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clincial pathophysiology > exam 2 > Flashcards

exam 2 Flashcards

1
Q

what is the difference between systole and diastole

A

systole is when ventricles contract
diastole is when ventricles relax and fill

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2
Q

what is preload

A

end-diastolic pressure
“volume”
“stretch”

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3
Q

what is afterload

A

work/force required to move blood into the aorta
“pressure”
“squeeze”

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4
Q

what increases preload

A

hypervolemia
regurgitation of cardiac valves
heart failure

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5
Q

what increases afterload

A

hypertension
vasoconstriction

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6
Q

true or false: increasing afterload decreases cardiac workload

A

false

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7
Q

what is atrial fibrillation

A

rapid, irregular beating

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8
Q

why does atrial fibrillation cause low blood pressure

A

the heart does not have enough time to fill; causing BP to drop

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9
Q

what is hypertension

A

sustained elevation of blood pressure

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10
Q

what is the primary risk factor of cardiovascular disease

A

hypertension

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11
Q

what is the leading cause of morbidity/mortality worldwide

A

hypertension

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12
Q

what race is most likely for hypertension

A

african americans

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13
Q

true or false: men are more likely to have a cardiovascular disease

A

true

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14
Q

what is atherosclerosis

A

the build up of fats, cholesterol, and other substances in and on the artery wall

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15
Q

what effect does smoking have on the cardiovascular system

A

increases: HR, CO, BP, and coronary flow

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16
Q

what is thrombosis

A

blood clots block veins or arteries

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17
Q

true or false: PAD and CAD are both caused by fatty deposits in the wall of the arteries (atherosclerosis)

A

true

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18
Q

where is CAD located

A

in the heart

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19
Q

where is PAD located

A

usually in the legs

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20
Q

what are the major risk factors of PAD and CAD

A

family history
age
smoking
high cholesterol
diabetes
obesity

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21
Q

what is the most common heart disease

A

CAD

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22
Q

what is the single leading cause of death in America today

A

CAD

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23
Q

true or false: PAD is a common circulatory problem

A

true

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24
Q

what increases the risk of PAD by 400%

A

smoking

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25
Q

what is likely to increase the risk of CAD

A

PAD

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26
Q

what can cause a decrease in coronary blood flow

A

vasospasm
fixed stenosis
thrombosis

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27
Q

what can cause angina (chest pain)

A

decreased coronary blood flow
increased oxygen consumption

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28
Q

what can cause increased oxygen consumption

A

increased: heart rate, contractility, afterload, preload

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29
Q

what stages of coronary artery disease have elevated troponins

A

NSTEMI
STEMI

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30
Q

what labs will you look for to evaluate heart damage

A

troponin
creatine phosphokinase
myoglobin

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31
Q

myocardial infarction -> pericardial inflammation -> ??

A

pericarditis

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32
Q

myocardial infarction -> electrical instability -> ??

A

arrhythmias

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33
Q

myocardial infarction -> tissue necrosis -> ventricular wall rupture -> ??

A

cardiac tamponade

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34
Q

myocardial infarction -> tissue necrosis -> papillary muscle infarction -> mitral regurgitation -> ??

A

congestive heart failure

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35
Q

myocardial infarction -> impaired contractility -> ??

A

congestive heart failure

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36
Q

myocardial infarction -> impaired contractility -> hypotension, decreased coronary perfusion, increased ischemia -> ??

A

cardiogenic shock

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37
Q

myocardial infarction -> impaired contractility -> ventricular thrombus -> ??

A

stroke (embolism)

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38
Q

what is pericarditis

A

inflammation of the pericardium

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39
Q

what is cardiac tamponade

A

rapid accumulation of exudate compresses the heart

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40
Q

what is pericardial effusion

A

serous exudate filling the pericardial cavity

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41
Q

what is constrictive pericarditis

A

fibrous scar tissue making the pericardium stick to the heart

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42
Q

what is stenosis

A

cardiac valve doesn’t open properly

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43
Q

what is regurgitation

A

valve doesn’t close properly

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44
Q

what valves are most commonly affected by stenosis

A

aortic and mitral

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45
Q

what do PTs with stenosis present with

A

fatigue
shortness of breath
arrhythmias

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46
Q

what are the signs and symptoms of mitral valve stenosis

A

pulmonary congestion
orthopnea
nocturnal paroxysmal dyspnea
palpitations
fatigue

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47
Q

what are the signs and symptoms of aortic valve stenosis

A

angina
syncope
easily tired
dyspena
peripheral cyanosis

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48
Q

what are the signs and symptoms of mitral valve regurgitation

A

don’t develop symptoms for years
pulmonary congestion
dyspnea on exertion
orthopnea

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49
Q

what are the signs and symptoms of aortic valve regurgitation

A

dyspnea on exertion
orthopnea
drop in diastolic pressure
widening arterial pulse pressure

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50
Q

what are the valves experiencing during systolic murmurs

A

pulmonic and aortic stenosis
mitral and tricuspid regurgitation

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51
Q

what are the valves experiencing during diastolic murmurs

A

aortic and pulmonic regurgitation
mitral and tricuspid stenosis

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52
Q

what causes heart failure

A

decreased cardiac output and tissue perfusion
increased fluid retention

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53
Q

what examples of fluid retention can contribute to heart failure

A

peripheral edema
shortness of breath
exercise intolerance

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54
Q

what does cardiac remodeling do

A

dilating ventricles and increasing wall thickness

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55
Q

what does inotropic do

A

contractility or force of heart

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56
Q

what does chronotropic do

A

heart rate

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57
Q

what is a consequence of dilation

A

it becomes inadequate and CO decreases

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58
Q

what is a consequence of hypertrophy

A

less volume space
poor circulation
impaired filling
higher oxygen needs
risk for ventricular dysrhythmias

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59
Q

true or false: ventricular heart failure (systolic) has a high ejection fraction and (diastolic) has a low ejection fraction

A

false: systolic had low and diastolic has normal

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60
Q

what does ventricular heart failure (diastolic) lead to

A

decreased stroke volume and CO
venous engorgement in pulmonary and systemic vascular systems

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61
Q

what can be a diagnosis for ventricular heart failure (diastolic)

A

pulmonary congestion
pulmonary hypertension
ventricular hypertrophy
normal EF

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62
Q

systolic dysfunction has what heart sound

A

S3

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63
Q

diastolic dysfunction has what heart sound

A

S4

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64
Q

where does left sided heart failure send venous return

A

lungs

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65
Q

where does right sided heart failure send venous return

A

body organs except lungs

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66
Q

true or false: left heart failure is the most common cause of right heart failure

A

true

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67
Q

what does acute decompensated heart failure manifest as

A

pulmonary edema

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68
Q

what are the signs and symptoms of pulmonary edema

A

anxious
pale, possibly cyanotic
skin is clammy and cold
severe dyspnea
wheezing, coughing
blood-tinged sputum
crackles, wheezes, rhonchi
HR rapid, BP variable

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69
Q

what are natriuretic peptides

A

natural substances released by the heart

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70
Q

what does ANP do and where is it secreted from

A

lower blood pressure
atrium

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71
Q

what does BNP do and where is it secreted from

A

regulates circulation (dilate blood vessels, causes kidneys to excrete more salt and water)
ventricles

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72
Q

true or false: high BNP levels equals better cardiac health than lower levels

A

false

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73
Q

what is the natural pacemaker of the heart

A

SA node

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74
Q

what is arrhythmias

A

abnormal conduction and/or formation of cardiac impulses

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75
Q

what are the common causes of arrhythmias

A

abnormal structure (hypertrophy and dilation)
inadequate oxygen
fluid/electrolyte/pH disturbances (potassium)
injury
excessive demand

76
Q

where is atrial depolarization

A

p interval

77
Q

where is ventricular depolarization found

A

QRS interval

78
Q

where is ventricular repolarization found

A

t interval

79
Q

what common arrhythmias leads to cardiac arrest

A

ventricular tachycardia and fibrillation

80
Q

which valve is affected with damage if the papillary muscle is in the left ventricle

A

mitral

81
Q

PT reports shortness of breath, tachycardia, productive cough, and orthopnea. these symptoms are consistent with

A

left ventricular failure

82
Q

what clinical manifestations are associated with right-sided heart failure

A

distended neck veins
putting edema in the feet and ankles
abdominal ascites

83
Q

what conditions would likely lead to diastolic heart failure

A

cardiac hypertrophy from long-standing hypertension
cardiac tamponade
restrictive cardiomyopathy

84
Q

what is the functional unit of the kidney

A

nephron

85
Q

what is the function of the kidneys

A

filter blood of toxins/waste and reabsorb needed molecules

86
Q

what can high levels of uric acid in the urine cause

A

kidney stones
gout

87
Q

what could high amounts of urea in the urine indicate

A

urea is a byproduct of protein formed in the liver
high levels could indicate tissue breakdown or diet high in protein (bodybuilders)

88
Q

what is the function of the nephron

A

reabsorption of water, electrolytes, and other substances from bloodstream

89
Q

what endocrine functions does the kidney perform

A

1) creates erythropoietin which regulates the differentiation of red blood cells
2) increases calcium absorption and regulates calcium deposition in bone

90
Q

what diuretics affect potassium levels

A

loop and thiazide diuretics

91
Q

what are the characteristics of normal urine

A

1) clear, amber-colored fluid
2) 95% water and 5% dissolves solids
3) contains metabolic wastes, no plasma proteins, blood cells, or glucose molecules

92
Q

how much urine does the kidney normally produce

A

1.5L of urine

93
Q

what is specific gravity of urine

A

provides a valuable index of the hydration status and functional ability of the kidneys

94
Q

what is a health/normal range for the specific gravity of urine

A

1.030-1.040

95
Q

what would a specific gravity of urine of 1.000 indicate

A

a very hydrated person

96
Q

what is renal clearance

A

the volume of plasma that is completely cleared each minute of any substance that finds it’s way into urine

97
Q

what are the determining factors of renal clearance

A

1) the ability of the substance to be filtered in the glomeruli
2) the capacity of the renal tubules to reabsorb or secrete the substance

98
Q

what primary hormone is produced by the kidney

A

erythropoietin

99
Q

what tests are used to test for renal function

A

1) urinalysis
2) GFR
3) serum creatinine
4) ultrasonography

100
Q

what is the difference between agenesis and hypogensis

A

1) agenesis: kidneys don’t develop
2) hypogenesis: kidney underdeveloped

101
Q

what is potter syndrome and what are some characteristics

A

newborns with renal agenesis
- eyes widely separated with epicanthic folds, ears low set, nose broad and flat, eyc

102
Q

what are some causes of potter syndrome

A

cystic renal dysplasia
obstructive uropathy
autosomal recessive polycystic disease
unilateral agenesis

103
Q

what is cystic disease of the kidney

A

fluid-filled sacs or segments of a dilated nephron

104
Q

what are kidney stones and what are the most common type

A

crystalline structures that form from components of urine
calcium (oxalate and phosphate)

105
Q

what is the second leading bacterial infection seen by healthcare providers

A

UTI

106
Q

what is the most common bacteria that causes UTI’s

A

e. coli

107
Q

what conditions lead to kidney stone formation

A

acidic pH
supersaturated urine
urine stasis

108
Q

what is glomerulonephritis and what are common characteristics

A

inflammation of the glomerular structure
- hematuria
- diminished GFR
- azotemia
- oliguria
- hypertension

109
Q

what is the second leading cause of renal failure

A

glomerulonephritis

110
Q

true or false: static urine flow will predispose your patient to development of a UTI

A

true

111
Q

what is renal failure

A

a condition in which the kidneys fail to remove metabolic end products from the blood and regulate the fluid

112
Q

what are the types of renal failure

A

acute and chronic

113
Q

what GFR is indicative of chronic renal failure

A

GFR < 15mL/min/1.73m2

114
Q

what are the clinical manifestations of chronic renal failure

A

accumulation of nitrogenous waste
anemia and coagulation disorders
hypertension
gastrointestinal disorders
immunologic disorders

115
Q

what are the cardiovascular disorders of renal failure

A

hypertension
heart disease
pericarditis

116
Q

what are the hematologic disorders of renal failure

A

anemia
coagulopathies

117
Q

what is a pulmonary embolism

A

a blockage in one or more of the pulmonary arteries in your lungs

118
Q

what is virchow’s triad and what makes it up

A

the perfect environment for a pulmonary embolism
- hypercoagulability
- vascular damage
- circulatory stasis

119
Q

what are the signs and symptoms of pulmonary embolism

A

SOB
chest pain
dyspnea
tachypnea
tachycardia
shock

120
Q

what is pulmonary hypertension

A

pressure in the blood vessels leading from the heart to the lungs is too high

121
Q

signs and symptoms of pulmonary hypertension

A

SOB
fainting
dizziness
chest pressure
tachycardia

122
Q

what is cor pulmonale and what causes it

A

right-sided heart failure caused by a primary lung disorder

123
Q

describe the pathogensis of cor pulmonale

A

1) lung disorder damages the lungs
2) low oxygen or hypoxia leads to pulmonary vasoconstriction which limits blood flow to alveoli
3) vascular remodeling (thickening of arteries)
4) increased pulmonary arterial pressure (>20mmHg)
5) increased right ventricular afterload

124
Q

what is the most common cause of cor pulmonale

A

COPD

125
Q

what are the clinical manifestations of cor pulmonale

A

SOB
chest pain
severe fatigue
exercise intolerance
warm/moist skin
peripheral edema

126
Q

what is an anatomical dead space

A

refers to the volume of ventilated air that does not participate in gas exchange
- nose, pharynx, trachea, bronchi)

127
Q

what is ventilation

A

the flow of air into and out of the alveoli

128
Q

what is perfusion (Q)

A

the flow of blood to alveolar capillaries

129
Q

what is dead space

A

portion of each tidal volume that does not take part in gas exchange

130
Q

what is a shunt

A

pathological condition in which alveoli are perfused but not ventilated (blood get shunted away from the area without ventilation to find an area with ventilation)

131
Q

what is an acute respiratory disorder

A

a failure of the respiratory system to add oxygen to the blood and remove CO2 and represents a life threatening occurrence

132
Q

what are three types of acute respiratory disorders

A

acute respiratory distress syndrome (ARDS)
acute respiratory failure (ARF)
covid-19

133
Q

what is acute respiratory distress syndrome (ARDS)

A

respiratory failure in critically ill patients
acute onset of cardiogenic pulmonary edema and hypoxemia caused by alveolar inflammation or infection requiring mechanical ventilation

134
Q

what are common causes of acute respiratory distress syndrome

A

near drowning
heroin
infections (most common)
trauma (burns, chest trauma)
shock

135
Q

what is respiratory failure

A

failure of gas exchange due to heart or lung failure

136
Q

what is the difference between ARDS and ARF

A

ARDS = life threatening condition caused by injury to the capillary wall either from illness or injury (alveolar walls become leaky)
ARF = broader term that refers to failure of lungs from any causes

137
Q

what is covid-19 and what causes it

A

an infectious disease caused by the SARS virus (severe acute respiratory syndrome)

138
Q

what is the pathogensis of covid-19

A

vital entry
macrophage activation
pro inflammatory cascade
acute lung injury
respiratory failure

139
Q

what are the stages of covid-19

A

1) asymptomatic stage (initial 1-2 days of infection)
2) upper airway and conducting airway response
3) hypoxia, progression to ARDS

140
Q

what are treatments for covid-19

A

1) antiviral treatments - target specific parts of the virus to stop it from multiplying in the body
2) monoclonal antibodies - help immune system recognize and respond more effectively to virus

141
Q

what is the main function of the respiratory system

A

remove appropriate amounts of CO2 from blood and add appropriate amounts of oxygen leaving the pulmonary circulatory system

142
Q

what is hypoxemia

A

decreased arterial oxygen supply (PaO2 of 92% or lower)

143
Q

what is hypoxia

A

decreased oxygen content in the tissues

144
Q

what is hypercapnia

A

increased CO2 in the blood

145
Q

what are the signs and symptoms of hypoxia

A

restlessness
headache
confusion
tachycardia
anxiety
dyspnea
severe cyanosis
low HR (severe)

146
Q

what are the signs and symptoms of hypoxemia

A

headache
dyspnea
tachycardia
wheezing
coughing
confusion
cyanosis (severe)

147
Q

what is strider

A

construction in the airways leading to a whistling noise

148
Q

how does the purse lip breathing technique help

A

helps control rate and volume
prolonged expiration of air
keeps airway open during exhalation and excretion of CO2

149
Q

what is cyanosis

A

abnormal blue discoloration of the skin and mucus is membranes caused by an increased concentration of deoxygenated hemoglobin in capillary bed
SpO2 less than 85%

150
Q

what is pleural effusion

A

excess fluid between the layers of the pleura outside the lungs

151
Q

what are the causes of pleural effusion

A

heart problems
cancer
pneumonia
pulmonary embolism

152
Q

what is pneumonia

A

disorder of inflammation of the bronchioles and alveoli
dead cell and debris then build up creating pus and filling parts of the small airways

153
Q

what causes pneumonia

A

infectious agents

154
Q

what is pulmonary edema and what causes it

A

lungs filled with fluid
lung congestion
causes: fluid overload, heart failure

155
Q

what is atelectasis and what causes it

A

an avoidable state where the alveoli don’t fill properly/incomplete lung expansion
causes: immobility, mucus plug, external pressure

156
Q

pnuemothorax

A

condition where air has entered normally closed pleural space (and expanded this space) driving pleural pressure up toward atmospheric pressure

157
Q

what are obstructive airways disorders characterized by

A

progressive declining lung function
airflow obstruction
abnormal chronic
inflammatory response
airway remodeling

158
Q

what is airway remodeling

A

cells that shouldn’t be there show up

159
Q

what is chronic/refractory asthma characterized by

A

chronic airway inflammation
airway hyper-responsiveness
airway obstruction
massive immune response
airway remodeling
genetics

160
Q

what is the inflammatory cascade

A

cause construction of epithelium
immune response is totally out of control

161
Q

what does refractory/chronic asthma cause

A

there is a “pro-inflammatory” Th2 response
activation of eosinophils and phagocytes which exacerbates allergies causing type-1 hypersensitivity reactions

162
Q

what are the clinical manifestations of asthma

A

SOB
chest tightness
wheezing
troubling sleeping

163
Q

what is the third leading cause of death worldwide

A

COPD

164
Q

two major categories of COPD

A

emphysema and chronic bronchitis

165
Q

what is emphysema

A

gradual damage of lung tissue (destruction of alveoli)

166
Q

what is chronic bronchitis

A

long term inflammation of the bronchi and the hyper production of mucus

167
Q

chronic infection in COPD leads to?

A

overproduction of mucus
chronic airway inflammation
reduced gas exchange
remodeling

168
Q

emphysema clinical manifestations

A

barrel chest
high CO2 retention
purse lip breathing
dyspnea
anxious
thin appearance
poor diffusion
fewer metabolic issues then chronic bronchitis

169
Q

chronic bronchitis clinical manifestations

A

recurrent cough
hypoxia
high incidence in smokers
leads to right sided heart failure

170
Q

what is the normal anterior/posterior diameter

A

1:2

171
Q

effects of COPD

A

increased risk of cardiovascular disease
depression and anxiety
osteoporosis
overproduction of EPO from hypoxia

172
Q

what is bronchiectasis

A

permanent and abnormal dilation of the bronchi, bronchioles (uncommon type of COPD)

173
Q

what is cystic fibrosis and how do you treat it

A

genetic disease causing the mutilation of the cystic fibrosis transmembrane conductance regulator (treatment is lung transplant)

174
Q

what is obstructive sleep apnea

A

the brain sends a signal to the muscles and the muscles make an effort to take a breath bit muscles are unsuccessful because the airway is obstructed

175
Q

most common sleep related disorder

A

obstructive sleep apnea

176
Q

what are interstitial lung disorders

A

umbrella term for problems with the lungs themselves can be related to the expansion rate of the lungs or total volume the lungs can hold

177
Q

what is idiopathic pulmonary fibrosis

A

most common form of ILD

starts with chronic cough and dyspnea
dilation of bronchi
alveolar remodeling
no cure (lung transplant)

178
Q

what are extrinsic restrictive lung diseases

A

problems outside of the lungs place pressure on the lungs or paralysis of muscles that help with breathing

179
Q

what do pulmonary function tests measure

A

lung volume
capacity
rates of flow
gas exchange
diagnostic and determination for the best treatments

180
Q

what is forced expiratory volume 1 (FEV1)

A

volume of air forcefully exhaled in 1 second
one of the most important factors

181
Q

what is forced vital capacity (FVC)

A

volume of air forcibly exhaled after deepest breath possible

182
Q

FEV1/FVC ratio

A

volume of air that once can forcefully exhale

183
Q

what is total lung capacity

A

volume of gas in the lung at the end of a full inspiration
~6 liters in a healthy adult

184
Q

what is residual volume (RV)

A

the volume of air remaining in the lungs after maximal exhalation

185
Q

what is the diffusing capacity for carbon monoxide (DLCO)

A

measures the ability of gas to transfer from the alveoli across the alveolar epithelium and the capillary endothelium to the red blood cells
- helps determine the underlying disorder and tell the severity

186
Q

what is functional residual capacity (FRC)

A

the volume of air in the lungs after a normal, passive exhalation

clincial pathophysiology (7 decks)

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