Test 4 Clinical Applications

Question 1

Cerebrovascular Accident:

• Also called:
• Define:
• Two categories:
• Ranks where in causes of death?

Answer 1

- Also called:
Stroke
- Define:
Blood loss to brain
- Two categories:
Ischemic stroke (caused by blockage)
Hemorrhagic Stroke (caused by hemorrhage)
- Ranks where in causes of death?
3rd in the US
2nd in the world

Question 2

Major risk factor for a cerebrovascular accident?

Other risk factors:

Answer 2

Hypertension
Other risk factors:
Diabetes
atrial fibrillation
High blood cholesterol

Question 3

Treatment for ischemic stroke:

Answer 3

Delivery of anticoagulants and antithrombolytic drugs

Question 4

Excitotoxicity:

• Is what?
• How does it complicate stroke treatment?

Answer 4

• Is what?
  Ischemia induced impairment of the removal of glutamate from synaptic cleft.
  Results in a build of Ca2+ through NMDA receptors causing neuronal death
• How does it complicate stroke treatment?
  It increases in magnitude with the duration of ischemia, so antithrombolytics/anticoagulants must be delivered rapidly.

Question 5

Atrial fibrillation:

- On a ECG:

Answer 5

• On a ECG:

Missing P wave

Question 6

Artificial Pacemaker:

• Where is it inserted:
• How does it work?

Answer 6

• Where is it inserted:
  Implanted in the skin under the clavicle
• How does it work?
  Electrodes from device are threaded into heart through a vein.
  Most sense if the heartbeat is delayed and stimulate the heart on demand.
  Some can even sense if you are exercising and increase cardiac rate accordingly.

Question 7

• Define:
  Swelling of arm or leg caused be excessive fluids and protein build up due to a blocked/damaged lymph drainage/vessel.
• Complications:
  Protein rich interstitial fluid can lead to inflammation, damaging peripheral tissue
• Causes:
  Damage from surgery or radiation therapy
  Infection of nematode worm causing elephantiasis (tropics)

Answer 7

Lymphedema:

• Define:
• Complications:

Question 8

Injection of what is given to treat endometriosis?

Answer 8

GnRH analog, which given at a constant level instead of a pulsatile fashion will desensitize the anterior pituitary.

Question 9

What do birth control pills contain?

How do they prevent contraception?

Answer 9

Synthetic progesterone and estrogen.
High levels of progesterone and estrogen simulate the luteal phase. A week spent of the pills mimics menstruation and allows shedding of buildup of stratum functionale which is seen in the luteal phase.
The patient will then be returned to pseudo-luteal phase by more synthetic progesterone and estrogen.

Question 10

Low blood plasma conc.
- Relation to edema development?
This lowers oncotic pressue, as the plasma colloid osmotic pressure is less. This will result in less water returning into the capillaries, and more leaving

Answer 10

Hypoproteinemia:

- Relation to edema development?

Question 11

Filariasis:

Answer 11

an infection by a nematode worm

Question 12

Elephantiasis:

Answer 12

A complication of filariasis, where the nematode larvae occupy and block lymphatic vessels
This causes build up of interstitial fluid and EDEMA from inability to drain

Question 13

Is Elephantiasis treatable?

Filariasis?

Answer 13

No.

Yes.

Question 14

At what rate is water lost per hour through sweat?

Answer 14

900 ml (I doubt this matters)

Question 15

• Causes of failure during exercise related to dehydration:
• Why is drinking water alone insufficient to restore rehydration?
• What is better?

Answer 15

• Causes of failure during exercise related to dehydration:
  Decreased cardiac output
  Inability to cool oneself
  Difficulty in oxygen flow
• Why is drinking water alone insufficient to restore rehydration?
  Salts are also lost during sweating, water does not restore these
• What is better?
  Electrolyte drink, such as a sports drink

Question 16

Sal is Roman for what?

Gandhi encouraged people to make their own ____.

Answer 16

Salt

Salt

Question 17

Angiotensin Converting Enzyme Inhibitors:

• Do what?
• Examples:
• Treats:

Answer 17

• Do what?
  Inhibit the conversion of Angiotensin 1 to angiotensin 2
  Lowers blood pressure by alleviating vasoconstriction
  Lower secretion of aldosterone by adrenal cortex
• Examples:
  Captopril, enapril, and lisinopril
• Treats:
  Hypertension, heart failure, stroke, and potential kidney failure

Question 18

Angiotensin receptor blockers (ARBs):

• Do what?
• Examples:
• Treats:

Answer 18

• Do what?
  Inhibits binding of angiotensin 2 to its target sites
  Lowers blood pressure by alleviating vasoconstriction
  Lower secretion of aldosterone by adrenal cortex
• Examples:
  Telmisartan, losartan, and valsartan
• Treats:
  Hypertension, heart failure, stroke, and potential kidney failure

Question 19

Essential hypertension:

Answer 19

Primary hypertension (hypertension without a known secondary cause)

Question 20

In Vitro Fertilization is done by what method in this application:

Answer 20

Ovarian Hyperstimulation -> collect eggs -> intracyoplasmic sperm injection (ICSI) -> grow from 3 - 5 days (8 cell or blastocyst) -> transfer 3 or more embryos into uterus with a small tube

Question 21

Ovarian Hyperstimulation:

Answer 21

Give FSH at high levels (or another gonadotropin, but this one is the most common)
->
Produces high number of eggs which can be collected

Question 22

Intracytoplasmic sperm injection (ICSI)

Answer 22

insertion of a single capacitated sperm through zona pellucida and into the cytoplasm of an egg.

Question 23

Angiogram:

• Define:
• Meant to identify:

Answer 23

- Define:
catheter is guided to spot of interest.
Iodine contrast material is injected is injected into blood
X-ray taken, with venous contrast increased
- Meant to identify:
Plaque
Atherosclerosis
Spasm

Question 24

Coronary angiogram is the primary method to assess what?

Answer 24

Coronary artery disease

Question 25

Coronary Angioplasty: - Used: - Common complication:

Answer 25

- Used: tube with a balloon is inserted into artery and inflated to open it - Common complication: Restenosis (recurrence of narrowing)

Question 26

How is restenosis normally prevented in a coronary angioplasty?

Answer 26

Insertion of a stent (metallic mesh tube)

Question 27

Most common open heart surgery. | A vessel taken from the patient is grafted back onto the patient to bypass a block or troublesome area

Answer 27

Coronary bypass grafting (CABG):

Question 28

Orthostatic (postural) hypotension:

Answer 28

Hypotension which occurs upon standing

Question 29

Postprandial hypotension:

Answer 29

hypotension after eating a meal, most common in elderly individuals

Question 30

Orthostatic Hypotension is prevented by the baroreceptor reflexes, unless there is an underlying condition like:

Answer 30

Anything which causes low blood pressure. Dehydration Medications (beta adrenergic receptor blockers) post-prandial hypotension

Question 31

Valsalva Maneuver:

Answer 31

Bearing down, as if having a bowel movement, while trying to exhale, while preventing exhaling (plugging nose)

Question 32

What does the Valsalva Maneuver do?

Answer 32

1: Intrathoracic pressure raises: - Fall in atrial pressure - Reduces pressure on baroreceptors 2: baroreceptor reflex - Heart rate slows 3: Venous return - There is a fall in venous return due to rise in intrathoracic pressure 4: baroreceptor reflex - Increases heart rate (due to low venous return dropping pressure) 5: person again breathes - Intrathoracic pressure falls - Less pressure in the aorta briefly 6: baroreceptor reflex - Increases heart rate (due to low venous return dropping pressure) 7: improved venous return - Causes rise in aortic pressure 8: baroreceptor reflex - Decreases heart rate

Question 33

When is Valsalva maneuver accidentally performed:

Answer 33

Weightlifters when they hold their breaths | Those straining at stools

Question 34

When is the Valsalva maneuver dangerous?

Answer 34

When someone has coronary heart disease

Question 35

Preclampsia: - Definitive symptoms: - Possible additional symptoms:

Answer 35

``` - Definitive symptoms: Hypertension onset during pregnancy Damage to liver and kidney - Possible additional symptoms: Thrombocytopenia Proteinurea (protein in urine) ```

Question 36

Preclampsia protein in urine: - cause: - consequences:

Answer 36

``` - cause: Damage to glomeruli, allowing protein to leak through - consequences: Low plasma conc. of proteins Lower oncotic pressure Edema ```

Question 37

Treatment for preclampsia:

Answer 37

Delivery of baby

Question 38

What may be the cause of preclampsia:

Answer 38

Dysfunction in the placenta involving vasoconstriction and hypoxia within uterus/placenta

Question 39

Crohn's disease:

Answer 39

Can involve loss of proteins into the intestines

Question 40

What type of cell does HIV infect? | Which region is hit hardest?

Answer 40

CD4 T cell (helper T cells) | The gastrointestinal tract, where up to 30% of helper t cells reside

Question 41

What does loss of CD4 T cells (helper T cells) result in?

Answer 41

Reduction in Cell mediated immunity, which targets intracellular issues. Increased risk of: cancer, opportunistic infections (especially tuberculosis, and other intracellular parasites)

Question 42

ART stands for (HINT: HIV related): | - Inhibits what enzyme?

Answer 42

Anti-Retroviral Therapy | Reverse transcriptase

Question 43

ART has what antiviral targets? | - Efficiency?

Answer 43

Two different reverse transcriptase inhibitors One protease inhibitor - Efficiency? Can delay HIV indefinitely, but does not cure it

Question 44

What hope is there for HIV treatment?

Answer 44

Early ART intervention reduces risk of spread by 96% Vaginal antiretroviral gels reduce transmission of HIV to women Circumcision reduces risk a man will be infected with HIV Vaccines against HIV may be possible. Utilizing passive immunity antibody treatments and designer antigens

Question 45

Sepsis: - Define: - Symptoms:

Answer 45

``` - Define: Whole body inflammation, usually caused by a bacterial infection - Symptoms: Organ dysfunction Hypotension (mass scale vasodilation caused by histamine/NO/Seratonin) Hypoxemia Oliguria (low urine output) Acidosis (due to lactic acid) ```

Question 46

Treatment of sepsis:

Answer 46

Antibiotics, intravenous fluids, and more aggressive measures when required

Question 47

Septic Shock:

Answer 47

Where blood pressure falls so all organs are not perfused due to an inflammatory response

Question 48

Endotoxin: - Other name: - Complication: - Bacteria type:

Answer 48

- Other name: Lipopolysaccharide - Complication: Small amounts activate toll-like receptors, helping. Large amounts in circulation is the most common cause of sepsis - Bacteria type: Gram negative bacteria

Question 49

Glucocorticoid drugs: - Examples: - Use:

Answer 49

- Examples: Hydrocortisone, cortisone, prednisone, prednisolone, and dexamethasone - Use: Suppress immune system to treat inflammation, autoimmune diseases, and allergies.

Question 50

Glucocorticoids: | - Specificity iin T cells:

Answer 50

- Specificity in T cells: | Broadly inhibitory but enchance Th2 cells over Th1 cells, this shifts from cell-mediated to humoral immunity

Question 51

Glucocorticoids: - How do they work: - Cytokines suppressed have whatever functionality:

Answer 51

- How do they work: Suppress pro-inflammatory cytokines (Interleukins, including IL-1, gamma interferon, and TNFalpha) - Cytokines suppressed have whatever functionality: cytokines promote Corticotropin-releasing hormone -> ACTH -> Cortisol Reduction of cytokines results in less CRH, and therefore less cortisol, making a negative feedback system between the nervous endocrine and immune system

Question 52

Glucocorticoids: - Cytokines suppressed have whatever functionality: - What cells produce the cytokines which these cytokines:

Answer 52

- Cytokines suppressed have whatever functionality: cytokines promote Corticotropin-releasing hormone (hypothalamus) -> ACTH (anterior pituitary) -> Cortisol Reduction of cytokines results in less CRH, and therefore less cortisol, making a negative feedback system between the nervous endocrine and immune system - What cells produce the cytokines which these cytokines: Microglia

Question 53

NMDA stands for: | - Related to what disease?

Answer 53

N-methyl D-aspartate | Excitatory toxcitity, overstimulated by glutamate causing Ca2+ build up (it's a Ca2= ion channel)