Pathophysiology 1 Flashcards
STUDY SMART : )
• What is ASHD?
○ Atherosclerotic heart disease
○ A narrowing of the coronary artery by atheroma
○ Can lead to acute myocardial infarction
• Prevention of ASHD/ Risk factors? (5)
○ Family history ○ Smoking- no ○ Hypertension- BP @ 120/80 ○ Hyperlipidemia- LDL @ 100 ○ Diabetes Mellitus- B.S. @ 100
• What is heart failure in general?
○ A pump failure
○ Can result from any disease of the heart
• What are the three most common fatal cancers?
○ LUNG
§ Preventable- no smoking
○ PROSTATE & BREAST
§ Exams catch early
§ Mammograms- 40 y.o or early if greater risk
§ Prostate rectal/physical exams- age 40
& repeat once a year
○ COLON
§ Start as polyp- takes 10 years become cancerous
§ Colonoscopy @ 50, then repeat once a year
Leg pain of the intermittent claudication variety is suggestive of what?
○ Arterial insufficiency
○ arterial=pain
• What is the manifestation of venous problems?
○ Edema
What are the causes of secondary hypertension?
○ “R.E.N,D,S”
§ Renal failure
§ Endocrine disease (Cushing's, Pheochromocytoma) § Drugs § Neurogenic § Sleep apnea
• What is the meaning of incompetence of a valve?
○ Does not close adequately
○ Ex: w/ bacterial endocarditis or rheumatic heart disease
• What are causes of congenital heart disease?
○ Artrial septal defect (ASD)
○ Ventricular septal defect (VSD)
○ Fallot’s tetralogy
○ Coarctation of the aorta
• A 32 year old female, who had a rheumatic fever as a child, is brought in with complains of malaise, a temperature of about 100 °F for approx. 3 weeks, and a new cardiac murmur. She also recently saw her dentist. What is your diagnosis? What tests?
○ Subacute bacterial endocarditis (strep infection= original cause rheumatic fever)
○ Test: culture blood, echocardiogram
• Describe fetal circulation
○ Right atrium to Left atrium to Left ventricle to aorta to body
○ Interatrial septum allows blood to bypass right ventricle and lungs
What are the signs and symptoms of heart failure?
○ Fatigue ○ SOB ○ Edema (bilateral) ○ Rales ○ Cardiomegaly ○ Hepatomegaly
Treatment of heart failure?
○ Diuretic- drain fluid ○ Oxygen- SOB ○ Sitting up- pressure on chest ○ Beta blockers ○ Surgery (by-pass, valve, left ventricular assist device)
• What are causes of heart failure?
○ ANY PROBLEM W/ HT--> HT FAILURE ○ Hypertension ○ Acute myocardial infarction ○ Arrhythmia ○ Rheumatic fever ○ Subacute bacterial endocarditis ○ ASHD ○ Valvular heart disease ○ Cardiomyopathy ○ Congenital heart disease
What percent of heart disease is ASHD?
○ 80%
○ s/s begin after 50% buildup
• What are some areas of the body where atherosclerosis leads to major disease?
○ Heart– ASHD– HT Failure
○ Brain– Stroke (CVA- cerebrovascular accident)
○ Aorta– Aortic Aneurism
○ Legs– peripheral vascular insufficiency
s/s intermittent claudication – gangrene
• In dealing with congenital heart disease, what is meant by “reversal of shunt”?
Reversal of shunt causes BLOOD FLOW RIGHT ATRIUM TO LEFT ATRIUM. High pressure on left atrium causes shunt. As pressure builds on right atrium over time, causes a reversal of shunt resulting in deoxygenated blood into circulation.
• What is pain in the chest w/ exertion?
○ Angina
• What are complications of uncontrolled hypertension?
“St.A.KD.Blind.Legs”
○ Stroke (CVA- cerebrovascular accident) ○ ASHD ○ KD disease/failure ○ Eyes- Blindness ○Periperal arterial insufficiency (legs)
• Symptoms of peripheral vascular(arterial) insufficiency?
○ Intermittent claudication
○ Loss of hair on toes/ affected limb
○ Cooler temperature
○ Weak/faint dorsalis pedis pulse
• What is the PMI and where is it located?
○ PMI- point of maximum intensity or heart apex beat
○ On the left side, medial to midclavicular line, in the fifth intercostal space
What are causes of PMI displacement?
○ Cardiomegaly
○ RT lung filled (biothorax, pneumothorax, pleural ephusion, hemothorax)
• Name examples of hemorrhages in different parts of the body:
○ Hemoptysis- coughing blood
○ Hematemesis- vomiting blood
○ Melena- tarry black stools (bleeding duodenum and above)
○ Hematochezia- fresh red blood in stools (bleeding after the duodenum)
• Classify shock
○ Hypovalemic- low fluid volume
§ Ex: severe dehydration
§ Test: orthostatic hypertension
○ Cardiogenic- inadequate circulation of blood d/t primary failure of HT function
§ ex: acute MI
○ Hypotonic- ex: anaphylactic
Classify EDEMA
○ BILATERAL all pitting
§ HT Failure- (d/t no venous return- HT not pumping) § Rel. Low oncotic pressure: □ KD Failure (d/t hypoprotenemia-Proteinuria) □ LR Disease (d/t not making proteins- albumin) □ Malnutrition (Cachexia)
○ UNILATERAL
§ Pitting:
□ Trauma
□ Venous blockage (ex:thrombophlebitis/clot)
§ Non-pitting:
□ Lymph Edema (ex: breast cancer or filaria)
• What are acute complications of acute myocardial infarction?
○ “HTBRA”
○ HT Failure (acute pulmonary edema)
○ Blood clot (thrombus/embolus)
○ Rupture
○ Arrhythmia
• What are chronic complications of acute myocardial infarction?
○ “AHA”
○ Aneurism
○ HT failure (acute pulmonary edema)
○ Arrhythmia
• What type of gland is the pancreas?
○ Endocrine & exocrine
○ Endocrine- ISLETS OF LANGERHAND
○ Exocrine duct- SPHINCTER OF ODDI
• What are the endocrine and exocrine productions of the pancreas?
○ Endocrine:
§ Insulin
§ Glucagon
○ Exocrine:
§ Protease
§ Amylase
§ Lipase
• Where are the exocrine productions of the pancreas released via the sphincter of oddi?
○ Into the 2nd part of the duodenum
• What stimulates the exocrine function of the pancreas?
○ The secretion of secretin in the duodenum (CCK- bile)
• What are four causes of acute pancreatitis?
○ GB disease
○ Alcohol
○ Trauma
○ Viral infection (ex: Mumps)
○ -GB + Alcohol= 90%
• What are s/s of acute pancreatitis?
○ Pain with eating
○ Pain around umbilicus that radiates to back
○ Test: amylase ↑, lipase↑
○ Tx: Pain meds, IV fluids, No solids
○ Q: w/ women- concern RUPTURED TUBAL PREGNANCY
• Where is amylase present?
○ Salivary glands- to begin digestion of carbohydrates
○ Duodenum- released from pancreas
○ Fallopian tubes- unknown reason
What are s/s of chronic pancreatitis?
○ Chronic diarrhea (10-12 xday) ○ Malnutrition ○ Emaciation (d/t malnutrition) ○ Vitamin xu s/s (d/t "") ○ Dehydration (d/t persistent diarrhea)
○ Test: stools for muscle fibers
○ Tx: pancreatic enzymes
• Classify Diabetes Mellitus
○ TYPE 1- (Juvenile) NO INSULIN- 10%
§ Skinny, not storing nutrients b/c no storage
hormone (insulin)
○ TYPE 2- (Adult onset) Dysfunctional insulin- 90%
§ Generally overweight
○ GESTATIONAL- w/ pregnancy
What are the general symptoms of diabetes mellitus?
○ Polyuria
○ Polydypsia
○ Blurring vision
○ Chronic yeast infections (women)
What is the diagnostic test for diabetes mellitus?
○ Fasting blood sugar (>126)
• What are chronic complications of diabetes mellitus?
○ “HKBL^2”
○ HT disease/attack
○ KD disease/failure
○ Blindness
○ Peripheral limb loss
• What are ways to prevent chronic complications of diabetes mellitus?
○ B.S. @ 100
○ A1C <7
○ B.P. @ 120/80
○ No smoking
○ Yearly eye exam
○ KD tests-
§ Creatinine clearance (urine)
§ microalbumin (earliest sign)
○ Yearly stress test (HT)
○ Dorsalis pedis pulse
• What are acute complications of diabetes mellitus?
○ Diabetic ketoacidosis (DKA) (B.S. generally 500+)
○ Hypoglycemia
○ Infection
• Make a list of heart diseases
○ Hypertensive ○ ASHD ○ Rheumatic ○ Infectious ○ Congenital ○ HT failure ○ Cardiomyopathy ○ Valvular ○ Arrhythmic
• When a person dies of a “heart attack” what 3 general causes?
○ Acute myocardial infarction
○ Arrhythmia (worst= ventricular fibrulation)
○ HT failure (pump fails d/t any disease of ht)
• What is the commonest cause of death in women?
○ Acute myocardial infarction/ ht attack
• Under what layer does an atheroma collect?
○ Endothelium
• What is diabetes insipidus?
○ No ADH (anti-diuretic hormone) from posterior pituitary
○ s/s polyuria, polydypsia
• What three organs are affected by mumps?
○ Pancreas
○ Gonads (testicles & ovaries)
§ Men become sterile
§ Women have full recovery
○ Parotid glands
• What are four pathological conditions of the esophagus?
○ Cancer of esophagus
○ Esophageal ulcer (peptic/gastric ulcer)
○ Stenosis of esophagus (from healed ulcer)
○ Reflux esophagitis
○ Hiatus hernia (A hiatus hernia or hiatal hernia is the protrusion of the upper part of the stomach into the thorax through the esophageal hiatus because of a tear or weakness in the diaphragm)
• What are the five secretions of the stomach?
○ Gastrin ○ Pepsin ○ Intrinsic factor ○ Hydrochloric acid ○ Mucin
Name three locations where peptic ulcers may occur
○ Esophagus
○ Stomach
○ Duodenum
• Name four complications of gastric ulcers?
○ Bleeding (hematemesis, melena)
○ Perforation
○ Acute peritonitis
○ Pyloric stenosis (pyloris= area ST connect to SI)
• Describe the differences between Crohn’s Disease & ulcerative colitis?
○ Crohn’s
§ Ulcerates through all layers of small intestine/gut
○ Ulcerative colitis
§ Only ulcerate mucosal layer
○ Both have s/s:
§ Abdominal pain
§ Bloody diarrhea
• What happens to an ulcer in the colon? (i.e. w/ ulcerative colitis)
○ After 10 years the without treatment the ulcer becomes cancerous
○ Therefore ↑risk cancer*
• What are complications of ulcerative colitis?
○ Bleeding (hematechezia) ○ Perforation ○ Acute peritonitis ○ Toxic megacolon ○ Cancer
• What is a fatal complication of ulcerative colitis?
○ Toxic megacolon
§ Norm size: wrist
§ T.M colon size: thigh!
• What type of anemia do Crohn’s disease patients often have?
○ Combined B12 & Iron Xu anemia
§ b/c ileum affected (where B12 absorbed) & they
are bleeding all the time (lose iron)
• What are possible complications for an ulceration, such as in Crohn’s disease, where the ulcer penetrates through all layers?
○ Perforation–>acute peritonitis
○ Fistula–Sticking together of organ, mainly the small gut, where ulcer penetrates through
• What is the MacBurney point?
○ Indicates acute appendicitis
○ Located 1/3 distance from ASIS, 2/3 distance from umbilicus, in RLQ
• What is the main cause of LLQ pain?
○ Diverticulitis
• Describe clinical features of acute peritonitis
○ Acute abdominal pain
○ Board-like rigidity
○ Rebound tenderness
○ Absence of bowel sounds
• What three conditions will lead to acute peritonitis?
○ Perforation of peptic ulcer
○ Ruptured appendix
○ Ruptured/perforated colon
• What are the complications of cirrhosis?
○ Hepatocellular jaundice
○ Coagulopathy
§ bruising (low/not producing coagulating proteins)
§ Bleeding (esophageal varices)
○ Hypoalbuminemia (–low oncotic pressure–low/not producing albumin)
§ Ascites (fluid filled abdomen)
§ Edema (pedal, bilateral)
○ Poor inactivation of hormones
§ Estrogen
□ Gynecomastia
□ Testicular atrophy
○ Hepatic encephalopathy (d/t NH₃ build up)
○ Portal hypertension
○ Esophageal varices
○ Splenomegaly (backing up in spleen b/c LR not functioning)
• What are the factors that lead to peptic ulcer disease?
○ ↑HCL
○ H pylori infection
○ NSAIDS (i.e. ibuprofein)
• What are the factors that lead to cirrhosis?
○ Chronic alcoholism
○ Hepatitis B/C/D (not A)
○ Hemachromotosis (iron storage disease)
○ Wilson’s Disease (disease with copper excess)
• What are the different terms for different sites of bleeding?
○ Above duodenum:
§ Hematemesis (vomiting blood)
§ Hemoptysis (coughing blood)
§ Melena (black tarry stools from digested blood)
○ Below duodenum:
§ Hematochezia (stools w/ fresh red blood)
• List Liver function tests (at least 6):
○ Bilirubin ○ Alkaline phosphatase ○ ALT/AST ○ NH₃ ○ Albumin ○ Prothrombin time ○ BUN (produced by liver sent to kidney for excretion)
• Classify Jaundice. Give an example of each.
○ Hepatocellular
§ Cirrhosis, Hepatitis B/C/D
○ Obstructive
§ GB stones
○ Hemolytic
§ Sickle cell anemia
• Chronic complications of Diabetes mellitus include: ○ A: Blindness ○ B: Renal Failure ○ C: Heart attack ○ D: all of the above
○ All of the above
“HKBL^2”
• In Type 1 Diabetes mellitus there is: ○ A: incapability of using insulin ○ B: No insulin present ○ C: No pancreas present ○ D: No islets of Langerhans present
○ No insulin present
• Leg pain of the intermittent claudication variety is suggestive of: ○ A: arterial insufficiency ○ B: venous insufficiency ○ C: Neuropathy ○ D: Deep thrombophlebitis
○ A: arterial insufficiency
• High hemoglobin A1C suggests: ○ A: good control of D.M. ○ B: Poor D.M. control ○ C: Diabetic complication ○ Presence of other disease in addition to D.M.
○ B: poor D.M. control
• Which one of the following is a cause of secondary hypertension: ○ A: portal hypertension ○ B: Carotid artery stenosis ○ C: Anemia ○ D: Renal artery stenosis
○ D: Renal artery stenosis
• Lab tests for acute pancreatitis include: ○ A: Creatinine ○ B: Amylase ○ C: LDL ○ D: Troponin
○ B: Amylase
• Acute complications following acute myocardial infarction include: ○ A: Rupture of the ventricle ○ B: Hemopericardium ○ C: Ventricular arrhythmia ○ D: All of the above
○ All of the above
• The complications of uncontrolled hypertension include: ○ A: Peptic ulceration ○ B: Stroke ○ C: Pulmonary embolism ○ D: COPD
○ B: Stroke
• The PMI of the heart (apex beat) is normally located in the:
○ A: Right 5th intercostal space
○ B: Left 6th intercostal space
○ C: Left 5th intercostal space
○ D: Lateral to the left midclavicular line
○ C: left 5th intercostal space
• Non pitting edema is suggestive of: ○ A; heart failure ○ B: kidney failure ○ C: lymphedema ○ D: Liver impairment
○ C: lymphedema
• What is the pathogenesis (basic cause) of rheumatic fever: ○ A: ASHD ○ B: past bacterial infection ○ C: congenital heart disease ○ D: alcohol
○ B: past bacterial infection
• The risk factors of ASHD include: ○ A: sexual promiscuity ○ B: diabetes insipidus ○ C: Lack of exercise ○ D: Family history
○ D: family history
• Causes of acute pancreatitis include: ○ A: trauma ○ B: Biliary tract disease ○ C: alcohol excess ○ D: all of the above
○ All of the above
