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patho part 3 Flashcards

1
Q

HTN?

A

consistent elevation of systemic arterial bp

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2
Q

if your bp is over 130/80 on 3 separate occasions you have…

A

htn

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3
Q

hypertensive emergency?

A

SBP over 180 mmHg AND OR DBP over 120 mmHG
Rapidly evolving end organ damage
Admit pt and give IV meds
Goal: reduce bp within hours bc changing it too quickly can cause cerebral ischemia

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4
Q

hypertensive urgency

A

SBP over 180 mmHg AND OR DBP over 120 mmHG
No evolving end organ damage
Out pt with oral meds
Goal: reduce bp over days

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5
Q

why may bp be elevated

A

pump, pipes, fluid, control system

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6
Q

what do they kidsneys do

A

uses a filtering process to remove contaminants by using a pressure gradient

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7
Q

renal artery stenosis is in ____% of hypertensive pts

A

1-2

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8
Q

2 types of renal artery stenosis

A

fibromuscular dysplasia and atherosclerosis

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9
Q

fibromuscular dysplasia? who does it mainly occur in

A

in young women; muscle wall in renal artery has changed

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10
Q

what type of renal artery stenosis is more common

A

atherosclerosis

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11
Q

who is renal artery stenosis from atherosclerosis more common in

A

older ppl

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12
Q

what happens in Endocrine mediated HTN by the ANS

A

catecholamines like epi, norepi, and dopamine increase EF

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13
Q

what impact does high serum Na have on blood volume

A

high serum sodium leads to increased blood volume which can increase bp

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14
Q

excessive RAAS leads to…

A

inc htn

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15
Q

Hyperaldosteronism (mineralcorticoid) causes the body to…

A

retains Na (inc fluid retention) and loses K

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16
Q

hypercortisolism in in what syndrome

A

cushings syndrome

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17
Q

what is cushings causes by

A

Caused by pituitary adenoma and chronic glucocorticoid use

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18
Q

what effect does too much cortisol have on the body

A

Too much cortisol leads to inc contractility, fluid retention, and inc effect of catecholamines of vasoconstriction

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19
Q

what does hyperparathyroidism cause

A

Hypercalcemia from renal insufficiency that causes calcium mediated vasoconstriction

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20
Q

what is hyperthyroidism

A

Isolated systolic HTN while diastolic is the same which causes inc CO

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21
Q

pheochromocytoma?

A

Benign adrenal tumor that secretes catecholamines causing headaches, palpitations, diaphoresis (sweating), and severe htn

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22
Q

when does pheochromocytoma occur

A

Occurs a lot between ages 20-50, but really can develop at any age

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23
Q

Testing: plasma free metanephrines or urinary fractionated metanephrines is for what disease

A

pheochromocytoma

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24
Q

trmt for pheochromocytoma

A

antihypertensives til surgery

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25
coarctation of the aorta?
congenital defect causing different blood pressures in different parts of the body; any pressure below the coarctation is lower
26
+ family hx, age, male, black, high Na intake, DM, smoking, obesity, alcohol, low dietary intake of K+, Ca++, and Mg++ A combination of genes AND environment are risk factors for....
primary htn
27
Increased SNS activity can result from…
Increased production of catecholamines Increased catecholamine receptor reactivity (either more receptors or more numerous ones) Receptors are not just in the heart and arteries Over expressed beta adrenergic receptors on juxtaglomerular cells that causes increased renin secretion
28
Increased SNS activity can cause...
Inc hr and pvr, inc insulin resistance, vascular remodeling, procoagulant effects, endothelial dysfunction, narrowing of vessels and vasospasms
29
wha Can cause endothelial damage and tissue ischemia
inflammation
30
excessive inflammation Can cause endothelial damage and tissue ischemia by:
Vascular remodeling and inc PVR Decreased production of vasodilators like NO Increased production of vasoconstrictors like endothelin
31
what are some other causes of HTN
Sleep apnea, obesity, preeclampsia (high bp during pregnancy and renal changes), iatrogenic from meds, alcohol, drugs, supplements
32
preeclampsia?
high bp during pregnancy and renal changes
33
requirements for hypotension
SBP less than 90 mmHg AND symptomatic MAP less than 60 mmHg
34
how do we decide when to treat hypotension
Treat based on degree of urgency and underlying cause
35
New onset syncope should/should not be ignored
should NOT
36
what are the 3 big causes of hypotension
cardiogenic shock, distributive shock, or hypovolemic shock
37
how does cardiogenic shock cause hypotension
poor contractility, less preload, regurgitation, arrhythmogenic, obstructive
38
3rd spacing?
fluid mvmt from intravascular space into interstitial/nonfunctional areas between cells
39
how can hypovolemic shock lead to hypotension
hemorrhage, volume depletion
40
Septic shock, hepatic failure, pancreatitis, anaphylactic shock, adrenal insufficiency, neurogenic shock, iatrogenic from meds we prescribed, alcohol, illicit drug, inactivity, gravity is a type of what shock from hypotension
distributive
41
syncope?
transient, self limited loss of consciousness due to impairment of cerebral flow
42
what is syncope caused by
orthostatic/postural hypotension (position changes) or neurogenic syncope
43
orthostatic/postural hypotension?
when bp does not compensate for changes in gravity
44
2 types of orthostatic/postural hypotension?
acute orthostatic hypotension aka fainting or chronic orthostatic hypotension
45
how do we know if someone has orthostatic/postural hypotension
when a person stands... SBP decreased by 20 mmHg or more DBP decreased by 10 mmHg or more Increase in HR by 20 bpm or more
46
what can orthostatic/postural hypotension be a sign of
hypovolemia (MC) or neurogenic syncope
47
neurogenic syncope?
Increased vagal tone /parasympathetic reflex from a cough, micturition, defecation, diving, sneezing, swallowing, carotid sinus massage (like during shaving)
48
lipids?
heterogeneous group of compounds related by their physical properties rather than their chemical such as fats, oils, steroids, and waxes
49
lipids are Insoluble in ____and soluble in _____
water, nonpolar solvents
50
how are lipids transported in the body
carrier protein
51
function of lipids
Have high nrg value, store energy, regulate heat, myelinate nerves, high concentration in brain ( so you don't want statins during pregnancy bc they lower cholesterol)
52
Key difference between plant and animal cells
lipids in membrane
53
cholesterol?
steroid like compound that is a precursor of all other steroids (corticosteroids, sex hormones, bile acids, and vitamin D)
54
It’s amphipathic- has a hydrophobic and hydrophilic side
cholesterol
55
how do we get cholesterol in the body
Can be ingested in foods of animal origin like egg yolk, meat, liver, and brain or made in tissues from acetyl CoA
56
triglyceride
ester that allows transport of fat and glucose from liver via chylomicrons
57
where is cholesterol
Free floating, Lipoprotein for transport, Stored as cholesteryl ester
58
lipoproteins?
large macromolecular structures with proteins that transport lipids throughout the body to and from tissues
59
types of lipoproteins
chylomicrons, VLDL, IDL, LDL, HDL
60
to many carriers of lipoproteins to tissues can cause this
hyperlipidemia
61
Chylomicrons and VLDL- carry ______
triglycerides
62
IDL- carry _______
triglycerides and cholesterol
63
LDL and HDL- carry
cholesterol
64
apolipoproteins are made here
liver and intestine
65
too much of this can cause gallstones and atherosclerosis | CAD
cholesterol
66
atherosclerosis
inflammatory response due to accumulation of lipids in arterial wall
67
atheromas or plaques?
accumulation and swelling in artery walls made of macrophage cells, lipids, fibrous CT and calcium
68
foam cells?
Macrophages filled with oxidized LDL in walls of arteries of most ppl
69
what do statins do?
stabilize paques and dec LDL

Pathophysiology (17 decks)

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