Exam 3 patho Flashcards
1
Q
SER
A
mood/sleep
pain pathway
2
Q
dop
A
behavior (emotions/attn) fine mvmt (parkinsons)
3
Q
NOR
A
sympathetic
4
Q
endorphins
A
pleasure NT. inhibits pain (runners high, hypothal)
masturbating on pd
5
Q
cerebrun/cerebral cortex
A
contains frontal/pariteal/occipital lobes
6
Q
frontal lobe
A
concentration, abstract thinking, memory, affect, judgement, inhibitions
-damage here can make pt seem noncompliant
brocas area: speech center
7
Q
parietal
A
sensory, LR orientaiton. size/shape discernment
8
Q
occipital
A
visual memory
9
Q
brain stem
A
composed of midbrain/pons/medulla
reflex ctr for resp/BP/HR/cough/swallow
damage here-> death
10
Q
cerebellum
A
smooth/coordination mvmt. fine movement/postural space/balance
11
Q
CSF
A
clear/colorless. cushions brain. produced in choroid plexus of ventricles of brain
12
Q
cerebral circulation
A
takes 15% CO
anterior: from common carotid
posterior: from vertebral/subclavian
13
Q
Spinal cord
A
protected by vertebral column
7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused)
damage to spine (esp cervical)-> paralysos
14
Q
peripheral nervous system composed of:
A
cranial nerves, spinal nerves, ANS
15
Q
Sensory/Motor/Both: nerves
A
Some say money matters, but my brother says big brains matter more
16
Q
nerves
A
- Olfactory
- Optic
- Oculomotor (+ troch+ abducens=muscle)
- Trochlear
- Trigeminal (face/mstication)
- Abducens
- Facial (muscles of face)
- Auditory (vesitubular)
- Glossopharyngeal
- Vagus (heart, lungs, GI)
- Accessory (sternocleidomastoid/upper shoulders)
- Hypoglossal (tongue)
17
Q
Ischemic stroke
types * 5
A
- lg artery thrombotic stroke
- small penetrating (lacunar). Pinpoints
- cardiogenic embolic stroke (bc a fib- gove blood thinner) Most common- b/c arrhythmia
- cryptogenic (unknown)
- Other: drugs, coagulopathy, migraine**, spontaneous dissection carotid
18
Q
CVA
A
umbrella term. Functional abnormality of CNS due to disruption of blood to brain
ichemica stroke or hemorhaggic
19
Q
Patho of ischemic stroke
A
CA -> disrupt blood flow -> ischemic cascade->can’t maintain anaerobic resp-> lactic acid -> dec ATP-> dec energy for depolarization-> cell death
20
Q
penumbra region
A
dec cerebral blood flow. Around area of infraction.
NI: care for penumbra region (give TPA)
S/S go away (s/s mean its working)
21
Q
Clinical manifestations ischemic stroke
A
- numbness- 1 side
- chenge mental status (get last known well)
- change speech/understanding speech
- diplopia
- dec walk/balance
- headache (hemorhaggic stroke)
- motor loss (hemiplegia, hemiparesis, flaccid, spastic, dyphagia)
- dec communication
aphasia: dec comprehension/form language (expressive vs receptive)
apraxia: cant perform actions - agnosia: cant recognize an object
- frontal lobe change
22
Q
Transient ischemic attack (TIA)
A
temporary. sudden loss sensory/visual.
brain imaging will show nothing.
23
Q
Diagnosing TIA/CVA
A
CT, CT angio, MRI, ECG (afib), TEC, carotid ultrasound (at bedside- plaques)
24
Q
meds for CVA
A
A fib: coumadin, novel anticoag antiplatelets: ASA, clopidogrel statins: dec cholesterol (LDL inc 70 mg) Anti HT meds TPA
25
hemorrhagic stroke
| Def, CA, S/S
worst CVA
def: bleeding into brain tissue/subarachnoid space
CA: *AV malformation*, intracranial aneurism, intracranial *neoplasms*, meds (aCOAGs)
S/S: headache, severe neuro deficits, ***nuchal rigidity, **ptosis/tinnitis, LOC
26
Vasospasm
7-10 days after hermohaggic stroke
intermittent spasms. clot undergoes lysis-> rebleed
S/S: H/A, dec LOC, new neuro def
27
Seizure definition
| diagnostic
abnormal motor/SNS/autonomic/psych b/c discharges inc electrical impulses from cerebral neurons
diagnostic: EEG (during seizure)
CT/MRI: blood for lesions/tumor
28
CA seizures
cerebrovasc disease, hypoxemia
fever (esp children), head injury, HT
CNS infection, brian tumor, withdrawal, allergies
metabolic/toxic cdtn (liver- inc ammonia, dec BG)**
29
epilepsy
unprovoked, recurring seizures (>2 in 24 hrs)
30
S/S seizure
```
LOC
tremors, unintelligible, dizzy
unusual aura
epileptic cry
tongue chewed/incontinence
```
31
post tictal
after a seizure: confused and hard to arouse. may sleep. check frequently
32
status epilepticus
| risk factors
acute prolonged seizure (inc O2 need- hypoxemia)
med emergency
Risk factors: interrupting AEDs, fever, concurrent inf
33
atherosclerosis vs arteriosclerosis
atherosclerosis: deposit fatty plaques interies (1. blcks arteries, 2. plaque can dislodge, 3- clost forms and blocks)
arteriosclerosis: hardening of walls (ca: chronic high BG, smoking)
34
BP: Syst/diast
Syst: max pressure
dias: pressure btw beats
35
PVR (peripheral vasc reisitant)
amount of obstruction to blood flow caused by vessel diameter, vessel length, and viscosity
CO= BP/PVR
CO=SVxHR
36
EF
howm much blood left the vent with each contration (L/contration)
baseline: 100 ml
Normal: 65%
37
RAAS
triggered by low BP
kidney senses-> renin released-> stim liver- tensinogen-> to lungs: to tensin 1-> ACE makes into tensin II (strong vasocontristor)-> adrenal gland (aldosterone)-> at nephrons (inc H2O/Na, exc K)
ACEi: PRILS. antagonize aldosterone - inc K
38
BP regulation via which mechanisms
Baroreceptors
RAAS
ADH
Natiuresis
39
Types of lipids
cholesterol: from diet and liver
triglercerides: lf lipid molecules (high carb diet)
LDL: deposit of arteries-> considered foreign-> inflammation-> WBC-> phages fail-> bigger plaque
no anti-inflammatories, eat Omega 3s
HDL: brings LDL back to liver. takes circ LDL Long term. Nuts/fatty fish
40
All chemicals that effect the arteries
Lipids
glucose (chronic high -> arteriosclerosis/MI)
Free radicals (damage endothelial lining) take antiox
Nicotine (can cause vaso const and hardenin BV)
Homocysteine (amino acid in vit B)
low vit B -> low breakdown homo-> inc homo-> damage walls/thrombosis formation
41
AHA/ACC define HTN:
2+ diastolic BP >80, or syst consistently >130
42
Etiology HTN
| risk factors
1* unknown CA
2* effect/complicaiton other disorder/SE drugs/toxins
risk factors: fam history, age, race, obseity, nicotine, inc salt/sat fat, excessive ETOH, sed lifestyle
43
CA HTN
1. change in enothel lining-> inc peripheral resistance
2. inc tone in SNS (stress)
3. inc blood volume (inc salt)
4. art wall thickening (fatty depos/age)
5. abnormal renin
44
prolonged HTN
| complications, S/S
inc resistant to vent ejection -> inc heart workload-> l vent hypertrophies-> inc work
Complications:
CVA, MI, CHF, arrhythmia, retinopathy (blindness), encephalopathy, RF
S/S:
1. non- asymptomatic
2. sometimes HA/nape pain
3. organ specific
45
Tx HTN
diet (dec fat/salt)
exercise (moderate)
```
meds:
A blocker
B blocker
diuretic
ARB/ACEi
```
46
Acute coronary syndrome (ACS)
acute ischemic heart disease
1. unstable angina (UA)
2. MI
47
MI
STEMI: emergency (classic MI)
NSTEMI: non emergent (UA)
48
serum biomarkers (heart panel)
Troponin I (heart muscle necrosis- 3 hrs after- 7-10 hrs, check after 4 hrs ***best diagnostic), Troponin T, Ck-MB (inc 4-8 hrs after for 2/3 days), myoglobin
normal TnI, high CK-MB: rhabdomyolis
49
Etiology/risk factors ACS
atherosclerosis, HTN, nic, fam hx
thrombus, coronary vasospasm (coke), anemia (also angina)
cornoray circ
RCA: posterior
LCA: anertior/curcumflex. High risk thrombus formation
50
Patho ACS
collateral circ
S/S
exercise opens collateral circulation
CA: dec blood-> dec perf heart muscles
S/S: chest pain (***relieved by rest/nitrglycerine---Sildenafil)
dec blood flow and inc metabolic demand: infarction
51
electrical currents through heart
SA node (60-80/100)-> AV (40-60) vent contract-> AV bundle/bundle of his-> bundle branches-> purkinje
52
angina def
types
clinical S/S
CP w/ diminished blood flow to heart
stable engine: similar to past
unstable: CP 1*, sudden ischemia, or inc severity (MED EMER)
```
clinical manifestations:
CP 2*. to stress/exertion
anginal equivalents: dyspnea, dizzy, lightheaded, jaw pain, epigastric pain, back pain
look paile/diaphoretic/dyspneic
HR may be normal, high, low, or irreg
```
53
Acute MI
```
heart muscles die from hypoxia (STEMI/NSTEMI)
prolonged ischemia (>30 mins)-> necrosis
```
S/S
diaphoresis, dysp, impending doom, CP, pallo, levines sign
radiates to L arm (angine=no radiation)
silent MI: alderly/diabetics
54
factors affecting survival of heart muscles
location, level of occlusion, lengeth of time, collateral circ
55
Tx MI
angina: rest/nitro
PTCA/PCI: catheter to femoral/radial art. flatten plaque
CABG: saphenous vein
56
CHF
impacted by
S/S
Diagnostic
chronic cdtn. heart cant pump enough blood for body
impacted by preload (end of diastole, dec blood volume-diuretic)/afterload (change by dilate BV)
S/S:
SOB, easy fatigue, weak, edma, persistent cough, wheezing, crackles
rapid weight gain (1 L= 1 kg)
Diagnostic:
BNP, EF, radiography (cardiomegaly)
57
risk factors CHF
HTN, CAD, arrythmia, valv hear disease (weakend valves- SOB), viruses, obestiy, ETOH, drugs
58
valvular heart disease (rheumatic)
a. dec blood to aorta- EF
| b. LA pressure inc-> inc pressure pulm vain -> fluid in lungs
59
types of HF
LHFL
inc afterload, LV works harder, LV hypertrophies, weakens, pushes back, LA/pulm affection-> fluids in lungs
RHF:
RV -> RA-> SVC/IVC-> gen edema (similar to cor pulmonale)
60
endoscopy
procedure to examine interior of hollow organ
61
2 sphincters of the esophagus
UES: directs food (prevents aspiration)- Vagus nerve
LES (cardiac sphincter)
both are contracted when resting
62
digestive process
cephallic: response to sensory stimuli
histamine/gastrin released
gastric:as food/fluids enter
intestinal phase: when chyme->duodenum
63
gastric process digestion
- stim production of mucus/gastric acid
- ---goblet cells: mucus
- ----parietal cells/intrinsic factors (need for vit b 12 absorption)....regulated by Proteins pump
64
fxn of goblet cells in SI
release dig enzymes, secrete nutrients, absorb nutrition
65
chyme, bile, panc enzymes
break down pats/proteins/carbs and **neutralize acid (in duodenum)
panc enzymes: fats-> fatty acids, prot-> aa, amylase: carbs-> simple sugar
bile: suspends fat
66
fxn of jejunum
absorbs aa, glucose, fe/ca, and fat sol vitamins
67
ileum fxn
reabsorbs B12 (requires intrinsic factor from stomach) and return bile -> liver
68
GERD
| CA/patho x2
CA: dec tone spinchters (alc, nic, choc, caff, drugs, obes, PG)
Patho 1: weak/relaxed LES (heartburn)
Path 2: delayed gastric emptying to SI (pastrparesis)
----give methoclothrimide
69
methoclothrimide
inc mvmt thru GI for pastroparesis and to stop GERD
70
GERD S/S and diag
S/S
- dysphagia, HB, epigas, pain, regurgitation
- resp complaint (chronic dry cough, asthma, asp pneumonia, noctural asthma attack)
- inc pain after high fat food (DONT LAY FAT AFTER EAT)
tx
-avoid triggers (NSAIDS), positioning, give antacids, PPIs
71
PUD
| def, risk, patho
lesions affecting lining of stomach/duodenum
risk factors
-age, nsaids, H pylori, tumors (assoc w/ ZES), gerd
patho: imbalance of acid production and mucus production (protective)
72
zollinger ellison syndrome
assoc w. PUD
| rare dig disorder. tumor (SI/Panc): releases gastrin-> inc gastric acid
73
types of ulcers
duodenal: inc acid/h pylori
- -apigastric pain relieved w/ food
gastric: less freq, more deadly
assoc w/ nsaids
pain: worse w/ eating
```
stress
2* to stressors: trauma/sepsi/surgery
-give PPI prophylactically
---curlings: burn
----cushings: w/ head injury (crush)
```
74
Ulcer complications and diagnosis
Comp
GI hem, GI obstruction, perf, peritonitis (tarry stool)
Diag: S/S, upper gi xray (erosion), EGD (bleeding), serum H pylori antibodies
75
SI-> LI
Water, unabsorbed food molecules, cellulose (indigestable), and electrolytes (Na/K)
76
IBD
chronic inflammation GI (usually intestines)
UC: colon, CT inflammation
Chrons: anywhere GI, healthy/inflamed parts
both have periods of remission and flare ups (unknown cause)
77
chrons
slow developing inflammatin. Can be anywhere.
patchy inflammation.
ulcers sep by thick elevations (nodules)-> cobblestone
if walls are too thick- can't absorb (malnut)
complications:
malnut, anemia, fistulas, adhesions (not slippery), intestinal obstruction: perforation, anal fissures, fluids/electrolyte imb
```
clinical:
ab cramping (LRQ) and during defacation, watery diarrhea/steattorrhea, palp ab mass, melena, anorexia, weight loss, s/s inflammation, constipation
```
78
UC
progressive cdtn. colon only. 2/3rd decade.
patho: inflam-> epithelial loss-> erosion-> ulcer (necrosis)
Location: begins in rectum, extends up
Complications: mal nut, anemia, hemorrhagic, perf, strict, fistula, toxic mega colon (rapid dilation LI), colectoral carcinoma, liver disease, flu/elec imb
Clinical: diarrhea, proctitis, N/V, ab cramping, S/S inflammation, tenesmus (urge to defecate), pseudopolyp (scar tissue)
79
diagnostic/tx for UC/chrons
diag: xray, CT/MRI ab, colonoscopy, biopsy
tx: S/S, avoid triggers
80
liver fxns
```
Bile salt secretion
bilirubin metabolism
fat/protein metabolism (synth albumin)
carb metabolism (glycogenolysis)
hematologic (factors in clottng)
detox
stores A,D, B12, Fe, Cu
converts ammonia-> urea (to be exc in urine)
```
81
liver fxn in bilirubin metab
heme-> fe/porphyrin -> porphyrin-> unconjugated bilirubin-> to liver, become conjugated (water soluble)-> excreted
why liver failure/jaundice-> yellow sclera
82
hepatitis
| def, CA, complication
```
inflammation of the liver
CA: Hep A-E, epstein barr, Coxsackie virus
drugs (Acet/ASA)
toxins (mushrooms)
etoh
autoimmune
```
complications: liver failure, liver cancer, cirrosis
83
acetylcysteine
antidote to acet toxicity (liver failure)
84
Cirrhosis
def: chronic progress, irreversible damage to liver, dec liver fxn
CA: all factors causing hep (1 in us: alc, 1 others: hepatitis)
patho: damage-> fibrosis/scarring/nodule/impp blood flow/bile obstruction-> liver fail
85
S/S cirrhosis
liver probs: bleeding (portal HT), scarring, edema (ascites due to portal HT)
steattorrhea, itching/dark urine (kidney compensates w/ bile)
liver inact. hormones
ammonia inc -> BBB-> encephalopathy
(confusion, asterixis (hand tremor), fetor hepaticus)
86
diagnosing cirrhosis
ab ultrasound, MRI/CT ab, liver/enzymes fxn test
serum aminotransferase
ALT: high in liver disorder
AST: high in damage/death heart, liver, MS, kidney
GGT: high In etoh liver disease, cholestystitis
