Unit II Flashcards
1
Q
prognosis for bacterial, fungal, and viral meningitis without treatment
with treatment
A
bacterial and fungal usually fatal, viral usually not fatal
with treatment most patients will survive but may have deficits
2
Q
what are goals of treating an ischemic stroke
A
reduce the size of infarction if possible
provide rehab
prevent future strokes
3
Q
what is the structural difference between adult and fetal hemoglobin
A
adult hemoglobin has 2 alpha and 2 beta chains
fetal hemoglobin has 2 alpha and 2 gamma chains
4
Q
causes of increased metabolism related to cardiac ischemia
A
hyperthyroid
fever
5
Q
describe the stroke belt
A
a statistical band across the southeastern US where strokes are more common
6
Q
what is the best treatment for renal cell carcinoma
A
surgery if there has been no distant spread
immunotherapy is more effective than radiation or chemo
7
Q
examples of neural pathway disruptions
A
MS
guillain barre
8
Q
on a CBC the hematocrit is generally how much higher than hemoglobin
A
3x
9
Q
how does insulin inhibit catabolism
A
inhibits glycogen break down
inhibits amino acid and fatty acid break down
10
Q
thee factors that influence cardiac output
A
HR
contractility
filling pressure
11
Q
5 adverse effects of cortisol
A
weight gain
striae
moon facies
HTN
peptic ulcers
12
Q
two types of CHF
A
CHF with reduced EF (systolic heart failure)
CHF with preserved heart failure (diastolic heart failure)
13
Q
two coronary effects of chronic atherosclerosis
A
angine pectoris
congestive or chronic heart failure
14
Q
T/F autonomic dysfunction and facial paralysis can occur in GBS
A
true
15
Q
how quickly will acute meningitis present symptoms
classic symptoms
causes for adults
causes for kids
A
very quickly
fever, stiff neck, headache, AMS, petechial skin rash
strep pneunmoniae, neisseria meningitidis
strep plus hemophilus
16
Q
polycythemia
A
overly productive bone marrow that produces too many blood cells
17
Q
two types of hemorrhagic strokes
A
intracerebral hemorrhage
subarachnoid hemorrhage
18
Q
are the risks associated with sickle cell anemia
A
chromic hemolytic anemia
microinfarction due to clottin
19
Q
where is B12 found
A
tightly bound to protein in meat
20
Q
tests and exams to confirm cushings
A
elevated cortisol
cortisol suppression test
Low ACTH levels
imaging
21
Q
three conditions sequela to hydronephrosis
A
ureteral stone
prostatic hypertrophy
malignancies
22
Q
how can a bioengineered polio virus treat glioblastomas
A
its been genetically engineered to only be able to infect cancer cells, killing the cancer cells and stimulating the immune response
23
Q
what is the function of TRH
A
stimulates the production of TSH and prolattin
24
Q
common symptoms of hemorrhagic strokes
A
“worst headache of my life”
decline in LOC
25
where are BP recordings most accurate
at home and work, not in the office
26
four steps to treat iron deficiecy
stop blood loss if there is any
improve diet
oral iron
parenteral iron
27
three diagnostic indicators of MS
clinical course and neurologic findings
MRI of brain and spine
testing of CSF for oligoclonal bandsof IgG
28
T/F the risk of death within 90 days of AMI is 75%
false, 1-22%
29
prevention of alzheimers
statins may reduce risk up to 50S%
NSAIDs
30
what is the main byproduct of hemoglobin breakdown
bilirubin
31
granular leukocytes
basophiles
neutrophils
eosinophils
32
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
33
what is the full name of T3
T4
which is the main functional hormone of the thyroid
triodothyroinine
tetraiodothyroinine
T3
34
HDL paradox
drugs that decrease LDL reduce risk
drugs that increase HDL do not reduce risk
35
non pharmacologic treatment of seizures
neurosurgical ablation/excision of lesion
vagus nerve stimulation for partial sz
36
what is the sympathetic response to decreased BP
* activation of Beta adrenergic receptors in the heart
* activation of Alpha adrenergic receptors in smooth muscle
37
two types of BPH symptoms
obstructive
irritative
38
three general symptoms of a primary CNS tumor
headache (CC in 30%)
sz
nausea
emesis
39
what is the first line treatment for hypothyroid
daily thyroxine
40
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
41
how is meningitis diagnosed
lumbar puncture and culture
42
what causes MS
areas of demylination in the CNS, followed by inflammation and gliosis (scarring)
43
how many patients with ESRD are candidates for transplant
about 50%
44
three environmental changes that can cause an endocrine response
nutritional
thermal
existential
45
why is the indicidence of CHF increasing
people who used to die from AMIs are now living with decreased heart function
46
does HTN mangement need to be life long
preferably not, as long as necessary but short as possible
47
what will be the difference in distribution from a primary and secondary CNS tumor
primary will be more localized
secondary will be more diffuse
48
what is the histological sign of B-12 and folate deficency
megaloblastic anemia
49
what is blood
dilute saline with dissolved chemicals and suspended cells
50
in what hyperthyroid condition does exopthalmos not occur
goiter
51
staghorn calculi
stones made of urate, cystine, or struvate that are too large to pass
52
folic acid is an essential cofactor in what
amino acid and DNA synthesis
53
what are 4 comorbidities associated with CVA
HTN
DM I/II
obesity
smoking
54
what is the determinant of symptoms caused by a brain tumor
location and size of tumor
55
three common statins
atorvastatin (lipitor)
simvastatin (zocor)
lovastatin (mevacor)
56
CHF EKG signs
left ventricular hypertrophy
57
describe the genetic characteristics of thalassemia
autosomal recessive
58
what is the treatment plan of hyperthyroid
control symptoms
prevent thyrid storm
plan long term control
59
what condition is commonly associated with intracerebral hemorrhage
HTN
60
what causes sickle cell disease
homozygous vs heterozygous Hgb A mutation
61
four conditions that are most commonly caused by DM
chronic renal failure
neuropathic pain
blindness
gangrene caused limb amputation
62
epilepsy
recurrent seizures with a chronic, underlying cause
63
what is the dialyzing fluid in peritoneal dialysis
1-3L of dextrose
64
three substances commonly secreted by testicular cancer
HCG
alpha-fetoprotein
lacate dehydrogenase
65
what are the pros and cons of kidney transplant
pro: improved quality of life
con: requires lifelong immunosuppresion
66
three common presenting symptoms of myasthenia gravis
ptosis
diplopia
dysphagia
67
what is the treatment for severe anemia for major thalassemia
what is the risk
repeat transfusions
iron overload (hemosiderosis)
68
three ways to reduce dementia risk
intellectual stimulation
social interaction and exercise
statins and nsaids
69
what is the most common symptom of testicular cancer
painless testicular mass
systemic symptoms are less likely
70
what is the most common cause of UTI
what gender is more susceptible
why
bacteria from the rectum
women
shorter urethra
71
four common sympathetic receptor blockers (examples)
beta blocker (atenolol, propanolol)
alpha blockers (prazosin, terazosin)
alpha and beta (labetalol)
centrally acting (methyldopa, clonidine)
72
when will most diabetic have complications
after 20 years
73
T/F most GBS has no trigger event
false
74
what percent of ESRD is idiopathic
22%
75
what forms carotid clots leading to embolic stroke
what might be heard on auscultation
what is the surgical treatment
atherosclerotic lesions
bruits
endarterectomy
76
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
77
5 grades of astrocytomas
which are most common in children
adults
I-IV
I and II most common in children
IV in adults
78
which thyroid hormone is most readily available
why is this effect in treatment
T4
because T4 is converted to T3 in tissues
79
T/F horomes are secreted continuously
false they are usually in pulses
80
differentiate between chronic and acute meningitis
usually a longer clinical course
similar, but less severe symptoms
usually cuased by mycobacteria, fungi, treponema
81
what is the protocol to test for prostate cancer
taking 12 needle biopsies at random locations
82
dementia
generalized loss of neurons
83
two conditions related to muscle damage from statin drugs
myopathy
rhabdomyolysis
84
what happens when an atherosclerotic plaque ruptures
a blood clot forms around the rupture and blocks the artery
85
thalassemia
genetic defect in globin biosynthesis
classified as alpha or beta thalassiema
86
less invasive surgical options for BPH
high intesity ultrasound
transurethral laser-induced prostatectomy
transurethral ablation
stents
87
risk of erythropoietin treatment
increasing hematocrit over 12g increase risk of stroke
88
three types of angina pectoris
stable
unstable
variant
89
treatment options for ESRD
dialysis or transplant
90
three causes of hypotension that can result ischemia
acute blood loss
anesthesia
cardiac arrhythmia
91
most CNS tumors come from what cells
glial cells
92
what is the most common benign tumor in men
benign prostatic hyperplasia
80% of men by 80 yrs old
93
normochromic, normocytic RBCs with normal reticulocytes, iron
but
pancytopenia
three things that top the DDx
aplastic anemia
bone marrow dysfunction
drug reaction
94
DDx for
megaloblastic anemia
low reticulocytes
normal iron studies
folate deficiency
B12 deficiency
metformin
GI symptoms
95
how is EF determined
echocardiogram
96
what are reticulocytes indictive of
rapid production of RBCs
destruction of RBCs
97
5 treatments for ESRD
restrictions of oral intake
control HTN
limit nephron loss
dialysis
transplant
98
what is the complication with oral iron supplements
compliance issues due to GI side effects
99
what are the laboratory tests that will confirm hyperthyroid
very low or absent TSH
very high T4
sometimes autoimmune tests are positive
100
what is the key feature of GBS
ascending paralysis progressing over hours or days
101
two types of testicular cancer
seminomas
non-seminomas
102
two adverse effects of statins
liver damage
muscle damage
103
what can happen to untreated cystitis
pyelonephritis
it can develop into pyelonephritis
frequent kidney infections can result in kidney damage and renal failure
104
anemia
pathological deficiency of oxygen carrying capacity of blood caused by a decrease in the number or function of RBCs
105
when are symtpoms of mild atherosclerosis noticed?
severe?
50% occulsion, usually on exertion
80%, effects can be felt at rest
106
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
107
what is the peak age for testicular cancer
15-40
108
what is a common iatrogenic cause of cushings
prednisone
109
four divisons of heart disease
coronary artery disease
valvular disease
HTN heart disease
cardiomyopathy
110
three main forms of coronary heart disease (CHD)
acute coronary syndrome
stable angina
CHF
111
what is the function of direct vasodilators in the treatment of HTN
reduce peripheral vascular resistance
112
seven signs associated with ERSD
elevated BUN and creatinine
oliguria
electrolyte imbalance
acid-base imbalance
HTN
anemia
113
T/F most women have atypical AMI presentation
true, more likely to be Dx as gi
114
two chronic effects of atherosclerosis
coronary effects
peripheral vascular disease
115
hemoglobin content is dependent on what two factors
production of Hgb - loss of Hgb
116
risk factors for atherosclerosis
* smoking
* hypertension
* diabetes
* family HX
* age
* dyslipidemia
* lifestyle
117
isolated vs progressive prostate cancer
stable and controlled
vs
capable of local extension and metastasis
118
causes of b12 deficiency
dietary (strict vegan)
gastric dysfunction
GI malabsorption (ileal disease)
119
BCG in bladder cancer
used for what
bacille calmette-guerin
vaccine for tuberculosis that can be used as an immune stimulant in some situations
120
why are ACE inhibitors effective
because angiotensin I is really just a precuros without much effect on blood pressure
121
LDL
transporter of endogeneous cholesterol
122
three strategies to prevent kidney stones
hydration
medication based on the type of stones
123
what common HTN treatment can cause malaise and fatigue
beta blockers
124
intervesicular treatment of bladder cancer
6 weeks of weekly treatments with cyotoxic drugs or BCG
125
life expectancy with ESRD
55-64 years
126
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
127
what is the prognosis of ESRD without dialysis
with dialysis
no dialysis: death in days or weeks
dialysis: yearly mortality 22%
128
how does cortisol exacebate HTN?
DM
HTN: increase salt intake
DM: increase blood sugar
129
5 year survival rates for testicular cancer
95-98% early
55-80% even with distant metastases
130
three amino acid hormones
dopamine
thyroxine
catecholamines
131
what percent of AMIs are precipitated by strenous events
50%
132
band cells
immature neutrophils that are indicative of rapid production of neutrophils
133
nephrolithiasis
kidney stones
134
silent stroke
a true stroke that causes infarction in a portion of the brain with no obvious motor or sensory functions
135
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
136
what typically causes subarachnoid hemorrhage
bleed from a major cerebral artery in the circle of willis, often from congenital vessel weakness
137
four classifications of HTN
primary/essential/idiopathic
renal
endocrine
pregnancy induced
138
what is the most common form of HTN
primary/essential/idiopathic
139
T/F all stones are painful
false, some can be painless
140
what lab tests confirm hypothyroid
Low T4
very high TSh
141
how much ultrafitrate is produce by the kidenys per minute
what is this called
120mL/min
the glomerular filtration rate (GFR)
142
how severe is GBS
it can be mild or severe, but most require hosptialization and 30% of severe GBS can require mechanical ventiliation
143
systolic pressure
pressure at which blood flow resumes in an occluded arterty
144
how to decrease stable angina attacks
HTN control
lipid management
lifestyle modification
cononary revascularization
145
five symptoms of ESRD
fatigue
pruritis
epistaxis
SOB
nausea
146
what are four dissolved components of blood
nutrients (glucose, vitamins)
Electrolytes (Na, K, Cl, Ca)
Hormones (insulin, T3/T4)
Proteins (albumen, carriers)
147
red pulp of the spleen
tortuous sinsoids that weed out old RBCs or RBCs with antigens to be broken down
148
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
149
three environmental sources of bone marrow toxic substances
solvents
pesticides
radiation
150
two etiology categories of epilepsy
primary and secondary
151
CHF symptoms
dyspnea, orthopnea, edema
152
what can happen if a homone is present in high enough concentrations
the hormone can interact with receptors of the same family
153
what are the 3 most common CNS tumor histologies
gliomas
meningiomas
schwannomas
154
three facts about steroid hormones
insoluble
requires transport molecules
causes DNA transcription and translation
155
two ways that hormone-receptor complexes elicit effects in target cells
2nd messanger
DNA transcription leading to protein production
156
STEMI is usually indicative of what
transmural ischemia (involves the full thickness of the cardiac wall)
157
fatal complication of diabetes
diabetic ketoacidosis
158
two actions of insulin
inhibit catabolism
promotes anabolism
159
three popular single drugs used in intial HTN treatment
ACE inhibitor
calcium channel blocker
diuretic
160
what is a normal blood volume
4-8 liters
161
what is the renal response to decreased blood pressure
decreased renal blood flow
162
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
163
what happens in response to decreased renal blood flow
renin is released
glomerular filtration is decreased
164
two types of vitamin derived hormones
retinoids (vitamin A)
vitamin D
165
what causes sickle cell anemia
autosomal recessive mutation of Hgb A
166
what are the most common minerals that form renal stones
calcium oxalate
calcium phosphate
167
5 symptoms of renal cell carcinoma
hematuria
flank pain
weight loss
anemia
palpable mass
168
what will be two signs of pernicious anemia
megaloblastic anemia and progressive neurological deterioration
169
Two types of UTI
lower urinary or upper urinary tract
170
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
171
T/F ESRD (end stage renal disease) is permanent
true
172
what percent of ARF survivors retain normal function
50%, with 5-10% having chronic renal failure
173
what is more common, STEMI or NSTEMI
NSTEMI (55-60%)(
174
how to reduce BP by decreasing PVR
two methods to achieve this
vasodilation
1. direct action on the vessels
2. CNS control
175
what determines the symptoms resulting from an interuption in arterial blood flow
the vessel affected
length of ischemia
neurologic redundancy
176
CVA working definition
condition resulting in an abrupt appearence of neurlogical symptoms due to focal vascular disruption that usually involves an infarction
177
what is the function of blocking RAA in treating HTN
reduce blood volume and peripheral resistance
178
describe tie etiology of Type I DM
an autoimmune disorder that causes rapid loss of beta cells
179
why do some RBCs appear "speckled"
they are reticulocytes that have remains of the endoplasmic reticulum remaining
180
what pattern is lost with cushing syndrome
the diurnal pattern which causes higher cortisol in the morning and lower at night
181
hemoglobinopathy
two types
change in Hgb structure and function
sickle cell anemia
thalassemia
182
diagnosis of testicular cancer
ultra sound, sometimes needly biopsy
retroperitonal lymph node dissection
CT of pelvic, abdomen, chest
183
T/F most myocardial infarctions are caused by HTN
false, caused by atherosclerotic plaque rupture
184
at what GFR is anemia usually found
\<30mL/min
185
I added an extra card because I didn't want there to be an unlucky number
Don't judge me
186
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
187
symptoms of
acute
subacute
chronic
ischemia
acute: acute coronary syndrome
subacute: angina
chronic : CHF
188
three causes of Cushings
iatrogenic
secondary adrenal hyperplasia
primary adrenal hyperplasia
189
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
190
what two effects of cortisol are considerd to improve resistance to stress
increased glucose availibility
increased blood pressure
191
what is the most common location of aneurysm in the brain
anterior cerebral or communicating artery
192
are antibiotics always needed for cystitis
no, they are generally needed but they are always needed for pyelonephritis
193
how is HDL increased
weight loss and exercise
194
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
195
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
196
STEMI treatment
reperfusion
supportive measures similar to NSTEMI
197
what is the function of aldosterone II
triggers vasoconstriction
aldosterone production and release from the adrenal cortex
198
recyclining function of RE macrophages
amino acids and iron from hemoglobin is recycled into the bone marrow to make new RBCs
199
who is usually victim of idiopathic cardiomyopathy
young and healthy people, generally with a precipitating even (viral infection, pregnancy)
200
chronic heart failure 9CHF) definition
ventricular function insufficent to meet the metabolic and blood flow demands
201
describe the negative feedback loop that regulates adrenal function
pituitary secretes ACTH
adrenal cortex secretes cortisol
cortsol inhibits ACTH secretion
202
five chronic complications of DM
CAD
PVD
nephropathy
neuropathy
retinopathy
203
orthopnea
the inability to sleep supine without breathing issues
204
three causes of ischemia
vessel stenosis or occulsion
vasospasm
pump failure
205
what is the most common form of renal and ureteral stone removal
how effect is it
lithotripsy
90-90%
206
five factors the kidney fails to regulate in renal failure
fluid balance
electrolyte balance
acid-base balance
excretion of nitrogenous waste
excretion of drugs
207
which are more prominent, alpha or beta cells?
alpha (75% to 20%)
208
why is stroke prognosis difficult to predict
one area can be damaged but other areas can be repurposed to compensate
209
what type of stroke is most common
ischemic (85-90% vs 10-15%)
210
what is the progression of chronic renal disease
gradual loss of nephrons
gradual decline of GFR
leads to end stage renal disease
211
what is required to for a renal stone
super saturation of urine with insoluble material
212
reduced hgb production is indicative of what?
bone marrow issue
213
medical treatment of BPH
alpha blocker drugs
5-alpha reductase inhibitors
214
where are T3 receptors found
in alll most all human tissue
215
what drug will cause hypothyroid
amiodirone
216
what are three general symptoms associated with HTN
Headaches
malaise/fatigue
symptoms of complications
217
what typpe of diabetics are most likely to have DKA
type one
218
what is the effect of statin drug treatment
reduction of endogenous cholesterol synthesis
lowers LDL
219
T/F BPH is not a precancerous condition
true, the incidence of BPH and prostate cancer are independent
220
what must be monitored during statin treatment due to the liver damaging side effects
liver enzymes
221
two branches of peripheral vascular disease
atherosclerotic
vasculitis
222
treatment of aplastic anemia
immunosuppresion
bone marrow transplant
223
B12 is important to the synthesis of what
nucleic acid synthesis
224
why are AMIs more common in the AM
BP is higher
increased blood viscosity
cortisol secretion is at its highest
225
T/F most chronic conditions are no effected by cortisol
false, many (such as DM and HTN) can be exacerbated by cortisol
226
four causes of isolated seizures
drug withdrawl
high fever
infections
vasovagal or orthostatic syncope
227
what is the long term concern with BPH
obstruction can cause renal damage from bilateral hydronephrosis
228
two types of mechanical assist devices used in cardiogenic shock
balloon pumps
LVADs
229
criteria for moderate chronic renal disease
symptoms or restrictions
GFR 20-60 mL/min
some dietary restrictions may be needed
230
what causes symptoms in brain abcesses
increased ICP
destruction of brain tissue
231
describe the course of recovery for GBS
recovery begins 1-4 weeks after onset
can take months or a year to complete
232
hydronephrosis
dilation of the renal collecting system due to outflow obstruction
233
what is the hallmark of type II DM
insulin resistance
234
multi centric cancer
multiple cells turn cancerous, not just a single cell that divides
235
why is it dangerous to give folate to treat pernicious anemia
folate will correct the anemia but not the neurlogical damage
236
three Ps of diabetes
polyuria
polydipsia
polyphagia
237
explain why endocrine systems are homeostatic
they respond to outside challenges to maintain homeostasis
238
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
239
important questions to ask in anemai
diet
menstruation
GI distress
medication
240
common name of HMG-CoA reducatse inhibitors
statins
241
two RBC enzyme deficiencies
G6pD
PKD
242
what causes the oxidation of LDL in fatty streaks
monocytes
243
supportive measures for STEMI
aspirin
oxygen
decrease myocardial oxygen demand
control arrhytmia
244
why is neutrophil count important in cancer treatment
chemo decreases bone marrow function
245
parkinsons disease
loss of extrapyramidal motor neurons
246
bilirubin is an indicator of what
liver function
247
three most common causes of dementia
alzheimers
vascular dementia from multiples infarcts
lwey body dementia
248
how can thrombopphlebitis (DVT) can an embolic stroke
passing between a atrial septal defect
249
two types of ischemic strokes
thrombotic
embolic
250
four types of generalized seizures
tonic-clonic
absence
myoclonic
febrile
251
four groups of drugs used to treat HTN
diuretics
sympathetic receptor blocker
direct vasodilators
RAA blockers
252
why can radioactive iodine be used to ablate the thyroid
because the thyroid is the only place where iodine is stored in the bdoy
253
T/F arterial blood flow interruption is a common probelm
true
254
what is the treatment for type I DM
type II
type I = insulin
type II = insulin plus other stuff
255
what is the most common type of hyperthyroidism (60-80%)
graves disease
256
what is neurological condition is caused by an excess of dopamine
psychosis
257
what is needed to gain access for hemodialysis
av fistula or prosthetic arteriovenous graft
258
what is the effect of sympathetic stimulation of alpha receptors in response to decreased BP
increased peripheral resistance through vasoconstriction
259
if there is a coexisting B12 deficiency what will folate treatment do
correct anemia but not neurodegeneration
260
paracrine
chemical signalling to nearby cells
261
NSTEMI treatment
supportive measures
anticoagulation
262
three strategies for treatment of BPH
observation
medical treatment
surgical treatment
263
three categories of neurotransmitter diseases
disorders of
deficiency of a neurotransmitter
excess of a neurotransmitter
imbalance of neurotransmitters
264
what type of hormones will dissolve in blood
what type of hormones will need a carrier
water soluable
lipid soluble
265
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
266
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
267
when are statins contraindicated
pregnacy
children
268
two key elements manipulated to regulate blood pressure
sympathetic nervous system input
renal blood flow
269
what is the progression of myasthenia gravis
85% will develop generalized muscle weakness notably with repetitive muscle use
270
cobalamin
B 12
271
common clinical indications of CNS infection
signs of infection (fever, malaise)
alteration of CNS function (AMS, SZ)
272
symptoms associated with primary temporal lobe tumor
sz
olfactory and gustatory hallucinations
deja vu/jamais vu
273
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
274
Dr Dodges suggested take home messages regarding HTN
1. 140/90 is still a reasonable threshold for the intiation of medical treatment of HTN
2. lifestyle modification are useful for patients with elevate BP
3. patients with diabetes or other comorbidities, medical treatment should be considered
275
two PCSK9 drugs
alirocumab (praluent)
evolcumab (repatha)
276
what nervous system are many of the symptoms of hyperthyroidism related to
sympathetic nervous system
1. restlessness
2. insomnia
3. tremor
4. weight loss
5. heat intolerance
277
G6PD homozygotes are at risk for hemolysis triggered by what three factors
certain diseases (infection, diabetes)
certain foods (fava beans)
certain drugs (sulfa, aspirin)
278
common symptoms of MS
limb weakness, numbness, paresthesia
spastic paraparesis
optic neuritis
diplopia
loss of sphincter control
vertigo
279
what are the symptoms associated with dementia
loss in
memory, reasoning, judgement, abstraction, learning, language
280
pheochromocytoma
5 primary symptoms
a rare tumor of the adrenal medulla or sympathetic ganglion that secretes norepinephrine
1. severe headaches
2. diaphoresis
3. palpitation
4. tremor
5. anxiety
281
treatment strategy for bladder cancer
transurethral resection
partial or radical cystectomy
chemo and radiation
282
what is the most common type of epilepsy
when does it usually start
primary (idiopathic or constitutonial)
usually before age 20
283
symptoms associated with primary brain stem or cerebellar tumor
ataxia
nystagmus
cranial nerve palsies
284
symptoms of acute MI
squeezing pressure chest pain
can be felt in the stomach or left arm, face, shoulder
anxiety
diaphoresis
GI distress
285
what components of blood come from the myeloid line
erythrocytes
megakaryocytes (platelets)
granulocytes (N, B, E-phils) and monocytes
286
three treatment options for MG
thymectomy (if present and the patient is between puberty and 60)
acetylcholinesterase inhibitors
immunosuppresive drugs
287
mitigating factors to consider in treatment of HTN
other medical conditions
RAA work less well on african americans
cost
288
four common RAA blockers (examples)
angiotensin converting enzyme (ACE) inhibitors (catopril, benazopril)
angiotensin II receptor antagonist (losartan)
aldosterone antagonist (spironolactone)
renin inhibitor (aliskiren)
289
three ways gastric disfunction can cause b12 deficiency
pernicious anemia
gastric atrophy
gastric surgery
290
three facts about peptide/protein/glycoprotein hormones
water soluble
interact with cell membrane
work through second messanger
291
what is the functional unit of the kidney
the nephron
292
how long does the tonic phase of a tonic clonic sz last
clonic phase
1minute
2-3 minutes
293
what has been the primary reason for decreasing number of cardiac death since the 1970
decreased in smoking
improved treatment
294
two divisions of cardiovascular disease
peripheral vascular disease
heart disease
295
treatment dilemma for prostate cancer
if the gleason score is low its caught early laproscopic surgery or "watch and wait" may be done
296
what age is mostly likely for the onset of MS
20-40
297
acute vs chronic renal failure
acute: sudden reaction, hours or days
chronic: gradual decline in function over months or years
298
primary adrenal hyperplasia causes
idiopathic
neoplasm
congenital
299
three ways to decrease BP by decreasing CO
reduce HR
reduce contractility
reduce venous return/decrease blood volume
300
what is the key component of ischemia
O2 supply is not sufficient for demand
301
what makes up the nephron
glomerulus
bowmans capsule
proximal tubule
distal tubule
loop of henle
collecting duct
302
medication to decrease urate stones
allopurinol to decrease uric acid
decrease protein
303
T/F 30% of AMIs are asymptomatic
treu
304
what constitutes a "hypertensive emergency"
200/140
305
what are the current treatment goals for alzheimers
slow the progression of disease
reduce plaques with anti amyloid drugs (possibly not beneficial)
306
what is the most common cause of death in the US
cardiovascular disease
307
three endocrine conditions associated with HTN
cushings
pheochromcytoma
congenital adrenal hyperplasia
308
what is considered the unifying element in the pathogenesis of atherosclerosis
how was this decided
inflammtion
inflammatory markers correlate to CV disease risk
309
what triggets the production of EPO
decreased oxygen saturation in the blood
310
three conditions associated with pregnancy induced HTN
toxemia
pre-eclampsia
eclampsia
311
NSTEMI is indicative of what
ischemia that is subendocardial rather than transmural
312
foam cells
monocytes that become macrophages and ingest oxidized LDL
313
what common HTN treatment will cause annoying dry cough
ACE inhibitors
314
unstable angina
angina that occurs with minimal activty or at rest
315
two methods for reperfusion in response to STEMI
percutaneous coronary intervention
thrombolytic therapy
316
T/F more than 50% of AMI death occur suddenly
true
317
what causes graves disease
auto-antibodies that bind and active TSH receptors
318
fatty streaks
LDL accumulation under endothelium
319
folate deficiency treatment
daily folic acid tablets
320
diastolic reading
pressure at which flow returns to normal in an occluded artery
321
three causes of bone marrow toxicity
pharmacological
environmental
immunologic
322
5 types of meningitis
acute
purulent
septic
chronic
aseptic
323
diagnosis of prostate cancer
digital rectal exam
ultrasound
biopsy
prostate specific antigen screen
324
what percent of the following have cardiovascular disease
people at age 20
people over 75
total population
5%
75%
20%
325
what are the risk factors for CNS tumors
radiation exposure
no other risk factors known
326
what gender is mostly likley to get renal cell carcinoma
2:1 men over women
327
four small neurpeptide hormones
GnRH
TRH
vasopressin
somatostatin
328
differniate between homozygous and heterozygous thalassemia
homozygotes have signifcant disease (major)
heterozygotes are mildly anemia or asymptomatic
329
autocrine
chemical signaling of cells among the same type
330
what portion of brain tumors are malignant
how many deaths per year
50%
13000/year
331
radiation options for CNS tumor treatment
whole brain vs focused radiation (gamma knife)
332
what is the gender ratio of patients with graves disease
female 8:1
333
what drug can stop the relase of T3 and T4
potassium iodine
334
where does glucagon like peptide naturally come from
what does it do
L cells in the intestine
opposes insulin
335
atherosclerotic process
* fatty streaks
* monocyte aggregation
* LDL oxidation
* formation of foam cells
* inflammation leading to LDL accumulation
336
when is cardiogenic shock the more common cause of MI mortality
in the case of large infarctions
337
CHF signs on CXR
cardiomegaly, pulmonary edema
338
what is the risk of decreasing blood pressure too low
toxicity
orthostatic hypertension
339
most bladder cancers are _____ with\_\_\_\_
transitional cell carcinomas
multi-cell centric organism
340
what is the immunosuppressive treatment of aplastic anemia
how often is it successful
antilymphocyte or antithymocyte globulin
50-70%
341
three lifestyle issues that increase risk of atherosclerosis
obesity
physical inactivity
atherogenic (inflammatory) diet
342
four strategies to prevent future strokes
reduce the chances of repeat embolis
control HTN
control DM
treat atherosclerosis
343
two supportive treatments for UTI
hydration
vitamin C (cranberry juice)
344
what causes BPH
unknown, but it does seem to require androgens and aging
345
atherosclerosis
vessel narrowing due to fatty deposits in the arteries related to lipid metabolism and cholesterol
346
10-15% of MG patients have a \_\_\_\_
3-8% will have or will develop \_\_\_\_
thymoma
hyperthyroid (graves disease)
347
what is the main cause of cardiovascular disease
atherosclerosis
348
what cells come from the lymphoid line
NK cells
dendritic cells
T & B lymphoctyes
349
diagnosis of renal cell carcinoma
symptoms or hematuria leading to abdominal chest CT and cytology
350
two diseases caused by a deficiency of a specific neurotransmitter
parkinsons (dopamine)
myasthenia gravis (acetylcholine)
351
stable angina
recurring episodes of chest pain brought on by exertion and relieved by rest
352
what cells break down RBCs
reticuloendothelial cells found in the spleen and liver
353
why would you check for hyperthyroidism in new onset a fib
because hyperthyroid can trigger arrhytmias
354
what is the main complication for peritoneal dialysis
infection through the port
355
Gaba vs glutamate
Gaba is a inhibitor of APs, glutamate excites APs
356
lipoproteins
macromolecule consisting of lipid and protein
357
what causes chronic anemia with ESRD
a deficiency in erythropoeitin
358
what is the primary condition associated with upper UTI
acute pyelonephritis
359
how do sympathetic receptors blockers function to lower HTN
block alpha and beta receptors
360
prognosis for:
pituitary tumors
meningiomas
astrocytomas
pituitary good
meningiomas usually good
astrocytomas usualyl bad
361
three drugs used in the treatment of stable angina
nitrates
beta blockers
calcium channel blockers
362
criteria for mild CRD
symptoms or restrictions?
GFR +60mL/min
none
363
what is the most common pathogen associated with UTI
E. Coli or other coliforms
364
5 locations in the body with especially high numbers of T3 receptors
brain
heart
muscle
kidneys
gonads
365
increasd hgb loss means
accelerated destruction or loss from vasculature
366
six disorders that will cause neurollogical disorders
1. vascular
2. neoplastic
3. infectious
4. degenerative
5. neurotransmitter
6. seizure disorders
367
the hydraulic equation
define the variables
BP = CO x PVR
BP = cardiac output x peripheral resistance
368
HDL
removes LDL cholesterol and triglycerides
369
what will microinfarctions from sickle cell cause
leg ulcers
functional splenomegaly
shortened life span
370
symptoms associated with primary frontal lobe tumor
personality changes
decreased intellect
371
four options for ureteral stone treatment
supportive
ureterscopic retrieval
surgical removal
lithotripsy
372
medication used to decrease glucagon secretion
glucagon like peptide 1
373
two main types of hyperthyroidism
graves disease
toxic nodular goiter
374
T/F complete control of glucose is bad
true, it decreases longevity
375
megaloblastic anemia
Large RBCs, hypersegmented neutrophils caused by impaired DNA synthesis
376
dyslipidemia related to atherosclerosis
high LDL
low HDL
377
where are other ACTH secreting cells located beside the pituitary
small cell lung cancers
378
four problems that would lead to decreased erythropoesis in the RBCs
nutritional deficiencies
loss of stimulation
toxicity
neoplasm
379
PCI
stent placement
380
what is required for reabsorption of the ultrafiltrate in the kidneys
energy
381
what is the evolutionary benefit to G6PD deficieny
heterozygotes have increase survival rate with malaria infection
382
ALS
amyotrophic lateral sclerosis, loss of upper and lower motor neurons
383
thee factors that influence PVR
arterial diameter
arterial length
elasticity
384
two indications of aseptic meningitis
more benign course
usually caused by viral infection (herpes, mumps, enteroviruses)
385
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
386
what is the first symptom of GBS
how does this progress
usually leg weakness
motor loss comes first, then sensory
387
primary hyperthyroid
the 99% of hypothyroidism that is caused by failure of the thyroid galdn
388
three systems that patients will often loss RBCs through (example of disoder)
GYN (heavy period)
GI (cancer, ulcer)
GU (cancer)
389
two common sources of embolic strokes
carotid
cardiac
390
four treatments for atherosclerosis
lifestyle changes
treatment of hyperlipidemia with statins
treat HTN
treat diabetes
391
benign prostatic hypertrophy
noncancerous enlargement of the prostate
392
two histological descriptors of iron deficient anemia
microcytic (small)
hypochromic (pale colored)
393
four triggers for GBS
food poisoning caused by campylobacter jejuni
cytomegaloy virus/epstein barr
mycoplasmic pneumonia
some vaccinations
394
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
395
what is the main complication associated with nephrolithaisis
ureteral occlusion which can cause severe back or flank pain and can cause hydronephrosis
396
partial sz (retain consciousness)
partial (single muscle group/limb)
complex (sensory hallucinations with increased or decreased motor function
397
what is a common accompaniment with lewy body dementia
hallucinations
398
three examples of neuronal loss disorders
dementia
ALS
parkinsons
399
two agents that improve survival with CHF
beta blockers
ACE inhibitors
400
four dietary sources of iron
meat, seafood, beans, spinach
401
aplastic anemia
an autoimmune disorder that causes the loss of hemopoietic cells
402
two types of prostate cancer
isolated malignant foci
progressive cancer
403
what is the effect of folic acid on fetal development
assist in neural tube development and decreases ther risk of anencephaly or spina bifida
404
four common MS treatments
corticosteriods (prednisone, medrol)
interferon beta 1a
immunosuppresants
IVIG
405
five non-insulin treatments of DM
reduce insulin resistance
stimulate secretion fo endogeneous insulin
reduce glucagoon
reduce glucose absorption
enhance urinary secretion
406
how many AMIs occur yearly
what percent are fatal
1.1 million
20-40%
407
two special categories of CVA
TIA
silent strokes
408
two sources of cholesterol
exogenous (diet and absorption)
endogeneous (production of cholesterol from the liver)
409
why is the age related risk for athersclerosis different for men and women
women haver higher HDL
estrogen raises HDL
410
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
411
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
412
limitation of prostate ultrasound for cancer ID
most prostate cancers look the same as prostate tissue
413
five important functions of the renal system
fluid balance
electrolyte balance
acid-base balance
excretion of nitrogenous waste
excretion of toxins and drugs
414
NSTEMI supportive treatments
rest
oxygen
sedation/analgesia
control of arrhytmia
415
three pronged approach to preventing sz
enhance inhibitory CNS influences (GABA)
reduce excitatory CNS influences (glutamate)
modulate ionic conductance
416
acute coronary syndromes
acute MI with ST segment elevation
acute MI without St elevation
unstable angina
417
T/F HTN is generally asymptomatic
true
418
what type of feedback loop primarily regulates the endocrine system
how is regulation accomplished
negative
secretion of inhibiting or enhancing factors
419
endocrine
chemical signaling between distant cells by ductless glands
420
erythropoetin
cytokine that stimulates the production of erythrocytes
421
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
422
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
423
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
424
CHF signs on echocardiogram
ventricular ejection fraction
425
T/F gamma hemoglobin production is turned off in adults
true
426
major endocrine glands (10)
1. pineal gland
2. parathyroid
3. thyroid
4. hypothalamus
5. pituitary
6. thymus
7. kidney
8. adrenal
9. pancreas
10. ovary/testes
427
what causes DKA
hyperglycemia \>300mg/dl causes keto acids to accumulate
428
two conditioned associated with renal hypertension
narrowed renal artery
chronic renal disease
429
what is the maximum time limit before recovery for a TIA
24 hours
430
what do beta blockers do in treating hyperthyroid
four results of treatment
block sympathetic pathways
rapid reduction in anxiety, restlessness, tremor, palpitations
431
what are three other minerals that can form renal stones
uric acid from gout
cystine
struvite
432
C reactive protin
an inflammtion marker related to heart disease
433
special consideration for renal tumors and spread
this cancer has a high likelihood to invade the vena cava to form embolism and mets
434
why is early detection of prostate cancer important
because cancers with distant metastases have a 5-10% chance of survival
435
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
436
common ischemic stroke symptoms
usually none other than mild neurological deficits, possibly a mild head ache and decreased LOC
437
are there any specific symptoms for ESRD
no, generally the patient just feels like crap
438
what is the most common source of cardiac emboli
mural thombi from atrila fibrillation
439
T/F G6PD and PKD defiency are both autosomal dominant
false, they are autosomal recessive
440
why can FSH, LH, TSH, and HCG cross react with each other
they have receptors in the same family
441
four risk factors for dementia
age
female
head injury
chronic disease (athersclerosis, DM)
442
what is a currently available treatment for testicular cancer that is very effective
external beam radiation with chemo
443
possible changes associated with recurrent silent stroke
change in mood/personality
vascular dementia
444
symptoms of bladder cancer
what is the most common
hematuria
irritative voiding symptoms
pain or masses in advanced disease
hematuria (85-90%)
445
classic GI causes of chronic bleeding
peptic ulcer or cancer
446
time constraint for hemodialysis
3-5 hours 3x per week
447
criteria for severe chronic renal disease (End stage)
GFR \<20mL/min
renal replacement therapy needed
448
what causes jaundice
high levels of bilirubin
449
three treatments of cardiogenic shock
vasopressors (maintain pressure)
inotropic agents to improve contractility
mechanical assist deveices
450
two factors related to renal blood flow that can be manipulated to regulate BP
renin-angiotensin-aldosterone pathway
total vascular volume
451
surgical treatment of BPH
prostate resection
452
T/F drugs are also found dissolved in blood
true
453
step down strategy for HTN treatment
decreasing dose based on stable normal pressures attained through lifestyle changes
454
dyspnea as it relates to CHF
air hunger with minimal exertion
455
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
456
specific symptoms associated with primary CNS tumor
focal neurological deficits dependent of the location
457
PCSK9 inhibitors
new drug that stimulated production of an enzyme show to decrease LDL and decrease risk of heart disease
458
what gender is most likely to form renal stones
men 3:1 over women
459
T/F heterozygous Hgb is usually asymptomatic
true
460
typical anginal episode
lasts 2-15 minutes
substernal pain with radiation
intiated by lifting, eating, emotions, cold weather
461
three types of steroid hormones
estrogens
androgens
progestins
462
causes of hemolysis
defect in RBC size shape or function
outside destructrion of normal RBCs
463
symptoms associated with primary parietal lobe tumor
sensory or motor deficits
spontaneous pain symdromes
464
symptoms associated with cystitis
frequency
urgency
painful urination
hematuria
465
two key RAA hormones
Angiotensin II
aldosterone
466
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
467
five hypothyroid symptoms
1. cold intolerance
2. hair loss
3. weight gain
4. weakness
5. dry skin
468
symptoms associated with primary occipital lobe tumor
visual field defects
visual agnosia (cant recognize what you are seeing)
469
thyroid storm
acute high levels of T3 and T4 that can cause hypotension and fever
470
classic urinary causes of anemia
renal cell carcinoma
bladder carcinoma
471
what percent of renal stones are made from calcium
75-85%
472
what is a lesser known issue with statin?
what is the result
muscle weakness
reduction in activities
473
T/F 20% of prostate cancer patients will not have elevated PSA
true, elevated PSA isn't a very specific marker
474
prostate cancer symptoms
none in the early stages oher than BPH
late stages include pain and urinary obstruction
475
the useful conbinations of drugs used in intitial treatment of HTN
ACE inhibitor + diuretic
Beta blocker + diuretic
beta blocker + alpha blocker
476
three examples of post meningitis deficits
hearing loss
impaired cognition
epilepsy
477
what is the most common medication for type II DM
metformin (glucophage)
478
three types of MS
relapsing-remitting
primary progressive
secondary progressive
479
what symptoms are associated with pyelonephritis
frequency
urgency
painful urination
hematuria *(same as cystitis)*
**plus**
flank pain
fever
480
cushing syndrome
a cluster of symptoms caused by excess cortisol
481
what two factors increase water retention in response to decreased blood pressure
decreased glomerular filtration
aldosterone production
482
CBC
complete blood count (RBCs, WBCs, platelets, hemoglobin and hematocrit)
483
two types of leukemia
myeloid (acute or chronic)
lymphoid (acute or chronic)
484
two long term control options for hyperthyroid
thyroid excision or destruction
continued antithyroid drugs
485
three types of gliomas
which is the most common
astrocytoma (common)
oligodendrogliomas
ependymomas
486
what is the shelf life of venous access for hemodialysis
3 years at about 30-80% failure
487
what drugs stop the production of T3 and T4
when are they most effective
thioamides
when combined with beta blockers and potassium iodine
488
four functional factors of red blood cells
Hemoglobin
size, shape
flexibility
longevity
489
what is the median survival of a low grade (I-II) astrocytomas
Grade III?
Grade IV?
5-10 years
3 years
\<1yr
490
what is sequela of stroke that can lead to early disfunction
increased intracranial pressure
491
two methods to reduce cardiac out in HTN treatment
block beta 1 sympathetic action
reduce blood volume
492
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
493
what is the treatment for idiopathic cardiomyopathy
spontaneous remission, but LVADs or transplant can be required
494
what is the function of the adrenal cortex
secretes glucocorticoids, androgens, mineralocorticoids
495
specific name for grade IV astrocytoma
glioblastoma multiforme
496
idiopathic (hereditary) hypercaluria
hereditary high calcium related to kidney stones
497
BNP
brain natriuretic peptide
498
what are two methods of lowering T3 and T4 in hyperthyroidism
prevent hormone release
stop T3 and T4 production
499
three peripheral vascular disease associated with the effects of chronic atherosclerosis
renal artery stenosis
femoral/popliteal stenosis
aortic aneurysm formation
500
where is erythropoietin produce
the juxtapoglomerular cells of the kidneys
501
white pulp of the spleen
lymph tissue
502
peritoneal vs hemodialysis
the peritoneum is used as the dialyzing membrane
"kidney machines" that filter and replace blood
503
treatment of stable angina
acute treatment with vasodilation
decrease frequency of attacks
504
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%
505
four types of receptor hormone interactions
agonists (stimulate receptors)
antagonists (block receptors)
down regulation
change receptor affinity
506
what percent of the body's oxygen is used by the kidneys
what percent of rest cardiac output
7%
20-25%
507
what is the preferred method of treatment to definatively cure hyperthyroid
what makes it good
ablation wth radioactive iodine
because it spares the parathyroid
508
two primary sympathetic receptors manipulated to control BP
Alpha 1 vascular receptors
Beta 1 cardiac receptors
509
three things needed to diagnose BPH
symptoms plus enlarged prostate and trans rectal ultrasound
510
anticoagulation therapy for NSTEMI
heparin
antiplatelets
511
AMI prognosis factors
age
size of vessel
prior infarctions
nature of treatment
512
when you spin out blood what is the "buffy coat"
white blood cells
513
irritative BPH symptoms
urgency
frequency
nocturnal voiding
514
5 lipid lowering agents
niacin
bile acid binding agents
HMG-CoA reductase inhibitors
fibric acid derivatives
inhibitors of sterol absorption
515
acute myocardial infarction
mycardial death due to abrupt reduction in coronary blood flow almost always caused by atherosclerosis
516
why is it imporant to know the amount of a hormone that is bound vs free
a bound hormone can't do anything
517
three common side effects of HTN treatment
electrolyte imbalances
annoying dry cough
malaise, fatigue
518
T/F cardiovascular illness is the most common serious disorder in the US
true
519
two main causes of MI mortality
cardiac arrhythmia (v fib)
pump failure (cardiogenic shock)
520
types of myeloproliferative disorders
leukemia
lymphoma
multiple myeloma
polycythemia
thromocythemia
521
describe the etiology of type II DM
a very slow loss of beta cells causd by genetic or obestity
522
CHF signs
peripheral edema, JVD
523
other oxygen transport issues related to heart damage that arent ischemia
hypotension
chronic anemia
increased metabolism
524
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
525
what is the result from blocking beta 1 sympathetic action
reduced cardiac rate and contractility
526
CHF treatment strategy II
reduct cardiac remodeling (aldosterone antagonists)
treat hyperlipidemia (statins, even if lipids are normal)
527
two types of lymphoma
hodgkins
non-hodgkins
528
treatment of v fib
cardioversion (defibrilation)
529
how is meningitis treated
antimicrobial drugs
prevention through vaccines or prophylactics
530
what links receptors of the same "family)
they have a similar structure
531
what is the effect of thyrotropin (TSH)
increased T3 and T4
532
three risk factors associated with renal cell cancer
smoking
obesity
genetic factors
533
define diabete mellitus
a disorder characterized by chronic hyperglycemia due to relative or absolute deficiency of insulin, or resistance to insulin
534
why drugs used to treat HTN will cause low potassium?
high?
diuretics
ACE and aldosterone inhibitors
535
why are growth abnormalities present in beta thalassemia
there is an overgrowth of bone marrow that can cause pathologic fractures or "chipmunk facies"
536
what is the benefit of PCSK9 treatment
drawback?
produce better lipid reduction that statins
very expensive
537
what causes pernicious anemia
auto antibodies against intrinsic factor
538
myeloproliferative disorders
cancers that will displace normal bone marrow
539
what is the treatment for hepatosplenomegaly caused by thalassemia
eventually splenectomy, which will increase risk of infection
540
what is the result of increased sodium and water retention in response to low BP
increasd blood volume, which increases cardiac output
541
what is the main condition associated witha lower UTI
acute cystitis
542
how common is hashimotos
is there a gender bias
1-4/1000
females 1:4
543
four causes of hypothyroid
post thyroidectomy/ablation
hashimotos thyroiditis
Drug induced
dietary iodine deficiency
544
thee common vasodilators (examples)
calcium channel blockers (diltiazem, amlodipine)
arterial (hydralazine, minoxidil, diazoxide)
arterial and venous (nitroprusside)
545
two types of strokes
ischemic strokes
hemorrhagic strokes
546
what is the most likely cause of a TIA
small emboli from heart or carotids
547
what is the mortality rate for acute renal failure
50%, usually due to the disorder that caused renal failure
548
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
549
based on new HTN guidelines how many people are afflicted
103million
550
how does insulin promote anabolism
increase glycogen production and storage
promotes triglyceride synthesis in fat cells
incrases protein synthesis in muscle
551
what happens in hashimotos
the thyroid is infiltrated with T and B cells
552
T/F pregnancy and lactation can caused anemia through loss of RBCs
false, they cause increased demand
553
obstructive BPH symptoms
decreased force and caliber
difficulty intiting flow
incomplete voiding
straining
post void dribbling
554
two HTN treatment strategies
reduce cardiac output
reduce peripheral vascular resistance
555
what will the response to T3 be
increased...
energy utilization
protein synthesis
sensitivity to other hormones
556
4 conditions associated with ESRD
diabetes
HTN
glomerulonephritis
cystic disease
557
target cell
the end-target of a hormone that produces a response within the cell
558
what symptoms are associated with passing a ureteral stone
what determines the pain
pain and hematuria
depends on the location of the stone
559
three facts about aldosterone
most potent natural mineralocorticoid
helps with sodium and fluid retention
also induces cardiac growth
560
occurance of MS
350,000, 2-1 women to men
561
what are the two pathological processes related to degenerative neurological disorders
gradual loss of neurons
gradual loss of axons
562
what are the risks of major thalassemia
severe anemia
hepatosplenomegaly
growth abnormalities
563
what is the histological pathophysiology of alzheimers
plaques of beta amyloid
tangles of tau proteins
564
5 protein/glycoprotein hormones
FSH
LH
TSH
HCG
Insulin
PTH
565
speficific treatment for prolactinomas
dopaminergic drugs
566
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
567
four causes of secondary epilepsy
intracranial neoplasms
post head trauma
post meningitis
others
568
how is bladder cancer usually found
hematuria leads to biopsy
569
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
570
why are PSA screening controversial
because it has not improved survival
571
pathophysiology of stable angina
unmet oxygen demand cuased by coronary atherosclerosis, anemia, fever, hyperthyroid
572
myasythenia gravis
a chronic autoimmune disease caused by antibodies against acetylcholine receptors at the neuromuscular junction
573
what causes GBS
autoimmune antibodies produced against myelin
574
four typical settings the lead to acute renal failure
severe burns
severe trauma
severe infections
severe heart disease
575
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
576
age range for increased atherosclerosis risk for men and women
\>/=45 men
\>/= 55 for women
577
renal failure
decrease in renal function until excretion is unable to regulate blood composition
578
what is needed to extract dietary b12
low gastric pH and intrinsic factor
579
4 types of prostatectomy
transurethral (TURP)
retropubic
perineal
laproscopic (robotic)
580
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
581
distinguish between treatments for mild and severe HTN
mild to moderate HTN usually uses one drug
severe HTN uses multiple drugs
582
four features of the post-ictal phase
headache/confusion
fatigue
muscle soreness
duration of up to several hours
583
two regulators of thyroid function
thyrotropin-releasing hormone (TRH)
thyrotropin (TSH)
584
what is expected with alzheimers progession of disease
steady loss of memory, speech, motor function
average life span of 7-8 years
585
T/F vitamin B deficiency can cause dementia
true
586
5 general categories of hormones
amino acid
neuropeptides
proteins/glycoproteins
Steroids
Vitamin deriviatives
587
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
588
how do chronic renal failure cause anemia
loss of EPO resulting in moderate anemia
589
where do RBCs come from
does all bone marrow produce RBCs
bone marrow
no, mostly in the hips, sternum, long bones
590
what cells in the pancreatic islets that secrete insulin
glucagon
beta cells
alpha cells
591
risk of thrombocythemia
increased clotting
592
classic cause of anemia from gyn
uterine (heavy period, leiomyoma
593
three methods to reduce peripheral resistance in HTN treatment
block alpha 1 sympathetic action
block central sympathetic action
directly dilate the blood vessels
594
what % of testicular cancer is assocatied with cryptoorchism
can orchiplexy resolve this
5%
no
595
what is an important consideration when treating hemorrhagic stroke
anticoagulation and antithrombolytics are contraindicated in hemorrhagic stroke
596
what is the function of the adrenal medulla
secretes epi/norepinephrine
597
what is the most common cause of hypothyroid
hashimotos thyroiditis
598
how do diuretic function to decrease blood pressure
lower blood volume
599
five symptoms of DKA
tachycardia
dehydration
SOB
lethargy
coma
600
what is the risk of TIA
they can progress to a full stroke without treatment
601
what accounts for the 1-4% fatality rate of GBS
pulmonary complications or cardiac arrhythmias
602
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
603
modulate ionic conductance in seizure treatment
decreases the permeability of the cell membrane
604
T/F a small number of RBCs are lost through the GI, Urine, Skin
true
605
preventing the recurrance of MI
lifestyle changes
beta blockers
statins
ACE inhibitors
antiplatelet drugs
606
limbo goal for high risk hypertensives
trying to go as low as is safely possible for people with severe comorbities (diabetes, CAD, CVA)
607
two parts of the adrenal gland
medulla
cortex
608
three questions to ask when considering bone marrow deficiency in anemia
enough stem cells
enough nutrients to make RBCs (iron, folate)
enough stimulation (EPO)
609
five effects of cortisol
increases glucose production
raises blood pressure
raises blood sugar
lowers lymphcyte and monocyte levesl
610
what is the intitial event of an acute MI
a plaque rupture
611
how long do RBCs last before being broken down
100-120 days
612
two other symptoms of diabetes that aren't the 3 Ps
weight loss despite increased appetite
fatigue
613
what diagnoses for cushings have a good prognosis?
poor?
good: cushings disease and iatrogenic cushings
bad: adrenal carcinoma and small cell lung cancer
614
what are the common causes of encephalitis (examples)
viruses
rabies, measels, polio, herpes, west nile
615
what does tight management of DM entail
diet
frequent blood assays
medication 3-4 times daily
flexible dosing
616
long feedback look
a feedback loop where the end hormone produce by trophic stimulation will inhibit production at the hypothalamus and pituitary
617
Gullian barre syndrome (acute, idipathic polyneuropathy)
rapidly progressive motor paralysis with likely spontaneous recovery
618
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
619
what methods can be used to reduce infarction
anticolagulation with IV heparin
IV thrombolytic therapy
cerebreal artery catherization and angioplasty
620
treatment for b12 deficiency
large oral doses of B12
intramuscular B12
621
which is more relevant, long or short feedback loops?
why?
long, because they work on the hypothalamus and the pitutiary
622
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
623
success rates of conventional seizure treatment
70% seizure free on one drug
20% sz on 2 or more drugs
remaining 10% unresponsive
624
how are hormones sent through out the body
dissolved in blood or bound to carriers
625
what is the main task of the thyroid
to produce T3 ad T4
626
exophthalmos
cause
protrusion of the eyes found in 20-40% of Graves patients
caused by lymphcytic infilitration of the eyes
627
what is the treatment for GBS
is this time sensitive?
IVIG
plasmapheresis
yes time is a factor, hours matter
628
what is the 5 year survival rate once diagnosed with CHF
50%
629
three common diuretics (examples)
thiazides (hydrochorthiazide)
loop diuretics (furosimide)
potassium sparring diuretics (spironolactone)
630
prognonsis for stable angina
some will improve, but most will develop CHF or have progress to acute cononary syndrome within 3-5 years
631
evaulation of elevated PSA
rectal exam/ultrasound with lesion biopsy
if there are lesions, determine gleason score
632
seizure
abnormal or excessve and synchronized discharge of CNS neurons
633
what is the most common neurological disorder in the US
incidents per year
deaths
CVA (stroke)
500,000/yr
150,000 deaths/yr
634
four methods to prevent ESRD
control HTN
control glucose
recognize and avoid drug toxicity
better treatment of acute renal failure
635
CHF lab signs
elevated BNP
636
CHF treatment strategy I
reduce cardiac work load (limit activity, reduce weight, control HTN)
reduce blood volume (decrease Na, diuretics)
637
medications to reduce calcium stone formation
thiazide diuretics to reduce calcium levels
638
causes of folate deficincy
not enough fruits and veggies
increased demand (pregnancy, hemolytic anemia)
malabsorption of folate
639
define TIA
stroke like deficits that with occur and resolve rapidly, usuallly within 60minutes
640
three types of non-seminoma
embryonal cell
teratoma
choriocarcinoma
641
two general nutrition deficiency that cause anemia
anemia of chronic disease
starvation
642
two stratgies to reduce insulin resistance
weight loss
medication (biguanides and thiaxolidinediones)
643
T/F CNS tumors commonly form from neurons
false, they usually come from support cells
644
three CNS infections that can cause neurologic symptoms
meningitis
encephalitis
abscess
645
three disease that can be triggered by hyperthyroid
acute chest pain (MI)
CHF
Arrhythmia
646
variant (prinzmetal) angina
extreme fatigue associated with minimal exertion related to coronary vasospasm
647
ejection fraction
fraction of ventricular volume eject by each beat of the heart, normally 50-65%
648
agranular leukocytes (mononuclear)
monocytes
lymphocytes
649
two disorders caused by an imbalance of neurotransmitters
chronic depression or psychosis
650
secondary hyperthyroid
failure of the pituitary to release TSH
651
four types of renal/GU cancer
prostate cancer
bladder cancer
renal cell carcinoma
testicular cancer
652
supportive treatment for ureteral stones
analgesia
enhanced urine flow
653
what is the goal of HTN treatment
maintenance of 120/80 BP for high risk patients
\<135/85 for mild to moderate risk patients
654
four phases of a tonic-clonic seizure
LOC, tonus or clonus, apnea, flaccid coma, post ictal
655
short feed back loop
a feedback loop where a trophic hormone from the pituitary inhibits production of stimulating factors from the hypothalamus
656
three possible treatment plans for cushings
stop glucocorticoids
surgery
antiglucocorticoid medication
657
what is the effect of sympathetic activation of Beta receptors in response to Decreased BP
increased cardiac output through contractility
658
three treatment for prostate cancer
radical prostatectomy
radiation thearpy
medical treatment
659
three general treatment options for CNS tumors
surgery, chemo, radiation
660
four factors to prevent CHF
lipid control
HTN treatment
lifestyle changes
prevent or reduce damage from AMI
661
what are the three clinical manifestations of aplastic anemia
anemia
leukocytopenia (chronic infection)
thrombocytopenia (no clotting factors0
662
three specifict nutrient deficiencies that will cause anemia
folate
b12
Iron
