 9

Stable Angina

Answer 9

Caused by a mismatch between O2 delivery and O2 need
Brought on by exertion or other form of stress
Occurs at a predictable heart rate
Reduction in stress reduces symptoms
Crushing or squeezing substernal sensation with possible radiation down the left arm

Question 10

Unstable Angina

Answer 10

Brought on by exertion or other form of stress
Onset is unpredictable
Thought to occur because of acute plaque changes, and/or coronary artery vasospasm

Question 11

Plaque Rupture

Answer 11

Exposes thrombogenic lipids to the blood

Stimulates localized thrombus formation with ischemic outcomes i.e. CA occlusion

Question 12

Occlusive event

Answer 12

Damage is dependent on coronary artery involved, time until treated

Question 13

Cardiomyopathy

Answer 13

Disorder within the cardiac myocytes themselves which results in abnormal cellular and hence cardiac performance

Question 14

Dilated Cardiomyopathy

Answer 14

abnormal cardiac morphology
dilated heart has undergone significant remodeling
Begins as a “ballooning” of the LV
This ballooning often leads to a dilation of the other chambers
lead to heart failure

Question 15

Dilated Cardiomyopathy results

Answer 15

A heavier than normal heart
Hypertrophied cardiac myocytes
Loss of myofibrils, reduced mitochondrial function, contraction
Fibrosis occurs
Chamber walls are thinned
Produces systolic dysfunction and reduced EF

Question 16

Hypertrophic Cardiomyopathy

Answer 16

Characterized by a thicken LV wall with a non-dilated LV chamber.
Septal wall can also hypertrophy disrupting normal LV outflow tract
Normal blood pressures are perceived as excessive by functionally defective myocytes

Question 17

Obstructive HCM

Answer 17

The septal wall thickens and the LV free wall of the ventricles stiffen, obstructing blood flow into the aorta

Question 18

Nonobstructive HCM

Answer 18

The walls of the LV stiffens, reducing LVEDV (preload) and SV
Blood flow is not blocked

Question 19

Restrictive / Infiltrative Cardiomyopathy

Answer 19

Characterized by restricted diastolic filling/loss of compliance i.e. diastolic dysfunction
EDVs are diminished/chambers cannot expand
BUT ESVs and EFs are normal; SV is compromised
Systolic function is normal

Question 20

Potts disease

Answer 20

TB of the spine

Question 21

What classify COPD?

Answer 21

Emphysema
Chronic obstructive bronchitis
Chronic, unremitting asthma

Question 22

Sign of COPD

Answer 22

dyspnea, sputum production, and chronic cough, reduced function.

Question 23

Spirometry COPD

Answer 23

COPD is diagnosed when the FEV1/FVC ratio is <0.70 after a bronchodilator has been given

Question 24

Emphysema etiology?

Answer 24

Pathologic accumulation of air in the lungs
Disease of exhalation
Characterized by air trapping in the lungs
Diaphragmatic function becomes compromise

Question 25

Emphysema lab value?

Answer 25

Causes an increase in residual volume (RV), total lung capacity (TLC) and a decrease in the FVC1/FVC ratio TLC → Flattened diaphragm (length-Tension relationship)

Question 26

A-1AT deficiency and cigarette smoking

Answer 26

Destruction of individual alveoli Development of “super” alveoli Destruction of connective tissue supports for the very smallest airways allowing them to collapse during expiration

Question 27

type of obstructive COPD ?

Answer 27

Asthma COPD (chronic obstructive pulmonary disease), which includes emphysema and bronchitis Bronchiectasis

Question 28

gentic A-1AT deficiency can also cause

Answer 28

emphysema and liver disease

Question 29

Emphysema

Answer 29

Creates hyperinflated lungs with enlarged alveoli (super alveoli) Forced expiration causes smaller airways to collapse during expiration Leads to “air trapping” in the alveoli Alveolar attachments are destroyed by cigarette smoke Alveolar contraction becomes increasing difficult Patient exhales even harder-causes collapse of small airways

Question 30

Lab value Emphysema

Answer 30

FEV1/FEV < .5

Question 31

signs of emphysema

Answer 31

``` SOB at rest Thin, cachectic addictied to O2 Deformed chest with prolonged expiration Absent or non-productive cough ```

Question 32

drugs for emphysema

Answer 32

``` β2 agonists or anticholinergics antiinflammatory agents Antibiotics mucolytic expectorants mast cell membrane stabilizers antihistamines glucocorticoids ```

Question 33

pink puffers

Answer 33

``` CO2 retention no cyanosis purs lip breathing ineffective cough orthopenic uses accessory muscles to breathe leads to right sided failure to cor pulmonale ```

Question 34

what classifies Chronic Bronchitis

Answer 34

Productive cough lasting at least 3 months per year for 2 consecutive years FEV1/FEV < 75% (suggests obstruction) plus chronic cough suggests bronchitis

Question 35

chronic Bronchitis leads to?

Answer 35

Destruction of ciliary cells lining airways occurs Smooth muscle hypertrophy, atrophy of epithelial cells ↓ r4 !! Airway collapse may occur leading to reduced alveoli ventilation, hypoxia and acidosis

Question 36

chronic bronchitis tend to have?

Answer 36

``` Be polycythemic (why?) cyanotic, and have peripheral edema from right ventricular failure Have cor pulmonale 2O to ↑ pulmonary vascular resistance ```

Question 37

chronic bronchitis are also called?

Answer 37

blue bloters

Question 38

Chronic bronchitis meds

Answer 38

Bronchodilators (B-2 agonists) Mucolytics NSAIDs

Question 39

Asthma

Answer 39

Episodic, reversible, obstructive lung disease characterized by bronchospasms resulting from an exaggerated inflammatory Bronchial hyperreactivity

Question 40

Extrinsic Asthma

Answer 40

Result of an allergic reaction to specific triggers Mast cells, sensitized by IgE antibodies, degranulate and release bronchoactive mediators (histamines) after exposure to a specific antigen

Question 41

intrinsic asthma

Answer 41

Has no known allergic cause or trigger | Has an adult onset

Question 42

Bronchial Provocation Test

Answer 42

Methacholine | Positive test: 20% ↓ in FEV1

Question 43

Asthma meds

Answer 43

bronchodilators (B2 agonists) and anti-inflammatory agents | Low dose corticosteroids