Test 4 Stuff (bruzz) Flashcards
What’s endocarditis?
Inflammation of endocardium
Caused by bacteria, viruses, fungi, ricketsia, parasites
Classic Findings of endocarditis
Fever
New or changed cardiac murmur
Petechial lesions of the skin , conjunctiva, and oral mucosa
Characteristic physical findings:
Olser nodes
Janeway lesions
What is rheumatic fever?
Systemic inflammatory disease
Streptococcal infection causing autoimmune response against molecularly similar self antigens in the heart, muscle, brain, and joints, causing an autoimmune response leading to inflamatory lesions in these tissues
Major clinical manifestations of rheumatic fever
Carditis: Murmur , chest pain, pericardial friction rub, ECG changes, valvular dysfx
Polyarthritis: Heat, redness, swelling, and joint pain
Chorea: Sudden, aimless, irregular, involuntary movements
Erythema Marginatum: Nonpruritic, erythemateous macules on the trunk that may fade on center
Subcutaneous nodules: Palpable nodules over bony prominences and extensor tendons
What is Frank Starling Mechanism? (heart failure)
Heart stroke volume increases in response to increased blood volume in ventricles
What is systolic heart failure?
EF is less than 40%
Inability of heart to generate adequate cardiac output to perfuse tissues
Stroke volume:
Manifestations of Left heart failure
Cough of frothy sputum
pulmonary edema
S3 gallop
What is diastolic Heart Failure?
Impaired filling of the heart during diastole
What are the types of Valvular Dysfunctions?
Valvular Stenosis
* Aortic Stenosis
* Mitral Stenosis
Valvular Regurgitation
* Aortic Regurgitation
* Mitral regurgitation
* Tricuspid regurgitation
Causes of aortic stenosis ?
Congenital bicuspid valve
Degeneration with aging
Inflammatory damage caused by rheumatic heart disease
What happens in aortic stenosis?
The orifice of the valve narrows causing resistance to blood flow from the left ventricle to aorta
True or False: Left ventricular hypertrophy occurs to compensate for increased workload in Aortic Stenosis?
TRUE
Treatment of Aortic Stenosis
Vasdilator therapy to reduce ventricular ejection
Surgical valve replacement
What does Mitral Stenosis do ?
Impairs the flow of blood from the left atrium to left ventrical
Results in incomplete empyting of the left atrium and elevated atrial pressure , continued increases in left atrial volume, atrial dilation and hypertrophy
What can mitral stenosis lead to?
A Fib
Thrombus formation
Pulmonary Hypertension
Pulmonary Edema
Right Ventricular failure
What does aortic regurgitation result from?
Inability of aortic valve leaflets to close properly during diastole
Some blood flows back into left ventricle
Leads to ventricular dilation and hypertrophy and heart failure can develop
Priimary and Secondary causes of aortic regurgitation
Primary: Congenital bicuspid valve or degeneration in elderly lol
Secondary: Chronic Hypertension, rheumatic heart disease, Bacterial endocarditis, syphillis, Connective tissue disease, appetitie suppressing medications, trauma, atherosclerosis
Manifestations of aortic regurgitation
Widened pulse pressure resulting from increased stroke volume and diastolic backflow ; can play a role in eye and kidney damage
Murmur in the 2nd, 3rd, or 4th intercostal spaces parasternally
Dysrhythmias
What does Mitral Regurgitation do?
Permits backflow of blood from left ventricle into left atrium during ventricular systole
Left atrium and ventricle become dilated and hypertrophied leading to heart failure
Symptoms of mitral regurgitation
Murmur ; heard best at apex and that radiates into back and axilla
What mostly causes tricuspid regurgitation?
Pulmonary Hypertension and dilation of right ventricle which pulls the valve leaflets apart
Can lead to volume overload in the right atrium and left ventricle, increased systemic venous blood pressure, and right heart failure
How does preload and afterload effect renal or hypertension?
Preload: Increases with decreased contractility or an excess of plasma volume; decreased ejection fration ; leads to renal failure, mitral valve disease
Afterload: Leads to hypertension ; decreased renal perfusion and increase in renin and angiotensin
What can cause right side heart failure?
Pulmonary diseases ; COPD, cystic fibrosis, ARDS
What kinds of shock are there and what’s their cause?
Cardiogenic: Heart failure or MI
Hypovolemic: Insufficient intravascular fluid volume
Neurogenic: Neural alterations of vascular smooth muscle tone
Anaphylactic : Immunologic process
Spetic: Infection
What is cardiogenic shock?
Decreased cardiac output and tissue hypoxia in presence of adequate intravascular volume
What are the compensatory systems of cardiogenic shock?
Renin angiotensin aldosterone and ADH to maintain blood volume or increase
Adrenal gland releases catecholamines like epi and norepi which causes vasoconstriction and increase contractility of heart
Hypovolemic shock happens when intravascular volume decreases by how much?
15%
What are the compensatory mechanisms of hypovolemic shock?
- HR and SVR increase, boosting cardiac output and tissue perfusion presures
- Interstitial fluid moves into vascular compartment
- Liver and Spleen add to blood volume by releasing stored red blood cells and plasma
- Renin stimulates aldosterone release
- ADH increases water retention
What is neurgenic shock?
Widespread vasodilation
Results in relative hypovolemia ; blood volume has not changed but SVR decreases so amount of space containing blood has increased
What can cause neurogenic shock?
Trauma to spinal cord or medulla
Depressive drugs, anesthetic agents, severe emotional distress and pain
Symptoms of neurogenic shock?
Hypotension
Bradyarrhythmia
Lushed
Mental status changes
Anaphylactic Shock symptoms
Vasodiltion and relative hypovolemia
Anxiety
Dizziness
Diff breathing
Stridor
Hives
Swollen Lips and Tongue
How to treat anaphylaxis
Epi
FLuids
Antihistamines and corticosteroids
Vasopressors and bronchodilators
Septic Shock symptoms
Systemic inflammation leading to systemic inflamatory response syndrome ; fever, tachycardia, tachypnea, elevated WBC
Early Stage: Hyperdynamic phase characterized by widespread vasodilation with compensatory tachycardia and increased cardiac output
Later stage: Decreased Myocardial contractility, cardiac output, and tissue perfusion
What are signs of organ failure due to sepsis?
Increased serum lactate
Thrombocytopenia
Hypotension
Hyperglycemia
Coagulalation abnormalaties
Increased bilirubin
Oliguria
Ileus
How is thermoregulation maintained?
Heat production
Heat Conservation
Heat Loss
What part of brian regulates body temp?
Hypothalamus
Peripheral thermoreceptor examples
Skin
Liver
SKeletal muscle
Central thermoreceptor examples
Hypothalamus
SPinal cord
VIscera
How does hypothalamus regulate body temp?
Stimulates anterior pituitary to releasse thyroid stimulating hormone
Hypertonia sub group things
Spasticity: gradual increase in tone
Gegenhalten: Resistance to passive movements
Dystonia: SUstained involuntary muscle contraction
Rigidity: Muscle resistance to passive movement of rigid limb that is uniform in both flexion and extension
What is Hyperkinesia?
Excessive purposeless movement
What is Paroxysmal Dyskinesias?
Rare involuntary movements that occur as spasms
Types of Paroxysmal Dyskinesias
Dystonia: Uncontrollable twisting, repetitive movement resulting in abnormal posture
Chorea: Abnormal jerky movements
Athetosis: Slow, irregular, twisting movements most obvious in distal extremitites
Ballism: Combination of all deez
What’s Tardive Dyskinesia?
Involuntary movement of the face, lip, tongue, trunk, and extremities
Can result as a side effect of antipsychotic therapy
What’s the most common symptom of tardive dyskinesia?
Rapid, repetitive, stereotypical movements
Continual chewing with intermittent protrusions of the tongue, lip, and facial grimacing
What is tourette syndrome?
Hallmark is presence of motor tics and vocal tics
Sensory tics: Unplasant sensations in face, head, and neck areas
What is Huntington Disease?
Autosomal Dominant hyperkinetic disorder of chromosome 4
Severe degeneration of basal ganglia specifically the caudate nucleus
There is a depletion of GABA
Symptoms of Huntingtons Disease
Progress over 15-20 years
Involuntary hyperkinetic movements like chorea, athetosis, ballism
Cognitive defects: SLow thinking, loss of memory, reduced capactiy to plan organize or sequence
Restlessness, disinhibilitation, irritibility are common
Apathy, depression , anxiety may follow
What is hypokinesia?
Loss of voluntary movement despite normal consciousness and peripheral nerve and muscle function
Types of hypokinesia?
Akinesia: Decrease in voluntary and associated movements
Bradykinesia: Slowness of voluntary movements
Loss of associated movement: Expressionless face, statue like posture, absence of speech, reduction in arm and shoulder movements
What is Parkinson Disease?
Depletion of dopamine
Excess of cholinergic activity
SYmptoms of parkinsons
Hypokinesia
Hypertonia
Resting remor, rigidity, bradykinesia/ akinesia, postural disturbance, dysarthria, dysphagia
Urinary urgency, sleep disorders,
Nonmotor symptoms: Inappropriate diaphoresis, ortho hypo, drooling
What are upper motor neuron syndromes?
Result from injury to motor pathways that descend from motor cortex
Can result from trauma, stroke, or tumors
Types of upper motor neuron syndromes
Paresis: Partial paralysis with incomplete loss of muscle power
Paralysis
Types of upper motor neuron paralysis
Hemiparesis/ Hemiplegia: Paresis/ paralysis of upper and lower extremities on one side
Diplegia: Both sides of body as a result of cerebral hemisphere injuries
Paraparesis/ Paraplegia: Lower extremities as a result of lower spinal cord injury
Quadriplegia: Paresis of all 4 extremities as a result from upper spinal cord injury
What are lower motor neuron injuries?
Result from injury to alpha motor neurons
Impair voluntary and involuntary movements
Types of lower motor neuron injuries
Flaccid paresis: Hypotonia and is accompanied by hyporeflexia or areflexia
Fasciculations: Muscle rippling or quivering under the skin because of muscle denervation ; tend to atropht over months
Fibrilation: Contraction of a single muscle fiber because of metabolic changes in denervated muscle
What is guillain barre syndrome?
Acquired inflammatory disease that causes demyelination of peripheral nerves
Usually caused by respiratory or GI infection
Symptoms of guillain barre syndrome
Tingling
Weakness
Paralysis of leg
Quadriplegia
Respiratory insufficiency
Autonomic nervous system insufficiency
How long does it take usually to recover from guillain barre syndrome?
Within weeks or months
Or up to 2 years
What is amytopic lateral sclerorsis?
Neurodegenertive disorder involving upper and lower motor neurons
Disease in brain and spinal cord
Typically diagnosed between 40-60
Usually spares sensory neurons
Symptoms of ALS
Muslce weakness in arms and legs
DIfficulty with cordination
Progresses to repsiraotry failure
What kinds of posture disorders are there?
Dystonia: Abnormal posture through muscle contractions
Dystonic: When dystonia lasts for long time
Decorticate: Arms flexed inwards, hands clenched, legs extended
Decerabate: Rigid muscles, extended arms and legs, arched back
Basal Ganglion: Stooped, hyperflexed posture with narrow based, short stepped gait
What are the disorders of gait?
Spastic gait: Shuffling, leg extended and held stiff
Cerebellar/ Ataxic: Wide based with feet apart and turned outward or inward
Basal Ganglion Gait: Broad Based Gait ; walks with small steps and decreased arm swinging, associated with parkinsons
Frontal Lobe Ataxic: Slow walking, freezing, start hesitation
What are the disorders of expression?
Hypermimesis: Pathological Laughter or crying ; right hemisphere injury if laughte; left hemisphere if crying
Hypomimesis: Aprosady ; Loss of emotional language, can be receptive or expressive
Apraxia: Disorder of learned skill movement with difficulty planning and executing coordinated motor movements
What is spinal shock?
Manifestation of spinal cord trauma
Normal activity of spinal cord ceases at and below level of injury
Manifestations of spinal shock
Complete loss of reflex function
Flaccid paralysis
Abscence of sensation
Incontinence
Transient drop in BP
Bradycardia
Poor venous circulation
What is multiple sclerosis?
Chronic and progressive CNS autoimmune inflammatory disease that effects peripheral nervous system
Demyelinating disorder that disrupts nerve conduction
Symptoms of Multiple Sclerosis
Paresthesia
Impaired giat
Urinary Incontinance
Visual Impairment
Cerebellar And Corticospinal involvment: Nystagmus, ataxia, weakness, with all 4 limbs involved
What is myasthenia gravis?
Aquired Chronic Autoimmune Disease
Muslce of the eye, face, mouth, throat, and neck are effected first
IgG antibody produced against acetylcholine receptors
Myasthenic and Cholinergic crisis
Very similar
Severe muscle weakness causing quadraplegia
Resp insufficiency
Extrememe Diff in swallowing
Rise in BP, Tachy cardi, Tachypnea
What is NREM sleep?
75- 80 % of sleep time
Brain stem coordinates activity between spinal cord and various reflexes
Quiet type of sleep
Relatively inactive but fully regulating brain
Fully moveable body
Sympathetic tone decreased but parasympathetic activity increased ; decrease in metabolic rate, temperature, HR, respiration, BP, muscle tone
What is REM sleep?
EEG similar to an awake person
Loss of muscle movements
Vivid dreams
Motor systems inhibited
BP, HR, Respirations increase and fluctuate, temp regulation is lost
Cerebral blood flow and metabolic rate decrease
Brain highly active
What is sleep apnea?
Central: Uncommon
Obstructive: Caused by upper airway obstruction
Manifestations of sleep apnea
Noisy snoring
Insomnia
Abnormal Movements during sleep
Morning Headaches
Excessive daytime sleepiness
Treatment of sleep apnea
Behavioral Methods
Positive pressure by a nasal or naso-oral CPAP
Traumatic vs nontraumatic brain injury
Traumatic: External force like getting hit
Nontraumatic: Strokes, infections, lack of oxygen
What’s excitatory amino acid injury?
Brain injury leads to an overabundance of excitatory amino acids
Excessive glutamate: Cause uncontrolled influx of sodium, potassium, and especially calcium ions into neurons
Signs of brain injury
Alterations in cognitive, sensory and motor function
Changes in LOC: FOcal injury and Infratentorial (brain stem)
Cheyne strokes breathing
Decorticate postering
decerebrate posturing
What are the alterations in arousal?
Metabolic: Alterations in delivery of oxygen ; seen with hypoxia, electrolyte disturbances, hypoglycemia
Psychogenic: Uncommon, may signal psychiatric disorders, despite apparant unconsiousness ; person is physiologically awake
Evaluation of conscioussness
Level of consciousness
Pattern of breathing
Pupillary Reaction
Oculomotor responses
Motor responses
What criteria to be declared brain dead?
Irriversible cessation of all brain functions
Asbcence of brainstem reflexes
Coma
Absence spontaneous
Confirmed by:
Physical assessment to confirm lack of responsiveness and brainstem reflexes
EEG to monitor brain activity
Apnea test to assess breathing without mechanical support
What’s a persistant vegitative state?
Loss of higher brain functions but with preserved brainstem function
Person may still be alive with basic reflexes and life support
Types of brain edema
Vasogenic: Caused by damage to blood vessels in brain allowing fluid to leak into brain tissue
Cytotoxic: Caused by damage to brain cells, which then swell and accumulate fluid
Interstitial: Caused by blockage of cerebrospinal fluid leading to accumulation in brain tissue
Osmotic Edema: Caused by imbalance of electrolytes, causing fluid to move into brain tissue
Treatment of brain edema
Reduce ICP
Manage underlying cause
Remove excess fluids
Correct electrolyte imbalanance
Stages of increased ICP
1: Normal
2: Episodes of confusion and restlessness
Pupils still equal and reactive
3: Beginning of decompensation ; pupils small ; breathing slow
What do basilar skull fractures increase the risk of?
Infection of meningitis or brain resulting in leakage of CSF
What’s a close brain injury ?
Head strikes surfaces
Dura remains intact and brain is not exposed
Coup: Directly below point of impact
Contrecoup: Injury opposite side of impact
Injuries include contusions, subdural or epidural hematomas
What’s an open brain injury?
Injury breaks dura and exposes cranial contents of the environment
Causes both faccal and diffuse injuries
What kind of hematomas are there?
Epidural
Subdural
Traumatic intracerebral hematoma
Epidural, subdrual, and traumatic intracerebral hematoma phases
Acute: Within 48 hours of injury theres symptoms
Subacute: SYmptoms 2- 14 days after
Chronic: symptoms weeks after
What’s a subdural hematoma?
Bleeding between dura matter and arachnoid membrane
What’s and epidural hematoma?
Bleeding between dura matter and skull
Symptoms: Headache, vomitting, drowsiness, confusion, seizure
Acute subdural hematoma
SYmptoms worsen over time
Homonymous hemianopia: Loss of vision in either right or left field , dysconjugate gaze, gaze palsies ; midline shift of greater than 5 mm are suggested as clinical parameters for surgery
Intracerebral hematomas
Bleeding within the brain
Increases ICP
Compresses brain tissue
Causes edema
Whats a transient ischemic stroke?
Event lasting less than an hour
Thromolic stroke vs embolic
Thromolic: Thrombus formation in arteries supplying brain or intracranial vessels
Embolic: Thrombus fragments obstruct brain vessels
What’s cushing reflex?
Physiological respopnse to increased ICP
Characterized by HTN, Bradycardia, Irregular Respirations ; indicates brain herniation
