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Health Studies > roop week 12 > Flashcards

roop week 12 Flashcards

1
Q

what is a 4th heart sound?

A

S4 and atrial gallop
(you should not be able to hear unless you are a child or small person)

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2
Q

the 4th heart sound occurs before ___ when ___ contract to force blood into the left ventricle

A
  1. S1
  2. atria
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3
Q

if the left ventricle is ___ and atrial contraction forces blood thru the atrioventricular valves, S4 is produced by the blood striking left ventricle

A

noncompliant

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4
Q

Noncompliance can be caused by the overreaction from hypertension leading to ___

A

ventricular hypertrophy

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5
Q

___is the closure of AV valves

A

S1

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6
Q

____is the closure of semilunar valve

A

S2

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7
Q

The S4 heart sound is a low frequency sound in ____

A

late diastole

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8
Q

what is the sound the 4th heart sound makes?

A

Le-lub-dub

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9
Q

what is the S4 heart sound caused by?

A

the atrial kick into a noncompliant ventricle

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10
Q

The 4th heart sound is seen in patients with stiffened left ventricles, resulting from conditions such as ?

A

hypertension, aortic stenosis, ischemic or hypertrophic cardiomyopathy, acute MI

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11
Q

In patients with mitral regurgitation, suggestive of acute onset of regurgitation due to the rupture of the ____that anchors the valvular leaflets

A

chorda tendinae

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12
Q

The 4th heart sound is heard best with the ____ of the stethoscope at the apex

A

bell

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13
Q

S4 pathology:
-rightventricular: _____

A

pulmonary stenosis and PAH

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14
Q

S4 pathology:
-left ventricular: ____

A

systemic HTN, aortic stenosis and HCM

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15
Q

other S4 pathology?

A

coronary artery disease, acute regurgitation lesions and heart block

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16
Q

what consists of S4 physiologically?

A

elderly greater than 50 and hyperkinetic states

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17
Q

____something putting pressure (ICP) on optic nerve and blurring optic disc

A

papilledema

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18
Q

papilledema on fundoscopic exam: you can see ____

A

you can not see optic disc anymore

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19
Q

what consists of microvascular lesions?

A

heart, kidney and brain

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20
Q

what organ is the long term regulator of BP?

A

Kidneys

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21
Q

____water

A

duiresis

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22
Q

___salt

A

natiuresis

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23
Q

what is causing the headaches

A

cerebral edema (ICP as a result of hypertension)

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24
Q

what is causing the papilledema?

A

arteriole constriction, increase filtration pressure due to high BP and sausage string pattern (blood vessels become constricted)

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25
Q

____vasocontrict, to decrease blood volume and control how much blood is coming in

A

arteriole

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26
Q

____cerebral edema is impinging optic nerve causing papilledema

A

increase filtration pressure due to high BP

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27
Q

increased blood pressure leads to failure of autoregulation leading to forced vasodilation (sausage string pattern), leading to ___endothelial permeability, hypoperfusion and ___ capillary hydrostatic pressure leading to ___

A

1and 2. increase
3. cerebral edema leading to hypertensive encephalopathy (headache, nausea, vomiting, altered mental status, convulsions)

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28
Q

Is the patient in renal failure?

A

Yes, bun and creatine levels are high, patient has not been able to urinate for the past 24 hours, metabolic acidosis (bicarbonate, ph and hydrogen iron is low)

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29
Q

Acidosis or alkalosis?
Respiratory:
PCO2 increase
H+ increase
PH low
HCO3- increase
Metabolic:

PCO2 normal or low
H+ increase
PH low
HCO3- low

A

Acidosis

30
Q

Acidosis or alkalosis?
Respiratory:
PCO2 decrease
H+ decrease
PH increase
HCO3- decrease
Metabolic:

PCO2 normal or increase
H+ decrease
PH increase
HCO3- increase

A

Alkalosis

31
Q

Is that patients myocardium damaged?

A

No, cardiac enzymes were not high and no shift in ST segment (damages to the heart like ischemia or infarction results in changes/shift in ST segment)

32
Q

Vasoconstriction of the afferent arteriole ____ resistance and ____ renal blood flow, capillary blood pressure (pH) and GFR

A

Increase, decrease

33
Q

-increase in bp results in pressure ____
- all these mechanisms results in low GFR, which activates the macula densa/ JG apparatus, thereby producing renin

A

Natiuresis

34
Q

____ sense distal tubule flow and release paracrines that affect afferent arteriole diameter

A

Macula densa cells

35
Q

____secrete renin, an enzyme involved in salt and water balance

A

Granular cells

36
Q

____detect low GFR in the distal convoluted tubule

A

Macula densa cells

37
Q

___simple cuboidal cells, when they become closely packed and tall = macula densa

A

DCT

38
Q

What occurs in a decrease in blood pressure

A

Decrease GFR, decrease NaCl transport, macula densa of distal tubule, paracrines and direct effect on granular cells of afferent arteriole producing renin, cardiovascular control center increasing sympathetic activity

39
Q

Liver constantly produces ____ —> Renin—> ANG I in plasma, blood vessel endothelium contains _____ —> ANG II in plasma

A
  1. Angiotensinogen in the plasma
  2. ACE enzyme
40
Q

What does ang II in plasma do to arterioles and cardiovascular control center in medulla oblongata

A

Arteriole: vasoconstrict leading to increased blood pressure
Cardio: increased cardiovascular response leading to increase blood pressure

41
Q

What does AnG II do to the hypothalamus, adrenal cortex and proximal tubule?

A

-hypothalamus: increased vasopressin, increased thirst leading to increased volume and maintain osmolarity
-adrenal cortex: increased aldosterone and increased Na leading to increased volume and maintain osmolarity
-proximal tubule: increased Na leading to increased volume and maintain osmolarity

42
Q

What would be the treatment for the patient?

A

Admit to the hospital give sodium nitroprusside (vasodilator) to gradually lower the bp given by IV

43
Q

<120/<80 mmHg promote healthy lifestyle, reassess BP annually

A

Normal blood pressure

44
Q

120-129/<80 mmHg start with nonpharmacologic therapy, reassess BP in 3-6 months

A

Elevated bp

45
Q

130-139/ 80-89 mmHg ASCVD or 10 year CVD risk greater than or equal to 10% start with non pharmacologic and pharmacologic therapy. Reassess BP in 1 month. If at goal, reassess 3-6 months. If not at goal assess for adherence and consider intensification of therapy

A

Stage 1 hypertension

46
Q

130-139/80-89 mmHg no ASCVD and 10 year CVD risk less than 10%. Start with nonpharamcologic therapy, reassess bp in 3-6 months. If not at goal, consider initiation of pharmacologic therapy

A

Stage 1 hypertension

47
Q

Greater than or equal to 140/ greater than or equal to 90 mmHg, start with both nonpharmacologic and pharmacologic therapy. Reassess bp in 1 month. If at goal, reassess every 3-6 months. If not at goal, assess for adherence and consider intensification of therapy

A

Stage 2 hypertension

48
Q

One year later bp 142/91 , what would be the treatment now?

A

National guidelines recommend diuretics as intitial therapy for pts with uncomplicated hypertension who have not responded to lifestyle changes

49
Q

Works in the DCT and blocks NaCl channel

A

Thiazides: hydrochlorothiazide

50
Q

____ reabsorbs most of sodium (67%), which is why you do not use drugs that work here unless very severe hypertension

A

Proximal tubule

51
Q

Blocks NKCC2 from cycling not moving them into cells
-releasing 25% of na, followed by water

A

Loop diuretics: furosemide (LASIX)

52
Q

Aldosterone antagonist, binds to potassium receptors

A

K+ sparing diuretics: spironolactone

53
Q

___inhibit na reabsorption at the P cells of the distal nephron

A

k+ sparing diuretics

54
Q

Case: 68 year old woman is being treated with 25 mg of hydrochlorothiazide. During her check up last week, her bp was 161/93 she was also diagnosed with type 2 DM. What changes would be made for treatment?

A

-keep bp low trying to protect the heart
-diabetes affects every single organ, change to loop diuretic and another diuretic, increase dosage, lifestyle changes and pharmacological intervention

55
Q

Patient is prescribed with enalaprilnalong with hydrochlorothiazide, what are the side effects?

A

Constant dry cough and angioedema are the primary side effects
-also watch for hypotension

56
Q

Ace inhibitors also block the degradation of ___and ___. If angioedema occurs stop drug and substitute with ang II receptor antagonist

A

Bradykin and substance P

57
Q

____are known to reduce effectiveness of many anti hypertensive drugs, especially blocking RAAS

A

NSAIDS

58
Q

____cross the placenta but have not shown any effects on the fetus

A

All thiazide like drugs

59
Q

_____are teratogenic. Methyldopa (a sympatholytic) is considered a safe alternative in pregnancy

A

Ace inhibitors and AT1 receptor antagonists

60
Q

___ means vasodilator that decreases bp

A

Sympatholytic

61
Q

hypertension damages small blood vessels resulting in ____

A

fibrinoid necrosis

62
Q

what is the arterial and venous flow in the kidneys?

A

artery: renal artery, segmental arteries, interlobar arteries, arcuate arteries, cortical radiate arteries, cortical radiate arterioles, afferent arterioles, glomerulus, efferent arteriole, peritubular capillaries
venous; venules, cortical radiate veins, arcuate veins, interlobar veins and renal vein

63
Q

autoregulation results in vasoconstriction of the ____ until autoregulation mechanisms fail

A

afferent arterioles

64
Q

____
-any part of the tunica media in smooth muscle
-release renin
-high renin in his blood test

A

JG cells in afferent arteriole

65
Q

_____
-precursos to angiotensin
-converts renin to Ang I
-made in the liver
-plasma protein

A

angiotensinogen

66
Q

____converts Ang I to Ang II

A

ACE

67
Q

43 year old man bp 138/88, he has no other health problems and his blood lab results are normal range. He is slightly overweight and has a family history of cardiovascular disease. What is the treatment?

A

-start with nonpharmacological therapy
-he is in stage 1 hypertension
-No ASCVD (no cardiovascular disease risks)
-dietary changes: DASH dietary approaches to stop hypertension, low sodium and decrease in fats, exercise

68
Q

____works in the nucleus of P cells to reabsorb sodium

A

aldosterone

69
Q

____are the first line drugs for diabetics with hypertension as they slow the development and progression of diabetic glomerulopathy
-drugs: captopril, enalapril, lisinopril, and quinapril

A

ACE inhibitors

70
Q

______is the most common, drugs works by inhibiting ACE and can not produce Ang 2

A

lisinopril

71
Q

How would you treat patient if only BP increases and she had no diabetes?

A

change diuretics, increase dosage and monitor patient

Health Studies (8 decks)

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