Test 4 Clinical Applications Flashcards
Cerebrovascular Accident:
- Also called:
- Define:
- Two categories:
- Ranks where in causes of death?
- Also called: Stroke - Define: Blood loss to brain - Two categories: Ischemic stroke (caused by blockage) Hemorrhagic Stroke (caused by hemorrhage) - Ranks where in causes of death? 3rd in the US 2nd in the world
Major risk factor for a cerebrovascular accident?
Other risk factors:
Hypertension Other risk factors: Diabetes atrial fibrillation High blood cholesterol
Treatment for ischemic stroke:
Delivery of anticoagulants and antithrombolytic drugs
Excitotoxicity:
- Is what?
- How does it complicate stroke treatment?
- Is what?
Ischemia induced impairment of the removal of glutamate from synaptic cleft.
Results in a build of Ca2+ through NMDA receptors causing neuronal death - How does it complicate stroke treatment?
It increases in magnitude with the duration of ischemia, so antithrombolytics/anticoagulants must be delivered rapidly.
Atrial fibrillation:
- On a ECG:
- On a ECG:
Missing P wave
Artificial Pacemaker:
- Where is it inserted:
- How does it work?
- Where is it inserted:
Implanted in the skin under the clavicle - How does it work?
Electrodes from device are threaded into heart through a vein.
Most sense if the heartbeat is delayed and stimulate the heart on demand.
Some can even sense if you are exercising and increase cardiac rate accordingly.
- Define:
Swelling of arm or leg caused be excessive fluids and protein build up due to a blocked/damaged lymph drainage/vessel. - Complications:
Protein rich interstitial fluid can lead to inflammation, damaging peripheral tissue - Causes:
Damage from surgery or radiation therapy
Infection of nematode worm causing elephantiasis (tropics)
Lymphedema:
- Define:
- Complications:
Injection of what is given to treat endometriosis?
GnRH analog, which given at a constant level instead of a pulsatile fashion will desensitize the anterior pituitary.
What do birth control pills contain?
How do they prevent contraception?
Synthetic progesterone and estrogen.
High levels of progesterone and estrogen simulate the luteal phase. A week spent of the pills mimics menstruation and allows shedding of buildup of stratum functionale which is seen in the luteal phase.
The patient will then be returned to pseudo-luteal phase by more synthetic progesterone and estrogen.
Low blood plasma conc.
- Relation to edema development?
This lowers oncotic pressue, as the plasma colloid osmotic pressure is less. This will result in less water returning into the capillaries, and more leaving
Hypoproteinemia:
- Relation to edema development?
Filariasis:
an infection by a nematode worm
Elephantiasis:
A complication of filariasis, where the nematode larvae occupy and block lymphatic vessels
This causes build up of interstitial fluid and EDEMA from inability to drain
Is Elephantiasis treatable?
Filariasis?
No.
Yes.
At what rate is water lost per hour through sweat?
900 ml (I doubt this matters)
- Causes of failure during exercise related to dehydration:
- Why is drinking water alone insufficient to restore rehydration?
- What is better?
- Causes of failure during exercise related to dehydration:
Decreased cardiac output
Inability to cool oneself
Difficulty in oxygen flow - Why is drinking water alone insufficient to restore rehydration?
Salts are also lost during sweating, water does not restore these - What is better?
Electrolyte drink, such as a sports drink
Sal is Roman for what?
Gandhi encouraged people to make their own ____.
Salt
Salt
Angiotensin Converting Enzyme Inhibitors:
- Do what?
- Examples:
- Treats:
- Do what?
Inhibit the conversion of Angiotensin 1 to angiotensin 2
Lowers blood pressure by alleviating vasoconstriction
Lower secretion of aldosterone by adrenal cortex - Examples:
Captopril, enapril, and lisinopril - Treats:
Hypertension, heart failure, stroke, and potential kidney failure
Angiotensin receptor blockers (ARBs):
- Do what?
- Examples:
- Treats:
- Do what?
Inhibits binding of angiotensin 2 to its target sites
Lowers blood pressure by alleviating vasoconstriction
Lower secretion of aldosterone by adrenal cortex - Examples:
Telmisartan, losartan, and valsartan - Treats:
Hypertension, heart failure, stroke, and potential kidney failure
Essential hypertension:
Primary hypertension (hypertension without a known secondary cause)
In Vitro Fertilization is done by what method in this application:
Ovarian Hyperstimulation -> collect eggs -> intracyoplasmic sperm injection (ICSI) -> grow from 3 - 5 days (8 cell or blastocyst) -> transfer 3 or more embryos into uterus with a small tube
Ovarian Hyperstimulation:
Give FSH at high levels (or another gonadotropin, but this one is the most common)
->
Produces high number of eggs which can be collected
Intracytoplasmic sperm injection (ICSI)
insertion of a single capacitated sperm through zona pellucida and into the cytoplasm of an egg.
Angiogram:
- Define:
- Meant to identify:
- Define: catheter is guided to spot of interest. Iodine contrast material is injected is injected into blood X-ray taken, with venous contrast increased - Meant to identify: Plaque Atherosclerosis Spasm
Coronary angiogram is the primary method to assess what?
Coronary artery disease
Coronary Angioplasty:
- Used:
- Common complication:
- Used:
tube with a balloon is inserted into artery and inflated to open it - Common complication:
Restenosis (recurrence of narrowing)
How is restenosis normally prevented in a coronary angioplasty?
Insertion of a stent (metallic mesh tube)
Most common open heart surgery.
A vessel taken from the patient is grafted back onto the patient to bypass a block or troublesome area
Coronary bypass grafting (CABG):
Orthostatic (postural) hypotension:
Hypotension which occurs upon standing
Postprandial hypotension:
hypotension after eating a meal, most common in elderly individuals
Orthostatic Hypotension is prevented by the baroreceptor reflexes, unless there is an underlying condition like:
Anything which causes low blood pressure.
Dehydration
Medications (beta adrenergic receptor blockers)
post-prandial hypotension
Valsalva Maneuver:
Bearing down, as if having a bowel movement, while trying to exhale, while preventing exhaling (plugging nose)
What does the Valsalva Maneuver do?
1: Intrathoracic pressure raises:
- Fall in atrial pressure
- Reduces pressure on baroreceptors
2: baroreceptor reflex
- Heart rate slows
3: Venous return
- There is a fall in venous return due to rise in intrathoracic pressure
4: baroreceptor reflex
- Increases heart rate (due to low venous return dropping pressure)
5: person again breathes
- Intrathoracic pressure falls
- Less pressure in the aorta briefly
6: baroreceptor reflex
- Increases heart rate (due to low venous return dropping pressure)
7: improved venous return
- Causes rise in aortic pressure
8: baroreceptor reflex
- Decreases heart rate
When is Valsalva maneuver accidentally performed:
Weightlifters when they hold their breaths
Those straining at stools
When is the Valsalva maneuver dangerous?
When someone has coronary heart disease
Preclampsia:
- Definitive symptoms:
- Possible additional symptoms:
- Definitive symptoms: Hypertension onset during pregnancy Damage to liver and kidney - Possible additional symptoms: Thrombocytopenia Proteinurea (protein in urine)
Preclampsia protein in urine:
- cause:
- consequences:
- cause: Damage to glomeruli, allowing protein to leak through - consequences: Low plasma conc. of proteins Lower oncotic pressure Edema
Treatment for preclampsia:
Delivery of baby
What may be the cause of preclampsia:
Dysfunction in the placenta involving vasoconstriction and hypoxia within uterus/placenta
Crohn’s disease:
Can involve loss of proteins into the intestines
What type of cell does HIV infect?
Which region is hit hardest?
CD4 T cell (helper T cells)
The gastrointestinal tract, where up to 30% of helper t cells reside
What does loss of CD4 T cells (helper T cells) result in?
Reduction in Cell mediated immunity, which targets intracellular issues.
Increased risk of: cancer, opportunistic infections (especially tuberculosis, and other intracellular parasites)
ART stands for (HINT: HIV related):
- Inhibits what enzyme?
Anti-Retroviral Therapy
Reverse transcriptase
ART has what antiviral targets?
- Efficiency?
Two different reverse transcriptase inhibitors
One protease inhibitor
- Efficiency?
Can delay HIV indefinitely, but does not cure it
What hope is there for HIV treatment?
Early ART intervention reduces risk of spread by 96%
Vaginal antiretroviral gels reduce transmission of HIV to women
Circumcision reduces risk a man will be infected with HIV
Vaccines against HIV may be possible. Utilizing passive immunity antibody treatments and designer antigens
Sepsis:
- Define:
- Symptoms:
- Define: Whole body inflammation, usually caused by a bacterial infection - Symptoms: Organ dysfunction Hypotension (mass scale vasodilation caused by histamine/NO/Seratonin) Hypoxemia Oliguria (low urine output) Acidosis (due to lactic acid)
Treatment of sepsis:
Antibiotics, intravenous fluids, and more aggressive measures when required
Septic Shock:
Where blood pressure falls so all organs are not perfused due to an inflammatory response
Endotoxin:
- Other name:
- Complication:
- Bacteria type:
- Other name:
Lipopolysaccharide - Complication:
Small amounts activate toll-like receptors, helping.
Large amounts in circulation is the most common cause of sepsis - Bacteria type:
Gram negative bacteria
Glucocorticoid drugs:
- Examples:
- Use:
- Examples:
Hydrocortisone, cortisone, prednisone, prednisolone, and dexamethasone - Use:
Suppress immune system to treat inflammation, autoimmune diseases, and allergies.
Glucocorticoids:
- Specificity iin T cells:
- Specificity in T cells:
Broadly inhibitory but enchance Th2 cells over Th1 cells, this shifts from cell-mediated to humoral immunity
Glucocorticoids:
- How do they work:
- Cytokines suppressed have whatever functionality:
- How do they work:
Suppress pro-inflammatory cytokines (Interleukins, including IL-1, gamma interferon, and TNFalpha) - Cytokines suppressed have whatever functionality:
cytokines promote Corticotropin-releasing hormone -> ACTH -> Cortisol
Reduction of cytokines results in less CRH, and therefore less cortisol, making a negative feedback system between the nervous endocrine and immune system
Glucocorticoids:
- Cytokines suppressed have whatever functionality:
- What cells produce the cytokines which these cytokines:
- Cytokines suppressed have whatever functionality:
cytokines promote Corticotropin-releasing hormone (hypothalamus) -> ACTH (anterior pituitary) -> Cortisol
Reduction of cytokines results in less CRH, and therefore less cortisol, making a negative feedback system between the nervous endocrine and immune system - What cells produce the cytokines which these cytokines:
Microglia
NMDA stands for:
- Related to what disease?
N-methyl D-aspartate
Excitatory toxcitity, overstimulated by glutamate causing Ca2+ build up (it’s a Ca2= ion channel)
