Unit II Flashcards
prognosis for bacterial, fungal, and viral meningitis without treatment
with treatment
bacterial and fungal usually fatal, viral usually not fatal
with treatment most patients will survive but may have deficits
what are goals of treating an ischemic stroke
reduce the size of infarction if possible
provide rehab
prevent future strokes
what is the structural difference between adult and fetal hemoglobin
adult hemoglobin has 2 alpha and 2 beta chains
fetal hemoglobin has 2 alpha and 2 gamma chains
causes of increased metabolism related to cardiac ischemia
hyperthyroid
fever
describe the stroke belt
a statistical band across the southeastern US where strokes are more common
what is the best treatment for renal cell carcinoma
surgery if there has been no distant spread
immunotherapy is more effective than radiation or chemo
examples of neural pathway disruptions
MS
guillain barre
on a CBC the hematocrit is generally how much higher than hemoglobin
3x
how does insulin inhibit catabolism
inhibits glycogen break down
inhibits amino acid and fatty acid break down
thee factors that influence cardiac output
HR
contractility
filling pressure
5 adverse effects of cortisol
weight gain
striae
moon facies
HTN
peptic ulcers
two types of CHF
CHF with reduced EF (systolic heart failure)
CHF with preserved heart failure (diastolic heart failure)
two coronary effects of chronic atherosclerosis
angine pectoris
congestive or chronic heart failure
T/F autonomic dysfunction and facial paralysis can occur in GBS
true
how quickly will acute meningitis present symptoms
classic symptoms
causes for adults
causes for kids
very quickly
fever, stiff neck, headache, AMS, petechial skin rash
strep pneunmoniae, neisseria meningitidis
strep plus hemophilus
polycythemia
overly productive bone marrow that produces too many blood cells
two types of hemorrhagic strokes
intracerebral hemorrhage
subarachnoid hemorrhage
are the risks associated with sickle cell anemia
chromic hemolytic anemia
microinfarction due to clottin
where is B12 found
tightly bound to protein in meat
tests and exams to confirm cushings
elevated cortisol
cortisol suppression test
Low ACTH levels
imaging
three conditions sequela to hydronephrosis
ureteral stone
prostatic hypertrophy
malignancies
how can a bioengineered polio virus treat glioblastomas
its been genetically engineered to only be able to infect cancer cells, killing the cancer cells and stimulating the immune response
what is the function of TRH
stimulates the production of TSH and prolattin
common symptoms of hemorrhagic strokes
“worst headache of my life”
decline in LOC
where are BP recordings most accurate
at home and work, not in the office
four steps to treat iron deficiecy
stop blood loss if there is any
improve diet
oral iron
parenteral iron
three diagnostic indicators of MS
clinical course and neurologic findings
MRI of brain and spine
testing of CSF for oligoclonal bandsof IgG
T/F the risk of death within 90 days of AMI is 75%
false, 1-22%
prevention of alzheimers
statins may reduce risk up to 50S%
NSAIDs
what is the main byproduct of hemoglobin breakdown
bilirubin
granular leukocytes
basophiles
neutrophils
eosinophils
what is the normal urine output per minute?
why is there a difference between GFR and urine output
1 mL/mins
because 119 mL/mine is reabsorbed by the kidneys
what is the full name of T3
T4
which is the main functional hormone of the thyroid
triodothyroinine
tetraiodothyroinine
T3
HDL paradox
drugs that decrease LDL reduce risk
drugs that increase HDL do not reduce risk
non pharmacologic treatment of seizures
neurosurgical ablation/excision of lesion
vagus nerve stimulation for partial sz
what is the sympathetic response to decreased BP
- activation of Beta adrenergic receptors in the heart
- activation of Alpha adrenergic receptors in smooth muscle
two types of BPH symptoms
obstructive
irritative
three general symptoms of a primary CNS tumor
headache (CC in 30%)
sz
nausea
emesis
what is the first line treatment for hypothyroid
daily thyroxine
differentiate between thrombotic and embolic ischemic strokes
thombolic comes from clot formation due to rupture of an artheroscleroctic plaque, similar to AMI
emoblic involves piece breaking off an existing clot and lodging in the cerebreal vessle
how is meningitis diagnosed
lumbar puncture and culture
what causes MS
areas of demylination in the CNS, followed by inflammation and gliosis (scarring)
how many patients with ESRD are candidates for transplant
about 50%
three environmental changes that can cause an endocrine response
nutritional
thermal
existential
why is the indicidence of CHF increasing
people who used to die from AMIs are now living with decreased heart function
does HTN mangement need to be life long
preferably not, as long as necessary but short as possible
what will be the difference in distribution from a primary and secondary CNS tumor
primary will be more localized
secondary will be more diffuse
what is the histological sign of B-12 and folate deficency
megaloblastic anemia
what is blood
dilute saline with dissolved chemicals and suspended cells
in what hyperthyroid condition does exopthalmos not occur
goiter
staghorn calculi
stones made of urate, cystine, or struvate that are too large to pass
folic acid is an essential cofactor in what
amino acid and DNA synthesis
what are 4 comorbidities associated with CVA
HTN
DM I/II
obesity
smoking
what is the determinant of symptoms caused by a brain tumor
location and size of tumor
three common statins
atorvastatin (lipitor)
simvastatin (zocor)
lovastatin (mevacor)
CHF EKG signs
left ventricular hypertrophy
describe the genetic characteristics of thalassemia
autosomal recessive
what is the treatment plan of hyperthyroid
control symptoms
prevent thyrid storm
plan long term control
what condition is commonly associated with intracerebral hemorrhage
HTN
what causes sickle cell disease
homozygous vs heterozygous Hgb A mutation
four conditions that are most commonly caused by DM
chronic renal failure
neuropathic pain
blindness
gangrene caused limb amputation
epilepsy
recurrent seizures with a chronic, underlying cause
what is the dialyzing fluid in peritoneal dialysis
1-3L of dextrose
three substances commonly secreted by testicular cancer
HCG
alpha-fetoprotein
lacate dehydrogenase
what are the pros and cons of kidney transplant
pro: improved quality of life
con: requires lifelong immunosuppresion
three common presenting symptoms of myasthenia gravis
ptosis
diplopia
dysphagia
what is the treatment for severe anemia for major thalassemia
what is the risk
repeat transfusions
iron overload (hemosiderosis)
three ways to reduce dementia risk
intellectual stimulation
social interaction and exercise
statins and nsaids
what is the most common symptom of testicular cancer
painless testicular mass
systemic symptoms are less likely
what is the most common cause of UTI
what gender is more susceptible
why
bacteria from the rectum
women
shorter urethra
four common sympathetic receptor blockers (examples)
beta blocker (atenolol, propanolol)
alpha blockers (prazosin, terazosin)
alpha and beta (labetalol)
centrally acting (methyldopa, clonidine)
when will most diabetic have complications
after 20 years
T/F most GBS has no trigger event
false
what percent of ESRD is idiopathic
22%
what forms carotid clots leading to embolic stroke
what might be heard on auscultation
what is the surgical treatment
atherosclerotic lesions
bruits
endarterectomy
best goal of LDL/HDL
why is this a good goal
make your lows low and highs high
decreasing LDL reduces risk of atherosclerosis
increased HDL decreases risk
5 grades of astrocytomas
which are most common in children
adults
I-IV
I and II most common in children
IV in adults
which thyroid hormone is most readily available
why is this effect in treatment
T4
because T4 is converted to T3 in tissues
T/F horomes are secreted continuously
false they are usually in pulses
differentiate between chronic and acute meningitis
usually a longer clinical course
similar, but less severe symptoms
usually cuased by mycobacteria, fungi, treponema
what is the protocol to test for prostate cancer
taking 12 needle biopsies at random locations
dementia
generalized loss of neurons
two conditions related to muscle damage from statin drugs
myopathy
rhabdomyolysis
what happens when an atherosclerotic plaque ruptures
a blood clot forms around the rupture and blocks the artery
thalassemia
genetic defect in globin biosynthesis
classified as alpha or beta thalassiema
less invasive surgical options for BPH
high intesity ultrasound
transurethral laser-induced prostatectomy
transurethral ablation
stents
risk of erythropoietin treatment
increasing hematocrit over 12g increase risk of stroke
three types of angina pectoris
stable
unstable
variant
treatment options for ESRD
dialysis or transplant
three causes of hypotension that can result ischemia
acute blood loss
anesthesia
cardiac arrhythmia
most CNS tumors come from what cells
glial cells
what is the most common benign tumor in men
benign prostatic hyperplasia
80% of men by 80 yrs old
normochromic, normocytic RBCs with normal reticulocytes, iron
but
pancytopenia
three things that top the DDx
aplastic anemia
bone marrow dysfunction
drug reaction
DDx for
megaloblastic anemia
low reticulocytes
normal iron studies
folate deficiency
B12 deficiency
metformin
GI symptoms
how is EF determined
echocardiogram
what are reticulocytes indictive of
rapid production of RBCs
destruction of RBCs
5 treatments for ESRD
restrictions of oral intake
control HTN
limit nephron loss
dialysis
transplant
what is the complication with oral iron supplements
compliance issues due to GI side effects
what are the laboratory tests that will confirm hyperthyroid
very low or absent TSH
very high T4
sometimes autoimmune tests are positive
what is the key feature of GBS
ascending paralysis progressing over hours or days
two types of testicular cancer
seminomas
non-seminomas
two adverse effects of statins
liver damage
muscle damage
what can happen to untreated cystitis
pyelonephritis
it can develop into pyelonephritis
frequent kidney infections can result in kidney damage and renal failure
anemia
pathological deficiency of oxygen carrying capacity of blood caused by a decrease in the number or function of RBCs
when are symtpoms of mild atherosclerosis noticed?
severe?
50% occulsion, usually on exertion
80%, effects can be felt at rest
what is the difference between urology and nephrology
urologists are surgeons who correct defects in the kidney and urinary tract
nephrologists are clinicians that treat kidney diesease
what is the peak age for testicular cancer
15-40
what is a common iatrogenic cause of cushings
prednisone
four divisons of heart disease
coronary artery disease
valvular disease
HTN heart disease
cardiomyopathy
three main forms of coronary heart disease (CHD)
acute coronary syndrome
stable angina
CHF
what is the function of direct vasodilators in the treatment of HTN
reduce peripheral vascular resistance
seven signs associated with ERSD
elevated BUN and creatinine
oliguria
electrolyte imbalance
acid-base imbalance
HTN
anemia
T/F most women have atypical AMI presentation
true, more likely to be Dx as gi
two chronic effects of atherosclerosis
coronary effects
peripheral vascular disease
hemoglobin content is dependent on what two factors
production of Hgb - loss of Hgb
risk factors for atherosclerosis
- smoking
- hypertension
- diabetes
- family HX
- age
- dyslipidemia
- lifestyle
isolated vs progressive prostate cancer
stable and controlled
vs
capable of local extension and metastasis
causes of b12 deficiency
dietary (strict vegan)
gastric dysfunction
GI malabsorption (ileal disease)
BCG in bladder cancer
used for what
bacille calmette-guerin
vaccine for tuberculosis that can be used as an immune stimulant in some situations
why are ACE inhibitors effective
because angiotensin I is really just a precuros without much effect on blood pressure
LDL
transporter of endogeneous cholesterol
three strategies to prevent kidney stones
hydration
medication based on the type of stones
what common HTN treatment can cause malaise and fatigue
beta blockers
intervesicular treatment of bladder cancer
6 weeks of weekly treatments with cyotoxic drugs or BCG
life expectancy with ESRD
55-64 years
what proprotion of transplant kidneys come from cadavers vs donors
what is the benefit of a living donor
2/3 cadaver, 1/3 living
living kidneys have a higher 1 year and 5 year survival rate
what is the prognosis of ESRD without dialysis
with dialysis
no dialysis: death in days or weeks
dialysis: yearly mortality 22%
how does cortisol exacebate HTN?
DM
HTN: increase salt intake
DM: increase blood sugar
5 year survival rates for testicular cancer
95-98% early
55-80% even with distant metastases
three amino acid hormones
dopamine
thyroxine
catecholamines
what percent of AMIs are precipitated by strenous events
50%
band cells
immature neutrophils that are indicative of rapid production of neutrophils
nephrolithiasis
kidney stones
silent stroke
a true stroke that causes infarction in a portion of the brain with no obvious motor or sensory functions
differentiate between the vascular causes of STEMI vs NSTEMI
STEMI is more likely to be in one of the great vessels
NSTEMI usually comes from a small vessel
what typically causes subarachnoid hemorrhage
bleed from a major cerebral artery in the circle of willis, often from congenital vessel weakness
four classifications of HTN
primary/essential/idiopathic
renal
endocrine
pregnancy induced
what is the most common form of HTN
primary/essential/idiopathic
T/F all stones are painful
false, some can be painless
what lab tests confirm hypothyroid
Low T4
very high TSh
how much ultrafitrate is produce by the kidenys per minute
what is this called
120mL/min
the glomerular filtration rate (GFR)
how severe is GBS
it can be mild or severe, but most require hosptialization and 30% of severe GBS can require mechanical ventiliation
systolic pressure
pressure at which blood flow resumes in an occluded arterty
how to decrease stable angina attacks
HTN control
lipid management
lifestyle modification
cononary revascularization
five symptoms of ESRD
fatigue
pruritis
epistaxis
SOB
nausea
what are four dissolved components of blood
nutrients (glucose, vitamins)
Electrolytes (Na, K, Cl, Ca)
Hormones (insulin, T3/T4)
Proteins (albumen, carriers)
red pulp of the spleen
tortuous sinsoids that weed out old RBCs or RBCs with antigens to be broken down
PSA
what does it do
how does it relate to cancer
prostate spefic antigen
helps liquify semen
BPH and prostate cancer will both have increased PSA
three environmental sources of bone marrow toxic substances
solvents
pesticides
radiation
two etiology categories of epilepsy
primary and secondary
CHF symptoms
dyspnea, orthopnea, edema
what can happen if a homone is present in high enough concentrations
the hormone can interact with receptors of the same family
what are the 3 most common CNS tumor histologies
gliomas
meningiomas
schwannomas
three facts about steroid hormones
insoluble
requires transport molecules
causes DNA transcription and translation
two ways that hormone-receptor complexes elicit effects in target cells
2nd messanger
DNA transcription leading to protein production
STEMI is usually indicative of what
transmural ischemia (involves the full thickness of the cardiac wall)
fatal complication of diabetes
diabetic ketoacidosis
two actions of insulin
inhibit catabolism
promotes anabolism
three popular single drugs used in intial HTN treatment
ACE inhibitor
calcium channel blocker
diuretic
what is a normal blood volume
4-8 liters
what is the renal response to decreased blood pressure
decreased renal blood flow
PCI vs thrombolysis
preference
when would thrombolysis be used
PCI is preferred
thrombolytics are indicated with PCI isn’t available and early treatment
early is key
what happens in response to decreased renal blood flow
renin is released
glomerular filtration is decreased
two types of vitamin derived hormones
retinoids (vitamin A)
vitamin D
what causes sickle cell anemia
autosomal recessive mutation of Hgb A
what are the most common minerals that form renal stones
calcium oxalate
calcium phosphate
5 symptoms of renal cell carcinoma
hematuria
flank pain
weight loss
anemia
palpable mass
what will be two signs of pernicious anemia
megaloblastic anemia and progressive neurological deterioration
Two types of UTI
lower urinary or upper urinary tract
DDx for
Normal indices (red blood cell size)
Reticulocyte count high
Iron studies normal
Bilirubin level elevated
Hemolysis
Inheritied hemoglobin disorderd (thalassemia or sickle cell)
Autoimmune disorders (lupus)
G6PD
Pyruvate kinase deficiency
T/F ESRD (end stage renal disease) is permanent
true
what percent of ARF survivors retain normal function
50%, with 5-10% having chronic renal failure
what is more common, STEMI or NSTEMI
NSTEMI (55-60%)(
how to reduce BP by decreasing PVR
two methods to achieve this
vasodilation
- direct action on the vessels
- CNS control
what determines the symptoms resulting from an interuption in arterial blood flow
the vessel affected
length of ischemia
neurologic redundancy
CVA working definition
condition resulting in an abrupt appearence of neurlogical symptoms due to focal vascular disruption that usually involves an infarction
what is the function of blocking RAA in treating HTN
reduce blood volume and peripheral resistance
describe tie etiology of Type I DM
an autoimmune disorder that causes rapid loss of beta cells
why do some RBCs appear “speckled”
they are reticulocytes that have remains of the endoplasmic reticulum remaining
what pattern is lost with cushing syndrome
the diurnal pattern which causes higher cortisol in the morning and lower at night
hemoglobinopathy
two types
change in Hgb structure and function
sickle cell anemia
thalassemia
diagnosis of testicular cancer
ultra sound, sometimes needly biopsy
retroperitonal lymph node dissection
CT of pelvic, abdomen, chest
T/F most myocardial infarctions are caused by HTN
false, caused by atherosclerotic plaque rupture
at what GFR is anemia usually found
<30mL/min
I added an extra card because I didn’t want there to be an unlucky number
Don’t judge me
TURP benefits vs risk
benefits: 75-96% chance of improvement, significant reduction in symptoms, low mortality, 5% max risk of complications
risks: incontinence, impotence, retrograde ejaculation
symptoms of
acute
subacute
chronic
ischemia
acute: acute coronary syndrome
subacute: angina
chronic : CHF
three causes of Cushings
iatrogenic
secondary adrenal hyperplasia
primary adrenal hyperplasia
T/F prostate cancer is rare and always life threatening
false, it is second most fatal cancer among men and 70% of men age +70 show prostate cancer
what two effects of cortisol are considerd to improve resistance to stress
increased glucose availibility
increased blood pressure
what is the most common location of aneurysm in the brain
anterior cerebral or communicating artery
are antibiotics always needed for cystitis
no, they are generally needed but they are always needed for pyelonephritis
how is HDL increased
weight loss and exercise
visious cycle of CHF
chronic ischemia damages myocardium
remodeling occurs due to stretching leads to cardiomegaly
overstretched remodeled myocardium reduces ventricular function leads to fluid overload and high BP
leads to increased ischemia
descrive the RAA pathway (5)
- renin is released by the kidneys in response to decreasing BP
- renin converts angiotensinogen to angiotensin I
- angiotensin converting enzyme converts angiotensin I to II
- angiotensin II stimulated an increase in BP and the release of aldosterone from the kidney
- Aldosterone causes salt retension
STEMI treatment
reperfusion
supportive measures similar to NSTEMI
what is the function of aldosterone II
triggers vasoconstriction
aldosterone production and release from the adrenal cortex
recyclining function of RE macrophages
amino acids and iron from hemoglobin is recycled into the bone marrow to make new RBCs
who is usually victim of idiopathic cardiomyopathy
young and healthy people, generally with a precipitating even (viral infection, pregnancy)
chronic heart failure 9CHF) definition
ventricular function insufficent to meet the metabolic and blood flow demands
describe the negative feedback loop that regulates adrenal function
pituitary secretes ACTH
adrenal cortex secretes cortisol
cortsol inhibits ACTH secretion
five chronic complications of DM
CAD
PVD
nephropathy
neuropathy
retinopathy
orthopnea
the inability to sleep supine without breathing issues
three causes of ischemia
vessel stenosis or occulsion
vasospasm
pump failure
what is the most common form of renal and ureteral stone removal
how effect is it
lithotripsy
90-90%
five factors the kidney fails to regulate in renal failure
fluid balance
electrolyte balance
acid-base balance
excretion of nitrogenous waste
excretion of drugs
which are more prominent, alpha or beta cells?
alpha (75% to 20%)
why is stroke prognosis difficult to predict
one area can be damaged but other areas can be repurposed to compensate
what type of stroke is most common
ischemic (85-90% vs 10-15%)
what is the progression of chronic renal disease
gradual loss of nephrons
gradual decline of GFR
leads to end stage renal disease
what is required to for a renal stone
super saturation of urine with insoluble material
reduced hgb production is indicative of what?
bone marrow issue
medical treatment of BPH
alpha blocker drugs
5-alpha reductase inhibitors
where are T3 receptors found
in alll most all human tissue
what drug will cause hypothyroid
amiodirone
what are three general symptoms associated with HTN
Headaches
malaise/fatigue
symptoms of complications
what typpe of diabetics are most likely to have DKA
type one
what is the effect of statin drug treatment
reduction of endogenous cholesterol synthesis
lowers LDL
T/F BPH is not a precancerous condition
true, the incidence of BPH and prostate cancer are independent
what must be monitored during statin treatment due to the liver damaging side effects
liver enzymes
two branches of peripheral vascular disease
atherosclerotic
vasculitis
treatment of aplastic anemia
immunosuppresion
bone marrow transplant
B12 is important to the synthesis of what
nucleic acid synthesis
why are AMIs more common in the AM
BP is higher
increased blood viscosity
cortisol secretion is at its highest
T/F most chronic conditions are no effected by cortisol
false, many (such as DM and HTN) can be exacerbated by cortisol
four causes of isolated seizures
drug withdrawl
high fever
infections
vasovagal or orthostatic syncope
what is the long term concern with BPH
obstruction can cause renal damage from bilateral hydronephrosis
two types of mechanical assist devices used in cardiogenic shock
balloon pumps
LVADs
criteria for moderate chronic renal disease
symptoms or restrictions
GFR 20-60 mL/min
some dietary restrictions may be needed
what causes symptoms in brain abcesses
increased ICP
destruction of brain tissue
describe the course of recovery for GBS
recovery begins 1-4 weeks after onset
can take months or a year to complete
hydronephrosis
dilation of the renal collecting system due to outflow obstruction
what is the hallmark of type II DM
insulin resistance
multi centric cancer
multiple cells turn cancerous, not just a single cell that divides
why is it dangerous to give folate to treat pernicious anemia
folate will correct the anemia but not the neurlogical damage
three Ps of diabetes
polyuria
polydipsia
polyphagia
explain why endocrine systems are homeostatic
they respond to outside challenges to maintain homeostasis
why do RBCs need to flexible?
why is this relevant?
RBCs neet to fit through small vessles
as people get older RBCs are less flexible and more likely to clot
important questions to ask in anemai
diet
menstruation
GI distress
medication
common name of HMG-CoA reducatse inhibitors
statins
two RBC enzyme deficiencies
G6pD
PKD
what causes the oxidation of LDL in fatty streaks
monocytes
supportive measures for STEMI
aspirin
oxygen
decrease myocardial oxygen demand
control arrhytmia
why is neutrophil count important in cancer treatment
chemo decreases bone marrow function
parkinsons disease
loss of extrapyramidal motor neurons
bilirubin is an indicator of what
liver function
three most common causes of dementia
alzheimers
vascular dementia from multiples infarcts
lwey body dementia
how can thrombopphlebitis (DVT) can an embolic stroke
passing between a atrial septal defect
two types of ischemic strokes
thrombotic
embolic
four types of generalized seizures
tonic-clonic
absence
myoclonic
febrile
four groups of drugs used to treat HTN
diuretics
sympathetic receptor blocker
direct vasodilators
RAA blockers
why can radioactive iodine be used to ablate the thyroid
because the thyroid is the only place where iodine is stored in the bdoy
T/F arterial blood flow interruption is a common probelm
true
what is the treatment for type I DM
type II
type I = insulin
type II = insulin plus other stuff
what is the most common type of hyperthyroidism (60-80%)
graves disease
what is neurological condition is caused by an excess of dopamine
psychosis
what is needed to gain access for hemodialysis
av fistula or prosthetic arteriovenous graft
what is the effect of sympathetic stimulation of alpha receptors in response to decreased BP
increased peripheral resistance through vasoconstriction
if there is a coexisting B12 deficiency what will folate treatment do
correct anemia but not neurodegeneration
paracrine
chemical signalling to nearby cells
NSTEMI treatment
supportive measures
anticoagulation
three strategies for treatment of BPH
observation
medical treatment
surgical treatment
three categories of neurotransmitter diseases
disorders of
deficiency of a neurotransmitter
excess of a neurotransmitter
imbalance of neurotransmitters
what type of hormones will dissolve in blood
what type of hormones will need a carrier
water soluable
lipid soluble
most current guidelines for blood pressure
Normal
elevated
Stage 1
Stage 2
normal: 120/80
elevated: systolic >120, diastolic >80
stage 1 HTN: >/= 130/80
stage 2 HTN: >/= 140/90
what is the protein structure of hemoglobin
a protein tetramer with alpha and beta or alpha and gamma polypeptide chains and one oxygen carrying heme group
when are statins contraindicated
pregnacy
children
two key elements manipulated to regulate blood pressure
sympathetic nervous system input
renal blood flow
what is the progression of myasthenia gravis
85% will develop generalized muscle weakness notably with repetitive muscle use
cobalamin
B 12
common clinical indications of CNS infection
signs of infection (fever, malaise)
alteration of CNS function (AMS, SZ)
symptoms associated with primary temporal lobe tumor
sz
olfactory and gustatory hallucinations
deja vu/jamais vu
what angiotensin II a potent actor on BP
it triggers the aldosterone production to increase blood volume
it acts on the blood vessels to increase peripheral resistance
Dr Dodges suggested take home messages regarding HTN
- 140/90 is still a reasonable threshold for the intiation of medical treatment of HTN
- lifestyle modification are useful for patients with elevate BP
- patients with diabetes or other comorbidities, medical treatment should be considered
two PCSK9 drugs
alirocumab (praluent)
evolcumab (repatha)
what nervous system are many of the symptoms of hyperthyroidism related to
sympathetic nervous system
- restlessness
- insomnia
- tremor
- weight loss
- heat intolerance
G6PD homozygotes are at risk for hemolysis triggered by what three factors
certain diseases (infection, diabetes)
certain foods (fava beans)
certain drugs (sulfa, aspirin)
common symptoms of MS
limb weakness, numbness, paresthesia
spastic paraparesis
optic neuritis
diplopia
loss of sphincter control
vertigo
what are the symptoms associated with dementia
loss in
memory, reasoning, judgement, abstraction, learning, language
pheochromocytoma
5 primary symptoms
a rare tumor of the adrenal medulla or sympathetic ganglion that secretes norepinephrine
- severe headaches
- diaphoresis
- palpitation
- tremor
- anxiety
treatment strategy for bladder cancer
transurethral resection
partial or radical cystectomy
chemo and radiation
what is the most common type of epilepsy
when does it usually start
primary (idiopathic or constitutonial)
usually before age 20
symptoms associated with primary brain stem or cerebellar tumor
ataxia
nystagmus
cranial nerve palsies
symptoms of acute MI
squeezing pressure chest pain
can be felt in the stomach or left arm, face, shoulder
anxiety
diaphoresis
GI distress
what components of blood come from the myeloid line
erythrocytes
megakaryocytes (platelets)
granulocytes (N, B, E-phils) and monocytes
three treatment options for MG
thymectomy (if present and the patient is between puberty and 60)
acetylcholinesterase inhibitors
immunosuppresive drugs
mitigating factors to consider in treatment of HTN
other medical conditions
RAA work less well on african americans
cost
four common RAA blockers (examples)
angiotensin converting enzyme (ACE) inhibitors (catopril, benazopril)
angiotensin II receptor antagonist (losartan)
aldosterone antagonist (spironolactone)
renin inhibitor (aliskiren)
three ways gastric disfunction can cause b12 deficiency
pernicious anemia
gastric atrophy
gastric surgery
three facts about peptide/protein/glycoprotein hormones
water soluble
interact with cell membrane
work through second messanger
what is the functional unit of the kidney
the nephron
how long does the tonic phase of a tonic clonic sz last
clonic phase
1minute
2-3 minutes
what has been the primary reason for decreasing number of cardiac death since the 1970
decreased in smoking
improved treatment
two divisions of cardiovascular disease
peripheral vascular disease
heart disease
treatment dilemma for prostate cancer
if the gleason score is low its caught early laproscopic surgery or “watch and wait” may be done
what age is mostly likely for the onset of MS
20-40
acute vs chronic renal failure
acute: sudden reaction, hours or days
chronic: gradual decline in function over months or years
primary adrenal hyperplasia causes
idiopathic
neoplasm
congenital
three ways to decrease BP by decreasing CO
reduce HR
reduce contractility
reduce venous return/decrease blood volume
what is the key component of ischemia
O2 supply is not sufficient for demand
what makes up the nephron
glomerulus
bowmans capsule
proximal tubule
distal tubule
loop of henle
collecting duct
medication to decrease urate stones
allopurinol to decrease uric acid
decrease protein
T/F 30% of AMIs are asymptomatic
treu
what constitutes a “hypertensive emergency”
200/140
what are the current treatment goals for alzheimers
slow the progression of disease
reduce plaques with anti amyloid drugs (possibly not beneficial)
what is the most common cause of death in the US
cardiovascular disease
three endocrine conditions associated with HTN
cushings
pheochromcytoma
congenital adrenal hyperplasia
what is considered the unifying element in the pathogenesis of atherosclerosis
how was this decided
inflammtion
inflammatory markers correlate to CV disease risk
what triggets the production of EPO
decreased oxygen saturation in the blood
three conditions associated with pregnancy induced HTN
toxemia
pre-eclampsia
eclampsia
NSTEMI is indicative of what
ischemia that is subendocardial rather than transmural
foam cells
monocytes that become macrophages and ingest oxidized LDL
what common HTN treatment will cause annoying dry cough
ACE inhibitors
unstable angina
angina that occurs with minimal activty or at rest
two methods for reperfusion in response to STEMI
percutaneous coronary intervention
thrombolytic therapy
T/F more than 50% of AMI death occur suddenly
true
what causes graves disease
auto-antibodies that bind and active TSH receptors
fatty streaks
LDL accumulation under endothelium
folate deficiency treatment
daily folic acid tablets
diastolic reading
pressure at which flow returns to normal in an occluded artery
three causes of bone marrow toxicity
pharmacological
environmental
immunologic
5 types of meningitis
acute
purulent
septic
chronic
aseptic
diagnosis of prostate cancer
digital rectal exam
ultrasound
biopsy
prostate specific antigen screen
what percent of the following have cardiovascular disease
people at age 20
people over 75
total population
5%
75%
20%
what are the risk factors for CNS tumors
radiation exposure
no other risk factors known
what gender is mostly likley to get renal cell carcinoma
2:1 men over women
four small neurpeptide hormones
GnRH
TRH
vasopressin
somatostatin
differniate between homozygous and heterozygous thalassemia
homozygotes have signifcant disease (major)
heterozygotes are mildly anemia or asymptomatic
autocrine
chemical signaling of cells among the same type
what portion of brain tumors are malignant
how many deaths per year
50%
13000/year
radiation options for CNS tumor treatment
whole brain vs focused radiation (gamma knife)
what is the gender ratio of patients with graves disease
female 8:1
what drug can stop the relase of T3 and T4
potassium iodine
where does glucagon like peptide naturally come from
what does it do
L cells in the intestine
opposes insulin
atherosclerotic process
- fatty streaks
- monocyte aggregation
- LDL oxidation
- formation of foam cells
- inflammation leading to LDL accumulation
when is cardiogenic shock the more common cause of MI mortality
in the case of large infarctions
CHF signs on CXR
cardiomegaly, pulmonary edema
what is the risk of decreasing blood pressure too low
toxicity
orthostatic hypertension
most bladder cancers are _____ with____
transitional cell carcinomas
multi-cell centric organism
what is the immunosuppressive treatment of aplastic anemia
how often is it successful
antilymphocyte or antithymocyte globulin
50-70%
three lifestyle issues that increase risk of atherosclerosis
obesity
physical inactivity
atherogenic (inflammatory) diet
four strategies to prevent future strokes
reduce the chances of repeat embolis
control HTN
control DM
treat atherosclerosis
two supportive treatments for UTI
hydration
vitamin C (cranberry juice)
what causes BPH
unknown, but it does seem to require androgens and aging
atherosclerosis
vessel narrowing due to fatty deposits in the arteries related to lipid metabolism and cholesterol
10-15% of MG patients have a ____
3-8% will have or will develop ____
thymoma
hyperthyroid (graves disease)
what is the main cause of cardiovascular disease
atherosclerosis
what cells come from the lymphoid line
NK cells
dendritic cells
T & B lymphoctyes
diagnosis of renal cell carcinoma
symptoms or hematuria leading to abdominal chest CT and cytology
two diseases caused by a deficiency of a specific neurotransmitter
parkinsons (dopamine)
myasthenia gravis (acetylcholine)
stable angina
recurring episodes of chest pain brought on by exertion and relieved by rest
what cells break down RBCs
reticuloendothelial cells found in the spleen and liver
why would you check for hyperthyroidism in new onset a fib
because hyperthyroid can trigger arrhytmias
what is the main complication for peritoneal dialysis
infection through the port
Gaba vs glutamate
Gaba is a inhibitor of APs, glutamate excites APs
lipoproteins
macromolecule consisting of lipid and protein
what causes chronic anemia with ESRD
a deficiency in erythropoeitin
what is the primary condition associated with upper UTI
acute pyelonephritis
how do sympathetic receptors blockers function to lower HTN
block alpha and beta receptors
prognosis for:
pituitary tumors
meningiomas
astrocytomas
pituitary good
meningiomas usually good
astrocytomas usualyl bad
three drugs used in the treatment of stable angina
nitrates
beta blockers
calcium channel blockers
criteria for mild CRD
symptoms or restrictions?
GFR +60mL/min
none
what is the most common pathogen associated with UTI
E. Coli or other coliforms
5 locations in the body with especially high numbers of T3 receptors
brain
heart
muscle
kidneys
gonads
increasd hgb loss means
accelerated destruction or loss from vasculature
six disorders that will cause neurollogical disorders
- vascular
- neoplastic
- infectious
- degenerative
- neurotransmitter
- seizure disorders
the hydraulic equation
define the variables
BP = CO x PVR
BP = cardiac output x peripheral resistance
HDL
removes LDL cholesterol and triglycerides
what will microinfarctions from sickle cell cause
leg ulcers
functional splenomegaly
shortened life span
symptoms associated with primary frontal lobe tumor
personality changes
decreased intellect
four options for ureteral stone treatment
supportive
ureterscopic retrieval
surgical removal
lithotripsy
medication used to decrease glucagon secretion
glucagon like peptide 1
two main types of hyperthyroidism
graves disease
toxic nodular goiter
T/F complete control of glucose is bad
true, it decreases longevity
megaloblastic anemia
Large RBCs, hypersegmented neutrophils caused by impaired DNA synthesis
dyslipidemia related to atherosclerosis
high LDL
low HDL
where are other ACTH secreting cells located beside the pituitary
small cell lung cancers
four problems that would lead to decreased erythropoesis in the RBCs
nutritional deficiencies
loss of stimulation
toxicity
neoplasm
PCI
stent placement
what is required for reabsorption of the ultrafiltrate in the kidneys
energy
what is the evolutionary benefit to G6PD deficieny
heterozygotes have increase survival rate with malaria infection
ALS
amyotrophic lateral sclerosis, loss of upper and lower motor neurons
thee factors that influence PVR
arterial diameter
arterial length
elasticity
two indications of aseptic meningitis
more benign course
usually caused by viral infection (herpes, mumps, enteroviruses)
Do RBCs have a nucleus?
why is that important in transfusion
no
because we don;t have to match HLA-1 antigens just blood type
what is the first symptom of GBS
how does this progress
usually leg weakness
motor loss comes first, then sensory
primary hyperthyroid
the 99% of hypothyroidism that is caused by failure of the thyroid galdn
three systems that patients will often loss RBCs through (example of disoder)
GYN (heavy period)
GI (cancer, ulcer)
GU (cancer)
two common sources of embolic strokes
carotid
cardiac
four treatments for atherosclerosis
lifestyle changes
treatment of hyperlipidemia with statins
treat HTN
treat diabetes
benign prostatic hypertrophy
noncancerous enlargement of the prostate
two histological descriptors of iron deficient anemia
microcytic (small)
hypochromic (pale colored)
four triggers for GBS
food poisoning caused by campylobacter jejuni
cytomegaloy virus/epstein barr
mycoplasmic pneumonia
some vaccinations
why is a good HLA match needed for bone marrow transplant
a poor match will produce graft versus host disease as the graft produces lymphocytes that react to antigens
what is the main complication associated with nephrolithaisis
ureteral occlusion which can cause severe back or flank pain and can cause hydronephrosis
partial sz (retain consciousness)
partial (single muscle group/limb)
complex (sensory hallucinations with increased or decreased motor function
what is a common accompaniment with lewy body dementia
hallucinations
three examples of neuronal loss disorders
dementia
ALS
parkinsons
two agents that improve survival with CHF
beta blockers
ACE inhibitors
four dietary sources of iron
meat, seafood, beans, spinach
aplastic anemia
an autoimmune disorder that causes the loss of hemopoietic cells
two types of prostate cancer
isolated malignant foci
progressive cancer
what is the effect of folic acid on fetal development
assist in neural tube development and decreases ther risk of anencephaly or spina bifida
four common MS treatments
corticosteriods (prednisone, medrol)
interferon beta 1a
immunosuppresants
IVIG
five non-insulin treatments of DM
reduce insulin resistance
stimulate secretion fo endogeneous insulin
reduce glucagoon
reduce glucose absorption
enhance urinary secretion
how many AMIs occur yearly
what percent are fatal
1.1 million
20-40%
two special categories of CVA
TIA
silent strokes
two sources of cholesterol
exogenous (diet and absorption)
endogeneous (production of cholesterol from the liver)
why is the age related risk for athersclerosis different for men and women
women haver higher HDL
estrogen raises HDL
what is the cause of goiters
is there a gender bias
what may be a contributing factor
unknown
no, 1:1
low iodine may contribute
differentiate between blood, plasma, and serum
blood is all the dissolved and suspended components
plasma is blood with the suspended components removed
serum has all the cell and clotting factors removed
limitation of prostate ultrasound for cancer ID
most prostate cancers look the same as prostate tissue
five important functions of the renal system
fluid balance
electrolyte balance
acid-base balance
excretion of nitrogenous waste
excretion of toxins and drugs
NSTEMI supportive treatments
rest
oxygen
sedation/analgesia
control of arrhytmia
three pronged approach to preventing sz
enhance inhibitory CNS influences (GABA)
reduce excitatory CNS influences (glutamate)
modulate ionic conductance
acute coronary syndromes
acute MI with ST segment elevation
acute MI without St elevation
unstable angina
T/F HTN is generally asymptomatic
true
what type of feedback loop primarily regulates the endocrine system
how is regulation accomplished
negative
secretion of inhibiting or enhancing factors
endocrine
chemical signaling between distant cells by ductless glands
erythropoetin
cytokine that stimulates the production of erythrocytes
4 key principles of CNS infections
not age dependent
follow acute or chronic course
can be lethal or cause long term disability
there are a wide range of possible pathogens
what is the fucntion of C peptide after it is removed from proinsulin
what would high levels of c peptide indicate?
low?
nothing
high levels = type 2 DM
low = type 1 DM
how would treatment differ for a patient with BP <200/140 vs >200/140
over 200/140 needs hospitalization due to stroke or MI concerns
below 200/140 can be managed outpatient
CHF signs on echocardiogram
ventricular ejection fraction
T/F gamma hemoglobin production is turned off in adults
true
major endocrine glands (10)
- pineal gland
- parathyroid
- thyroid
- hypothalamus
- pituitary
- thymus
- kidney
- adrenal
- pancreas
- ovary/testes
what causes DKA
hyperglycemia >300mg/dl causes keto acids to accumulate
two conditioned associated with renal hypertension
narrowed renal artery
chronic renal disease
what is the maximum time limit before recovery for a TIA
24 hours
what do beta blockers do in treating hyperthyroid
four results of treatment
block sympathetic pathways
rapid reduction in anxiety, restlessness, tremor, palpitations
what are three other minerals that can form renal stones
uric acid from gout
cystine
struvite
C reactive protin
an inflammtion marker related to heart disease
special consideration for renal tumors and spread
this cancer has a high likelihood to invade the vena cava to form embolism and mets
why is early detection of prostate cancer important
because cancers with distant metastases have a 5-10% chance of survival
why is time a necessary to determine the fullt extent of damage caused by a stroke
the infarcted area can be under perfused so the extent of the infarcted tissue might not be known for weeks
common ischemic stroke symptoms
usually none other than mild neurological deficits, possibly a mild head ache and decreased LOC
are there any specific symptoms for ESRD
no, generally the patient just feels like crap
what is the most common source of cardiac emboli
mural thombi from atrila fibrillation
T/F G6PD and PKD defiency are both autosomal dominant
false, they are autosomal recessive
why can FSH, LH, TSH, and HCG cross react with each other
they have receptors in the same family
four risk factors for dementia
age
female
head injury
chronic disease (athersclerosis, DM)
what is a currently available treatment for testicular cancer that is very effective
external beam radiation with chemo
possible changes associated with recurrent silent stroke
change in mood/personality
vascular dementia
symptoms of bladder cancer
what is the most common
hematuria
irritative voiding symptoms
pain or masses in advanced disease
hematuria (85-90%)
classic GI causes of chronic bleeding
peptic ulcer or cancer
time constraint for hemodialysis
3-5 hours 3x per week
criteria for severe chronic renal disease (End stage)
GFR <20mL/min
renal replacement therapy needed
what causes jaundice
high levels of bilirubin
three treatments of cardiogenic shock
vasopressors (maintain pressure)
inotropic agents to improve contractility
mechanical assist deveices
two factors related to renal blood flow that can be manipulated to regulate BP
renin-angiotensin-aldosterone pathway
total vascular volume
surgical treatment of BPH
prostate resection
T/F drugs are also found dissolved in blood
true
step down strategy for HTN treatment
decreasing dose based on stable normal pressures attained through lifestyle changes
dyspnea as it relates to CHF
air hunger with minimal exertion
what side of the face will have deficits from a right sided stroke?
what side of the body>
ipsilateral face
contralateral body
right stroke will cause right facial deficits and right peripheral deficits
specific symptoms associated with primary CNS tumor
focal neurological deficits dependent of the location
PCSK9 inhibitors
new drug that stimulated production of an enzyme show to decrease LDL and decrease risk of heart disease
what gender is most likely to form renal stones
men 3:1 over women
T/F heterozygous Hgb is usually asymptomatic
true
typical anginal episode
lasts 2-15 minutes
substernal pain with radiation
intiated by lifting, eating, emotions, cold weather
three types of steroid hormones
estrogens
androgens
progestins
causes of hemolysis
defect in RBC size shape or function
outside destructrion of normal RBCs
symptoms associated with primary parietal lobe tumor
sensory or motor deficits
spontaneous pain symdromes
symptoms associated with cystitis
frequency
urgency
painful urination
hematuria
two key RAA hormones
Angiotensin II
aldosterone
what was the mean survival of a diabetic patient before 1922
after
what changed?
5 year <5%
increaed to 30-40 years
insulin was discovered
five hypothyroid symptoms
- cold intolerance
- hair loss
- weight gain
- weakness
- dry skin
symptoms associated with primary occipital lobe tumor
visual field defects
visual agnosia (cant recognize what you are seeing)
thyroid storm
acute high levels of T3 and T4 that can cause hypotension and fever
classic urinary causes of anemia
renal cell carcinoma
bladder carcinoma
what percent of renal stones are made from calcium
75-85%
what is a lesser known issue with statin?
what is the result
muscle weakness
reduction in activities
T/F 20% of prostate cancer patients will not have elevated PSA
true, elevated PSA isn’t a very specific marker
prostate cancer symptoms
none in the early stages oher than BPH
late stages include pain and urinary obstruction
the useful conbinations of drugs used in intitial treatment of HTN
ACE inhibitor + diuretic
Beta blocker + diuretic
beta blocker + alpha blocker
three examples of post meningitis deficits
hearing loss
impaired cognition
epilepsy
what is the most common medication for type II DM
metformin (glucophage)
three types of MS
relapsing-remitting
primary progressive
secondary progressive
what symptoms are associated with pyelonephritis
frequency
urgency
painful urination
hematuria (same as cystitis)
plus
flank pain
fever
cushing syndrome
a cluster of symptoms caused by excess cortisol
what two factors increase water retention in response to decreased blood pressure
decreased glomerular filtration
aldosterone production
CBC
complete blood count (RBCs, WBCs, platelets, hemoglobin and hematocrit)
two types of leukemia
myeloid (acute or chronic)
lymphoid (acute or chronic)
two long term control options for hyperthyroid
thyroid excision or destruction
continued antithyroid drugs
three types of gliomas
which is the most common
astrocytoma (common)
oligodendrogliomas
ependymomas
what is the shelf life of venous access for hemodialysis
3 years at about 30-80% failure
what drugs stop the production of T3 and T4
when are they most effective
thioamides
when combined with beta blockers and potassium iodine
four functional factors of red blood cells
Hemoglobin
size, shape
flexibility
longevity
what is the median survival of a low grade (I-II) astrocytomas
Grade III?
Grade IV?
5-10 years
3 years
<1yr
what is sequela of stroke that can lead to early disfunction
increased intracranial pressure
two methods to reduce cardiac out in HTN treatment
block beta 1 sympathetic action
reduce blood volume
three characteristics of relapsing-remitting MS
intial symptoms resolve or significantly improve over weaks
months or year can go by before a new lesion forms
eventual decrease in remission and increasing disability
what is the treatment for idiopathic cardiomyopathy
spontaneous remission, but LVADs or transplant can be required
what is the function of the adrenal cortex
secretes glucocorticoids, androgens, mineralocorticoids
specific name for grade IV astrocytoma
glioblastoma multiforme
idiopathic (hereditary) hypercaluria
hereditary high calcium related to kidney stones
BNP
brain natriuretic peptide
what are two methods of lowering T3 and T4 in hyperthyroidism
prevent hormone release
stop T3 and T4 production
three peripheral vascular disease associated with the effects of chronic atherosclerosis
renal artery stenosis
femoral/popliteal stenosis
aortic aneurysm formation
where is erythropoietin produce
the juxtapoglomerular cells of the kidneys
white pulp of the spleen
lymph tissue
peritoneal vs hemodialysis
the peritoneum is used as the dialyzing membrane
“kidney machines” that filter and replace blood
treatment of stable angina
acute treatment with vasodilation
decrease frequency of attacks
PSA levels
normal
moderate
high
what percent of patients with high PSA have prostate cancer
<4ng/mL
>4.1 - 10ng/mL
> 10ng/mL
50-70%
four types of receptor hormone interactions
agonists (stimulate receptors)
antagonists (block receptors)
down regulation
change receptor affinity
what percent of the body’s oxygen is used by the kidneys
what percent of rest cardiac output
7%
20-25%
what is the preferred method of treatment to definatively cure hyperthyroid
what makes it good
ablation wth radioactive iodine
because it spares the parathyroid
two primary sympathetic receptors manipulated to control BP
Alpha 1 vascular receptors
Beta 1 cardiac receptors
three things needed to diagnose BPH
symptoms plus enlarged prostate and trans rectal ultrasound
anticoagulation therapy for NSTEMI
heparin
antiplatelets
AMI prognosis factors
age
size of vessel
prior infarctions
nature of treatment
when you spin out blood what is the “buffy coat”
white blood cells
irritative BPH symptoms
urgency
frequency
nocturnal voiding
5 lipid lowering agents
niacin
bile acid binding agents
HMG-CoA reductase inhibitors
fibric acid derivatives
inhibitors of sterol absorption
acute myocardial infarction
mycardial death due to abrupt reduction in coronary blood flow almost always caused by atherosclerosis
why is it imporant to know the amount of a hormone that is bound vs free
a bound hormone can’t do anything
three common side effects of HTN treatment
electrolyte imbalances
annoying dry cough
malaise, fatigue
T/F cardiovascular illness is the most common serious disorder in the US
true
two main causes of MI mortality
cardiac arrhythmia (v fib)
pump failure (cardiogenic shock)
types of myeloproliferative disorders
leukemia
lymphoma
multiple myeloma
polycythemia
thromocythemia
describe the etiology of type II DM
a very slow loss of beta cells causd by genetic or obestity
CHF signs
peripheral edema, JVD
other oxygen transport issues related to heart damage that arent ischemia
hypotension
chronic anemia
increased metabolism
what are three factors that will increase saturation of urine and kidney stone formation
low urine flow
production of minerals is high
urine concentration of minerals is high
what is the result from blocking beta 1 sympathetic action
reduced cardiac rate and contractility
CHF treatment strategy II
reduct cardiac remodeling (aldosterone antagonists)
treat hyperlipidemia (statins, even if lipids are normal)
two types of lymphoma
hodgkins
non-hodgkins
treatment of v fib
cardioversion (defibrilation)
how is meningitis treated
antimicrobial drugs
prevention through vaccines or prophylactics
what links receptors of the same “family)
they have a similar structure
what is the effect of thyrotropin (TSH)
increased T3 and T4
three risk factors associated with renal cell cancer
smoking
obesity
genetic factors
define diabete mellitus
a disorder characterized by chronic hyperglycemia due to relative or absolute deficiency of insulin, or resistance to insulin
why drugs used to treat HTN will cause low potassium?
high?
diuretics
ACE and aldosterone inhibitors
why are growth abnormalities present in beta thalassemia
there is an overgrowth of bone marrow that can cause pathologic fractures or “chipmunk facies”
what is the benefit of PCSK9 treatment
drawback?
produce better lipid reduction that statins
very expensive
what causes pernicious anemia
auto antibodies against intrinsic factor
myeloproliferative disorders
cancers that will displace normal bone marrow
what is the treatment for hepatosplenomegaly caused by thalassemia
eventually splenectomy, which will increase risk of infection
what is the result of increased sodium and water retention in response to low BP
increasd blood volume, which increases cardiac output
what is the main condition associated witha lower UTI
acute cystitis
how common is hashimotos
is there a gender bias
1-4/1000
females 1:4
four causes of hypothyroid
post thyroidectomy/ablation
hashimotos thyroiditis
Drug induced
dietary iodine deficiency
thee common vasodilators (examples)
calcium channel blockers (diltiazem, amlodipine)
arterial (hydralazine, minoxidil, diazoxide)
arterial and venous (nitroprusside)
two types of strokes
ischemic strokes
hemorrhagic strokes
what is the most likely cause of a TIA
small emboli from heart or carotids
what is the mortality rate for acute renal failure
50%, usually due to the disorder that caused renal failure
what is insulin
what compound is it derived from
how does this happen
a small protein
conversion of proinsulin into insulin
removal of connecting C peptide
based on new HTN guidelines how many people are afflicted
103million
how does insulin promote anabolism
increase glycogen production and storage
promotes triglyceride synthesis in fat cells
incrases protein synthesis in muscle
what happens in hashimotos
the thyroid is infiltrated with T and B cells
T/F pregnancy and lactation can caused anemia through loss of RBCs
false, they cause increased demand
obstructive BPH symptoms
decreased force and caliber
difficulty intiting flow
incomplete voiding
straining
post void dribbling
two HTN treatment strategies
reduce cardiac output
reduce peripheral vascular resistance
what will the response to T3 be
increased…
energy utilization
protein synthesis
sensitivity to other hormones
4 conditions associated with ESRD
diabetes
HTN
glomerulonephritis
cystic disease
target cell
the end-target of a hormone that produces a response within the cell
what symptoms are associated with passing a ureteral stone
what determines the pain
pain and hematuria
depends on the location of the stone
three facts about aldosterone
most potent natural mineralocorticoid
helps with sodium and fluid retention
also induces cardiac growth
occurance of MS
350,000, 2-1 women to men
what are the two pathological processes related to degenerative neurological disorders
gradual loss of neurons
gradual loss of axons
what are the risks of major thalassemia
severe anemia
hepatosplenomegaly
growth abnormalities
what is the histological pathophysiology of alzheimers
plaques of beta amyloid
tangles of tau proteins
5 protein/glycoprotein hormones
FSH
LH
TSH
HCG
Insulin
PTH
speficific treatment for prolactinomas
dopaminergic drugs
what is the preferred imaging method for brain tumor
how might the histology of the tumor be idenified
MRI over CT
tissue biopsy via needle or craniotomy
four causes of secondary epilepsy
intracranial neoplasms
post head trauma
post meningitis
others
how is bladder cancer usually found
hematuria leads to biopsy
what is the effect of angiotensin to released in response to renin production
aldosterone production leading to increased salt and water retention
increased peripheral resistance
why are PSA screening controversial
because it has not improved survival
pathophysiology of stable angina
unmet oxygen demand cuased by coronary atherosclerosis, anemia, fever, hyperthyroid
myasythenia gravis
a chronic autoimmune disease caused by antibodies against acetylcholine receptors at the neuromuscular junction
what causes GBS
autoimmune antibodies produced against myelin
four typical settings the lead to acute renal failure
severe burns
severe trauma
severe infections
severe heart disease
what triggers beta cell loss in type I DM
can be a virus or toxin such as mumps or coxsackie, as well as a genetic predispostion
age range for increased atherosclerosis risk for men and women
>/=45 men
>/= 55 for women
renal failure
decrease in renal function until excretion is unable to regulate blood composition
what is needed to extract dietary b12
low gastric pH and intrinsic factor
4 types of prostatectomy
transurethral (TURP)
retropubic
perineal
laproscopic (robotic)
of the 75% of the patients who have HTN and are aware of it, how many are getting treated?
how many are controlled?
50% are being treated
25% are under control
distinguish between treatments for mild and severe HTN
mild to moderate HTN usually uses one drug
severe HTN uses multiple drugs
four features of the post-ictal phase
headache/confusion
fatigue
muscle soreness
duration of up to several hours
two regulators of thyroid function
thyrotropin-releasing hormone (TRH)
thyrotropin (TSH)
what is expected with alzheimers progession of disease
steady loss of memory, speech, motor function
average life span of 7-8 years
T/F vitamin B deficiency can cause dementia
true
5 general categories of hormones
amino acid
neuropeptides
proteins/glycoproteins
Steroids
Vitamin deriviatives
what causes cushings disease
what is the distinction between this and secondary adrenal hyperplasia
an ACTH secreting tumor on the pituitary
there isn;t one
how do chronic renal failure cause anemia
loss of EPO resulting in moderate anemia
where do RBCs come from
does all bone marrow produce RBCs
bone marrow
no, mostly in the hips, sternum, long bones
what cells in the pancreatic islets that secrete insulin
glucagon
beta cells
alpha cells
risk of thrombocythemia
increased clotting
classic cause of anemia from gyn
uterine (heavy period, leiomyoma
three methods to reduce peripheral resistance in HTN treatment
block alpha 1 sympathetic action
block central sympathetic action
directly dilate the blood vessels
what % of testicular cancer is assocatied with cryptoorchism
can orchiplexy resolve this
5%
no
what is an important consideration when treating hemorrhagic stroke
anticoagulation and antithrombolytics are contraindicated in hemorrhagic stroke
what is the function of the adrenal medulla
secretes epi/norepinephrine
what is the most common cause of hypothyroid
hashimotos thyroiditis
how do diuretic function to decrease blood pressure
lower blood volume
five symptoms of DKA
tachycardia
dehydration
SOB
lethargy
coma
what is the risk of TIA
they can progress to a full stroke without treatment
what accounts for the 1-4% fatality rate of GBS
pulmonary complications or cardiac arrhythmias
who is more likely to get bladder cancer
what are two risk factors associated with bladder cancer
men over women 3:1
smoking or exposure to industrial dyes/solvents
modulate ionic conductance in seizure treatment
decreases the permeability of the cell membrane
T/F a small number of RBCs are lost through the GI, Urine, Skin
true
preventing the recurrance of MI
lifestyle changes
beta blockers
statins
ACE inhibitors
antiplatelet drugs
limbo goal for high risk hypertensives
trying to go as low as is safely possible for people with severe comorbities (diabetes, CAD, CVA)
two parts of the adrenal gland
medulla
cortex
three questions to ask when considering bone marrow deficiency in anemia
enough stem cells
enough nutrients to make RBCs (iron, folate)
enough stimulation (EPO)
five effects of cortisol
increases glucose production
raises blood pressure
raises blood sugar
lowers lymphcyte and monocyte levesl
what is the intitial event of an acute MI
a plaque rupture
how long do RBCs last before being broken down
100-120 days
two other symptoms of diabetes that aren’t the 3 Ps
weight loss despite increased appetite
fatigue
what diagnoses for cushings have a good prognosis?
poor?
good: cushings disease and iatrogenic cushings
bad: adrenal carcinoma and small cell lung cancer
what are the common causes of encephalitis (examples)
viruses
rabies, measels, polio, herpes, west nile
what does tight management of DM entail
diet
frequent blood assays
medication 3-4 times daily
flexible dosing
long feedback look
a feedback loop where the end hormone produce by trophic stimulation will inhibit production at the hypothalamus and pituitary
Gullian barre syndrome (acute, idipathic polyneuropathy)
rapidly progressive motor paralysis with likely spontaneous recovery
what are the signs of hypervolemia based on the amount of blood lost
10-15% initial signs of vascular instability
greater than 30% orthostatic hypertension
greater than 40% hypovolemic shock
what methods can be used to reduce infarction
anticolagulation with IV heparin
IV thrombolytic therapy
cerebreal artery catherization and angioplasty
treatment for b12 deficiency
large oral doses of B12
intramuscular B12
which is more relevant, long or short feedback loops?
why?
long, because they work on the hypothalamus and the pitutiary
what wil happen if the thyroid gland is dysfunctional
what can also happen?
TRH and TSH will be produced in high amounts
prolactin can also be produced
success rates of conventional seizure treatment
70% seizure free on one drug
20% sz on 2 or more drugs
remaining 10% unresponsive
how are hormones sent through out the body
dissolved in blood or bound to carriers
what is the main task of the thyroid
to produce T3 ad T4
exophthalmos
cause
protrusion of the eyes found in 20-40% of Graves patients
caused by lymphcytic infilitration of the eyes
what is the treatment for GBS
is this time sensitive?
IVIG
plasmapheresis
yes time is a factor, hours matter
what is the 5 year survival rate once diagnosed with CHF
50%
three common diuretics (examples)
thiazides (hydrochorthiazide)
loop diuretics (furosimide)
potassium sparring diuretics (spironolactone)
prognonsis for stable angina
some will improve, but most will develop CHF or have progress to acute cononary syndrome within 3-5 years
evaulation of elevated PSA
rectal exam/ultrasound with lesion biopsy
if there are lesions, determine gleason score
seizure
abnormal or excessve and synchronized discharge of CNS neurons
what is the most common neurological disorder in the US
incidents per year
deaths
CVA (stroke)
500,000/yr
150,000 deaths/yr
four methods to prevent ESRD
control HTN
control glucose
recognize and avoid drug toxicity
better treatment of acute renal failure
CHF lab signs
elevated BNP
CHF treatment strategy I
reduce cardiac work load (limit activity, reduce weight, control HTN)
reduce blood volume (decrease Na, diuretics)
medications to reduce calcium stone formation
thiazide diuretics to reduce calcium levels
causes of folate deficincy
not enough fruits and veggies
increased demand (pregnancy, hemolytic anemia)
malabsorption of folate
define TIA
stroke like deficits that with occur and resolve rapidly, usuallly within 60minutes
three types of non-seminoma
embryonal cell
teratoma
choriocarcinoma
two general nutrition deficiency that cause anemia
anemia of chronic disease
starvation
two stratgies to reduce insulin resistance
weight loss
medication (biguanides and thiaxolidinediones)
T/F CNS tumors commonly form from neurons
false, they usually come from support cells
three CNS infections that can cause neurologic symptoms
meningitis
encephalitis
abscess
three disease that can be triggered by hyperthyroid
acute chest pain (MI)
CHF
Arrhythmia
variant (prinzmetal) angina
extreme fatigue associated with minimal exertion related to coronary vasospasm
ejection fraction
fraction of ventricular volume eject by each beat of the heart, normally 50-65%
agranular leukocytes (mononuclear)
monocytes
lymphocytes
two disorders caused by an imbalance of neurotransmitters
chronic depression or psychosis
secondary hyperthyroid
failure of the pituitary to release TSH
four types of renal/GU cancer
prostate cancer
bladder cancer
renal cell carcinoma
testicular cancer
supportive treatment for ureteral stones
analgesia
enhanced urine flow
what is the goal of HTN treatment
maintenance of 120/80 BP for high risk patients
<135/85 for mild to moderate risk patients
four phases of a tonic-clonic seizure
LOC, tonus or clonus, apnea, flaccid coma, post ictal
short feed back loop
a feedback loop where a trophic hormone from the pituitary inhibits production of stimulating factors from the hypothalamus
three possible treatment plans for cushings
stop glucocorticoids
surgery
antiglucocorticoid medication
what is the effect of sympathetic activation of Beta receptors in response to Decreased BP
increased cardiac output through contractility
three treatment for prostate cancer
radical prostatectomy
radiation thearpy
medical treatment
three general treatment options for CNS tumors
surgery, chemo, radiation
four factors to prevent CHF
lipid control
HTN treatment
lifestyle changes
prevent or reduce damage from AMI
what are the three clinical manifestations of aplastic anemia
anemia
leukocytopenia (chronic infection)
thrombocytopenia (no clotting factors0
three specifict nutrient deficiencies that will cause anemia
folate
b12
Iron
