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272 Pathophysiology > Exam 3 patho > Flashcards

Exam 3 patho Flashcards

1
Q

SER

A

mood/sleep

pain pathway

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2
Q

dop

A 
behavior (emotions/attn)
fine mvmt (parkinsons)
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3
Q

NOR

A

sympathetic

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4
Q

endorphins

A

pleasure NT. inhibits pain (runners high, hypothal)

masturbating on pd

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5
Q

cerebrun/cerebral cortex

A

contains frontal/pariteal/occipital lobes

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6
Q

frontal lobe

A

concentration, abstract thinking, memory, affect, judgement, inhibitions
-damage here can make pt seem noncompliant
brocas area: speech center

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7
Q

parietal

A

sensory, LR orientaiton. size/shape discernment

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8
Q

occipital

A

visual memory

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9
Q

brain stem

A

composed of midbrain/pons/medulla
reflex ctr for resp/BP/HR/cough/swallow
damage here-> death

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10
Q

cerebellum

A

smooth/coordination mvmt. fine movement/postural space/balance

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11
Q

CSF

A

clear/colorless. cushions brain. produced in choroid plexus of ventricles of brain

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12
Q

cerebral circulation

A

takes 15% CO

anterior: from common carotid
posterior: from vertebral/subclavian

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13
Q

Spinal cord

A

protected by vertebral column
7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused)
damage to spine (esp cervical)-> paralysos

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14
Q

peripheral nervous system composed of:

A

cranial nerves, spinal nerves, ANS

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15
Q

Sensory/Motor/Both: nerves

A

Some say money matters, but my brother says big brains matter more

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16
Q

nerves

A
  1. Olfactory
  2. Optic
  3. Oculomotor (+ troch+ abducens=muscle)
  4. Trochlear
  5. Trigeminal (face/mstication)
  6. Abducens
  7. Facial (muscles of face)
  8. Auditory (vesitubular)
  9. Glossopharyngeal
  10. Vagus (heart, lungs, GI)
  11. Accessory (sternocleidomastoid/upper shoulders)
  12. Hypoglossal (tongue)
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17
Q

Ischemic stroke

types * 5

A
  1. lg artery thrombotic stroke
  2. small penetrating (lacunar). Pinpoints
  3. cardiogenic embolic stroke (bc a fib- gove blood thinner) Most common- b/c arrhythmia
  4. cryptogenic (unknown)
  5. Other: drugs, coagulopathy, migraine**, spontaneous dissection carotid
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18
Q

CVA

A

umbrella term. Functional abnormality of CNS due to disruption of blood to brain
ichemica stroke or hemorhaggic

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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

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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)

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21
Q

Clinical manifestations ischemic stroke

A
  1. numbness- 1 side
  2. chenge mental status (get last known well)
  3. change speech/understanding speech
  4. diplopia
  5. dec walk/balance
  6. headache (hemorhaggic stroke)
  7. motor loss (hemiplegia, hemiparesis, flaccid, spastic, dyphagia)
  8. dec communication
    aphasia: dec comprehension/form language (expressive vs receptive)
    apraxia: cant perform actions
  9. agnosia: cant recognize an object
  10. frontal lobe change
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22
Q

Transient ischemic attack (TIA)

A

temporary. sudden loss sensory/visual.

brain imaging will show nothing.

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23
Q

Diagnosing TIA/CVA

A

CT, CT angio, MRI, ECG (afib), TEC, carotid ultrasound (at bedside- plaques)

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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
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25
Q

hemorrhagic stroke

Def, CA, S/S

A

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

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26
Q

Vasospasm

A

7-10 days after hermohaggic stroke
intermittent spasms. clot undergoes lysis-> rebleed
S/S: H/A, dec LOC, new neuro def

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27
Q

Seizure definition

diagnostic

A

abnormal motor/SNS/autonomic/psych b/c discharges inc electrical impulses from cerebral neurons
diagnostic: EEG (during seizure)
CT/MRI: blood for lesions/tumor

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28
Q

CA seizures

A

cerebrovasc disease, hypoxemia
fever (esp children), head injury, HT
CNS infection, brian tumor, withdrawal, allergies
metabolic/toxic cdtn (liver- inc ammonia, dec BG)**

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29
Q

epilepsy

A

unprovoked, recurring seizures (>2 in 24 hrs)

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30
Q

S/S seizure

A 
LOC
tremors, unintelligible, dizzy
unusual aura
epileptic cry
tongue chewed/incontinence
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31
Q

post tictal

A

after a seizure: confused and hard to arouse. may sleep. check frequently

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32
Q

status epilepticus

risk factors

A

acute prolonged seizure (inc O2 need- hypoxemia)
med emergency
Risk factors: interrupting AEDs, fever, concurrent inf

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33
Q

atherosclerosis vs arteriosclerosis

A

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)

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34
Q

BP: Syst/diast

A

Syst: max pressure
dias: pressure btw beats

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35
Q

PVR (peripheral vasc reisitant)

A

amount of obstruction to blood flow caused by vessel diameter, vessel length, and viscosity
CO= BP/PVR
CO=SVxHR

36
Q

EF

A

howm much blood left the vent with each contration (L/contration)
baseline: 100 ml
Normal: 65%

37
Q

RAAS

A

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
Q

BP regulation via which mechanisms

A

Baroreceptors
RAAS
ADH
Natiuresis

39
Q

Types of lipids

A

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
Q

All chemicals that effect the arteries

A

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
Q

AHA/ACC define HTN:

A

2+ diastolic BP >80, or syst consistently >130

42
Q

Etiology HTN

risk factors

A

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
Q

CA HTN

A
  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
Q

prolonged HTN

complications, S/S

A

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
Q

Tx HTN

A

diet (dec fat/salt)
exercise (moderate)

meds:
A blocker
B blocker
diuretic
ARB/ACEi
46
Q

Acute coronary syndrome (ACS)

A

acute ischemic heart disease

  1. unstable angina (UA)
  2. MI
47
Q

MI

A

STEMI: emergency (classic MI)
NSTEMI: non emergent (UA)

48
Q

serum biomarkers (heart panel)

A

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
Q

Etiology/risk factors ACS

A

atherosclerosis, HTN, nic, fam hx
thrombus, coronary vasospasm (coke), anemia (also angina)
cornoray circ
RCA: posterior
LCA: anertior/curcumflex. High risk thrombus formation

50
Q

Patho ACS
collateral circ
S/S

A

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
Q

electrical currents through heart

A

SA node (60-80/100)-> AV (40-60) vent contract-> AV bundle/bundle of his-> bundle branches-> purkinje

52
Q

angina def
types
clinical S/S

A

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
Q

Acute MI

A 
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
Q

factors affecting survival of heart muscles

A

location, level of occlusion, lengeth of time, collateral circ

55
Q

Tx MI

A

angina: rest/nitro
PTCA/PCI: catheter to femoral/radial art. flatten plaque
CABG: saphenous vein

56
Q

CHF
impacted by
S/S
Diagnostic

A

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
Q

risk factors CHF

A

HTN, CAD, arrythmia, valv hear disease (weakend valves- SOB), viruses, obestiy, ETOH, drugs

58
Q

valvular heart disease (rheumatic)

A

a. dec blood to aorta- EF

b. LA pressure inc-> inc pressure pulm vain -> fluid in lungs

59
Q

types of HF

A

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
Q

endoscopy

A

procedure to examine interior of hollow organ

61
Q

2 sphincters of the esophagus

A

UES: directs food (prevents aspiration)- Vagus nerve
LES (cardiac sphincter)

both are contracted when resting

62
Q

digestive process

A

cephallic: response to sensory stimuli
histamine/gastrin released
gastric:as food/fluids enter
intestinal phase: when chyme->duodenum

63
Q

gastric process digestion

A
  • stim production of mucus/gastric acid
  • —goblet cells: mucus
  • —-parietal cells/intrinsic factors (need for vit b 12 absorption)….regulated by Proteins pump
64
Q

fxn of goblet cells in SI

A

release dig enzymes, secrete nutrients, absorb nutrition

65
Q

chyme, bile, panc enzymes

A

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
Q

fxn of jejunum

A

absorbs aa, glucose, fe/ca, and fat sol vitamins

67
Q

ileum fxn

A

reabsorbs B12 (requires intrinsic factor from stomach) and return bile -> liver

68
Q

GERD

CA/patho x2

A

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
Q

methoclothrimide

A

inc mvmt thru GI for pastroparesis and to stop GERD

70
Q

GERD S/S and diag

A

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
Q

PUD

def, risk, patho

A

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
Q

zollinger ellison syndrome

A

assoc w. PUD

rare dig disorder. tumor (SI/Panc): releases gastrin-> inc gastric acid

73
Q

types of ulcers

A

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
Q

Ulcer complications and diagnosis

A

Comp
GI hem, GI obstruction, perf, peritonitis (tarry stool)

Diag: S/S, upper gi xray (erosion), EGD (bleeding), serum H pylori antibodies

75
Q

SI-> LI

A

Water, unabsorbed food molecules, cellulose (indigestable), and electrolytes (Na/K)

76
Q

IBD

A

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
Q

chrons

A

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
Q

UC

A

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
Q

diagnostic/tx for UC/chrons

A

diag: xray, CT/MRI ab, colonoscopy, biopsy
tx: S/S, avoid triggers

80
Q

liver fxns

A 
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
Q

liver fxn in bilirubin metab

A

heme-> fe/porphyrin -> porphyrin-> unconjugated bilirubin-> to liver, become conjugated (water soluble)-> excreted

why liver failure/jaundice-> yellow sclera

82
Q

hepatitis

def, CA, complication

A 
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
Q

acetylcysteine

A

antidote to acet toxicity (liver failure)

84
Q

Cirrhosis

A

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
Q

S/S cirrhosis

A

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
Q

diagnosing cirrhosis

A

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

272 Pathophysiology (4 decks)

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