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Human Disease And Therapeutics > Week 5 (test 2) > Flashcards

Week 5 (test 2) Flashcards

1
Q

Name in order the three most major causes of death. Give the percentages of their contribution to the total deaths for each.

A

1) heart disease (28%)
2) malignancies (23%)
3) stroke (6%)

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2
Q

Define hypertrophy

A

The enlargement of an organ or tissue from the increase in size of its cells

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3
Q

Define hyperplasia

A

The enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells, often as an initial stage in the development of cancer.

(Increase in # of cells)

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4
Q

Define metaplasia

A

Replacement of one cell type with another

E.g, smoker’s airway, cervix Barrett’s esophagus

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5
Q

Define dysplasia. What are some examples?

A

The presence of cells of an abnormal type (abnormal DNA) within a tissue, which may signify a stage preceding the development of cancer.(per neoplastic)

Disordered hyperplasia without maturation.

Examples: uterine cervix. Bowel in inflammatory bowel disease

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6
Q

Define atrophy. What can cause it?

A

Cell shrinkage or loss.

Caused by: lack of hormonal signals, loss of innervation, lack of use, loss of blood supply, starvation, individual cell death.

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7
Q

Define necrosis

A

Uncoordinated cell death. Often happens in cell clusters rather than individual cells. Cells are often swollen

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8
Q

Define heterolysis

A

The dissolution of cells by lysins or enzymes from different species

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9
Q

Define autolysis

A

The destruction of cells or tissues by their own enzymes, especially those released by lysosomes

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10
Q

Define apoptosis

A

Orderly, energy-requiring cell death. Often a normal phenomenon. No inflammation, one cell at a time.

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11
Q

Hypertrophy/atrophy, hyperplasia, metaplasia, and dysplasia are all types of responses to direct ____ or to changing ____.

A

Injury/stress

Hormonal or chemical signals

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12
Q

How does cardiac hypertrophy cause anoxia?

A

Increased cell size causes the blood vessels to be more dispersed.

This predisposes the heart to arrhythmias or failure

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13
Q

True or false… the dementia brain undergoes processes of necrosis.

A

False. It undergoes atrophy

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14
Q

What is cachexia? When is it fatal?

A

Fatty atrophy

Cachexia at ~68% of normal body weight is fatal.

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15
Q

What is BPH?

A

Benign prostatic hyperplasia

Note that hyperplasia can occur with hypertrophy

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16
Q

Which cells are most prone to injury?

A

High metabolic cells (cardiac myocytes, renal tubular cells, hepatocytes)

Rapidly proliferating cells (testicular cells, intestinal lining cells, hematopoietic cells)

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17
Q

What are the two degrees of cell injury?

A

Reversible

Irreversible

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18
Q

What 3 things may cause reversible cell injury? (Not enough to cause cell death)

A

Loss of ATP from hypoxia

Loss of Na pump (causing swelling)

Anaerobic glycolysis (severe exercise)

Examples: Toxic liver injury and mild acute tubular necrosis

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19
Q

Describe irreversible cell injury

A

More severe damage causing cell death

Examples: holes in cell membrane, long calcium influx, mitochondrial loss

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20
Q

What are the two types of cell death? Define them.

A

Necrosis - uncoordinated cell death. Often happens in clusters rather than individual cells. Incites acute inflammation from leakage of cell contents. Cells often swollen (loss of ion pumps). Cell membrane disruption, calcium signal and energy loss are early events.

Apoptosis - orderly, energy-requireing cell death. No inflammation. Normal phenomenon. Happens one cell at a time. Happens in normal embryology, normal cell turnover, viral infection

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21
Q

Name 5 different types of necrosis

A

Coagulative necrosis

Liquefactive necrosis

Caseous necrosis

Gangrenous necrosis

Fat necrosis

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22
Q

What is coagulative necrosis?

A

Heart infarct. Dead cells within the area, may have a scar that forms later on and the scar is smaller than the myocardium that it replaces.

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23
Q

What is liquefactive necrosis?

A

Brain, deteriorates and there is a space left

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24
Q

What is caseous necrosis?

A

Tuberculosis, cell death in a granuloma (if there is necrosis in a granuloma there is almost infection)

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25
Q

What is gangrenous necrosis?

A

Death of a whole body part. Frostbite or diabetes.

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26
Q

What is karyorrhexis?

A

Nuclear change in cell death. Destructive fragmentation of nucleus of a dying cell causing irregular chromatin distribution

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27
Q

What is nuclear pyknosis? What is karyolysis?

A

Nuclear changes in cell death.

Nuclear pyknosis - Nucleus is shriveled and dark

Karyolysis - digested pale nucleus

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28
Q

Describe some abnormal storage products of fats.

A

Fatty change of liver associated with alcoholism and obesity

Glycogen accumulation - liver in diabetes

Lipid storage can accumulate in vessels in atherosclerosis. Lipid storage disease - Fabry’s- gaucher’s

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29
Q

What is gaucher disease?

A

Lysosomal accumulation of lipid

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30
Q

What is lipofuscin?

A

Degraded lipid in lysosomes

Increases with age, free radical damage

Brown storage product

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31
Q

What is bilirubin?

A

Hemoglobin breakdown product

Normally present in bile

Increased with biliary obstruction and hepatocyte disorders

Too much causes jaundice/icterus (yellow-brown color seen with hyperbilirubinemia)

Brown storage product

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32
Q

What is hemosiderin?

A

Iron containing pigment

Increased with excessive iron absorption, bleeding into tissues

Brown storage product

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33
Q

Large deposits of proteins (immunoglobulin) can be stored intracellularly in plasma cells in __ bodies

A

Russell

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34
Q

What is alpha-1-antitrypsin?

A

Involved in intracellular protein storage deficiency ?

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35
Q

True or false.. amyloid is only found in the brain

A

False. It is an extracellular protein storage product that can be found throughout the body, namely the lung

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36
Q

What is antracosis?

A

Carbon pigment found mostly in the lung (coal worker’s lung)

It in of itself is harmless, but other harmful materials can be deposited with it (silica, asbestos)

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37
Q

What is the difference between dystrophic calcification and metastatic calcification?

A

Dystrophic calcification - into damaged tissue (causes a dark purple lesion in stain)

Metastatic calcification - into normal tissue

Disorder of calcium metabolism (renal failure, hyperparathyroidism, malignancy)

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38
Q

Define edema

A

Too much extravascular fluid in tissues

Pulmonary edema interferes with gas exchange

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39
Q

What is effusion? Describe three types of effusion.

A

Effusion - too much fluid in body cavity

Ascites - excess fluid in peritoneal space

Pleural effusion - excess fluid in pleural space

Hydrocephalus - excess fluid in cerebralspinal fluid

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40
Q

What are thrombi or emboli?

A

Thrombus - a blood clot that blocks flow

Embolus - any material that circulates through the blood stream and can block flow once it reaches a vessel that is too small to allow it to pass

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41
Q

What is hypotension and what causes it?

A

Hypotension (shock) is too low blood pressure.

It can be caused from low cardiac output or low vascular resistance

Hypovolemic - blood
Cardiogenic - arrhythmic
Septic shock - due to generalized infection and endotoxin release. It is associated with vasodilation (the body’s response to compensate)

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42
Q

What is hypertension? What causes it?

A

High blood pressure

Caused by high cardiac output or high vascular resistance

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43
Q

Define ascites. What may cause it?

A

Massive amounts of fluid in the peritoneal space.

Caused by liver failure, heart failure, compromised heart function, or kidney disease

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44
Q

What is dependent edema?

A

Edema in the lower extremities.

Finger pressure temporarily pushes fluid away - pitting edema

Can be caused by hormonal fluid retention, heart failure, and inflammation

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45
Q

True or false…. foreign material, amniotic fluid, and even air can embolize, causing infarcts by blocking blood flow. Tumors however, rarely grow into veins and embolize

A

True

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46
Q

Which cause of shock, hypovolemia or septic shock has a better prognosis?

A

Hypovolemia.

Hypovolemia is low blood volume from bleeding or dehydration

Septic shock is from an overwhelming infection. Vasodilation and high permeability, poor cardiac pumping, and increased metabolism occur

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47
Q

Define congestive heart failure

A

Cardiac output is insufficient for metabolic needs of the body

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48
Q

What is the difference between systolic dysfunction and diastolic dysfunction?

A

Systolic dysfunction - decreased myocardial contractiliy (heart pumps weakly)

Diastolic dysfunction - insufficient expansion (heart does not fill with blood between beats)

49
Q

What are some ways the body compensates for congestive heart failure?

A

Tachycardia

Myocardial hypertrophy

Increased stroke volume. Frank starling - increased end diastolic volume results in increased stroke volume

Increase of catecholamine activity leading to positive ionotropic effect

Redistribution of blood flow (kidneys)

Increased oxygen extraction from hemoglobin

Renin-angiotensin-aldosterone system

50
Q

What may cause left-sided heart failure?

A

Hypertension

Ischemic heart disease

Pulmonary edema and breathing problems

Orthopenia (dyspnea lying down)

Reduced blood perfusion to organs such as kidneys

Aortic and mitral valve disease

Myocardial disease such as cardiomyopathy or myocarditis

51
Q

Define paroxysmal nocturnal dyspnea

A

Extreme dyspnea (breathlessness), develops over a few hours. Due to pulmonary edema from heart failure while lying down.

52
Q

What may cause right-sided heart failure?

A

Lung disease (cor pulmonale - abnormal enlargement of right side of heart)

Hepatomegaly; pools in liver

Hyperemia (in the liver)

Myocardial - myocarditis, cardiomyopathy, constrictive pericarditis

Consequence of left-sided failure

53
Q

True or false… right-sided failure is more common than left sided failure and causes left sided failure

A

False. Right sided failure is uncommon to be isolated, usually associated with left sided failure. It can cause swollen ankles/peripheral edema

54
Q

What are some systemic effects of right-sided failure?

A

Liver - chronic passive congestion

Spleen - congestive splenomegaly

Kidneys - congestion and hypoxia

Subcutaneous - peripheral edema and anasarca

Pleural space - effusions

Brain - venous congestion and hypoxia

Portal - ascites

55
Q

What is the normal blood pressure in adults?

A

Normal is = 120/80

Lower in children

56
Q

What is a hypertensive emergency?

A

Direct acute organ damage when BP is over 180/110

57
Q

What are some potential causes for essential hypertension?

A

No obvious cause..

Increased sodium retention and intravascular volume.

Narrowing of arteries and arteries (espicially in kidney)

High vascular resistance lowers effective blood pressure in kidneys. Kidneys sense lowere pressure, signal to retain sodium/fluid and increase blood pressure. (Renin/angiotensin/aldosterone)

Increased pressure causes further vessel damage.

58
Q

What is secondary hypertension? What are some causes?

A

Uncommon, 5-10% of all hypertensive pateints. Known cause..

Endocrine (steroid, thyroid, pheochromocytoma)

Drugs

Pregnancy

Renal failure

Sleep apnea

Renal artery stenosis

Pain/stress causes temporary increase in BP

59
Q

What are some risk factors for getting essential hypertension?

A

Increasing age

Black (family history of hypertension)

Obesity and metabolic syndrome

High salt diet

Lack of physical activity

60
Q

What causes a transmural infarct?

A

Aneurysm in heart wall

61
Q

What are some hypertension-induced problems?

A

Accelerated atherosclerosis due to endothelial injury such as… myocardial infarcts, stroke, peripheral vascular disease, aneurysms

Heart failure (seen with chronic hyperorphy)

Renal failure

Retinal and brain damage, including hemorrhages

62
Q

What is the main cause of ventricular hypertrophy?

A

Hypertension

63
Q

What is arterionephrosclerosis? What causes it?

A

Kidney becomes smaller and have finely pitted surface.

Caused by hypertension

This is an extremely common cause of renal failure, especially in black pateints

64
Q

Brain hemorrhages due to HTN is most common in what population?

A

Asians

65
Q

___% of U.S adults have hypercholesterolemia above 240.

A

13%. (Under 200 is ideal)

50% have hypercholesterolemia above 200

66
Q

Which is the more common cause for hyperlipidemia, familial causes or secondary causes (diabetes, sedentary lifestyle, poor diet, heavy alcohol use)

A

Secondary causes are far more common than familial

67
Q

What are the roles of…

HDL
LDL
VLDL
Chylomicrons

A

HDL - delivers lipids from periphery to liver

LDL and VLDLs - delivers lipids from liver to periphery

Chylomicrons - delivers lipids from gut to liver

68
Q

True or false… ideal HDL levels are greater than 40 in men and greater than 50 in females

A

True

69
Q

Atherosclerosis is the leading cause of death. It causes ___% of heart disease, and is the main cause of stroke and peripheral vascular disease. It accounts for about ___% of all deaths

A

80%

30%

70
Q

What is the difference between arteriosclerosis and atherosclerosis?

A

Arteriosclerosis - hardening of the arteries

Atherosclerosis - lipid deposits/plaques (called atheromas) in arteries. Most common kind of arteriosclerosis

71
Q

In regards to transmural infarct, mural thrombus often forms from __ or ___

A

MI or atrial fibrillation

72
Q

What are the symptoms of a MI?

A

Retrosternal chest pain, dyspnea (shortness of breath), diaphoresis (sweating), nausea/vomiting, palpitations, anxiety.

Patient may also be asymptomatic or present as sudden death

73
Q

What is the differential for an MI?

A

Pulmonary emboli

Aortic dissection

Pericardial tamponade (blood around heart)

Tension pneumothorax (patient has tear in lung so air leaks into pleural space)

Esophageal reflux

Chest wall pain

74
Q

What is the diagnostic criteria for MI?

A

At least 2 of the following…

Ischemic type chest pain > 20 minutes

Acute EKG changes

Rising/falling of serum cardiac biomarkers

Pathologic documentation of an infarct at autopsy

75
Q

MIs are asymptomatic in __% of cases

A

10-20%

76
Q

What are some elevated cardiac enzymes associated with MI?

A

CK-MB

Troponin T (particularly common test for heart damage)

Myoglobin (often the first marker to increase)

Creatinine phosphate

77
Q

What complication of MI causes most of the deaths?

A

Arrhythmias

78
Q

What is the difference between stenosis and regurgitation?

A

Stenosis - valve wont open

Regurgitation - valve cant close complexity

79
Q

What is a transmural infarct?

A

Full thickness infarct - from endocardium to epicardium

Usually involves LV anterior and posterior free wall or septum with extension into RV wall in 15-30% of cases.

Correlates with STEMI (ST segment elevation MI)

More severe

80
Q

What is a sub endo cardinal infarct? What causes it?

A

Due to hypotension, global ischemia

Multifocal or diffuse areas of necrosis confined to inner 1/3-1/2 of LV wall

Infarct is not necessarily in distribution of one coronary artery.

Correlates with NSTEMI (non ST segment elevation MI)

Less severe but still potential lethal

81
Q

What are the types of endocarditis complications? (3)

A

Libman-sacks - endocarditis is not associated with bacterial infection but associated with autoimmune disorders such as lupus erythematosus

Infective form can be caused by intresnic oral bacteria

Rheumatic form often involves mitral valve which becomes calcified at time of infection

82
Q

What are splinter hemorrhages?

A

From tiny blood clots that migrate from the inflamed heart to under the nails or other body parts.

83
Q

What is an aneurism?

A

Blood forces a separation of wall layers of aorta and may result in a rupture. Often associated with increased BP

84
Q

What is cardiac tamponade?

A

Cardiac tompanade includes compression of the heart from fluid accumulation which can reduce cardiac output and cause death

85
Q

What are some complications of artificial valves?

A

Can cause thrombi

Increased risk of infective endocarditis

Wears out valves and leaks (develops murmurs)

86
Q

Briefly describe the atherosclerosis mechanisms

A

Endothelial dysfunction (smoking, hypertension, diabetes, lipids, inflammation)

Leads to lipid deposit in vessel wall

Leads to inflammation/foamy macrofages

Leads to intimal smooth muscle fibrosis which causes leads to fibroatheroma with stenosis

Or leads to plaque ulcer or rupture, which leads to thrombosis and can cause infarcts

87
Q

What are some different forms of aortic stenosis?

A

Postinflammatory scarring - rheumatic heart disease

Senile calcific aortic stenosis (heart valves become more firm with age. Can occur with younger aortic valve if it is a bicuspid valve)

88
Q

Calcific aortic valve stenosis is likely to occur after….

A

Post infective endocarditis or rheumatic fever

It is common in congentical biscuspid valves or normal valves of elderly people

89
Q

Which is more common aortic stenosis or aortic regurgitation?

A

Aortic stenosis

90
Q

T or F… premature heart beats are deadly

A

False.. they are usually not dangerous

91
Q

Tacharrythmias are ___ common and ___ serious - such as fibrillation

A

Less

More

92
Q

What are some symptoms of arrhythmias?

A

Palpitations; syncope (fainting), sudden cardiac death

93
Q

What are some causes of conduction disturbance resulting in arrhythmias?

A

Ischemic heart disease – scarring

Degenerative changes

Antiarrhythmic drucs

MI

Trauma

Congenital

94
Q

Which valve is infective endocarditis most likely to affect?

A

Mitral valve

Right sided valves are less common

95
Q

What is the differential diagnosis of syncope?

A

Dizziness

Seizure. Can resemble syncope. Look for postictal changes

96
Q

Bradycardia is a BPM of ___

Tachycardia is a BPM of ___

A

<60

> 100

97
Q

What is a conduction block?

A

Abnormal impulse propagation (causes bradycardia)

Can occur at the level of the SA node, AV node, His-purkinje system, branches of the His bundle, or myocardium itself

98
Q

What are some causes of conduction disturbances?

A

Ischemic heart disease and cardiomyopathy scarring

Degenerative changes in the conduction system

Aniarrhythmic drugs

Hyperkalemia

Myocardial infection (Lyme disease), infiltration (amyloid or a tumor)

Trauma (including cardiac surgery)

Congenital abnormally

99
Q

What is a first degree heart block?

A

Slow but reliable impulse propagation to ventricles

Generally not symptomatic. No treatment needed.

P wave and QRS wave are further apart

100
Q

What is a second degree heart block?

A

Impulse propagation to ventricles sometimes fails.

Irregular ventricular contraction.

Sometimes causes syncope

Pacemaker sometimes needed

101
Q

What is a third degree AV block?

A

Complete block. No conduction of any atrial electrical impulses to the ventricles.

Ventricles resort to latent pacemakers

result is more p waves than QRS, QRS are regular and determined by latent pacemaker. No relationship between p waves and QRS. Risk for sudden cardiac death

102
Q

What are ectopic beats?

A

Increased rate of depolarization at any site, to a rate faster than the sinus node results in a premature depolarization

Since it originates from a site other than the sinus node its called ectopic.

Latent pacemakers (such as the AV node) are often sites of origin of ectopic beats, however other sites may be responsible as well

103
Q

Where can ectopic beats originate from?

A

The atria

Specialized conduction system

The ventricles (area where its the most serious)

104
Q

What can cause tachycardia?

A

An ectopic focus that is firing rapidly

Multiple ectopic foci collectively causing a fast rhythm

Re-entrant circuits

105
Q

What is the most common ineffective contraction (arrhythmia)?

A

Atrial fibrillation

106
Q

What causes ~25% of strokes?

A

Thrombi formation in atria and emboli formation

107
Q

Atrial fibrillation increases with age. More than __% of Americans older than 65 have AF

A

10%

108
Q

What accounts for the majority of cardiovascular related deaths in the US?

A

Sudden cardiac death (often caused by ventricular fibrillation which leads to abrupt cessation)

109
Q

What are some patients that have an inherited risk for ventricular arrhythmias due to channelopatheis?

A

Congenital long QT syndrome

Brugada syndrome

Catecholaminergic polymorphic ventricular tachycardia

Arrhythmogenic right ventricular cardiomyopathy

Short QT syndrome

110
Q

Brain damage and brain death occurs within ___ minutes of sudden cardiac arrest. Survival rate reduces ___% per minute without CPR or defibrillator

A

4-6 minutes

10%

111
Q

What is preclampsia?

A

Secondary hypertension associated with pregnancy often connected with diabetes. Can lead to eclampsia and seizures

112
Q

What is malignant hypertension?

A

Sudden increase in BP, most common in African Americans

113
Q

What are some risk factors for atherosclerosis?

A 
Smoking
HTN
Diabetes
Nephosclerosis
Post menopause
114
Q

Stenosis impedes blood flow at __% blockage

A

75%

115
Q

Which is more dangerous, abrupt stenosis or chronic?

A

Abrupt

116
Q

Strokes cause numbness/paralysis on the ___ side

A

Contralateral

117
Q

What is the difference between stable angina, variant angina, and unstable angina?

A

Stable angina - caused by exertion, most common type and the easiest to manage. Subendocardial ischemia. Relieved by vasodilators. ST depesssion

Variant angina - brief like stable angina. Classically occurs at rest. Reversible spasm. ST segment elevation, sometimes depression

Unstable angina - new or worsening angina. Prolonged pain or pain at rest. ST depression. Often due to acute plaque change (dangerous)

118
Q

What is ludwig’s angina?

A

Neck infection sometimes from mandibular molar and can block airway

119
Q

What is pericarditis? What are some causes?

A

Swelling and irritation of the pericardium

Associated with stabbing sharp pain usually acute in chest but may be chronic

Causes: infection and inflammatory disorders

Human Disease And Therapeutics (13 decks)

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