Exam 3 Flashcards

1
Q

Erythrocytes have what two unique properties:

A
  1. Biconcave shape
  2. Capacity to be reversibly deformed
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2
Q

Biconcave shape increases… on RBCs

A

Surface area

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3
Q

RBCs that have abnormal shapes

A

Poikilocytosis

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4
Q

RBCs that have abnormal sizes

A

Aniscocytosis

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5
Q

What is poikilocytosis

A

RBCs have abnormal shapes

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6
Q

What is anisocytosis

A

RBCs have abnormal sizes

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7
Q

Biconcave shape of RBCs allows for better…

A

Gas exchange

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8
Q

RBCs with their reversible deformity allow for

A

Diffusion of oxygen and squeezing through the capillaries

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9
Q

What type of anemia
RBCs are abnormally large and not fully developed

A

Megaloblastic anemia

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10
Q

What type of anemia RBCs
Bone marrow produces fewer cells and sometimes they die before 120 day lifespan

A

Megaloblastic anemia

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11
Q

Pernicious anemia is an example of what type of anemia

A

Megaloblastic anemia

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12
Q

What is the main disorder in pernicious anemia

A

Absence of intrinsic factor

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13
Q

What vitamin is deficient in pernicious anemia

A

Vitamin B12

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14
Q

A glycoprotein produced in the stomach that binds with vitamin B12 so that it can be absorbed in the intestines

A

Intrinsic factor

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15
Q

If the stomach doesn’t produce enough IF what happens?

A

The intestines can’t properly absorb vitamin B12
Leads to vitamin B12 deficiency

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16
Q

What doesn’t mature properly in RBCs in pernicious anemia?

A

The nucleus

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17
Q

In PA RBCs
Three characteristics
A

A

Wrong shape
Wrong size
Die more quickly

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18
Q

Mechanism by which medications cause pernicious anemia

A

Some medications block IF or stop it from working properly

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19
Q

Older adult presentation of pernicious anemia

A

Neuropsychiatric disorders
Cognitive impairment
Fix with B12 shots

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20
Q

Reduction in total number of erythrocytes in circulating blood or a decrease in the quality or quantity of hemoglobin

A

Anemia

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21
Q

Anemia is either a decrease in

A

Total number of erythrocytes in circulating blood or
Decrease in quality or quantity of hemoglobin

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22
Q

Four causes of anemia

A

1) impaired erythrocyte production
2) blood loss- acute or chronic
3) increased erythrocyte destruction
4) a combination of above three factors

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23
Q

When is DNA synthesis impaired in megaloblastic anemia

A

During RBC production

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24
Q

Impaired DNA synthesis prevents what in megaloblastic anemia

A

Further nuclear division

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25
Impaired DNA synthesis during RBC production prevents what Also, leads to asynchronous maturation of what organelles
Prevents further nuclear division and leads to asynchronous maturation of nucleus and cytoplasm
26
Large red blood cell precursors are called what in the bone marrow?
Megaloblasts
27
Shape of megaloblasts
Oval instead of round or disc shaped
28
The actual prevalence of vitamin B12 deficiency may be higher than statistics because
Use of gastric acid blocking agents and Aging of US population
29
What anemia Characterized by abnormally small erythrocytes that contain unusually reduced amounts of hemoglobin
Microcytic hypochromic
30
Iron deficiency anemia is an example of which anemia
Microcytic hypochromic
31
How much blood loss can cause iron deficiency anemia
2-4 ml per day 1-2 mg of iron
32
Cause of primary IDA in females
Menorrhagia
33
Bleeding sources of IDA
Ulcers Hiatal hernia Esophageal varices Cirrhosis Hemorrhoids Ulcerative colitis Cancer
34
Ulcers Hiatal hernia Esophageal varices Cirrhosis Hemorrhoids Ulcerative colitis Cancer
Causes of bleeding in IDA
35
Occult bleeding source like GI cancer or other lesion can lead to which anemia
IDA
36
Early symptoms of IDA are…
Nonspecific
37
Fatigue Heart palpitations Weakness Shortness of breath Pale earlobes, palms,conjunctivae
Early symptoms of IDA Nonspecific
38
Main regulator of systemic iron balance
Hepcidin (peptide)
39
Most common nutritional disorder of Microcytic-hypochromic anemia
Iron deficiency anemia
40
Example of normocytic normochromic anemia
Aplastic anemia
41
Three causes of aplastic anemia
1)an autoimmune disease against hematopoiesis 2) exposure to chemical agents 3) unknown idiopathic
42
Hematopoietic failure in aplastic anemia is characterized by what
Pancytopenia
43
Reduction or absence of all three blood cell types Term for this
Pancytopenia
44
Failure or suppression of bone marrow to produce adequate amounts of erythrocytes leukocytes and thrombocytes causes
Pancytopenia in aplastic anemia
45
What anemia is characterized by hypo cellular bone marrow that has been replaced with fat
Aplastic anemia
46
Example of normocytic normochromic anemia
Aplastic anemia
47
Aplastic anemia is an example of which type of anemia
Normocytic normochromic
48
A group of inherited red blood cell disorders that affect hemoglobin
Sickle cell disease
49
Protein that carries oxygen through the body
Hemoglobin
50
Most prevalent type of sickle cell disease
Sickle cell anemia
51
Shape of red blood cells in sickle cell anemia?
Crescent or sickle shaped
52
What causes crescent shape of RBCs in sickle cell anemia?
Genetic mutation
53
Two problems caused by sickle shaped cells
Do not move or bed easily Can block blood flow to the rest of the body
54
Under conditions of decreased oxygen tension and dehydration (decreased plasma volume) and cold temperatures due to vasoconstriction What happens to hemoglobin S?
Stretches and elongates
55
Consequences of repeated cycles of damaged cells
Converted to end stage non-deformable in or stiff and irreversibly sickled cells
56
Consequence of sickled cells 3
Hemolytic anemia Micro vascular obstruction Ischemic tissue damage
57
Hemolytic anemia Micro vascular obstruction Ischemic tissue damage
These are the three reasons sickle shaped RBCs die prematurely
58
An acquired clinical syndrome characterized by widespread activation of coagulation
DIC
59
What condition results in the formation of fibrin clots in medium and small vessels throughout the body
DIC
60
Widespread activation of coagulation in DIC results in
Formation of fibrin clots in medium and small vessels throughout the body
61
The most common condition associated with DIC
Sepsis
62
Although thrombosis is generalized and widespread, patients with DIC are paradoxically at risk for
Hemorrhage
63
Why does hemorrhage happen in DIC?
Abnormally high consumption of clotting factors and platelets
64
In DIC platelet consumption exceeds what?
Production
65
In DIC Platelet consumption exceeds production resulting in what
Thrombocytopenia
66
Platelet consumption exceeds production resulting in a thrombocytopenia in DIC that increases….
Bleeding
67
In DIC extensive clotting consumes clotting factors and platelets leading to
Widespread hemorrhage
68
A malignant lymphoma
Hodgkin Lymphoma
69
What disease is characterized by its progression from one group of lymph nodes to another?
Hodgkin lymphoma
70
Hodgkin lymphoma
Characterized by its progression from one group of lymph nodes to another, the development of systemic symptoms, presence of Hodgkin and Reed Sternberg Cells
71
What cells are the hallmark of HL?
Reed sternberg cells
72
First sign Of Hodgkin lymphoma
Enlarged painless lymph nodes in the neck
73
Most indicative sign of HL
Enlarged painless lymph nodes in the neck
74
Non Hodgkin lymphoma gene changes are usually
Acquired and not inherited
75
What factor is NHL associated with?
Occupational exposure to pesticides
76
What is common in NHL?
Extranodal involvement
77
What heme disease is inherited in an autosomal recessive pattern?
Hereditary hemochromatosis
78
What does autosomal recessive pattern
Both copies of the gene in each cell have mutations
79
What disease Iron accumulates in tissues and organs (such as the liver) and disrupting function
Hereditary hemochromatosis
80
What is injured in HH
Beta islet cells leading to diabetes
81
Decreased synthesis of what is present in some forms of HH
Hepcidin
82
Iron absorption in the GI tract is increased or decreased in HH
increased
83
Common inherited iron overload disorder characterized by excessive absorption of iron
Hereditary hemochromatosis
84
What condition is due to a deficiency of Hepcidin or to decreased binding of Hepcidin to ferroportin?
Hereditary hemochromatosis
85
Genetic pattern of childhood hemophilia
X-linked recessive
86
Why are x linked recessive conditions more common in males?
Males have only one copy of the X chromosome
87
What results in the clinical manifestations of hemophilia?
Mutation
88
What results in the clinical manifestations of hemophilia?
Mutation
89
How many males are living with hemophilia
1,125,000
90
Hemophilia manifestations range from
Mild to severe disease
91
What may exposure a diagnosis of hemophilia?
Positive family history
92
Two most prevalent types of hemophilia
A and B
93
Classic hemophilia or factor VIII deficiency
Hemophilia A
94
Christmas disease or factor IX deficiency
Hemophilia B
95
Which disease results from mutations in the F8 gene which codes for factor VIII
Hemophilia A
96
F8 gene codes for which clotting factor
VIII
97
What factor is an essentialncofactor for factor IX in the coagulation cascade?
Factor VIII
98
What is factor VIII an essential cofactor for?
Cofactor IX
99
The most common hereditary disease associated with life-threatening bleeding
Hemophilia A
100
Results from a mutation in the F9 gene
Hemophilia B
101
F9 gene codes for which clotting factor?
IX
102
Hemophilia A and B are clinically indistinguishable because why
Because both factors VIII and IX function together to activate Factor X
103
Both factors VIII and IX function together to activate which factor
Factor X
104
The alterations or deficiencies of which coagulation factors decrease the ability to form blood clots in response to injury?
Factors VIII and IX
105
The decreased or ineffective blood clotting leads to In hemophilia
Continuous bleeding
106
Most characteristic type of bleeding in hemophilia
Joint bleeding (hemarthrosis)
107
Joint bleeding in hemophilia most often affects which joints?
Knees Ankles Elbows
108
Most common childhood cancer in children and adolescents (14 years and younger)
Leukemias
109
Cancer of the blood forming tissues like bone marrow
Leukemia
110
Uncontrolled proliferation of malignant leukocytes
Leukemia
111
Abnormal immature white blood cells are called
Leukemic cells
112
Leukemic cells in leukemia do what
Fill bone marrow and spill into the blood
113
What happens to Leukemic cells once in the blood?
Spread to other organs
114
What organs can Leukemic cells spread to? 3
Brain Lymph nodes Spleen
115
A chronic relapsing proliferation immune mediated inflammatory disorder that involves the skin, scalp, and nails often accompanied by systemic comorbidities
Psoriasis
116
What is psoriasis mediated by?
Immune mediated inflammatory disorder
117
Onset of psoriasis later in life is
Less familial and more secondary to comorbidities
118
Comorbidities seen in later life onset psoriasis
Obesity Smoking hypertension Diabetes
119
Inflammatory cascade of psoriasis involves complex interactions between what cells
Macrophages Fibroblasts Dendritic cells NK cells T helper cells Regulatory T cells
120
Inflammatory cascade of psoriasis involves complex interactions between what cells
Macrophages Fibroblasts Dendritic cells NK cells T helper cells Regulatory T cells
121
What skin layers are thickened in psoriasis?
Dermis and epidermis
122
Three causes of thickening of dermis and epidermis in psoriasis?
Cellular hyperproliferation Altered keratinocyte differentiation Expanded dermal vasculature
123
Cellular hyperproliferation Altered keratinocyte differentiation Expanded dermal vasculature
Causes of dermis and epidermis thickening in psoriasis
124
Normal epidermal shedding time
14-20 days
125
Epidermal shedding time in psoriasis?
3-4 days
126
A multisystem inflammatory disease caused by spirochete Borreliella Burgdorferi
Lyme disease
127
What transmits Lyme disease?
Ixodes tick
128
Most frequently reported vector borne illness?
Lyme disease
129
Borreliella is difficult to culture why?
Escapes immune defenses through antigenic variation Blocks complement mediated killing Impedes release of antimicrobial peptides leukocyte chemotaxis and antimicrobial killing Hides in tissue
130
How does Lyme disease spread to other tissues?
By entering capillary beds
131
What is bulls eye rash called?
Erythema migrants
132
Erythema migrans is what kind of rash Another name for this
Bulls eye rash
133
Is there a vaccination for Lyme disease?
No
134
Is there a vaccination for Lyme disease?
No
135
How does Borriella escape immune defenses? Genetic process
Antigenic variation
136
What does Lyme block?
Complement mediated killing
137
What is impeded in Lyme?
Release of antimicrobial peptides Leukocytes chemotaxis Antimicrobial killing Hides
138
Where does Lyme hide?
The tissue
139
How is HSV1 spread?
Oral secretions
140
How is HSV1 spread?
Oral secretions
141
Which herpes more commonly causes genital infection?
HSV 2
142
How is HSV2 generally spread?
Skin to skin mucous membrane contact during viral shedding
143
What is happening to virus when transmitted in herpes2?
Viral shedding
144
HSV2 risk of infection is high in which populations
Immunosuppressed persons or persons who have sexual contact with infected individuals
145
What is associated with significant neonatal neurological morbidity and mortality? Which herpes virus and by what process
Vertical transmission in HSV2 from mother to neonate
146
HSV2 vertical transmission from mother to neonate is associated with
Significant neonatal neurologicnmorbidity and mortality
147
What cells does HSV infect?
Epithelia cells
148
Where does HSV embed?
Sensory nerve endings
149
How does HSV have lifelong latency?
By inhibiting apoptosis of target cells
150
Five causes of HSV reactivation
Exposure to UV light Skin irritation Fever Fatigue Stress
151
Exposure to UV light Skin irritation Fever Fatigue Stress
Causes of HSV reactivation
152
Herpes zoster is also known as
Human herpesvirus 3
153
What two conditions are caused by the same herpes virus?
Varicella Herpes Zoster
154
How are varicella viruses spread?
Airborne droplets or direct contact with actively shedding lesions
155
How does varicella zoster virus enter body?
Respiratory tract Highly infectious
156
Where does VZV virus remain latent?
Trigeminal and dorsal (sensory) root ganglia
157
Initial symptoms of herpes zoster?
Pain Parenthesia to affected dermatome
158
Cutaneous area innervated by a single spinal nerve
Dermatome
159
Later symptoms of shingles
Vesicular eruptions and then crusting
160
What can prevent chicken pox?
Varicella vaccine safe and effective in children and adults
161
What age can receive shingles vaccine?
60 years and older to prevent shingles
162
Benign pigmented or no pigmented lesions
Nevi
163
Another name for moles
Nevi
164
What cells form melanocytic Nevi?
Melanocytes
165
Melanocytic Nevi causes can be either..
Congenital or acquired
166
Size of melanocytic Nevi can be
Small (<1cm) Or large 20 cm
167
Where do cells accumulate at the early stages of Nevi development?
Junction of the dermis and epidermis (junctional nevi)
168
Junctional Nevi are formed at the junction of the
Dermis and epidermis
169
What type of lesions are junctional Nevi?
Macular lesions
170
Nevi Over time cells move deeper into the
Dermis
171
With time, Nevi become
Modular and symmetric without irregular borders (compound Nevi)
172
Nodular and symmetric Nevi without irregular borders are called
Compound Nevi
173
Where can Nevi appear on the skin
Any where
174
Can Nevi vary in size?
Yes
175
Nevi can occur either (pattern)
Singly or in groups
176
What skin lesion may undergo transition to malignant melanoma
Nevi
177
Treatment for Nevi that are irritated by clothing or trauma or large lesions
Excision
178
Moles that require regular evaluation?
Multiple and changing
179
Why is it important for the clinician to understand the various forms of Nevi?
Relationship between Nevi and melanoma
180
Most Nevi never become
Suspicious
181
What type of Nevi need to be removed?
Suspicious pigmented Nevi
182
A of ABCDE rule
Asymmetry
183
B of ABCDE rule
Border irregularity
184
C of ABCDE rule
Color variation
185
D of ABCDE rule
Diameter of larger than 6 mm
186
E of ABCDE rule
Elevation or evolving which includes raised appearance or rapid enlargement
187
Three suspicious characteristics of Nevi
Bleeding or oozing Scab formation Ulceration
188
Bleeding or oozing Scab formation Ulceration Are what
Suspicious characteristics of Nevi
189
A malignant tumor of the skin that originates from transformation of melanocytes
Cutaneous melanoma
190
Where does cutaneous melanoma originate from?
Transformation of melanocytes
191
Where do melanocytes arise from?
Neural crest tissue
192
What do melanocytes synthesize?
Pigment melanin
193
Where are melanocytes located?
Basal layer of skin
194
Where do melanocytes arise
Mucosal tissue and uveal tract
195
Surface epithelial tumor originating from undifferentiated basal or stem cells
Basal cell carcinoma
196
Presumed cause of BCC
UV radiation exposure
197
Arsenic in food or water thought to contribute to
BCC
198
Radiation therapy can lead to what skin condition
BCC
199
Long term immunosuppressive therapy can cause what skin condition
BCC
200
What type of tumor is BCC
Surface epithelial tumor
201
Cells in which BCC originates
Undifferentiated basal or stem cells
202
BCC lesion often begins as a
Nodule
203
How big is nodule at beginning of BCC
Greater than 5 mm
204
Color of BCC lesion
Pearly or ivory
205
Lesion is slightly elevated above skin surface and has teleangiectasis
BCC
206
Lesion is slightly elevated above skin surface and has teleangiectasis
BCC
207
Term for small blood vessels on surface
Teleangiectasis
208
What groups of people are significantly less likely to develop BCC?
Dark skin Avoid sunlight
209
What is the protective factor experienced by dark skinned persons in BCC?
Basal cells contain more pigment melanin
210
A protective factor against the sun in basal cells
Melanin pigment
211
Why is metastatic spread rare in BCC?
Tumors don’t invade blood or lymph vessels
212
Why is metastatic spread rare in BCC?
Tumors don’t invade blood or lymph vessels
213
A benign proliferation of cutaneous basal cells that produces flat or slightly elevated lesions that may be smooth or warty in appearance
Seborrheic keratosis
214
What cells benign proliferate in seborrheic keratosis?
Cutaneous basal cells
215
Appearance of seborrheic keratosis lesions
Flat or slightly elevated that may be smooth or warty in appearance
216
The pathogenesis of seborrheic keratosis is
Unknown
217
Benign tumors of seborrheic keratosis are usually seen in people aged
Over 50 Can also appear in young adults
218
Grouping of seborrheic keratosis lesions
Singularly or in multiples
219
Where do SK lesions occur?
Chest Back Face
220
Colors of SK lesions
Tan to waxy yellow Flesh colored Dark brown to black
221
Size of SK lesion
Few millimeters to several centimeters
222
Oval and greasy appearing lesions seen in
SK
223
Hyperkeratotic scaly stuck on appearance lesions seen in
SK
224
Three treatment options for SK
Cryotherapy with liquid nitrogen Shave excision Laser therapy
225
Liquid nitrogen is treatment option for what seem condition
SK
226
Shave excision is a treatment option for what derm condition
SK
227
Laser therapy can treat what skin condition
SK
228
Pilosebaceous units are also known as
Sebaceous follicles
229
Where does acne develop?
Sebaceous follicles
230
Sebaceous follicles are also called
Pilosebaceous units
231
Two androgens that are secreted increasingly in puberty
Dehydroepiandrosterone sulfate Testosterone
232
Sebaceous gland size and productivity are increased by what during puberty?
Androgens
233
Androgens promote the formation of what
Comedone
234
Production of what is altered in acne?
Sebum
235
Organism of follicular proliferation in acne
cutibacterium acnes
236
Anaerobic bacterium of acne
Cutibacterium acnes
237
C acnes strains shift from being what to what
Symbiotic to pathogenic strain of bacterium
238
Ruptured comedones trigger what in acne
Inflammatory mediators
239
Another name for atopic eczema
Atopic dermatitis
240
What is the most common cause of eczema in children?
Atopic dermatitis
241
When does AD usually first appear
2-6 months
242
Most cases of AD develop when
During the first five years of life Can affect any ages
243
Chronic relapsing form of pruritic eczema
Atopic dermatitis
244
AD involves an interplay of
Genetic predisposition
245
Atopic comorbidities 3
Asthma Allergic rhinitis Food allergies
246
What allergies are well recognized in patients with AD
Food allergies
247
What immunoglobulin is increased in AD
IGE
248
What WBC type is increased in AD
Eosinophils
249
Positive skin test results to a variety of common food and inhalant allergens are seen in what Dx
AD
250
The most common bacterial skin infection in children 2-5 years of age
Impetigo
251
Highly contagious skin infection (bacterial) in kids
Impetigo
252
What is the most common organism of impetigo
S aureus
253
Less common organism of impetigo
Strep pyogenes
254
Impetigo mode of transmission
Direct and indirect contact
255
What do staph produce in impetigo?
Bacterial toxins
256
Another name for bacterial toxins produced by staph in impetigo
Exfoliative toxins
257
What do exfoliative toxins disrupt in impetigo?
Disruption in skin barrier with blister formation
258
Disruption in skin barrier with blister formation are caused by what produced by staph
Exfoliative toxins
259
A benign self limiting skin disease
Molloscum contaigiosum
260
What type of organism causes molluscum?
A pox virus
261
Three ways MC can spread
Person to person direct contact Autoinoculation Contaminated fomites
262
Two primary mechanisms that cause significantly elevated or depressed hormones
Inappropriate amounts of hormone delivered to the target cell Inappropriate responses by target cell
263
Failure of feedback systems designed to control hormone release leads to
Inappropriate amounts of hormone delivered
264
Disorders of the endocrine glands causing them to synthesize too little or too much hormone is a cause of
Inappropriate amounts of hormone delivered
265
Dysfunctional or ectopically produced hormones can lead to
Inappropriate amounts of hormone delivered
266
Defects in the delivery of the hormone in the blood stream can lead to
Inappropriate amounts of hormone delivered
267
When is ADH released?
When not enough fluid in the body
268
What condition results from insufficient ADH?
Diabetes insipidus
269
In this condition, not enough ADH Body cannot hold onto water and excretes
DI
270
Polyuria or oliguria in DI
Polyuria (massive amounts)
271
Hypervolemia or hypovolemia in DI
Hypovolemia volume depletion
272
What symptom in DI is caused by hypovolemia?
THIRST POLYDIPSIA
273
What symptom in DI is caused by hypovolemia?
THIRST POLYDIPSIA
274
A condition associated with traumatic brain injuries
Neurogenic diabetes insipidus
275
Condition characterized by insufficient ADH activity
Polyuria POLYDIPSIA
276
Patients with this condition have a partial to total inability to to concentrate urine
DI
277
What causes excretion of large volumes of dilute urine in DI
insufficient ADH activity
278
Hyper or hypo natremia in DI
Hyper natremia
279
Mucotaneous lymph node syndrome AKA
Kawasaki disease
280
Acute systemic vasculitis What disease
Kawasaki disease
281
Kawasaki disease may result in these two conditions
Myocarditis Coronary artery aneurysms
282
Leading cause of acquired heart disease among children in the US
Kawasaki disease
283
Cause of KD?
Remains unknown
284
Cause of this may be a normal immunologic response to an infectious, toxic, or antigenic substance
KD
285
What disease may be caused by an abnormal immune response to a common stimulus?
KD
286
What immune responses occur in KD?
Innate Adaptive
287
What cells of immune system infiltrate vessel walls in KD? Think LMN
Neutrophils Macrophages Lymphocytes
288
What two things are increased in immune response to KD?
Inflammatory cytokines Antibodies
289
What parts of vasculature are inflamed in KD?
Small capillaries Arterioles Venules
290
Acute myocarditis is a complication of what disease?
KD
291
Necrotizing arteritis occurs in what disease?
KD
292
Aneurysm development associated with necrotizing arteritis occurs in what disease?
KD
293
HHNKS stands for
Hyperosmolar hyperglycemic nonketotic syndrome
294
Another name for HHNKS is
HHS Hyperglycemic hyperosmolar state
295
Life threatening emergency precipitated by infections Medications Nonadherance to diabetes treatment Coexisting disease
HHNKS
296
HHNKS more commonly seen with which type of diabetes?
Type 2
297
Why isn’t there keyosis in HHNKS?
Still producing some insulin
298
Disease in capillaries with diabetes is called
Microvascular disease
299
Retinopathy with potential lead to blindness caused by what type of diabetes complication?
Microvascular
300
End stage kidney failure in diabetes caused by what diabetes complication?
Microvascular
301
Neuropathies result from what diabetes complication?
Microvascular
302
Thickening of the capillary basement membrane Endothelial cell hhperplasia Thrombosis Seen in what diabetes complication?
Microvascular disease
303
Thickening of the capillary basement membrane in Microvascular disease eventually leads to
Decreased tissue perfusion
304
Decreased tissue perfusion in diabetic Microvascular disease is caused by
Thickening of the capillary basement membrane
305
Lesions in medium and large sized arteries caused by diabetes
Macrovascular disease
306
Macrovascular disease in diabetes increases what two metrics
Increased morbidity and mortality
307
What three things have accelerated risk in diabetic Macrovascular disease?
Atherosclerosis MI Stroke
308
Diabetic patients have a higher /lower mortality during acute phase of MIs than non diabetic patients
Higher
309
Why do diabetic patients have higher mortality during acute phase of MI
They are often asymptomatic as a result of sensory and autonomic neuropathy
310
Why do diabetic patients have higher mortality during acute phase of MI
They are often asymptomatic as a result of sensory and autonomic neuropathy
311
What two neuropathies make diabetics asymptomatic during acute phase of MI?
Sensory and autonomic neuropathy
312
What type of complications justify need for diabetes screening and monitoring of A1C
Macrovascular
313
Glycated hemoglobin determines glucose control over how long
3-4 months
314
What synthesis is inadequate in Addison disease Two things
Inadequate corticosteroid and mineralocorticoid synthesis
315
Elevated ACTH levels are seen in what disease
Addison disease
316
Hypocortisolism and hypoaldosteronism are seen in what disease
Addison disease
317
What organ does aldosterone primarily act on?
Kidney
318
What is aldosterone’s effect on the kidney?
Sodium and water reabsorption and potassium excretion
319
If not enough aldosterone… hyper or hypo kalemia?
Hyperkalemia
320
Why does aldosterone deficiency cause hyperkalemia?
Too much potassium because not enough aldosterone to excrete
321
Hyper or hypo volemia in Addison disease
Hypovolemia
322
What causes hypovolemia in Addison disease?
Not enough aldosterone (Water follows sodium and without enough aldosterone, cannot hang on to sodium so excreting sodium and water)
323
A general term referring to ALL clinical manifestations related to excessive exposure to cortisol
Cushing syndrome
324
Cushing like syndrome may develop as a side effect of long term pharmacological administration of glucocorticoids
Exogenous Cushing like syndrome may develop
325
Patho of Cushing syndrome is opposite of what disease
Addison disease
326
Hyper or hyponatremia in Cushing syndrome
Hypermatremia
327
Hyper or hypoglycemia in Cushing syndrome
Hyperglycemia
328
Hyper or hypo kalemia in Cushing syndrome
Hypokalemia
329
What three places does weight gain occur in Cushing syndrome
Truncal central obesity Moon face Buffalo hump
330
What causes glucose intolerance in Cushing syndrome?
Cortisol induced insulin resistance
331
Increased gluconeogenesis in Cushing syndrome causes
Glucose intolerance
332
Cortisol induced insulin resistance and increased gluconeogenesis and glycogen storage by the liver causes what in Cushing syndrome
Glucose intolerance
333
The catabolic effects of cortisol on peripheral tissues causes what in Cushing syndrome
Protein wasting
334
Muscle wasting in Cushing syndrome leads to what symptom
Muscle weakness
335
Where is muscle wasting most prominent in Cushing syndrome
In the extremities with thinning of the limbs
336
Loss of what leads to thin, weakened integumentary tissues in Cushing syndrome
Loss of collagen
337
Purple striae and easy bruising in Cushing disease caused by loss of
Collagen
338
Very rare disease that returns to the clinical manifestations resulting from chronic exposure to excess endogenous cortisol
Cushing disease
339
Cushing disease is more common in men or women
More common in women
340
What disease Refers to excessive exposure endogenous secretion of ACTH (corticotropin)
Cushing disease
341
What is the term for several days of total dietary abstinence or deprivation
Short term starvation
342
What is another term for short term starvation
Extended fasting
343
In short term starvation the body responds with mechanisms to protect what
Protein mass
344
How long after a meal is body in a well fed state
4-6 hours
345
When body is in a well fed state what supplies its energy requirements
Glucose from recently ingested carbohydrates
346
The splitting of glycogen into glucose is called
Glycogenolysis
347
Glycogen in the liver is converted to glucose by what process
Glycogenolysis
348
Once all available energy has been absorbed from the intestine, what gets converted to glucose
Glycogen
349
What condition begins after several days of dietary abstinence
Long term starvation
350
What eventually causes death from proteolysis?
Long term starvation
351
Persistent restriction of energy intake leading to significantly low body weight
Anorexia nervosa
352
What four considerations determine context of body weight
What is minimally expected for Age Sex Developmental trajectory Physical health
353
Anorexia causes disturbances in the way what two things are experienced
Body weight Body shape
354
In anorexia there is an undue influence of body shape and weight on what
Self evaluation
355
In anorexia there is a persistent lack of what regarding the current low body weight
Recognition of the seriousness of
356
Recurrent episodes of binge eating occur in what condition
Bulimia
357
What is the frequency and duration of binge eating and inappropriate compensatory mechanisms in bulimia
At least once a week for 3 months
358
An episode of binge eating is characterized by what two things
Recurrent inappropriate compensatory behavior to prevent weight gain Binge eating and inappropriate compensatory behaviors both occur on average at least once a week for 3 months
359
What are examples of compensatory behaviors to prevent weight gain in bulimia
Self induced vomiting Misuse of medication Fasting or excessive exercise
360
What medications are misused in bulimia
Laxatives Diuretics
361
What disorder is associated with eating large amounts of food when not physically hungry
Binge eating disorder
362
Eating disorder NOT associated with recurrent use of inappropriate compensatory behaviors
Binge eating disorder
363
Three or more of these characteristics must occur to diagnose binge eating episodes in binge eating disorder
Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not physically hungry Eating alone because of feeling embarrassed by how much one is eating Feeling disgusted with oneself, depressed, or very guilty afterward Marked distress regarding binge eating is present Binge eating occurs on average at least once a week for three months
364
What condition describes a decrease in appetite or food intake in older adults
Anorexia of aging
365
Patients that are illness free and have an adequate food supply may still experience
Anorexia of aging
366
Anorexia of aging results from multiple … changes
Age related
367
Examples of age related changes in anorexia of aging
Reduced energy needs Waning hunger Diminished sense of smell and taste Decreased saliva production Altered GI satiety control Presence of comorbidities
368
Aging is associated with increased or decreased orexigenic signals
Decreased
369
Signals that increase food intake
Orexigenic signals
370
Signals that decrease food intake
Anorexigenic signals
371
Aging is associated with increased or decreased anorexigenic signal la
INCREASED ANOTEXIGENIC SIGNALS
372
Two consequences of chronic low grade inflammation with elevated cytokines in anorexia of aging
Delayed gastric emptying Decreased motility of the small intestine
373
Decreased motility of what part occurs in anorexia of aging
Small intestine
374
What happens to gastric emptying in anorexia if aging?
Delayed
375
Functional impairments and deficiencies are risk factors for what nutritional disorder
Anorexia of aging
376
Four examples of functional impairment associated with anorexia of aging
Loss of vision Poor dentition Dysphagia Inability to prepare foods
377
Medical and psychiatric conditions increase the risk for what nutritional disorder
Anorexia of aging
378
Loneliness and grief are involved in what nutritional disorder
Anorexia of aging
379
Social isolation and abuse and neglect are associated with what nutritional disorder
Anorexia of aging
380
Medications and polypharmacy increase the risk for what nutritional disorder
Anorexia of aging
381
Progression of the underlying causes of anorexia leads to decreased WHAT required to eat and digest food
Energy reserves
382
Examples of two diseases that are underlying causes of anorexia of aging that increase work of breathing
COPD CHF
383
What is a key strategy in treating patients with anorexia of aging
Exercise
384
How does exercise help anorexia of aging?
Improved oral intake Elevated mood Build muscle and strength
385
Malnutrition and physical frailty are consequences of what nutritional disorder
Anorexia of aging
386
Malnutrition and physical frailty are consequences of what nutritional disorder
Anorexia of aging
387
What organelle is dysfunctional in anorexia of aging
Mitochondrial dysfunction
388
Increased oxidative stress is a consequence of what nutritional disorder
Anorexia of aging
389
Reduced regenerative capacity is seen in what nutritional disorder
Anorexia of aging
390
Reduced regenerative capacity is seen in what nutritional disorder
Anorexia of aging
391
Hormonal imbalance is a consequence of what nutritional disorder
Anorexia of aging
392
Hormonal imbalance is a consequence of what nutritional disorder
Anorexia of aging
393
Exercise and what else are important in treating anorexia of aging
Nutrition
394
Supportive interventions to mitigate anorexia of aging Three
Improved access to food and appearance Dental and eye care Social stimulation
395
Three nonmodifiable risk factors for CAD
Advanced age Male gender or women after menopause Family history
396
Advanced age Male gender or women after menopause Family history Are three examples of what
Nonmodifiable risks of CAD
397
7 modifiable risks of CAD
Dyslipidemia Hypertension Cigarette smoking Diabetes and insulin resistance Obesity Sedentary lifestyle Atherogenic diet
398
Obesity means a BMI of
OVER 30
399
A good BMI is less than
25
400
High levels of what are BAD (in CAD)
LDL
401
Low levels of WHAT are BAD in CAD
HDL
402
An increased serum concentration of what is an indicator of coronary risk
LDL
403
Relative risk of elevated LDL depends on presence of other risk factors like
Age Diabetes CKD
404
What is responsible for delivery of cholesterol to the tissues?
LDL
405
Low levels of what are also a strong indicator of coronary risk?
HDL
406
What is responsible for reverse cholesterol transport?
HDL
407
Process of returning excess cholesterol from the tissues to the liver
Reverse cholesterol transport
408
Reverse cholesterol transport moves excess cholesterol from where to where
From tissues to the liver
409
What type of angina is relieved with the usual interventions the patient utilizes
Stable angina
410
Stable angina is predictable or unpredictable
Predictable
411
In unstable angina, the pain is…
Worse Different
412
Usual interventions don’t relieve pain in which type of angina
Unstable angina
413
Chest pain attributable to transient ischemia of the myocardium that occurs unpredictable and often at rest
Vasospastic prinzmetal angina
414
Prinzmetal or vasospastic angina is attributable to
Transient ischemia of the myocardium
415
Chest pain caused by vasospasm of one or more major coronary arteries
Vasospastic or prinzmetal angina
416
Type of angina that can occur in those with or without CAD
Prinzmetal angina
417
Causes of vasospasm in prinzmetal angina
Coronary smooth muscle hyper contractions Decreased cabal activity Endothelial dysfunction Magnesium deficiency Inflammation Oxidative stress Hyperactivity of the SNS
418
Decreased vagal activity can cause which angina
Vasospastic or prinzmetal angina
419
What electrolyte imabalance worsens Vasospastic angina
Hypokalemia
420
Hyper or hypo kalemia worsens symptoms and outcomes of Vasospastic angina
Hypokalemia
421
Deficiency of what electrolyte can cause vasospasm in prinzmetal angina
Magnesium
422
Triggers of prinzmetal angina
Hyperventilation Mental stress Smoking Use of stimulants Alcohol REM sleep
423
What angina is diagnosed by matching clinical manifestations with documented transient ischemic changes in ECG
Vasospastic angina
424
How is Vasospastic angina diagnosed
By matching clinical manifestations with documented transient ischemic changes in ECG
425
Management of Vasospastic angina involves what two things
Avoidance of triggers Use of calcium channel blockers or nitrates
426
What medications treat Vasospastic angina
Calcium channel blockers Nitrates
427
Complications (2) of Vasospastic angina
Dysrhythmias Infarction
428
Dysrhythmias and infarction in patients with Vasospastic angina are especially common in patients with what kind of lesions
Atherosclerotic coronary lesions
429
An angina that is usually a benign condition
Vasospastic angina
430
What type of angina has been reclassified under NSTEMI
Unstable angina
431
Why has unstable angina been reclassified as NSTEMI
Studies found some damage to myocardium
432
What type of angina signals that the atherosclerotic plaque has begun to rupture
Unstable angina
433
What type of angina leads to transient episodes of vessel occlusions and vasoconstriction at the site of plaque damage
Unstable angina
434
How long does thrombus occlude vessel before reperfusion iccurs in unstable angina
10-20 minutes
435
After 10-20 minutes of thrombus occluding the vessel what occurs
Reperfusion
436
Infarction will only involve the myocardium directly beneath the endocardium which heart attack
NSTEMI
437
Which heart attack Infarction extends through the myocardium all the way from endocardium to epicardium
Transmural MI STEMI
438
What part of the heart muscle is affected in NSTEMI
Myocardium directly beneath the endocardium
439
Term for the myocardium directly beneath the endocardium
Subendocardial MI
440
Term for the myocardium directly beneath the endocardium
Subendocardial MI
441
ST depression T wave inversion What is this called
NSTEMI
442
If thrombus breaks up before complete distal tissue necrosis has occurred Leads to which MI
NSTEMI
443
Plaque buildup and rupture obstructs flow in a coronary artery resulting in irreversible cell death Which heart attack Infarction extends
STEMI
444
Term for Infarction will extend through the myocardium from endocardium to epicardium
Transmural MI
445
What kind of infarction causes marked elevations in ST segments on ECG
Transmural infarction
446
Irreversible cell death caused by which MI
STEMI
447
What is secreted after a MI in response to hemodynamic changes and contributes to pathogenesis of MI
Angiotensin II
448
MOST IMPORTANTLY angiotensin II results in
Peripheral vasoconstriction
449
Potential impact Homeostatic responses are counterproductive in that they can increase myocardial work on a heart that may be struggling
Angiotensin II
450
Acute inflammation of the pericardium
Acute pericarditis
451
Etiology of acute pericarditis is usually
Idiopathic
452
Viral infection MI Are other causes of acute
Pericarditis
453
Most common complication of pericarditis
Pericardial effusion
454
Accumulation of fluid in the pericardial sac
Pericardial effusion
455
Cardiac compression
Cardiac tamponade
456
Rapid accumulation of fluid in pericardial sac leads to
Cardiac tamponade
457
Patho condition in which heart is unable to generate an adequate cardiac output
Heart failure
458
Inadequate perfusion of tissues or increased diastolic filling pressure of left ventricle Patho of what condition
Heart failure
459
Decreased compliance of the left ventricle thus inability of the heart to achieve a normal cardiac output
Heart failure with reduced ejection fraction
460
Heart failure with preserved EF is systolic or diastolic failure?
Diastolic heart failure
461
Which ventricle has decreased compliance in HF with preserved EF
Left ventricle
462
Heart failure with reduced EF is systolic or diastolic HF??
Systolic
463
EF less than 40% and an inability of the heart to generate an adequate cardiac output due to decreased contractility
HF with reduced EF systolic heart failure
464
Diagnosis of what cardiac condition relies heavily on clinical signs and symptoms
HF
465
Comprehensive history and physical exam are critical parts of what cardiac diagnosis
HF
466
Load on the heart caused by volume of blood received into the left ventricle from the left atrium (at the end of ventricular diastole) and that it must eject with each contraction
Preload
467
Volume of blood received into left ventricle from left atrium at the end of ventricular diastole
Preload
468
If preload is too much the muscle fibers are what
Overstretched
469
The resistance the heart encounters when ejecting blood to the rest of the body
Afterload
470
Heart stretch think
Preload
471
Heart squeeze thinks
Afterload
472
Stroke volume is reduced by increasing
Afterload
473
Increasing Afterload reduces
Stroke volume
474
The strength of the heart’s muscle contraction is called
Contractility
475
Decreased perfusion result of failure of which side of heart
Left heart failure
476
Contractility
The strength of the heart’s muscle contraction
477
EF less than 40% and an inability of the heart to generate an adequate cardiac output to perfuse vital tissues
HF with reduced EF systolic heart
478
EF in heart failure with reduced EF is
Less than 40%
479
Contractility in HF is increased or decreased
Decreased
480
Preload in HF with rEF is Increased or decreased
Increased
481
HFrEF and after load is Increased or decreased
Increased
482
Catecholamines in HFrEF Sympathetic nervous system initially compensates for a decrease in CO by increasing what two things
Heart rate Peripheral vascular resistance (Afterload)
483
Peripheral vascular resistance reflects what on heart
Afterload
484
Increased heart rate caused by catecholamines increases the what on the heart
Workload
485
Activation of RAAS in HF increases what measures of heart
PRELOAD AFTERLOAD
486
RAAS activation in HF causes direct toxicity to what type of cells
Myocytes
487
Direct toxicity to myocytes is caused by what in Hf
RAAS activation
488
What are the three main substances of RAAS system?
Renin Angiotensin II Aldosterone
489
What type of BP activates the RAAS system
Low
490
What type of BP activates the RAAS system
Low
491
what two things cause RAAS activation in HF
Low BP Poor renal perfusion
492
RAAS activation causes increased or decreased preload
Increased
493
RAAS activation causes increased or decreased Afterload
Increased
494
Renin activates what to increase peripheral vascular resistance and BP (Afterload)
Angiotensin II
495
Aldosterone causes retention of what two things
Sodium Water
496
Retention of sodium and water caused by what hormone
Aldosterone
497
Aldosterone effects what heart measure by causing sodium and water retention
Preload
498
Reduced pressure in the carotid sinus and renal afferent arteriole caused by decrease in what
Cardiac output
499
Reduced pressure in carotid sinus and renal afferent arteriole leads to body perceiving what
Volume depletion
500
Antidiuretic hormone in HF causes what two things
Peripheral vasoconstriction (Afterload) Renal fluid retention (preload)
501
Peripheral vasoconstriction effects what cardiac measure
Afterload
502
Renal fluid retention caused by ADH affects what heart metric
Preload
503
What hormones counteract neurohormonal processes of heart failure by improving sodium and water excretion
Natriuretic peptides
504
Natriuretic peptides improve excretion of what two things
Sodium Water
505
What two type of natriuretic peptides are increased in HF
Atrial natriuretic peptides B type natriuretic peptides
506
What two hormones may have some protective effect in HF by decreasing preload?
Atrial and b type natriuretic peptides
507
Compensatory mechanisms of what two hormones are inadequate in HF
Atrial and b type natriuretic peptides
508
What hormone is produced and released in response to pressure and volume overload of the cardiac changes?
BNP
509
What hormone inhibits myocardial fibrosis and hypertrophy and enhances diastolic function
BNP
510
BNP enhances systolic or diastolic heart function?
Diastolic
511
Lab value along with other signs and symptoms to determine if patient experiencing an exacerbation of HF and monitoring if other treatments are effective
BNP
512
Common complication of many congenital heart defects in children
Heart failure
513
Likely etiology of new onset HF in kids is determined by what
Age at time of diagnosis
514
HF in kids that results from CHD with pulmonary over circulation causes what type of shunt in heart
Left to right
515
Over circulation of what part of the body causes left to right shunt in HF caused by CHD
Pulmonary
516
Large left to right shunt is common in what age group of heart failure
Newborns and infants
517
HF in older children is most often due to what type of disorders
Acquired
518
Viral myocarditis Rheumatic heart disease Autoimmune disorders Anemia Kawasaki disease Hypothyroidism Causes of what
Heart failure in children
519
A complex condition with many contributing factors is what cardiac condition
HTN
520
What two types of factors play a role in HTN?
Genetic Environmental
521
What is often asymptomatic and a silent killer
HTN
522
What is the usual first line treatment for HTN?
Lifestyle changes
523
Renal pressure natriuresis is impaired in what condition
HTN
524
What type of system regulates BP by increasing the amount of sodium and water the kidneys excrete?
Feedback system
525
Feedback system regulating blood pressure can be impaired by what two things
Impaired kidney function Inappropriate activation of hormones that regulate sodium and water excretion
526
Excessive activation of the SNS causes what heart condition
HTN
527
Excessive activation of what system leads to HTN
SNS
528
Increased systemic vascular resistance seen in what heart condition
HTN
529
Systemic vascular resistance is increased or decreased in HTN
Increased
530
Obesity and increased dietary salt intake contribute to what heart condition
HTN
531
Vessel resistance abnormalities contribute to what cardiac condition
HTN
532
Endothelial dysfunction contributes to what cardiac condition
HTN
533
Sodium retention leads to increased retention of what
Water retention
534
Increased sodium and water retention leads to increased
Blood volume
535
Increased blood volume in HTN caused by what
Increased water and sodium retention
536
Increased blood volume in HTN leads to increased what Vicious cycle
Blood pressure
537
Inflammation of kidney in HTN is caused by what
Tissue ischemia
538
Tissue ischemia causes inflammation of the kidney and contributes to the dysfunction of what two anatomical renal parts
Glomeruli Tubules
539
Microalbuminuria is caused by what cardiac condition
HTN
540
Protein escaping in the urine is called
Microalbuminuria
541
Increased retinal arterial pressure and damage to the microvasculature are caused by what condition
HTN
542
Retinopathy is seen in what cardiac condition
HTN
543
Accelerating atherosclerosis is seen in what cardiac condition
HTN
544
Damage to the blood vessel walls in HTN leads to what complication
Accelerating atherosclerosis
545
Cholesterol and fats build up to form what at damaged areas
Plaques
546
Most common form of rheumatic heart disease
Mitral stenosis
547
What condition impairs the flow of blood from the left atrium to the left ventricle
Mitral stenosis
548
Mitral stenosis results in incomplete emptying of what heart chamber
Left atrium
549
Mitral stenosis leads to elevated pressure in what heart chamber?
Atrial pressure
550
What ventricle fails with untreated mitral stenosis?
Right ventricular failure
551
Three outcomes of untreated mitral stenosis
Pulmonary hypertension Edema Right ventricular failure
552
What condition Permits back flow of blood from left ventricle into left atrium during ventricular systole
Mitral regurgitation
553
What phase of heart cycle impacted in mitral regurgitation?
Ventricular systole
554
Back flow of blood is from left ventricle to what chamber in mitral regurgitation?
Left atrium
555
Mitral valve regurgitation progression leads to failure of what heart chamber?
Left ventricular function may be impaired to the point of failure
556
Increased atrial pressure also causes pulmonary hypertension and failure of the right ventricle Which valve dysfunction?
Mitral regurgitation
557
Valve dysfunction associated with connective tissue disorders such as Marian syndrome
Mitral regurgitation
558
Resistance to blood flow from left ventricle into aorta seen in which valve dysfunction
Aortic stenosis
559
Outflow obstruction increases pressure within the left ventricle as it tries to eject blood through the narrowed opening in which valve dysfunction
Aortic stenosis
560
Aortic stenosis Outflow obstruction increases pressure within which ventricle
Left ventricle
561
Left ventricular hypertrophy is complication of which valve dysfunction
Aortic stenosis
562
Why does left ventricular hypertrophy develop in aortic stenosis?
Compensate for increased workload
563
Remodeling of the LV myocardium with fibrosis leads to a gradual decline in what function
Left ventricular function with decreased cardiac output
564
Hypertrophic cardiomyopathy is a complication of what valve disorder
Aortic stenosis
565
Hypertrophic cardiomyopathy MI Oliguria Stroke Heart failure Pulmonary edema Are complications of what cardiac condition
Aortic stenosis
566
Atherosclerotic disease of arteries that perfuse the limbs, especially lower extremities What disease
Peripheral artery disease
567
Pain with ambulation is called
Intermittent claudication
568
Pain with ambulation that subsides with rest is called
Intermittent claudication
569
Gradually increasing obstruction to arterial blood flow causes what physical assessment finding in PAD
Prolonged capillary refill in toes
570
Superficial veins in which blood has pooled are called
Varicose veins
571
Trauma to which veins cause varicose veins
Saphenous veins
572
One or more saphenous valve damages causes what
Varicose veins
573
Sustained inadequate venous return is called what
Chronic venous insufficiency
574
Varicose veins can progress to
Chronic venous insufficiency
575
Hyperpigmentation of the skin of the feet and ankles is seen in
Cvi
576
Edema of the lower extremities Ankles and feet Seen with what vascular condition
Chronic venous insufficiency
577
If part of the aorta is narrowed it is hard for blood to pass through the artery Which condition
Coarctation of the aorta
578
A type of birth defect where part of the aorta is narrowed
Coarctation of aorta
579
What condition causes an increase in the upper extremity blood pressure Poor perfusion of tissues and organs
Coarctation of aorta Neonate
580
Upper extremity hypertension is the most important physical finding in what condition
Coarctation of aorta in neonate
581
History of poor feeding in neonates linked with what cardiac condition
Coarctation of aorta
582
Evidence of shock with poor perfusion seen in what condition
COA
583
Evidence of shock with poor perfusion seen in what condition
COA
584
What is heard when ausculatating COA in neonates linked?
Gallop
585
What type of murmur is heard in COA?
Mitral regurgitation murmur
586
Acidosis or alkalosis seen in COA?
Acidosis may be present
587
COA leads to what hypertrophy?
Left ventricle
588
Neonatal myocardium’s intolerance of the sudden increase in Afterload that occurs with the closure of the ductus arteriosus? This presentation is associated with what two things
Left ventricular dysfunction Shock
589
The closure of what causes a sudden increase in Afterload in COA
Ductus arteriosus
590
High levels of ADH in the absence of normal physiologic stimuli for its release What condition
SIADH
591
High levels of ADH in the absence of normal physiologic stimuli for its release What condition
SIADH
592
SIADH is associated with ectopic secretion of ADH of several types of tumor cells What two systems see these tumor cells
Pulmonary disorders Central nervous system disorders
593
SIADH is associated with ectopic secretion of ADH of several types of tumor cells What two systems see these tumor cells
Pulmonary disorders Central nervous system disorders
594
Secretion of what is altered in SIADH
ADH
595
Is ADH high or low in SIADH?
High
596
What type of sodium imbalance is seen in SIADH?
Dilutional hyponatremia
597
Hyper or hypovolemia in SIADH?
Hypervolemia
598
Is urinary sodium concentration high or low in SIADH?
High urinary sodium concentration in SIADH
599
Dilutional hyponatremia associated with Hypervolemia High urinary sodium concentration Weight gain Manifestations of what condition
SIADH
600
What three things is the thyroid responsible for?
Metabolism Growth Development
601
What type of loop does thyroid hormone use?
Negative feedback loop
602
What hormone is released when T3 and T4 decrease below normal?
TRH
603
What hormone is released when T3 and T4 decrease below normal?
TRH
604
TRH stands for
Thyrotropin releasing hormone
605
TRH stimulates the pituitary gland to produce what hormone
Thyroid stimulating hormone
606
What hormone acts on the thyroid to produce more hormones and raise the blood levels
TSH
607
Once levels rise, the hypothalamus shuts off and stops secreting TRH which in turn inhibits the pituitary gland release of what hormone
TSH
608
Low TSH levels usually indicate what condition
Hyperthyroidism
609
Is TSH low or high in hyperthyroidism
Low
610
High TSH levels usually indicate what condition
Hypothyroidism
611
Are TSH levels low or high in hypothyroidism?
High
612
Manifestations of lower levels of thyroid hormone are what (4)
Constipation Brady cardia Dyspnea Lethargy
613
Decreased energy metabolism in hypothyroidism results in what four manifestations
Constipation Bradycardia Dyspnea Lethargy
614
Constipation Bradycardia Dyspnea Lethargy Caused by high or low levels of thyroid hormone?
Low levels
615
Lower levels of thyroid hormone results in increased or decreased energy metabolism?
Decreased energy metabolism
616
Graves’ disease is what type of hypersensitivity
Type II
617
Graves’ disease is an example of what thyroid condition
Hyperthyroidism
618
Stimulation of the thyroid by autoantibodies directed against the TSH receptor What condition
Graves Disease
619
Type II hypersensitivity Thyroid condition
Graves’ disease
620
A disorder of pancreatic dysfunction and beta cell destruction
DM 1
621
Beta cell destruction leads to absolute insulin deficiency What condition
Type 1 DM
622
Most of the time these patients aren’t obese Which diabetes
Type 1
623
Immune mediated diabetes is most common form of which diabetes
Type 1 Approximately 90%
624
What is destroyed in type 1 diabetes?
Beta cells
625
Chronic and metabolic disease characterized by defects in pancreatic insulin secretion and insulin resistance in target tissues generating a persistent state of hyperglycemia What disease
Diabetes type 2
626
Three risk factors for diabetes type 2
Obesity Poor diet Lack of regular exercise
627
Defects in pancreatic insulin secretion seen in which diabetes
Type 2
628
What diabetes causes a persistent state of hyperglycemia
Type 2
629
A suboptimal response of insulin sensitive tissues to insulin What is the term for this
Insulin resistance
630
What are the three most insulin sensitive tissues
Liver Muscle Adipose tissue
631
The most studied incretin is what
Glucagon like peptide 1
632
Beta cell responsiveness to what hormone is reduced in both pre diabetes and type 2 diabetes
GLP1
633
What condition is one of the most important contributors to insulin resistance and diabetes
Obesity
634
Cytokines produced by adipose tissue
Adipokines
635
Obesity results in increased or decreased adipokines
Increased
636
Term for increased serum levels of leptin
Leptin resistance
637
What does obesity do to levels of leptin?
Increased leptin
638
Adiponectin is increased or decreased in obesity?
Decreased
639
Free fatty acids are increased or decreased in obesity?
Increased
640
Increased FFAs and intracellular deposits of triglycerides and cholesterol lead to what type of tissue response to insulin
Decreased tissue responses to insulin
641
What two things do adipocytes release in obesity?
Adipocyte associated pro inflammatory macrophages Inflammatory cytokines
642
What two things are cytotoxic to beta cells in context of inflammation
Adipocyte associated pro inflammatory macrophages Inflammatory cytokines
643
Decreased insulin induced mitochondrial activity leads to what in obesity
Insulin resistance
644
What organelle is dysfunctional in obesity relative to insulin resistance?
Mitochondria
645
A serious complication related to a deficiency of insulin and an increase in the levels of insulin counterregulatory hormones What condition
DKA
646
What are the four counterregulatory hormones involved in DKA?
Catecholamines Glucagon Growth hormone Cortisol
647
DKA is much more common in which diabetes?
Type 1
648
Why is DKA more common in type 1 diabetes?
Insulin is more deficient in type 1
649
Why is DKA more common in type 1 diabetes?
Insulin is more deficient in type 1
650
What three features characterize DKA?
Hyperglycemia Acidosis Ketonuria
651
Insulin normally stimulates what process?
Lipogenesis
652
Insulin normally inhibits what process?
Lipolysis
653
How does insulin prevent fat catabolism?
Insulin normally stimulates lipogenesis and inhibits lipolysis
654
With insulin deficiency, what process is enhanced?
Lipolysis
655
With insulin deficiency, Lipolysis is enhanced and there is an increase in the amount of what delivered to the liver?
Fatty acids
656
Consequence of insulin deficiency and associated Lipolysis is what process
Glyconeogenesis
657
Glyconeogenesis contributes to what two things in DKA
Hyperglycemia Production of ketone bodies
658
What are the three ketone bodies in DKA? AHA!
Acetoacetate Hydroxybutyrate Acetone
659
Accumulation of ketone bodies does what to pH?
Drops PH
660
Accumulation of ketone bodies causes a drop in ph in DKA leading to what condition?
Metabolic acidosis
661
Hyperventilation in DKA in an attempt to compensate for the acidosis leads to what type of respirations
kussmaul respirations
662
Postural dizziness is a symptom of what endocrine issue
DKA
663
CNS depression is a symptom of what endocrine disorder
DKA
664
Ketonuria is a symptom of what endocrine disorder
DKA
665
Thirst and Polyuria are symptoms of what diabetic complication
DKA
666
Nausea vomiting and abdominal pain are symptoms of what endocrine issue
DKA
667
What three things are used to manage DKA?
Fluids Insulin Electrolyte replacement
668
Why is hyperglycemia an issue in DKA?
No insulin
669
Catecholamines Cortisol Glucagon GH Are counterregulatory hormones involved what condition
DKA
670
How does skin look in DKA?
Flushed and dry
671
Polyuria and dehydration result from what in DKA?
Diuretics associated with hyperglycemia
672
Acidosis in DKA is caused by production of what?
Ketones
673
Why does vomiting happen in DKA?
Another attempt to get rid of acid due to production of ketones
674
Hormones that increase blood glucose concentration
Glucocorticoids
675
Glucocorticoids are released under what type of conditions?
Stress
676
Most potent naturally occurring glucocorticoid?
Cortisol
677
Cortisol secretion is regulated primarily by the
Hypothalamus Anterior pituitary gland
678
Adrenicorticotropic hormone is the main regulator of what secretion
Cortisol
679
Aldosterone is what kind of hormone
Mineralocorticoid
680
Aldosterone conserves what electrolyte
Sodium
681
What hormone has antagonistic effects of insulin?
Glucagon
682
What hormone acts to increase blood glucose during fasting exercise and hypoglycemia
Glucagon
683
Low levels of glucose and sympathetic stimulation stimulate release of what hormone
Glucagon
684
What organ does glucagon act on?
Liver
685
Hormones secreted from endocrine cells in the GIT in the presence of carbs proteins and fats
Incretin hormones
686
What hormone Control postprandial glucose levels by promoting hepatic glucose secretion and delaying gastric emptying
Incretin
687
Synthesis of glucose from non carbohydrate sources like lactic acid and amino acids What is this called
Gluconeogenesis
688
Where does gluconeogenesis occur?
Liver and kidneys
689
Breakdown of glycogen occurring in the liver when blood glucose levels drop
Glycogenolysis
690
Peptide hormone cosecreted with insulin by beta cells in response to nutrient stimuli What is it called
Amylin
691
What hormone works with insulin to prevent hyperglycemia?
Amylin
692
What hormone has antagonistic effects to insulin?
Glucagon
693
Volume inside the ventricle at the end of diastole is called
Preload
694
Resistance to ejection of blood from the left ventricle
Left ventricular Afterload
695
The volume of blood ejected per beat during systole Called what
Stroke volume
696
Degree of myocardial fiber shortening is called what
Myocardial contractility
697
Cardiac output is calculated by
Heart rate x stroke volume
698
Blood pressure Resistance to flow in vessels Blood consistency Anatomic features that cause turbulent flow Compliance These are factors that affect what
Blood flow
699
Varicosities are most common in which anatomical veins
Saphenous veins
700
Condition that causes pathological ischemic changes in the vascular, skin, and supporting tissues?
CVI
701
Sustained elevation of the systemic arterial blood pressure resulting from increases in cardiac output, total peripheral resistance, or both ?
Hypertension
702
What type of hypertension is the most significant factor in target organ damage?
Systolic hypertension
703
Clinical manifestations of hypertension result from damage of organs and tissues located where?
Outside the vascular system
704
An inflammatory disease that begins with the endothelial layer and progresses through several stages to become a fibrotic plaque
Atherosclerosis
705
Spasm or occlusion of the coronary arteries that is most often the result of atherosclerotic lesions that limit flow of blood to the heart
CAD
706
Two types of angina with reversible myocardial ischemia
Stable angina Prinzmetal angina
707
Chronic coronary obstruction results in recurrent oredictable chest pain called what
Stable angina
708
Abnormal vasospasm of coronary vessels results in what type of unpredictable chest pain
Prinzmetal angina
709
What results when there is a sudden coronary obstruction caused by thrombus formation over a ruptured organs ulcerated atherosclerotic plaque? Name of condition
Acute coronary syndrome
710
What type of angina is the result of reversible myocardial ischemia and is a harbinger of impending infarction?
Unstable angina
711
What condition results when prolonged ischemia causes irreversible damage to the heart muscle?
Myocardial infarction
712
What angina signals that the atherosclerotic plaque has ruptured and infarction may soon follow?
Unstable angina
713
When coronary blood flow is interrupted for an extended period, necrosis of what cells occurs?
Myocyte
714
Two major types of MI
Subendocardial infarction and Transmural infarction
715
Thickening of the myocardium is called
Hypertrophic cardiomyopathy
716
What condition of valves has the most common cause of Congenital bicuspid valve, degenerative changes with aging, rheumatic fever
Aortic stenosis
717
Left ventricular hypertrophy followed by left heart failure Caused by which valve condition if untreated
Aortic stenosis
718
Most common cause of mitral stenosis
Rheumatic heart disease
719
Left atrial hypertrophy and dilation followed by left heart failure seen in which valve disorder
Mitral regurgitation
720
An inability of the heart to supply the metabolism with adequate circulatory volume and pressure What condition
Heart failure
721
Left heart failure can be categorized as what two things
Systolic or diastolic heart failure
722
What three things influence stroke volume
Contractility Preload Afterload
723
What is the most common cause of decreased contractility
MI
724
Myocardial ischemia results in what that causes progressive myocyte contractile dysfunction over time
Ventricular remodeling
725
Left ventricular end diastolic volume is another term for what
Preload
726
Another term for preload is
Left ventricular end diastolic volume
727
Increased Afterload is most commonly the result of what
Increased peripheral vascular resistance
728
Increase in peripheral vascular resistance decreases ventricular emptying and makes more workload for which part of the heart?
Left ventricle
729
Three features of the vicious cycle in HF
Decreasing contractility Increasing preload Increasing Afterload
730
Management of left heart failure involves two main things
Contractility Reducing preload and Afterload
731
Diseases of which gland usually cause abnormal secretion of ADH?
Posterior pituitary
732
An excess amount of which hormone result in water retention and a hypoosmolar state
ADH
733
Deficiency in the amount or response to ADH results in serum
Hyperosmolarity
734
High levels of ADH in the absence of normal physiologic stimuli for its release
SIADH
735
The patho features of SIADH are the result of what
Enhanced renal water retention
736
Insufficiency of ADH characterizes what condition
DI
737
DI caused insufficient secretion of ADH
Neurogenic or central DI
738
DI caused by inadequate response of renal tubules to ADH
Nephrogenic DI
739
Most common disorder of thyroid function
Hypothyroidism
740
Primary hypocortisolism is also called
Addison disease
741
A primary inability of the adrenals to produce and secrete the adrenocortical hormones What disease
Addison disease
742
Disease characterized by inadequate corticosteroid and mineralocorticoid synthesis and elevated ACTH (loss of negative feedback)
Addison
743
Hormone that regulates the release of cortisol from the adrenal cortex
ACTH
744
Major homeostatic function of what gland is to control plasma similarity through ADH
Posterior pituitary
745
ADH leads to increased reabsorption of what
Water
746
What hormone acts to conserve sodium
Aldosterone
747
What hormone is produced primarily by visceral adipose tissue
Adiponectin
748
Hereditary hemachromatosis what genetic inheritance pattern
Autosomal recessive
749
Hereditary hemochromatosis What genetic inheritance pattern
Autosomal recessive
750
Reed Sternberg cells in lymph nodes are associated with what disease
HL
751
What cardiac measure depends on the amount of blood in the ventricle
Preload
752
Most common valvular abnormality
Aortic stenosis
753
Condition where a valve orifice is constricted and narrowed impeding the forward flow of blood and increasing the workload of the cardiac chamber proximal to the diseased valve
Valvular stenosis
754
Valve leaflets fail to shut completely, permitting blood flow to continue even when the valve is supposed to be closed
Valve regurgitation
755
Condition that increases the volume of blood the heart must pump and increases the workload of the affected heart chamber
Valve regurgitation
756
What valve dysfunction causes atrial fibrillation
Mitral regurgitation
757
Inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure What condition
Right heart failure
758
Heart disease Renal disease CNS problems Retinal changes
Clinical manifestations of hypertension
759
What cells secrete intrinsic factor
Gastric parietal cells
760
Where does vitamin B12 form complexes with intrinsic factor
Small intestine
761
Cellular hyperproliferation seen in what derm condition
Psoriasis
762
Altered keratinocyte differentiation seen in what skin condition
Psoriasis
763
Need what in order to make hemoglobin?
IRON
764
Most common nutritional disorder?
Iron deficiency anemia
765
What is the main dietary source of B12?
MEAT
766
Benzene exposure can lead to which anemia
Aplastic anemia Normocytic normochromic
767
Activation of what leads to clotting in DIC
Tissue factor
768
Which lymphoma moves faster and further?
Non Hodgkin
769
Hepcidin increases or decreases when iron levels are high
Increases
770
Tissue factor is involved in extrinsic or intrinsic pathway
Extrinsic
771
Extrinsic or intrinsic pathway impacted in hemophilia
Intrinsic
772
Extrinsic or intrinsic pathway involved in DIC
Extrinsic
773
What are overactivated in psoriasis
Interleukins
774
Impetigo blisters are very
Fragile
775
DI ACRONYM
Dry inside
776
SIADH acronym mneumonic
Soaked inside
777
Posterior pituitary stores hormones from what gland
Hypothalamus
778
Insufficient ADH characterizes which endocrine disorder
Diabetes insipidus
779
Too much ADH Which endocrine disorder
SIADH
780
Pulmonary disorders cause with endocrine disorder?
SIADH
781
Dilutional hyponatremia seen in which endocrine disorder
SIADH
782
Hypervolemia and weight gain seen in which endocrine disorder?
SIADH
783
Anterior pituitary involved in
Thyroid disorders
784
Hypothyroidism memory aid
Low and slow
785
Hyperthyroidism memory aid
Hot and high
786
Autoimmune thyroiditis causes hypo or hyperthyroid
Hypothyroidism
787
TSH levels are low or high in hyperthyroidism
TSH levels are low because sensing lots of T3 T4
788
High TSH levels indicate what condition because TSH keeps trying to turn on thyroid
Hypothyroidism
789
Graves’ disease is what type of hypersensitivity
Type II
790
Graves’ disease is hypo or hyperthyroidism
Hyperthyroidism
791
Adipokines are increased or decreased in obesity
Increased
792
Free fatty acids are increased or decreased in obesity
Increased
793
Adipocytes are pro- what
Inflammatory
794
Adipocytes are cytotoxic to what cells
Beta cell
795
Insulin induced mitochondrial activity is increased or decreased in obesity
Decreased
796
GLP1 is an
Incretin
797
What activate gut brain connection
Incretins
798
Newly diagnosed type 1 diabetic is at risk for
DKA
799
Four hormones that increase glucose
Catecholamines Cortisol Glucagon Growth hormone
800
Diuretics is associated with hyper or hypoglycemia
Hyperglycemia
801
Ketones are a very strong what
Acid
802
Body produces too little cortisol and aldosterone
Addison disease
803
Body produces too much cortisol
Cushing syndrome
804
A’s for Addison
A decreased cortisol level Adrenal gland damage (main cause) Appearance bronzed Appetite decreased with weight loss
805
What gland secretes ADH
Hypothalamus
806
ADH reabsorbs only what
Water
807
What is the target organ for ADH
Kidney
808
What effect does ADH have on vascular smooth muscle?
Vasoconstriction
809
Does ADH raise or lower BP?
Raise blood pressure
810
What is ADH’s one purpose in life?
Raise blood pressure
811
ADH does what to blood volume?
Increase
812
Lack of ADH leads to what endocrine condition?
Diabetes insipidus
813
Neurogenic DI example
Traumatic brain injury
814
What hormone is released when not enough fluid in body?
ADH
815
Dry inside
Diabetes insipidus
816
Soaked inside
SIADH
817
Pulmonary disorders CNS disorders Cause which endocrine disorder
SIADH
818
Dilutional hyponatremia seen in which endocrine disorder
SIADH
819
What kind of system regulates thyroid hormones?
Negative feedback system
820
Glucocorticoids raise what in the blood
Glucose
821
Attaches to the lining of the arteries forming atherosclerotic plaque
LDL
822
Brings cholesterol to the liver to be excreted as a constituent of bile
HDL
823
What hormone Causes widespread arteriolar vasoconstriction in the body and stimulates adrenal gland to release aldosterone
Angiotensin II