Exam 3 Flashcards by Sara Clements

Erythrocytes have what two unique properties:

Biconcave shape
Capacity to be reversibly deformed

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Biconcave shape increases… on RBCs

Surface area

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RBCs that have abnormal shapes

Poikilocytosis

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RBCs that have abnormal sizes

Aniscocytosis

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What is poikilocytosis

RBCs have abnormal shapes

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What is anisocytosis

RBCs have abnormal sizes

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Biconcave shape of RBCs allows for better…

Gas exchange

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RBCs with their reversible deformity allow for

Diffusion of oxygen and squeezing through the capillaries

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

Megaloblastic anemia

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

Megaloblastic anemia

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Pernicious anemia is an example of what type of anemia

Megaloblastic anemia

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What is the main disorder in pernicious anemia

Absence of intrinsic factor

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What vitamin is deficient in pernicious anemia

Vitamin B12

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

Intrinsic factor

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

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

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

The nucleus

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In PA RBCs
Three characteristics
A

Wrong shape
Wrong size
Die more quickly

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Mechanism by which medications cause pernicious anemia

Some medications block IF or stop it from working properly

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Older adult presentation of pernicious anemia

Neuropsychiatric disorders
Cognitive impairment
Fix with B12 shots

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

Anemia

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Anemia is either a decrease in

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

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Four causes of anemia

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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When is DNA synthesis impaired in megaloblastic anemia

During RBC production

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Impaired DNA synthesis prevents what in megaloblastic anemia

Further nuclear division

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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

Large red blood cell precursors are called what in the bone marrow?

Megaloblasts

Shape of megaloblasts

Oval instead of round or disc shaped

The actual prevalence of vitamin B12 deficiency may be higher than statistics because

Use of gastric acid blocking agents and Aging of US population

What anemia Characterized by abnormally small erythrocytes that contain unusually reduced amounts of hemoglobin

Microcytic hypochromic

Iron deficiency anemia is an example of which anemia

Microcytic hypochromic

How much blood loss can cause iron deficiency anemia

2-4 ml per day 1-2 mg of iron

Cause of primary IDA in females

Menorrhagia

Bleeding sources of IDA

Ulcers Hiatal hernia Esophageal varices Cirrhosis Hemorrhoids Ulcerative colitis Cancer

Causes of bleeding in IDA

Occult bleeding source like GI cancer or other lesion can lead to which anemia

IDA

Early symptoms of IDA are…

Nonspecific

Fatigue Heart palpitations Weakness Shortness of breath Pale earlobes, palms,conjunctivae

Early symptoms of IDA Nonspecific

Main regulator of systemic iron balance

Hepcidin (peptide)

Most common nutritional disorder of Microcytic-hypochromic anemia

Iron deficiency anemia

Example of normocytic normochromic anemia

Aplastic anemia

Three causes of aplastic anemia

1)an autoimmune disease against hematopoiesis 2) exposure to chemical agents 3) unknown idiopathic

Hematopoietic failure in aplastic anemia is characterized by what

Pancytopenia

Reduction or absence of all three blood cell types Term for this

Pancytopenia

Failure or suppression of bone marrow to produce adequate amounts of erythrocytes leukocytes and thrombocytes causes

Pancytopenia in aplastic anemia

What anemia is characterized by hypo cellular bone marrow that has been replaced with fat

Aplastic anemia

Example of normocytic normochromic anemia

Aplastic anemia

Aplastic anemia is an example of which type of anemia

Normocytic normochromic

A group of inherited red blood cell disorders that affect hemoglobin

Sickle cell disease

Protein that carries oxygen through the body

Hemoglobin

Most prevalent type of sickle cell disease

Sickle cell anemia

Shape of red blood cells in sickle cell anemia?

Crescent or sickle shaped

What causes crescent shape of RBCs in sickle cell anemia?

Genetic mutation

Two problems caused by sickle shaped cells

Do not move or bed easily Can block blood flow to the rest of the body

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

Consequences of repeated cycles of damaged cells

Converted to end stage non-deformable in or stiff and irreversibly sickled cells

Consequence of sickled cells 3

Hemolytic anemia Micro vascular obstruction Ischemic tissue damage

These are the three reasons sickle shaped RBCs die prematurely

An acquired clinical syndrome characterized by widespread activation of coagulation

DIC

What condition results in the formation of fibrin clots in medium and small vessels throughout the body

DIC

Widespread activation of coagulation in DIC results in

Formation of fibrin clots in medium and small vessels throughout the body

The most common condition associated with DIC

Sepsis

Although thrombosis is generalized and widespread, patients with DIC are paradoxically at risk for

Hemorrhage

Why does hemorrhage happen in DIC?

Abnormally high consumption of clotting factors and platelets

In DIC platelet consumption exceeds what?

Production

In DIC Platelet consumption exceeds production resulting in what

Thrombocytopenia

Platelet consumption exceeds production resulting in a thrombocytopenia in DIC that increases….

Bleeding

In DIC extensive clotting consumes clotting factors and platelets leading to

Widespread hemorrhage

A malignant lymphoma

Hodgkin Lymphoma

What disease is characterized by its progression from one group of lymph nodes to another?

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

What cells are the hallmark of HL?

Reed sternberg cells

First sign Of Hodgkin lymphoma

Enlarged painless lymph nodes in the neck

Most indicative sign of HL

Enlarged painless lymph nodes in the neck

Non Hodgkin lymphoma gene changes are usually

Acquired and not inherited

What factor is NHL associated with?

Occupational exposure to pesticides

What is common in NHL?

Extranodal involvement

What heme disease is inherited in an autosomal recessive pattern?

Hereditary hemochromatosis

What does autosomal recessive pattern

Both copies of the gene in each cell have mutations

What disease Iron accumulates in tissues and organs (such as the liver) and disrupting function

Hereditary hemochromatosis

What is injured in HH

Beta islet cells leading to diabetes

Decreased synthesis of what is present in some forms of HH

Hepcidin

Iron absorption in the GI tract is increased or decreased in HH

increased

Common inherited iron overload disorder characterized by excessive absorption of iron

Hereditary hemochromatosis

What condition is due to a deficiency of Hepcidin or to decreased binding of Hepcidin to ferroportin?

Hereditary hemochromatosis

Genetic pattern of childhood hemophilia

X-linked recessive

Why are x linked recessive conditions more common in males?

Males have only one copy of the X chromosome

What results in the clinical manifestations of hemophilia?

Mutation

What results in the clinical manifestations of hemophilia?

Mutation

How many males are living with hemophilia

1,125,000

Hemophilia manifestations range from

Mild to severe disease

What may exposure a diagnosis of hemophilia?

Positive family history

Two most prevalent types of hemophilia

A and B

Classic hemophilia or factor VIII deficiency

Hemophilia A

Christmas disease or factor IX deficiency

Hemophilia B

Which disease results from mutations in the F8 gene which codes for factor VIII

Hemophilia A

F8 gene codes for which clotting factor

VIII

What factor is an essentialncofactor for factor IX in the coagulation cascade?

Factor VIII

What is factor VIII an essential cofactor for?

Cofactor IX

The most common hereditary disease associated with life-threatening bleeding

Hemophilia A

Results from a mutation in the F9 gene

Hemophilia B

F9 gene codes for which clotting factor?

Hemophilia A and B are clinically indistinguishable because why

Because both factors VIII and IX function together to activate Factor X

Both factors VIII and IX function together to activate which factor

Factor X

The alterations or deficiencies of which coagulation factors decrease the ability to form blood clots in response to injury?

Factors VIII and IX

The decreased or ineffective blood clotting leads to In hemophilia

Continuous bleeding

Most characteristic type of bleeding in hemophilia

Joint bleeding (hemarthrosis)

Joint bleeding in hemophilia most often affects which joints?

Knees Ankles Elbows

Most common childhood cancer in children and adolescents (14 years and younger)

Leukemias

Cancer of the blood forming tissues like bone marrow

Leukemia

Uncontrolled proliferation of malignant leukocytes

Leukemia

Abnormal immature white blood cells are called

Leukemic cells

Leukemic cells in leukemia do what

Fill bone marrow and spill into the blood

What happens to Leukemic cells once in the blood?

Spread to other organs

What organs can Leukemic cells spread to? 3

Brain Lymph nodes Spleen

A chronic relapsing proliferation immune mediated inflammatory disorder that involves the skin, scalp, and nails often accompanied by systemic comorbidities

Psoriasis

What is psoriasis mediated by?

Immune mediated inflammatory disorder

Onset of psoriasis later in life is

Less familial and more secondary to comorbidities

Comorbidities seen in later life onset psoriasis

Obesity Smoking hypertension Diabetes

Inflammatory cascade of psoriasis involves complex interactions between what cells

Macrophages Fibroblasts Dendritic cells NK cells T helper cells Regulatory T cells

Inflammatory cascade of psoriasis involves complex interactions between what cells

Macrophages Fibroblasts Dendritic cells NK cells T helper cells Regulatory T cells

What skin layers are thickened in psoriasis?

Dermis and epidermis

Three causes of thickening of dermis and epidermis in psoriasis?

Cellular hyperproliferation Altered keratinocyte differentiation Expanded dermal vasculature

Causes of dermis and epidermis thickening in psoriasis

Normal epidermal shedding time

14-20 days

Epidermal shedding time in psoriasis?

3-4 days

A multisystem inflammatory disease caused by spirochete Borreliella Burgdorferi

Lyme disease

What transmits Lyme disease?

Ixodes tick

Most frequently reported vector borne illness?

Lyme disease

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

How does Lyme disease spread to other tissues?

By entering capillary beds

What is bulls eye rash called?

Erythema migrants

Erythema migrans is what kind of rash Another name for this

Bulls eye rash

Is there a vaccination for Lyme disease?

How does Borriella escape immune defenses? Genetic process

Antigenic variation

What does Lyme block?

Complement mediated killing

What is impeded in Lyme?

Release of antimicrobial peptides Leukocytes chemotaxis Antimicrobial killing Hides

Where does Lyme hide?

The tissue

How is HSV1 spread?

Oral secretions

How is HSV1 spread?

Oral secretions

Which herpes more commonly causes genital infection?

HSV 2

How is HSV2 generally spread?

Skin to skin mucous membrane contact during viral shedding

What is happening to virus when transmitted in herpes2?

Viral shedding

HSV2 risk of infection is high in which populations

Immunosuppressed persons or persons who have sexual contact with infected individuals

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

HSV2 vertical transmission from mother to neonate is associated with

Significant neonatal neurologicnmorbidity and mortality

What cells does HSV infect?

Epithelia cells

Where does HSV embed?

Sensory nerve endings

How does HSV have lifelong latency?

By inhibiting apoptosis of target cells

Five causes of HSV reactivation

Exposure to UV light Skin irritation Fever Fatigue Stress

Causes of HSV reactivation

Herpes zoster is also known as

Human herpesvirus 3

What two conditions are caused by the same herpes virus?

Varicella Herpes Zoster

How are varicella viruses spread?

Airborne droplets or direct contact with actively shedding lesions

How does varicella zoster virus enter body?

Respiratory tract Highly infectious

Where does VZV virus remain latent?

Trigeminal and dorsal (sensory) root ganglia

Initial symptoms of herpes zoster?

Pain Parenthesia to affected dermatome

Cutaneous area innervated by a single spinal nerve

Dermatome

Later symptoms of shingles

Vesicular eruptions and then crusting

What can prevent chicken pox?

Varicella vaccine safe and effective in children and adults

What age can receive shingles vaccine?

60 years and older to prevent shingles

Benign pigmented or no pigmented lesions

Nevi

Another name for moles

Nevi

What cells form melanocytic Nevi?

Melanocytes

Melanocytic Nevi causes can be either..

Congenital or acquired

Size of melanocytic Nevi can be

Small (<1cm) Or large 20 cm

Where do cells accumulate at the early stages of Nevi development?

Junction of the dermis and epidermis (junctional nevi)

Junctional Nevi are formed at the junction of the

Dermis and epidermis

What type of lesions are junctional Nevi?

Macular lesions

Nevi Over time cells move deeper into the

Dermis

With time, Nevi become

Modular and symmetric without irregular borders (compound Nevi)

Nodular and symmetric Nevi without irregular borders are called

Compound Nevi

Where can Nevi appear on the skin

Any where

Can Nevi vary in size?

Yes

Nevi can occur either (pattern)

Singly or in groups

What skin lesion may undergo transition to malignant melanoma

Nevi

Treatment for Nevi that are irritated by clothing or trauma or large lesions

Excision

Moles that require regular evaluation?

Multiple and changing

Why is it important for the clinician to understand the various forms of Nevi?

Relationship between Nevi and melanoma

Most Nevi never become

Suspicious

What type of Nevi need to be removed?

Suspicious pigmented Nevi

A of ABCDE rule

Asymmetry

B of ABCDE rule

Border irregularity

C of ABCDE rule

Color variation

D of ABCDE rule

Diameter of larger than 6 mm

E of ABCDE rule

Elevation or evolving which includes raised appearance or rapid enlargement

Three suspicious characteristics of Nevi

Bleeding or oozing Scab formation Ulceration

Bleeding or oozing Scab formation Ulceration Are what

Suspicious characteristics of Nevi

A malignant tumor of the skin that originates from transformation of melanocytes

Cutaneous melanoma

Where does cutaneous melanoma originate from?

Transformation of melanocytes

Where do melanocytes arise from?

Neural crest tissue

What do melanocytes synthesize?

Pigment melanin

Where are melanocytes located?

Basal layer of skin

Where do melanocytes arise

Mucosal tissue and uveal tract

Surface epithelial tumor originating from undifferentiated basal or stem cells

Basal cell carcinoma

Presumed cause of BCC

UV radiation exposure

Arsenic in food or water thought to contribute to

BCC

Radiation therapy can lead to what skin condition

BCC

Long term immunosuppressive therapy can cause what skin condition

BCC

What type of tumor is BCC

Surface epithelial tumor

Cells in which BCC originates

Undifferentiated basal or stem cells

BCC lesion often begins as a

Nodule

How big is nodule at beginning of BCC

Greater than 5 mm

Color of BCC lesion

Pearly or ivory

Lesion is slightly elevated above skin surface and has teleangiectasis

BCC

Lesion is slightly elevated above skin surface and has teleangiectasis

BCC

Term for small blood vessels on surface

Teleangiectasis

What groups of people are significantly less likely to develop BCC?

Dark skin Avoid sunlight

What is the protective factor experienced by dark skinned persons in BCC?

Basal cells contain more pigment melanin

A protective factor against the sun in basal cells

Melanin pigment

Why is metastatic spread rare in BCC?

Tumors don’t invade blood or lymph vessels

Why is metastatic spread rare in BCC?

Tumors don’t invade blood or lymph vessels

A benign proliferation of cutaneous basal cells that produces flat or slightly elevated lesions that may be smooth or warty in appearance

Seborrheic keratosis

What cells benign proliferate in seborrheic keratosis?

Cutaneous basal cells

Appearance of seborrheic keratosis lesions

Flat or slightly elevated that may be smooth or warty in appearance

The pathogenesis of seborrheic keratosis is

Unknown

Benign tumors of seborrheic keratosis are usually seen in people aged

Over 50 Can also appear in young adults

Grouping of seborrheic keratosis lesions

Singularly or in multiples

Where do SK lesions occur?

Chest Back Face

Colors of SK lesions

Tan to waxy yellow Flesh colored Dark brown to black

Size of SK lesion

Few millimeters to several centimeters

Oval and greasy appearing lesions seen in

Hyperkeratotic scaly stuck on appearance lesions seen in

Three treatment options for SK

Cryotherapy with liquid nitrogen Shave excision Laser therapy

Liquid nitrogen is treatment option for what seem condition

Shave excision is a treatment option for what derm condition

Laser therapy can treat what skin condition

Pilosebaceous units are also known as

Sebaceous follicles

Where does acne develop?

Sebaceous follicles

Sebaceous follicles are also called

Pilosebaceous units

Two androgens that are secreted increasingly in puberty

Dehydroepiandrosterone sulfate Testosterone

Sebaceous gland size and productivity are increased by what during puberty?

Androgens

Androgens promote the formation of what

Comedone

Production of what is altered in acne?

Sebum

Organism of follicular proliferation in acne

cutibacterium acnes

Anaerobic bacterium of acne

Cutibacterium acnes

C acnes strains shift from being what to what

Symbiotic to pathogenic strain of bacterium

Ruptured comedones trigger what in acne

Inflammatory mediators

Another name for atopic eczema

Atopic dermatitis

What is the most common cause of eczema in children?

Atopic dermatitis

When does AD usually first appear

2-6 months

Most cases of AD develop when

During the first five years of life Can affect any ages

Chronic relapsing form of pruritic eczema

Atopic dermatitis

AD involves an interplay of

Genetic predisposition

Atopic comorbidities 3

Asthma Allergic rhinitis Food allergies

What allergies are well recognized in patients with AD

Food allergies

What immunoglobulin is increased in AD

IGE

What WBC type is increased in AD

Eosinophils

Positive skin test results to a variety of common food and inhalant allergens are seen in what Dx

The most common bacterial skin infection in children 2-5 years of age

Impetigo

Highly contagious skin infection (bacterial) in kids

Impetigo

What is the most common organism of impetigo

S aureus

Less common organism of impetigo

Strep pyogenes

Impetigo mode of transmission

Direct and indirect contact

What do staph produce in impetigo?

Bacterial toxins

Another name for bacterial toxins produced by staph in impetigo

Exfoliative toxins

What do exfoliative toxins disrupt in impetigo?

Disruption in skin barrier with blister formation

Disruption in skin barrier with blister formation are caused by what produced by staph

Exfoliative toxins

A benign self limiting skin disease

Molloscum contaigiosum

What type of organism causes molluscum?

A pox virus

Three ways MC can spread

Person to person direct contact Autoinoculation Contaminated fomites

Two primary mechanisms that cause significantly elevated or depressed hormones

Inappropriate amounts of hormone delivered to the target cell Inappropriate responses by target cell

Failure of feedback systems designed to control hormone release leads to

Inappropriate amounts of hormone delivered

Disorders of the endocrine glands causing them to synthesize too little or too much hormone is a cause of

Inappropriate amounts of hormone delivered

Dysfunctional or ectopically produced hormones can lead to

Inappropriate amounts of hormone delivered

Defects in the delivery of the hormone in the blood stream can lead to

Inappropriate amounts of hormone delivered

When is ADH released?

When not enough fluid in the body

What condition results from insufficient ADH?

Diabetes insipidus

In this condition, not enough ADH Body cannot hold onto water and excretes

Polyuria or oliguria in DI

Polyuria (massive amounts)

Hypervolemia or hypovolemia in DI

Hypovolemia volume depletion

What symptom in DI is caused by hypovolemia?

THIRST POLYDIPSIA

What symptom in DI is caused by hypovolemia?

THIRST POLYDIPSIA

A condition associated with traumatic brain injuries

Neurogenic diabetes insipidus

Condition characterized by insufficient ADH activity

Polyuria POLYDIPSIA

Patients with this condition have a partial to total inability to to concentrate urine

What causes excretion of large volumes of dilute urine in DI

insufficient ADH activity

Hyper or hypo natremia in DI

Hyper natremia

Mucotaneous lymph node syndrome AKA

Kawasaki disease

Acute systemic vasculitis What disease

Kawasaki disease

Kawasaki disease may result in these two conditions

Myocarditis Coronary artery aneurysms

Leading cause of acquired heart disease among children in the US

Kawasaki disease

Cause of KD?

Remains unknown

Cause of this may be a normal immunologic response to an infectious, toxic, or antigenic substance

What disease may be caused by an abnormal immune response to a common stimulus?

What immune responses occur in KD?

Innate Adaptive

What cells of immune system infiltrate vessel walls in KD? Think LMN

Neutrophils Macrophages Lymphocytes

What two things are increased in immune response to KD?

Inflammatory cytokines Antibodies

What parts of vasculature are inflamed in KD?

Small capillaries Arterioles Venules

Acute myocarditis is a complication of what disease?

Necrotizing arteritis occurs in what disease?

Aneurysm development associated with necrotizing arteritis occurs in what disease?

HHNKS stands for

Hyperosmolar hyperglycemic nonketotic syndrome

Another name for HHNKS is

HHS Hyperglycemic hyperosmolar state

Life threatening emergency precipitated by infections Medications Nonadherance to diabetes treatment Coexisting disease

HHNKS

HHNKS more commonly seen with which type of diabetes?

Type 2

Why isn’t there keyosis in HHNKS?

Still producing some insulin

Disease in capillaries with diabetes is called

Microvascular disease

Retinopathy with potential lead to blindness caused by what type of diabetes complication?

Microvascular

End stage kidney failure in diabetes caused by what diabetes complication?

Microvascular

Neuropathies result from what diabetes complication?

Microvascular

Thickening of the capillary basement membrane Endothelial cell hhperplasia Thrombosis Seen in what diabetes complication?

Microvascular disease

Thickening of the capillary basement membrane in Microvascular disease eventually leads to

Decreased tissue perfusion

Decreased tissue perfusion in diabetic Microvascular disease is caused by

Thickening of the capillary basement membrane

Lesions in medium and large sized arteries caused by diabetes

Macrovascular disease

Macrovascular disease in diabetes increases what two metrics

Increased morbidity and mortality

What three things have accelerated risk in diabetic Macrovascular disease?

Atherosclerosis MI Stroke

Diabetic patients have a higher /lower mortality during acute phase of MIs than non diabetic patients

Higher

Why do diabetic patients have higher mortality during acute phase of MI

They are often asymptomatic as a result of sensory and autonomic neuropathy

Why do diabetic patients have higher mortality during acute phase of MI

They are often asymptomatic as a result of sensory and autonomic neuropathy

What two neuropathies make diabetics asymptomatic during acute phase of MI?

Sensory and autonomic neuropathy

What type of complications justify need for diabetes screening and monitoring of A1C

Macrovascular

Glycated hemoglobin determines glucose control over how long

3-4 months

What synthesis is inadequate in Addison disease Two things

Inadequate corticosteroid and mineralocorticoid synthesis

Elevated ACTH levels are seen in what disease

Addison disease

Hypocortisolism and hypoaldosteronism are seen in what disease

Addison disease

What organ does aldosterone primarily act on?

Kidney

What is aldosterone’s effect on the kidney?

Sodium and water reabsorption and potassium excretion

If not enough aldosterone… hyper or hypo kalemia?

Hyperkalemia

Why does aldosterone deficiency cause hyperkalemia?

Too much potassium because not enough aldosterone to excrete

Hyper or hypo volemia in Addison disease

Hypovolemia

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)

A general term referring to ALL clinical manifestations related to excessive exposure to cortisol

Cushing syndrome

Cushing like syndrome may develop as a side effect of long term pharmacological administration of glucocorticoids

Exogenous Cushing like syndrome may develop

Patho of Cushing syndrome is opposite of what disease

Addison disease

Hyper or hyponatremia in Cushing syndrome

Hypermatremia

Hyper or hypoglycemia in Cushing syndrome

Hyperglycemia

Hyper or hypo kalemia in Cushing syndrome

Hypokalemia

What three places does weight gain occur in Cushing syndrome

Truncal central obesity Moon face Buffalo hump

What causes glucose intolerance in Cushing syndrome?

Cortisol induced insulin resistance

Increased gluconeogenesis in Cushing syndrome causes

Glucose intolerance

Cortisol induced insulin resistance and increased gluconeogenesis and glycogen storage by the liver causes what in Cushing syndrome

Glucose intolerance

The catabolic effects of cortisol on peripheral tissues causes what in Cushing syndrome

Protein wasting

Muscle wasting in Cushing syndrome leads to what symptom

Muscle weakness

Where is muscle wasting most prominent in Cushing syndrome

In the extremities with thinning of the limbs

Loss of what leads to thin, weakened integumentary tissues in Cushing syndrome

Loss of collagen

Purple striae and easy bruising in Cushing disease caused by loss of

Collagen

Very rare disease that returns to the clinical manifestations resulting from chronic exposure to excess endogenous cortisol

Cushing disease

Cushing disease is more common in men or women

More common in women

What disease Refers to excessive exposure endogenous secretion of ACTH (corticotropin)

Cushing disease

What is the term for several days of total dietary abstinence or deprivation

Short term starvation

What is another term for short term starvation

Extended fasting

In short term starvation the body responds with mechanisms to protect what

Protein mass

How long after a meal is body in a well fed state

4-6 hours

When body is in a well fed state what supplies its energy requirements

Glucose from recently ingested carbohydrates

The splitting of glycogen into glucose is called

Glycogenolysis

Glycogen in the liver is converted to glucose by what process

Glycogenolysis

Once all available energy has been absorbed from the intestine, what gets converted to glucose

Glycogen

What condition begins after several days of dietary abstinence

Long term starvation

What eventually causes death from proteolysis?

Long term starvation

Persistent restriction of energy intake leading to significantly low body weight

Anorexia nervosa

What four considerations determine context of body weight

What is minimally expected for Age Sex Developmental trajectory Physical health

Anorexia causes disturbances in the way what two things are experienced

Body weight Body shape

In anorexia there is an undue influence of body shape and weight on what

Self evaluation

In anorexia there is a persistent lack of what regarding the current low body weight

Recognition of the seriousness of

Recurrent episodes of binge eating occur in what condition

Bulimia

What is the frequency and duration of binge eating and inappropriate compensatory mechanisms in bulimia

At least once a week for 3 months

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

What are examples of compensatory behaviors to prevent weight gain in bulimia

Self induced vomiting Misuse of medication Fasting or excessive exercise

What medications are misused in bulimia

Laxatives Diuretics

What disorder is associated with eating large amounts of food when not physically hungry

Binge eating disorder

Eating disorder NOT associated with recurrent use of inappropriate compensatory behaviors

Binge eating disorder

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

What condition describes a decrease in appetite or food intake in older adults

Anorexia of aging

Patients that are illness free and have an adequate food supply may still experience

Anorexia of aging

Anorexia of aging results from multiple … changes

Age related

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

Aging is associated with increased or decreased orexigenic signals

Decreased

Signals that increase food intake

Orexigenic signals

Signals that decrease food intake

Anorexigenic signals

Aging is associated with increased or decreased anorexigenic signal la

INCREASED ANOTEXIGENIC SIGNALS

Two consequences of chronic low grade inflammation with elevated cytokines in anorexia of aging

Delayed gastric emptying Decreased motility of the small intestine

Decreased motility of what part occurs in anorexia of aging

Small intestine

What happens to gastric emptying in anorexia if aging?

Delayed

Functional impairments and deficiencies are risk factors for what nutritional disorder

Anorexia of aging

Four examples of functional impairment associated with anorexia of aging

Loss of vision Poor dentition Dysphagia Inability to prepare foods

Medical and psychiatric conditions increase the risk for what nutritional disorder

Anorexia of aging

Loneliness and grief are involved in what nutritional disorder

Anorexia of aging

Social isolation and abuse and neglect are associated with what nutritional disorder

Anorexia of aging

Medications and polypharmacy increase the risk for what nutritional disorder

Anorexia of aging

Progression of the underlying causes of anorexia leads to decreased WHAT required to eat and digest food

Energy reserves

Examples of two diseases that are underlying causes of anorexia of aging that increase work of breathing

COPD CHF

What is a key strategy in treating patients with anorexia of aging

Exercise

How does exercise help anorexia of aging?

Improved oral intake Elevated mood Build muscle and strength

Malnutrition and physical frailty are consequences of what nutritional disorder

Anorexia of aging

Malnutrition and physical frailty are consequences of what nutritional disorder

Anorexia of aging

What organelle is dysfunctional in anorexia of aging

Mitochondrial dysfunction

Increased oxidative stress is a consequence of what nutritional disorder

Anorexia of aging

Reduced regenerative capacity is seen in what nutritional disorder

Anorexia of aging

Reduced regenerative capacity is seen in what nutritional disorder

Anorexia of aging

Hormonal imbalance is a consequence of what nutritional disorder

Anorexia of aging

Hormonal imbalance is a consequence of what nutritional disorder

Anorexia of aging

Exercise and what else are important in treating anorexia of aging

Nutrition

Supportive interventions to mitigate anorexia of aging Three

Improved access to food and appearance Dental and eye care Social stimulation

Three nonmodifiable risk factors for CAD

Advanced age Male gender or women after menopause Family history

Advanced age Male gender or women after menopause Family history Are three examples of what

Nonmodifiable risks of CAD

7 modifiable risks of CAD

Dyslipidemia Hypertension Cigarette smoking Diabetes and insulin resistance Obesity Sedentary lifestyle Atherogenic diet

Obesity means a BMI of

OVER 30

A good BMI is less than

High levels of what are BAD (in CAD)

LDL

Low levels of WHAT are BAD in CAD

HDL

An increased serum concentration of what is an indicator of coronary risk

LDL

Relative risk of elevated LDL depends on presence of other risk factors like

Age Diabetes CKD

What is responsible for delivery of cholesterol to the tissues?

LDL

Low levels of what are also a strong indicator of coronary risk?

HDL

What is responsible for reverse cholesterol transport?

HDL

Process of returning excess cholesterol from the tissues to the liver

Reverse cholesterol transport

Reverse cholesterol transport moves excess cholesterol from where to where

From tissues to the liver

What type of angina is relieved with the usual interventions the patient utilizes

Stable angina

Stable angina is predictable or unpredictable

Predictable

In unstable angina, the pain is…

Worse Different

Usual interventions don’t relieve pain in which type of angina

Unstable angina

Chest pain attributable to transient ischemia of the myocardium that occurs unpredictable and often at rest

Vasospastic prinzmetal angina

Prinzmetal or vasospastic angina is attributable to

Transient ischemia of the myocardium

Chest pain caused by vasospasm of one or more major coronary arteries

Vasospastic or prinzmetal angina

Type of angina that can occur in those with or without CAD

Prinzmetal angina

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

Decreased vagal activity can cause which angina

Vasospastic or prinzmetal angina

What electrolyte imabalance worsens Vasospastic angina

Hypokalemia

Hyper or hypo kalemia worsens symptoms and outcomes of Vasospastic angina

Hypokalemia

Deficiency of what electrolyte can cause vasospasm in prinzmetal angina

Magnesium

Triggers of prinzmetal angina

Hyperventilation Mental stress Smoking Use of stimulants Alcohol REM sleep

What angina is diagnosed by matching clinical manifestations with documented transient ischemic changes in ECG

Vasospastic angina

How is Vasospastic angina diagnosed

By matching clinical manifestations with documented transient ischemic changes in ECG

Management of Vasospastic angina involves what two things

Avoidance of triggers Use of calcium channel blockers or nitrates

What medications treat Vasospastic angina

Calcium channel blockers Nitrates

Complications (2) of Vasospastic angina

Dysrhythmias Infarction

Dysrhythmias and infarction in patients with Vasospastic angina are especially common in patients with what kind of lesions

Atherosclerotic coronary lesions

An angina that is usually a benign condition

Vasospastic angina

What type of angina has been reclassified under NSTEMI

Unstable angina

Why has unstable angina been reclassified as NSTEMI

Studies found some damage to myocardium

What type of angina signals that the atherosclerotic plaque has begun to rupture

Unstable angina

What type of angina leads to transient episodes of vessel occlusions and vasoconstriction at the site of plaque damage

Unstable angina

How long does thrombus occlude vessel before reperfusion iccurs in unstable angina

10-20 minutes

After 10-20 minutes of thrombus occluding the vessel what occurs

Reperfusion

Infarction will only involve the myocardium directly beneath the endocardium which heart attack

NSTEMI

Which heart attack Infarction extends through the myocardium all the way from endocardium to epicardium

Transmural MI STEMI

What part of the heart muscle is affected in NSTEMI

Myocardium directly beneath the endocardium

Term for the myocardium directly beneath the endocardium

Subendocardial MI

Term for the myocardium directly beneath the endocardium

Subendocardial MI

ST depression T wave inversion What is this called

NSTEMI

If thrombus breaks up before complete distal tissue necrosis has occurred Leads to which MI

NSTEMI

Plaque buildup and rupture obstructs flow in a coronary artery resulting in irreversible cell death Which heart attack Infarction extends

STEMI

Term for Infarction will extend through the myocardium from endocardium to epicardium

Transmural MI

What kind of infarction causes marked elevations in ST segments on ECG

Transmural infarction

Irreversible cell death caused by which MI

STEMI

What is secreted after a MI in response to hemodynamic changes and contributes to pathogenesis of MI

Angiotensin II

MOST IMPORTANTLY angiotensin II results in

Peripheral vasoconstriction

Potential impact Homeostatic responses are counterproductive in that they can increase myocardial work on a heart that may be struggling

Angiotensin II

Acute inflammation of the pericardium

Acute pericarditis

Etiology of acute pericarditis is usually

Idiopathic

Viral infection MI Are other causes of acute

Pericarditis

Most common complication of pericarditis

Pericardial effusion

Accumulation of fluid in the pericardial sac

Pericardial effusion

Cardiac compression

Cardiac tamponade

Rapid accumulation of fluid in pericardial sac leads to

Cardiac tamponade

Patho condition in which heart is unable to generate an adequate cardiac output

Heart failure

Inadequate perfusion of tissues or increased diastolic filling pressure of left ventricle Patho of what condition

Heart failure

Decreased compliance of the left ventricle thus inability of the heart to achieve a normal cardiac output

Heart failure with reduced ejection fraction

Heart failure with preserved EF is systolic or diastolic failure?

Diastolic heart failure

Which ventricle has decreased compliance in HF with preserved EF

Left ventricle

Heart failure with reduced EF is systolic or diastolic HF??

Systolic

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

Diagnosis of what cardiac condition relies heavily on clinical signs and symptoms

Comprehensive history and physical exam are critical parts of what cardiac diagnosis

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

Volume of blood received into left ventricle from left atrium at the end of ventricular diastole

Preload

If preload is too much the muscle fibers are what

Overstretched

The resistance the heart encounters when ejecting blood to the rest of the body

Afterload

Heart stretch think

Preload

Heart squeeze thinks

Afterload

Stroke volume is reduced by increasing

Afterload

Increasing Afterload reduces

Stroke volume

The strength of the heart’s muscle contraction is called

Contractility

Decreased perfusion result of failure of which side of heart

Left heart failure

Contractility

The strength of the heart’s muscle contraction

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

EF in heart failure with reduced EF is

Less than 40%

Contractility in HF is increased or decreased

Decreased

Preload in HF with rEF is Increased or decreased

Increased

HFrEF and after load is Increased or decreased

Increased

Catecholamines in HFrEF Sympathetic nervous system initially compensates for a decrease in CO by increasing what two things

Heart rate Peripheral vascular resistance (Afterload)

Peripheral vascular resistance reflects what on heart

Afterload

Increased heart rate caused by catecholamines increases the what on the heart

Workload

Activation of RAAS in HF increases what measures of heart

PRELOAD AFTERLOAD

RAAS activation in HF causes direct toxicity to what type of cells

Myocytes

Direct toxicity to myocytes is caused by what in Hf

RAAS activation

What are the three main substances of RAAS system?

Renin Angiotensin II Aldosterone

What type of BP activates the RAAS system

Low

What type of BP activates the RAAS system

Low

what two things cause RAAS activation in HF

Low BP Poor renal perfusion

RAAS activation causes increased or decreased preload

Increased

RAAS activation causes increased or decreased Afterload

Increased

Renin activates what to increase peripheral vascular resistance and BP (Afterload)

Angiotensin II

Aldosterone causes retention of what two things

Sodium Water

Retention of sodium and water caused by what hormone

Aldosterone

Aldosterone effects what heart measure by causing sodium and water retention

Preload

Reduced pressure in the carotid sinus and renal afferent arteriole caused by decrease in what

Cardiac output

Reduced pressure in carotid sinus and renal afferent arteriole leads to body perceiving what

Volume depletion

Antidiuretic hormone in HF causes what two things

Peripheral vasoconstriction (Afterload) Renal fluid retention (preload)

Peripheral vasoconstriction effects what cardiac measure

Afterload

Renal fluid retention caused by ADH affects what heart metric

Preload

What hormones counteract neurohormonal processes of heart failure by improving sodium and water excretion

Natriuretic peptides

Natriuretic peptides improve excretion of what two things

Sodium Water

What two type of natriuretic peptides are increased in HF

Atrial natriuretic peptides B type natriuretic peptides

What two hormones may have some protective effect in HF by decreasing preload?

Atrial and b type natriuretic peptides

Compensatory mechanisms of what two hormones are inadequate in HF

Atrial and b type natriuretic peptides

What hormone is produced and released in response to pressure and volume overload of the cardiac changes?

BNP

What hormone inhibits myocardial fibrosis and hypertrophy and enhances diastolic function

BNP

BNP enhances systolic or diastolic heart function?

Diastolic

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

Common complication of many congenital heart defects in children

Heart failure

Likely etiology of new onset HF in kids is determined by what

Age at time of diagnosis

HF in kids that results from CHD with pulmonary over circulation causes what type of shunt in heart

Left to right

Over circulation of what part of the body causes left to right shunt in HF caused by CHD

Pulmonary

Large left to right shunt is common in what age group of heart failure

Newborns and infants

HF in older children is most often due to what type of disorders

Acquired

Viral myocarditis Rheumatic heart disease Autoimmune disorders Anemia Kawasaki disease Hypothyroidism Causes of what

Heart failure in children

A complex condition with many contributing factors is what cardiac condition

HTN

What two types of factors play a role in HTN?

Genetic Environmental

What is often asymptomatic and a silent killer

HTN

What is the usual first line treatment for HTN?

Lifestyle changes

Renal pressure natriuresis is impaired in what condition

HTN

What type of system regulates BP by increasing the amount of sodium and water the kidneys excrete?

Feedback system

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

Excessive activation of the SNS causes what heart condition

HTN

Excessive activation of what system leads to HTN

SNS

Increased systemic vascular resistance seen in what heart condition

HTN

Systemic vascular resistance is increased or decreased in HTN

Increased

Obesity and increased dietary salt intake contribute to what heart condition

HTN

Vessel resistance abnormalities contribute to what cardiac condition

HTN

Endothelial dysfunction contributes to what cardiac condition

HTN

Sodium retention leads to increased retention of what

Water retention

Increased sodium and water retention leads to increased

Blood volume

Increased blood volume in HTN caused by what

Increased water and sodium retention

Increased blood volume in HTN leads to increased what Vicious cycle

Blood pressure

Inflammation of kidney in HTN is caused by what

Tissue ischemia

Tissue ischemia causes inflammation of the kidney and contributes to the dysfunction of what two anatomical renal parts

Glomeruli Tubules

Microalbuminuria is caused by what cardiac condition

HTN

Protein escaping in the urine is called

Microalbuminuria

Increased retinal arterial pressure and damage to the microvasculature are caused by what condition

HTN

Retinopathy is seen in what cardiac condition

HTN

Accelerating atherosclerosis is seen in what cardiac condition

HTN

Damage to the blood vessel walls in HTN leads to what complication

Accelerating atherosclerosis

Cholesterol and fats build up to form what at damaged areas

Plaques

Most common form of rheumatic heart disease

Mitral stenosis

What condition impairs the flow of blood from the left atrium to the left ventricle

Mitral stenosis

Mitral stenosis results in incomplete emptying of what heart chamber

Left atrium

Mitral stenosis leads to elevated pressure in what heart chamber?

Atrial pressure

What ventricle fails with untreated mitral stenosis?

Right ventricular failure

Three outcomes of untreated mitral stenosis

Pulmonary hypertension Edema Right ventricular failure

What condition Permits back flow of blood from left ventricle into left atrium during ventricular systole

Mitral regurgitation

What phase of heart cycle impacted in mitral regurgitation?

Ventricular systole

Back flow of blood is from left ventricle to what chamber in mitral regurgitation?

Left atrium

Mitral valve regurgitation progression leads to failure of what heart chamber?

Left ventricular function may be impaired to the point of failure

Increased atrial pressure also causes pulmonary hypertension and failure of the right ventricle Which valve dysfunction?

Mitral regurgitation

Valve dysfunction associated with connective tissue disorders such as Marian syndrome

Mitral regurgitation

Resistance to blood flow from left ventricle into aorta seen in which valve dysfunction

Aortic stenosis

Outflow obstruction increases pressure within the left ventricle as it tries to eject blood through the narrowed opening in which valve dysfunction

Aortic stenosis

Aortic stenosis Outflow obstruction increases pressure within which ventricle

Left ventricle

Left ventricular hypertrophy is complication of which valve dysfunction

Aortic stenosis

Why does left ventricular hypertrophy develop in aortic stenosis?

Compensate for increased workload

Remodeling of the LV myocardium with fibrosis leads to a gradual decline in what function

Left ventricular function with decreased cardiac output

Hypertrophic cardiomyopathy is a complication of what valve disorder

Aortic stenosis

Hypertrophic cardiomyopathy MI Oliguria Stroke Heart failure Pulmonary edema Are complications of what cardiac condition

Aortic stenosis

Atherosclerotic disease of arteries that perfuse the limbs, especially lower extremities What disease

Peripheral artery disease

Pain with ambulation is called

Intermittent claudication

Pain with ambulation that subsides with rest is called

Intermittent claudication

Gradually increasing obstruction to arterial blood flow causes what physical assessment finding in PAD

Prolonged capillary refill in toes

Superficial veins in which blood has pooled are called

Varicose veins

Trauma to which veins cause varicose veins

Saphenous veins

One or more saphenous valve damages causes what

Varicose veins

Sustained inadequate venous return is called what

Chronic venous insufficiency

Varicose veins can progress to

Chronic venous insufficiency

Hyperpigmentation of the skin of the feet and ankles is seen in

Cvi

Edema of the lower extremities Ankles and feet Seen with what vascular condition

Chronic venous insufficiency

If part of the aorta is narrowed it is hard for blood to pass through the artery Which condition

Coarctation of the aorta

A type of birth defect where part of the aorta is narrowed

Coarctation of aorta

What condition causes an increase in the upper extremity blood pressure Poor perfusion of tissues and organs

Coarctation of aorta Neonate

Upper extremity hypertension is the most important physical finding in what condition

Coarctation of aorta in neonate

History of poor feeding in neonates linked with what cardiac condition

Coarctation of aorta

Evidence of shock with poor perfusion seen in what condition

COA

Evidence of shock with poor perfusion seen in what condition

COA

What is heard when ausculatating COA in neonates linked?

Gallop

What type of murmur is heard in COA?

Mitral regurgitation murmur

Acidosis or alkalosis seen in COA?

Acidosis may be present

COA leads to what hypertrophy?

Left ventricle

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

The closure of what causes a sudden increase in Afterload in COA

Ductus arteriosus

High levels of ADH in the absence of normal physiologic stimuli for its release What condition

SIADH

High levels of ADH in the absence of normal physiologic stimuli for its release What condition

SIADH

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

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

Secretion of what is altered in SIADH

ADH

Is ADH high or low in SIADH?

High

What type of sodium imbalance is seen in SIADH?

Dilutional hyponatremia

Hyper or hypovolemia in SIADH?

Hypervolemia

Is urinary sodium concentration high or low in SIADH?

High urinary sodium concentration in SIADH

Dilutional hyponatremia associated with Hypervolemia High urinary sodium concentration Weight gain Manifestations of what condition

SIADH

What three things is the thyroid responsible for?

Metabolism Growth Development

What type of loop does thyroid hormone use?

Negative feedback loop

What hormone is released when T3 and T4 decrease below normal?

TRH

What hormone is released when T3 and T4 decrease below normal?

TRH

TRH stands for

Thyrotropin releasing hormone

TRH stimulates the pituitary gland to produce what hormone

Thyroid stimulating hormone

What hormone acts on the thyroid to produce more hormones and raise the blood levels

TSH

Once levels rise, the hypothalamus shuts off and stops secreting TRH which in turn inhibits the pituitary gland release of what hormone

TSH

Low TSH levels usually indicate what condition

Hyperthyroidism

Is TSH low or high in hyperthyroidism

Low

High TSH levels usually indicate what condition

Hypothyroidism

Are TSH levels low or high in hypothyroidism?

High

Manifestations of lower levels of thyroid hormone are what (4)

Constipation Brady cardia Dyspnea Lethargy

Decreased energy metabolism in hypothyroidism results in what four manifestations

Constipation Bradycardia Dyspnea Lethargy

Constipation Bradycardia Dyspnea Lethargy Caused by high or low levels of thyroid hormone?

Low levels

Lower levels of thyroid hormone results in increased or decreased energy metabolism?

Decreased energy metabolism

Graves’ disease is what type of hypersensitivity

Type II

Graves’ disease is an example of what thyroid condition

Hyperthyroidism

Stimulation of the thyroid by autoantibodies directed against the TSH receptor What condition

Graves Disease

Type II hypersensitivity Thyroid condition

Graves’ disease

A disorder of pancreatic dysfunction and beta cell destruction

DM 1

Beta cell destruction leads to absolute insulin deficiency What condition

Type 1 DM

Most of the time these patients aren’t obese Which diabetes

Type 1

Immune mediated diabetes is most common form of which diabetes

Type 1 Approximately 90%

What is destroyed in type 1 diabetes?

Beta cells

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

Three risk factors for diabetes type 2

Obesity Poor diet Lack of regular exercise

Defects in pancreatic insulin secretion seen in which diabetes

Type 2

What diabetes causes a persistent state of hyperglycemia

Type 2

A suboptimal response of insulin sensitive tissues to insulin What is the term for this

Insulin resistance

What are the three most insulin sensitive tissues

Liver Muscle Adipose tissue

The most studied incretin is what

Glucagon like peptide 1

Beta cell responsiveness to what hormone is reduced in both pre diabetes and type 2 diabetes

GLP1

What condition is one of the most important contributors to insulin resistance and diabetes

Obesity

Cytokines produced by adipose tissue

Adipokines

Obesity results in increased or decreased adipokines

Increased

Term for increased serum levels of leptin

Leptin resistance

What does obesity do to levels of leptin?

Increased leptin

Adiponectin is increased or decreased in obesity?

Decreased

Free fatty acids are increased or decreased in obesity?

Increased

Increased FFAs and intracellular deposits of triglycerides and cholesterol lead to what type of tissue response to insulin

Decreased tissue responses to insulin

What two things do adipocytes release in obesity?

Adipocyte associated pro inflammatory macrophages Inflammatory cytokines

What two things are cytotoxic to beta cells in context of inflammation

Adipocyte associated pro inflammatory macrophages Inflammatory cytokines

Decreased insulin induced mitochondrial activity leads to what in obesity

Insulin resistance

What organelle is dysfunctional in obesity relative to insulin resistance?

Mitochondria

A serious complication related to a deficiency of insulin and an increase in the levels of insulin counterregulatory hormones What condition

DKA

What are the four counterregulatory hormones involved in DKA?

Catecholamines Glucagon Growth hormone Cortisol

DKA is much more common in which diabetes?

Type 1

Why is DKA more common in type 1 diabetes?

Insulin is more deficient in type 1

Why is DKA more common in type 1 diabetes?

Insulin is more deficient in type 1

What three features characterize DKA?

Hyperglycemia Acidosis Ketonuria

Insulin normally stimulates what process?

Lipogenesis

Insulin normally inhibits what process?

Lipolysis

How does insulin prevent fat catabolism?

Insulin normally stimulates lipogenesis and inhibits lipolysis

With insulin deficiency, what process is enhanced?

Lipolysis

With insulin deficiency, Lipolysis is enhanced and there is an increase in the amount of what delivered to the liver?

Fatty acids

Consequence of insulin deficiency and associated Lipolysis is what process

Glyconeogenesis

Glyconeogenesis contributes to what two things in DKA

Hyperglycemia Production of ketone bodies

What are the three ketone bodies in DKA? AHA!

Acetoacetate Hydroxybutyrate Acetone

Accumulation of ketone bodies does what to pH?

Drops PH

Accumulation of ketone bodies causes a drop in ph in DKA leading to what condition?

Metabolic acidosis

Hyperventilation in DKA in an attempt to compensate for the acidosis leads to what type of respirations

kussmaul respirations

Postural dizziness is a symptom of what endocrine issue

DKA

CNS depression is a symptom of what endocrine disorder

DKA

Ketonuria is a symptom of what endocrine disorder

DKA

Thirst and Polyuria are symptoms of what diabetic complication

DKA

Nausea vomiting and abdominal pain are symptoms of what endocrine issue

DKA

What three things are used to manage DKA?

Fluids Insulin Electrolyte replacement

Why is hyperglycemia an issue in DKA?

No insulin

Catecholamines Cortisol Glucagon GH Are counterregulatory hormones involved what condition

DKA

How does skin look in DKA?

Flushed and dry

Polyuria and dehydration result from what in DKA?

Diuretics associated with hyperglycemia

Acidosis in DKA is caused by production of what?

Ketones

Why does vomiting happen in DKA?

Another attempt to get rid of acid due to production of ketones

Hormones that increase blood glucose concentration

Glucocorticoids

Glucocorticoids are released under what type of conditions?

Stress

Most potent naturally occurring glucocorticoid?

Cortisol

Cortisol secretion is regulated primarily by the

Hypothalamus Anterior pituitary gland

Adrenicorticotropic hormone is the main regulator of what secretion

Cortisol

Aldosterone is what kind of hormone

Mineralocorticoid

Aldosterone conserves what electrolyte

Sodium

What hormone has antagonistic effects of insulin?

Glucagon

What hormone acts to increase blood glucose during fasting exercise and hypoglycemia

Glucagon

Low levels of glucose and sympathetic stimulation stimulate release of what hormone

Glucagon

What organ does glucagon act on?

Liver

Hormones secreted from endocrine cells in the GIT in the presence of carbs proteins and fats

Incretin hormones

What hormone Control postprandial glucose levels by promoting hepatic glucose secretion and delaying gastric emptying

Incretin

Synthesis of glucose from non carbohydrate sources like lactic acid and amino acids What is this called

Gluconeogenesis

Where does gluconeogenesis occur?

Liver and kidneys

Breakdown of glycogen occurring in the liver when blood glucose levels drop

Glycogenolysis

Peptide hormone cosecreted with insulin by beta cells in response to nutrient stimuli What is it called

Amylin

What hormone works with insulin to prevent hyperglycemia?

Amylin

What hormone has antagonistic effects to insulin?

Glucagon

Volume inside the ventricle at the end of diastole is called

Preload

Resistance to ejection of blood from the left ventricle

Left ventricular Afterload

The volume of blood ejected per beat during systole Called what

Stroke volume

Degree of myocardial fiber shortening is called what

Myocardial contractility

Cardiac output is calculated by

Heart rate x stroke volume

Blood pressure Resistance to flow in vessels Blood consistency Anatomic features that cause turbulent flow Compliance These are factors that affect what

Blood flow

Varicosities are most common in which anatomical veins

Saphenous veins

Condition that causes pathological ischemic changes in the vascular, skin, and supporting tissues?

CVI

Sustained elevation of the systemic arterial blood pressure resulting from increases in cardiac output, total peripheral resistance, or both ?

Hypertension

What type of hypertension is the most significant factor in target organ damage?

Systolic hypertension

Clinical manifestations of hypertension result from damage of organs and tissues located where?

Outside the vascular system

An inflammatory disease that begins with the endothelial layer and progresses through several stages to become a fibrotic plaque

Atherosclerosis

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

Two types of angina with reversible myocardial ischemia

Stable angina Prinzmetal angina

Chronic coronary obstruction results in recurrent oredictable chest pain called what

Stable angina

Abnormal vasospasm of coronary vessels results in what type of unpredictable chest pain

Prinzmetal angina

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

What type of angina is the result of reversible myocardial ischemia and is a harbinger of impending infarction?

Unstable angina

What condition results when prolonged ischemia causes irreversible damage to the heart muscle?

Myocardial infarction

What angina signals that the atherosclerotic plaque has ruptured and infarction may soon follow?

Unstable angina

When coronary blood flow is interrupted for an extended period, necrosis of what cells occurs?

Myocyte

Two major types of MI

Subendocardial infarction and Transmural infarction

Thickening of the myocardium is called

Hypertrophic cardiomyopathy

What condition of valves has the most common cause of Congenital bicuspid valve, degenerative changes with aging, rheumatic fever

Aortic stenosis

Left ventricular hypertrophy followed by left heart failure Caused by which valve condition if untreated

Aortic stenosis

Most common cause of mitral stenosis

Rheumatic heart disease

Left atrial hypertrophy and dilation followed by left heart failure seen in which valve disorder

Mitral regurgitation

An inability of the heart to supply the metabolism with adequate circulatory volume and pressure What condition

Heart failure

Left heart failure can be categorized as what two things

Systolic or diastolic heart failure

What three things influence stroke volume

Contractility Preload Afterload

What is the most common cause of decreased contractility

Myocardial ischemia results in what that causes progressive myocyte contractile dysfunction over time

Ventricular remodeling

Left ventricular end diastolic volume is another term for what

Preload

Another term for preload is

Left ventricular end diastolic volume

Increased Afterload is most commonly the result of what

Increased peripheral vascular resistance

Increase in peripheral vascular resistance decreases ventricular emptying and makes more workload for which part of the heart?

Left ventricle

Three features of the vicious cycle in HF

Decreasing contractility Increasing preload Increasing Afterload

Management of left heart failure involves two main things

Contractility Reducing preload and Afterload

Diseases of which gland usually cause abnormal secretion of ADH?

Posterior pituitary

An excess amount of which hormone result in water retention and a hypoosmolar state

ADH

Deficiency in the amount or response to ADH results in serum

Hyperosmolarity

High levels of ADH in the absence of normal physiologic stimuli for its release

SIADH

The patho features of SIADH are the result of what

Enhanced renal water retention

Insufficiency of ADH characterizes what condition

DI caused insufficient secretion of ADH

Neurogenic or central DI

DI caused by inadequate response of renal tubules to ADH

Nephrogenic DI

Most common disorder of thyroid function

Hypothyroidism

Primary hypocortisolism is also called

Addison disease

A primary inability of the adrenals to produce and secrete the adrenocortical hormones What disease

Addison disease

Disease characterized by inadequate corticosteroid and mineralocorticoid synthesis and elevated ACTH (loss of negative feedback)

Addison

Hormone that regulates the release of cortisol from the adrenal cortex

ACTH

Major homeostatic function of what gland is to control plasma similarity through ADH

Posterior pituitary

ADH leads to increased reabsorption of what

Water

What hormone acts to conserve sodium

Aldosterone

What hormone is produced primarily by visceral adipose tissue

Adiponectin

Hereditary hemachromatosis what genetic inheritance pattern

Autosomal recessive

Hereditary hemochromatosis What genetic inheritance pattern

Autosomal recessive

Reed Sternberg cells in lymph nodes are associated with what disease

What cardiac measure depends on the amount of blood in the ventricle

Preload

Most common valvular abnormality

Aortic stenosis

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

Valve leaflets fail to shut completely, permitting blood flow to continue even when the valve is supposed to be closed

Valve regurgitation

Condition that increases the volume of blood the heart must pump and increases the workload of the affected heart chamber

Valve regurgitation

What valve dysfunction causes atrial fibrillation

Mitral regurgitation

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

Heart disease Renal disease CNS problems Retinal changes

Clinical manifestations of hypertension

What cells secrete intrinsic factor

Gastric parietal cells

Where does vitamin B12 form complexes with intrinsic factor

Small intestine

Cellular hyperproliferation seen in what derm condition

Psoriasis

Altered keratinocyte differentiation seen in what skin condition

Psoriasis

Need what in order to make hemoglobin?

IRON

Most common nutritional disorder?

Iron deficiency anemia

What is the main dietary source of B12?

MEAT

Benzene exposure can lead to which anemia

Aplastic anemia Normocytic normochromic

Activation of what leads to clotting in DIC

Tissue factor

Which lymphoma moves faster and further?

Non Hodgkin

Hepcidin increases or decreases when iron levels are high

Increases

Tissue factor is involved in extrinsic or intrinsic pathway

Extrinsic

Extrinsic or intrinsic pathway impacted in hemophilia

Intrinsic

Extrinsic or intrinsic pathway involved in DIC

Extrinsic

What are overactivated in psoriasis

Interleukins

Impetigo blisters are very

Fragile

DI ACRONYM

Dry inside

SIADH acronym mneumonic

Soaked inside

Posterior pituitary stores hormones from what gland

Hypothalamus

Insufficient ADH characterizes which endocrine disorder

Diabetes insipidus

Too much ADH Which endocrine disorder

SIADH

Pulmonary disorders cause with endocrine disorder?

SIADH

Dilutional hyponatremia seen in which endocrine disorder

SIADH

Hypervolemia and weight gain seen in which endocrine disorder?

SIADH

Anterior pituitary involved in

Thyroid disorders

Hypothyroidism memory aid

Low and slow

Hyperthyroidism memory aid

Hot and high

Autoimmune thyroiditis causes hypo or hyperthyroid

Hypothyroidism

TSH levels are low or high in hyperthyroidism

TSH levels are low because sensing lots of T3 T4

High TSH levels indicate what condition because TSH keeps trying to turn on thyroid

Hypothyroidism

Graves’ disease is what type of hypersensitivity

Type II

Graves’ disease is hypo or hyperthyroidism

Hyperthyroidism

Adipokines are increased or decreased in obesity

Increased

Free fatty acids are increased or decreased in obesity

Increased

Adipocytes are pro- what

Inflammatory

Adipocytes are cytotoxic to what cells

Beta cell

Insulin induced mitochondrial activity is increased or decreased in obesity

Decreased

GLP1 is an

Incretin

What activate gut brain connection

Incretins

Newly diagnosed type 1 diabetic is at risk for

DKA

Four hormones that increase glucose

Catecholamines Cortisol Glucagon Growth hormone

Diuretics is associated with hyper or hypoglycemia

Hyperglycemia

Ketones are a very strong what

Acid

Body produces too little cortisol and aldosterone

Addison disease

Body produces too much cortisol

Cushing syndrome

A’s for Addison

A decreased cortisol level Adrenal gland damage (main cause) Appearance bronzed Appetite decreased with weight loss

What gland secretes ADH

Hypothalamus

ADH reabsorbs only what

Water

What is the target organ for ADH

Kidney

What effect does ADH have on vascular smooth muscle?

Vasoconstriction

Does ADH raise or lower BP?

Raise blood pressure

What is ADH’s one purpose in life?

Raise blood pressure

ADH does what to blood volume?

Increase

Lack of ADH leads to what endocrine condition?

Diabetes insipidus

Neurogenic DI example

Traumatic brain injury

What hormone is released when not enough fluid in body?

ADH

Dry inside

Diabetes insipidus

Soaked inside

SIADH

Pulmonary disorders CNS disorders Cause which endocrine disorder

SIADH

Dilutional hyponatremia seen in which endocrine disorder

SIADH

What kind of system regulates thyroid hormones?

Negative feedback system

Glucocorticoids raise what in the blood

Glucose

Attaches to the lining of the arteries forming atherosclerotic plaque

LDL

Brings cholesterol to the liver to be excreted as a constituent of bile

HDL

What hormone Causes widespread arteriolar vasoconstriction in the body and stimulates adrenal gland to release aldosterone

Angiotensin II

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