Things I cannot Remember Test 1 Flashcards
Blood pressure extrinsic factors
Disease
Obesity
HTN is a key risk factor for
Stroke
Primary HTN has what kind of etiology
Heterogenous, unknown
Risk factors for secondary HTN in women due to hormones
Smoking*
History of HTN during pregnancy
Family history
Symptoms of hypertensive urgency
Severe headache and anxiety
HTN emergency symptoms and potential complications
End organ damage
Chest pain
SOB
Difficulty speaking
Complicaitons:
Stroke
Pulmonary edema- blood leaks out of heart into lungs.
CVD
Disease of the heart and vessels that affect the efficient functioning of the cardiovascular system.
How many adults have CVD? What are the 4 types of CVD
- Hypertension
- Coronary heart disease
- Stroke
- Heart failure
Leading cause of mortality in the US from CVD
- Heart disease
2. Stroke
Primary form of CVD
Coronary heart disease- disease of blood vessels that supply the heart.
Hyperlipidemia levels
Tg 150+
HDL less than 40
LDL over 100
Cholesterol over 200
Secondary Hyperlipidemia due to what
Polygenic. Due to high fat diet and sedentary lifestyle. Much more common than primary/genetic.
Most common chronic disease in the US
Responsible for 80% of CVD
Atherosclerosis
CHD risk factors (4)
Smoking, HTN, hyperlipidemia, diabetes.
What causes MI
Thrombosis
Elevated blood indicators for MI
myoglobin
Troponin
Creatine kinase
Pericardium tamponade
Pericardium fills with blood. Decrease CO- swells. Less room in heart for blood.
Percutanous coronary intervention PCI for CAD
Angioplasty
Intracoronary stents
Heart failure causes
MI*
HTN
Valvular disease
Cardiomyopathy- muscle heart disease
Heart failure
Inability to increase cardiac output as needed
Left side HF
Pulmonary edema
Tachypnea- rapid breathing
Cyanosis
Right side HF
Most commonly caused by left sided failure
Peripheral edema
Hepatomegaly- enlargement of liver
Ascites- Excess venous pressure drains into abdomen.
Main cause of cardiac arrhythmia
MI- most common side effect of MI is arrhythmia.
Two forms of cardiomyopathy
- Ischemic due to thrombosis
- Non-ischemic
- Toxic: Alcohol
- Metabolic disease: hyperthyroid disease, amyloidosis,
- Infection: HIV, COVID. Post viral myocarditis.
Primary cause of cardiomyopathy myocyte injury
MI
Hypertrophic cardiomyopathy is what type of genetic defect
Autosomal dominant
AA men most likely to have
Mitral valve regurgitation may be due to
Mitral valve prolapse
backflow from left ventricle to circulation
Mitral valve prolapse
Degeneration of connective tissue in the valve.
May lead to mitral valve regurgitation.
Acute pericarditis is caused by what
Neoplasm
chronic pericarditis is caused by what
Idioparthic
Systemic associations to pericardial disease
Uremia- excessive ammonia in blood
Ocular manifestations of infective endocarditis
Roths spots
The defining feature of diabetes
Hyperglycemia
Primary pathology of Diabetes due to hyperglycemia
Vascular damage happens all over body
Normal blood glucose levels
F 70-99
R less than 140
A 5.7 or below
O Less than 140
Diagnostic criteria for diabetes
F 126+
R 200+
A 6.5 +
O 200+
Average patient with diabetes has what A1C
8.5%
Predicts likelihood of disability and death
AIC
eAG
6% AIC = blood sugar 125
For every 1% increase in AIC, add 30 mg/dl
Most common endocrine disorder in the US
Diabetes 9-11% of population.
2 main risk factors of Diabetes
Overweight, sedentary life style
diabetes is the number __ cause of death
7
3 major diabetes complications
Retinopathy
Cerebrovascular disease- stroke
Neuropathy- palsy
Diabetic is the leading cause of
Kidney failure
non traumatic lower limb amputation
New cases of blindness in adults due to retinopathy
Diabetes is a major contributor to
coronary heart disease
Stroke
Prediabetic stats
F 100-125
R 140-199
A 5.7-6.5
O 140-199
Prediabetic risk factors
Overweight, sedentary lifestyle
History of high BMI, gestational diabetes, having a baby over 9 pounds
Two causes of type 1 diabetes
Immune mediated - molecular mimicry, altered beta cells.
Idiopathic
What is type 2 diabetes mellitus
Insulin resistance
Risk factors of type 2 diabetes
Sedentary lifestyle, obesity
Gestational diabetes increases risk of type
2 by 50%
DOC for gestational diabetes
insulin
Metabolic syndrome
Percentage of people it affects
Cluster of conditions that occur together
Affects 23-25% of population
Diagnosis of metabolic syndrome
3 or more of the following
- TG over 150
- Fasting glucose over 100
- HDL less than 40
- Large waistline
- Blood pressure 135/85
3 main effects of chronic hyperglycemia
- Glycation of proteins causes abnormal crosslinking
- PKA levels increase
- Sorbital causes edema
Macrovascular results due to diabetes
Coronary artery disease
Peripheral artery disease - Amputations= ulcerations
Cerebrovascular disease - transient ischemic attack, stroke.
Other- hearing loss and immunosuppression
DM is the number 1 cause of
Lower leg amputation
Microvascular Diabetes mellitus side effects
Retinopathy
Neuropathy
Nephropathy
What damages endothelium in microvascular DM
Endothelial glycation. Basement membrane thickens and reduces O2 transmission.
Loss of pericyes = microaneursyms leak
Glycated platelets cause thrombosis- blood leakage and ischmia
prevalence of diabetic retinopathy
28-33%
Leading cause of renal failure
Diabetic nephropathy due to glomerulosclerosis
Risk factors of diabetic nephropathy
Hyperglycemia and HTN
Most common cause of death in type 1 diabetse
Diabetic nephropathy
Diabetes is the number 1 cause of
ESRD
Most common diabetic neuropathy
Peripheral
Other:
Autonomic
Proximal
Focal (cranial nerve palsies)
Incidence of diabetic retinopathy increases with ____
Duration of DM
How does diabetes contribute to cataract formation
40% increase in risk
Sorbital in lens fibers causes swelling, apoptosis, and increased free radical formation
DKA triad
Hyperglycemia
Acidic blood
High ketones
Diabetic ketoacidosis sugar level
200 mg/dl
Hypoglycemic shock sugar level
70
Severe is 50-55
Most common neurological disorder
Headaches
3 types of primary HA
TTN (80%)
Migraines (20%)
Cluster (0.4%)
Secondary HA are associated with what
Fasting Sinus inflammation Infections Stroke Trauma Refraction Medication over use
TTH are due to what?
Persistent myofascial input- constantly contracting muscle somewhere Causes pain and sterile inflammation.
Migraine neurovascular theory
Lower threshold to stimuli leads to cortical hyper excitability followed by cortical spreading depression (CSD). CSD activates trigeminal nerves and causes pain in dural blood vessels.
starts in occipital lobe
54321 Migraine criteria
24321 for classic migraines
5 or more attacks
4 hours - 3 days
2 of the following: Unilateral, throbbing, severe pain, activity worsens
1 of the following: photophobia, photophobia, vomitting, nausea
Childhood periodic syndromes
Migraines in kids. Car sickness
Probable migraine
Hasn’t met 54321 critera, but on their way.
What primary HA causes conj injection and tearing due to neuromuscular problems?
Migraines and cluster
Migraines without aura (common) has what percentage of risk for what
25% increased risk for stroke and MI
Migraines with aura “classic migraine” has what risks associated?
2x risk of MI in women
2x risk of stroke in men= women
Retinal migraines
Transient, monocular visual disturbance. Vascular spasm causes ischemia = visual disturbances. Send to neuro
What kind of primary headache causes projectile lacrimation
Cluster HA
Ophthalmodynia Periodica
Shooting eye pain
Prob occurs along CN V ophthalmic branch
HA work up
History CN eval Sinus eval Blood pressure Refraction Bino testing Health asses VF screening Consider brainscan Refer to neuro
Thrombosis causes
Endothelial damage due to atherosclerosis. Collagen exposed and pro clotting factors cause thrombosis.
Blood flow irreg due to immobility or anything that causes turbulent blood flow
hypercoaguability due to predisposition towards clotting. Congenital or acquired.
Thrombosis is more frequent when
During sleep when blood is static + decreased blood pressure (no pressure to push blood along)
Arterial thrombosis
cause
Effects
Risk factors
Cause: Endothelial damage- atherosclerosis
Effects: MI, Stroke
Risk factors: Smoking, HTN, hyper cholesterol, diabetes
Venous thrombosis
- Associations
- Location
- Effect
- Risk factors
- Associations- venous stasis and hypercoaguabiltiy
- Location- deep veins
- Effect- thromboembolism, DVT, pulmonary embolism
- Risk factors- Immobilization
DVT tests
D Dimer test
Angiography ultra sound
Pulmonary embolism symptoms
Shortness of breath
Hemoptysis - cough up blood
Sharp chest pain
Venous thrombosis ocular manifestations
Papilledema due to venous sinus thrombosis, BRVO/CRVO
Aneurysm risk factors
Tobacco use
Location of aneurysms
Cerebral arteries
Brain stem
3 Aneurysm complications
Rupture- hemorrhagic stroke
Dissecction– ischemia
Thrombus due to turbulent flow causes ischemia
Ocular manifest of aneurysm
Posterior communicating artery out pouching causes CN III palsy
Shock shared feature
Inadequate tissue perfusion leads to anaerobic metabolism
3 shock MOA
- Inadequate oxygen delivery - respiratory failure, heart failure, fluid loss, hemorrhage or anemia.
- Inadequate oxygen uptake- poisoning
- Inadequate nutrients
Final common pathway of shock
Metabolic acidosis and cell death
5 types of shock
- Hypovolemic - loss of blood volume due to injury, child birth, or dehydration.
- Cariogenic- heart damage. Unable to pump blood. MI, HF.
- Septic - bacterial infection. Causes fever and peripheral thrombus formation. May lead to hypovolemic or cardiogenic shock.
- Anaphylactic/hypotonic - Type I hypersensitivity. Widespread vasodilation.
- Neurogenic - damage to brain or spinal cord.
three phases of shock
Compensatory
Progressive
Refractory
presentation of compensatory phase of shock
Decreased skin perfusion
