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PAS 753 (Molecular Pathophysiology) > Unit II > Flashcards

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

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2
Q

what are goals of treating an ischemic stroke

A

reduce the size of infarction if possible

provide rehab

prevent future strokes

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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

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4
Q

causes of increased metabolism related to cardiac ischemia

A

hyperthyroid

fever

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5
Q

describe the stroke belt

A

a statistical band across the southeastern US where strokes are more common

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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

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7
Q

examples of neural pathway disruptions

A

MS

guillain barre

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8
Q

on a CBC the hematocrit is generally how much higher than hemoglobin

A

3x

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9
Q

how does insulin inhibit catabolism

A

inhibits glycogen break down

inhibits amino acid and fatty acid break down

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10
Q

thee factors that influence cardiac output

A

HR

contractility

filling pressure

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11
Q

5 adverse effects of cortisol

A

weight gain

striae

moon facies

HTN

peptic ulcers

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12
Q

two types of CHF

A

CHF with reduced EF (systolic heart failure)

CHF with preserved heart failure (diastolic heart failure)

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13
Q

two coronary effects of chronic atherosclerosis

A

angine pectoris

congestive or chronic heart failure

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14
Q

T/F autonomic dysfunction and facial paralysis can occur in GBS

A

true

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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

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16
Q

polycythemia

A

overly productive bone marrow that produces too many blood cells

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17
Q

two types of hemorrhagic strokes

A

intracerebral hemorrhage

subarachnoid hemorrhage

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18
Q

are the risks associated with sickle cell anemia

A

chromic hemolytic anemia

microinfarction due to clottin

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19
Q

where is B12 found

A

tightly bound to protein in meat

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20
Q

tests and exams to confirm cushings

A

elevated cortisol

cortisol suppression test

Low ACTH levels

imaging

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21
Q

three conditions sequela to hydronephrosis

A

ureteral stone

prostatic hypertrophy

malignancies

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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

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23
Q

what is the function of TRH

A

stimulates the production of TSH and prolattin

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24
Q

common symptoms of hemorrhagic strokes

A

“worst headache of my life”

decline in LOC

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25
Q

where are BP recordings most accurate

A

at home and work, not in the office

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26
Q

four steps to treat iron deficiecy

A

stop blood loss if there is any

improve diet

oral iron

parenteral iron

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27
Q

three diagnostic indicators of MS

A

clinical course and neurologic findings

MRI of brain and spine

testing of CSF for oligoclonal bandsof IgG

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28
Q

T/F the risk of death within 90 days of AMI is 75%

A

false, 1-22%

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29
Q

prevention of alzheimers

A

statins may reduce risk up to 50S%

NSAIDs

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30
Q

what is the main byproduct of hemoglobin breakdown

A

bilirubin

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31
Q

granular leukocytes

A

basophiles

neutrophils

eosinophils

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32
Q

what is the normal urine output per minute?

why is there a difference between GFR and urine output

A

1 mL/mins

because 119 mL/mine is reabsorbed by the kidneys

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33
Q

what is the full name of T3

T4

which is the main functional hormone of the thyroid

A

triodothyroinine

tetraiodothyroinine

T3

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34
Q

HDL paradox

A

drugs that decrease LDL reduce risk

drugs that increase HDL do not reduce risk

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35
Q

non pharmacologic treatment of seizures

A

neurosurgical ablation/excision of lesion

vagus nerve stimulation for partial sz

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36
Q

what is the sympathetic response to decreased BP

A
  • activation of Beta adrenergic receptors in the heart
  • activation of Alpha adrenergic receptors in smooth muscle
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37
Q

two types of BPH symptoms

A

obstructive

irritative

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38
Q

three general symptoms of a primary CNS tumor

A

headache (CC in 30%)

sz

nausea

emesis

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39
Q

what is the first line treatment for hypothyroid

A

daily thyroxine

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40
Q

differentiate between thrombotic and embolic ischemic strokes

A

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

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41
Q

how is meningitis diagnosed

A

lumbar puncture and culture

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42
Q

what causes MS

A

areas of demylination in the CNS, followed by inflammation and gliosis (scarring)

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43
Q

how many patients with ESRD are candidates for transplant

A

about 50%

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44
Q

three environmental changes that can cause an endocrine response

A

nutritional

thermal

existential

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45
Q

why is the indicidence of CHF increasing

A

people who used to die from AMIs are now living with decreased heart function

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46
Q

does HTN mangement need to be life long

A

preferably not, as long as necessary but short as possible

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47
Q

what will be the difference in distribution from a primary and secondary CNS tumor

A

primary will be more localized

secondary will be more diffuse

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48
Q

what is the histological sign of B-12 and folate deficency

A

megaloblastic anemia

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49
Q

what is blood

A

dilute saline with dissolved chemicals and suspended cells

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50
Q

in what hyperthyroid condition does exopthalmos not occur

A

goiter

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51
Q

staghorn calculi

A

stones made of urate, cystine, or struvate that are too large to pass

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52
Q

folic acid is an essential cofactor in what

A

amino acid and DNA synthesis

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53
Q

what are 4 comorbidities associated with CVA

A

HTN

DM I/II

obesity

smoking

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54
Q

what is the determinant of symptoms caused by a brain tumor

A

location and size of tumor

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55
Q

three common statins

A

atorvastatin (lipitor)

simvastatin (zocor)

lovastatin (mevacor)

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56
Q

CHF EKG signs

A

left ventricular hypertrophy

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57
Q

describe the genetic characteristics of thalassemia

A

autosomal recessive

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58
Q

what is the treatment plan of hyperthyroid

A

control symptoms

prevent thyrid storm

plan long term control

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59
Q

what condition is commonly associated with intracerebral hemorrhage

A

HTN

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60
Q

what causes sickle cell disease

A

homozygous vs heterozygous Hgb A mutation

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61
Q

four conditions that are most commonly caused by DM

A

chronic renal failure

neuropathic pain

blindness

gangrene caused limb amputation

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62
Q

epilepsy

A

recurrent seizures with a chronic, underlying cause

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63
Q

what is the dialyzing fluid in peritoneal dialysis

A

1-3L of dextrose

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64
Q

three substances commonly secreted by testicular cancer

A

HCG

alpha-fetoprotein

lacate dehydrogenase

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65
Q

what are the pros and cons of kidney transplant

A

pro: improved quality of life
con: requires lifelong immunosuppresion

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66
Q

three common presenting symptoms of myasthenia gravis

A

ptosis

diplopia

dysphagia

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67
Q

what is the treatment for severe anemia for major thalassemia

what is the risk

A

repeat transfusions

iron overload (hemosiderosis)

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68
Q

three ways to reduce dementia risk

A

intellectual stimulation

social interaction and exercise

statins and nsaids

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69
Q

what is the most common symptom of testicular cancer

A

painless testicular mass

systemic symptoms are less likely

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70
Q

what is the most common cause of UTI

what gender is more susceptible

why

A

bacteria from the rectum

women

shorter urethra

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71
Q

four common sympathetic receptor blockers (examples)

A

beta blocker (atenolol, propanolol)

alpha blockers (prazosin, terazosin)

alpha and beta (labetalol)

centrally acting (methyldopa, clonidine)

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72
Q

when will most diabetic have complications

A

after 20 years

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73
Q

T/F most GBS has no trigger event

A

false

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74
Q

what percent of ESRD is idiopathic

A

22%

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75
Q

what forms carotid clots leading to embolic stroke

what might be heard on auscultation

what is the surgical treatment

A

atherosclerotic lesions

bruits

endarterectomy

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76
Q

best goal of LDL/HDL

why is this a good goal

A

make your lows low and highs high

decreasing LDL reduces risk of atherosclerosis

increased HDL decreases risk

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77
Q

5 grades of astrocytomas

which are most common in children

adults

A

I-IV

I and II most common in children

IV in adults

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78
Q

which thyroid hormone is most readily available

why is this effect in treatment

A

T4

because T4 is converted to T3 in tissues

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79
Q

T/F horomes are secreted continuously

A

false they are usually in pulses

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80
Q

differentiate between chronic and acute meningitis

A

usually a longer clinical course

similar, but less severe symptoms

usually cuased by mycobacteria, fungi, treponema

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81
Q

what is the protocol to test for prostate cancer

A

taking 12 needle biopsies at random locations

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82
Q

dementia

A

generalized loss of neurons

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83
Q

two conditions related to muscle damage from statin drugs

A

myopathy

rhabdomyolysis

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84
Q

what happens when an atherosclerotic plaque ruptures

A

a blood clot forms around the rupture and blocks the artery

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85
Q

thalassemia

A

genetic defect in globin biosynthesis

classified as alpha or beta thalassiema

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86
Q

less invasive surgical options for BPH

A

high intesity ultrasound

transurethral laser-induced prostatectomy

transurethral ablation

stents

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87
Q

risk of erythropoietin treatment

A

increasing hematocrit over 12g increase risk of stroke

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88
Q

three types of angina pectoris

A

stable

unstable

variant

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89
Q

treatment options for ESRD

A

dialysis or transplant

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90
Q

three causes of hypotension that can result ischemia

A

acute blood loss

anesthesia

cardiac arrhythmia

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91
Q

most CNS tumors come from what cells

A

glial cells

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92
Q

what is the most common benign tumor in men

A

benign prostatic hyperplasia

80% of men by 80 yrs old

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93
Q

normochromic, normocytic RBCs with normal reticulocytes, iron

but

pancytopenia

three things that top the DDx

A

aplastic anemia

bone marrow dysfunction

drug reaction

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94
Q

DDx for

megaloblastic anemia

low reticulocytes

normal iron studies

A

folate deficiency

B12 deficiency

metformin

GI symptoms

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95
Q

how is EF determined

A

echocardiogram

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96
Q

what are reticulocytes indictive of

A

rapid production of RBCs

destruction of RBCs

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97
Q

5 treatments for ESRD

A

restrictions of oral intake

control HTN

limit nephron loss

dialysis

transplant

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98
Q

what is the complication with oral iron supplements

A

compliance issues due to GI side effects

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99
Q

what are the laboratory tests that will confirm hyperthyroid

A

very low or absent TSH

very high T4

sometimes autoimmune tests are positive

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100
Q

what is the key feature of GBS

A

ascending paralysis progressing over hours or days

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101
Q

two types of testicular cancer

A

seminomas

non-seminomas

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102
Q

two adverse effects of statins

A

liver damage

muscle damage

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103
Q

what can happen to untreated cystitis

pyelonephritis

A

it can develop into pyelonephritis

frequent kidney infections can result in kidney damage and renal failure

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104
Q

anemia

A

pathological deficiency of oxygen carrying capacity of blood caused by a decrease in the number or function of RBCs

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105
Q

when are symtpoms of mild atherosclerosis noticed?

severe?

A

50% occulsion, usually on exertion

80%, effects can be felt at rest

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106
Q

what is the difference between urology and nephrology

A

urologists are surgeons who correct defects in the kidney and urinary tract

nephrologists are clinicians that treat kidney diesease

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107
Q

what is the peak age for testicular cancer

A

15-40

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108
Q

what is a common iatrogenic cause of cushings

A

prednisone

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109
Q

four divisons of heart disease

A

coronary artery disease

valvular disease

HTN heart disease

cardiomyopathy

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110
Q

three main forms of coronary heart disease (CHD)

A

acute coronary syndrome

stable angina

CHF

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111
Q

what is the function of direct vasodilators in the treatment of HTN

A

reduce peripheral vascular resistance

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112
Q

seven signs associated with ERSD

A

elevated BUN and creatinine

oliguria

electrolyte imbalance

acid-base imbalance

HTN

anemia

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113
Q

T/F most women have atypical AMI presentation

A

true, more likely to be Dx as gi

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114
Q

two chronic effects of atherosclerosis

A

coronary effects

peripheral vascular disease

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115
Q

hemoglobin content is dependent on what two factors

A

production of Hgb - loss of Hgb

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116
Q

risk factors for atherosclerosis

A
  • smoking
  • hypertension
  • diabetes
  • family HX
  • age
  • dyslipidemia
  • lifestyle
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117
Q

isolated vs progressive prostate cancer

A

stable and controlled

vs

capable of local extension and metastasis

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118
Q

causes of b12 deficiency

A

dietary (strict vegan)

gastric dysfunction

GI malabsorption (ileal disease)

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119
Q

BCG in bladder cancer

used for what

A

bacille calmette-guerin

vaccine for tuberculosis that can be used as an immune stimulant in some situations

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120
Q

why are ACE inhibitors effective

A

because angiotensin I is really just a precuros without much effect on blood pressure

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121
Q

LDL

A

transporter of endogeneous cholesterol

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122
Q

three strategies to prevent kidney stones

A

hydration

medication based on the type of stones

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123
Q

what common HTN treatment can cause malaise and fatigue

A

beta blockers

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124
Q

intervesicular treatment of bladder cancer

A

6 weeks of weekly treatments with cyotoxic drugs or BCG

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125
Q

life expectancy with ESRD

A

55-64 years

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126
Q

what proprotion of transplant kidneys come from cadavers vs donors

what is the benefit of a living donor

A

2/3 cadaver, 1/3 living

living kidneys have a higher 1 year and 5 year survival rate

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127
Q

what is the prognosis of ESRD without dialysis

with dialysis

A

no dialysis: death in days or weeks

dialysis: yearly mortality 22%

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128
Q

how does cortisol exacebate HTN?

DM

A

HTN: increase salt intake

DM: increase blood sugar

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129
Q

5 year survival rates for testicular cancer

A

95-98% early

55-80% even with distant metastases

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130
Q

three amino acid hormones

A

dopamine

thyroxine

catecholamines

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131
Q

what percent of AMIs are precipitated by strenous events

A

50%

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132
Q

band cells

A

immature neutrophils that are indicative of rapid production of neutrophils

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133
Q

nephrolithiasis

A

kidney stones

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134
Q

silent stroke

A

a true stroke that causes infarction in a portion of the brain with no obvious motor or sensory functions

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135
Q

differentiate between the vascular causes of STEMI vs NSTEMI

A

STEMI is more likely to be in one of the great vessels

NSTEMI usually comes from a small vessel

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136
Q

what typically causes subarachnoid hemorrhage

A

bleed from a major cerebral artery in the circle of willis, often from congenital vessel weakness

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137
Q

four classifications of HTN

A

primary/essential/idiopathic

renal

endocrine

pregnancy induced

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138
Q

what is the most common form of HTN

A

primary/essential/idiopathic

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139
Q

T/F all stones are painful

A

false, some can be painless

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140
Q

what lab tests confirm hypothyroid

A

Low T4

very high TSh

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141
Q

how much ultrafitrate is produce by the kidenys per minute

what is this called

A

120mL/min

the glomerular filtration rate (GFR)

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142
Q

how severe is GBS

A

it can be mild or severe, but most require hosptialization and 30% of severe GBS can require mechanical ventiliation

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143
Q

systolic pressure

A

pressure at which blood flow resumes in an occluded arterty

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144
Q

how to decrease stable angina attacks

A

HTN control

lipid management

lifestyle modification

cononary revascularization

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145
Q

five symptoms of ESRD

A

fatigue

pruritis

epistaxis

SOB

nausea

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146
Q

what are four dissolved components of blood

A

nutrients (glucose, vitamins)

Electrolytes (Na, K, Cl, Ca)

Hormones (insulin, T3/T4)

Proteins (albumen, carriers)

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147
Q

red pulp of the spleen

A

tortuous sinsoids that weed out old RBCs or RBCs with antigens to be broken down

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148
Q

PSA

what does it do

how does it relate to cancer

A

prostate spefic antigen

helps liquify semen

BPH and prostate cancer will both have increased PSA

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149
Q

three environmental sources of bone marrow toxic substances

A

solvents

pesticides

radiation

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150
Q

two etiology categories of epilepsy

A

primary and secondary

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151
Q

CHF symptoms

A

dyspnea, orthopnea, edema

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152
Q

what can happen if a homone is present in high enough concentrations

A

the hormone can interact with receptors of the same family

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153
Q

what are the 3 most common CNS tumor histologies

A

gliomas

meningiomas

schwannomas

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154
Q

three facts about steroid hormones

A

insoluble

requires transport molecules

causes DNA transcription and translation

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155
Q

two ways that hormone-receptor complexes elicit effects in target cells

A

2nd messanger

DNA transcription leading to protein production

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156
Q

STEMI is usually indicative of what

A

transmural ischemia (involves the full thickness of the cardiac wall)

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157
Q

fatal complication of diabetes

A

diabetic ketoacidosis

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158
Q

two actions of insulin

A

inhibit catabolism

promotes anabolism

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159
Q

three popular single drugs used in intial HTN treatment

A

ACE inhibitor

calcium channel blocker

diuretic

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160
Q

what is a normal blood volume

A

4-8 liters

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161
Q

what is the renal response to decreased blood pressure

A

decreased renal blood flow

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162
Q

PCI vs thrombolysis

preference

when would thrombolysis be used

A

PCI is preferred

thrombolytics are indicated with PCI isn’t available and early treatment

early is key

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163
Q

what happens in response to decreased renal blood flow

A

renin is released

glomerular filtration is decreased

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164
Q

two types of vitamin derived hormones

A

retinoids (vitamin A)

vitamin D

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165
Q

what causes sickle cell anemia

A

autosomal recessive mutation of Hgb A

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166
Q

what are the most common minerals that form renal stones

A

calcium oxalate

calcium phosphate

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167
Q

5 symptoms of renal cell carcinoma

A

hematuria

flank pain

weight loss

anemia

palpable mass

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168
Q

what will be two signs of pernicious anemia

A

megaloblastic anemia and progressive neurological deterioration

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169
Q

Two types of UTI

A

lower urinary or upper urinary tract

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170
Q

DDx for

Normal indices (red blood cell size)

Reticulocyte count high

Iron studies normal

Bilirubin level elevated

A

Hemolysis

Inheritied hemoglobin disorderd (thalassemia or sickle cell)

Autoimmune disorders (lupus)

G6PD

Pyruvate kinase deficiency

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171
Q

T/F ESRD (end stage renal disease) is permanent

A

true

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172
Q

what percent of ARF survivors retain normal function

A

50%, with 5-10% having chronic renal failure

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173
Q

what is more common, STEMI or NSTEMI

A

NSTEMI (55-60%)(

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174
Q

how to reduce BP by decreasing PVR

two methods to achieve this

A

vasodilation

  1. direct action on the vessels
  2. CNS control
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175
Q

what determines the symptoms resulting from an interuption in arterial blood flow

A

the vessel affected

length of ischemia

neurologic redundancy

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176
Q

CVA working definition

A

condition resulting in an abrupt appearence of neurlogical symptoms due to focal vascular disruption that usually involves an infarction

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177
Q

what is the function of blocking RAA in treating HTN

A

reduce blood volume and peripheral resistance

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178
Q

describe tie etiology of Type I DM

A

an autoimmune disorder that causes rapid loss of beta cells

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179
Q

why do some RBCs appear “speckled”

A

they are reticulocytes that have remains of the endoplasmic reticulum remaining

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180
Q

what pattern is lost with cushing syndrome

A

the diurnal pattern which causes higher cortisol in the morning and lower at night

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181
Q

hemoglobinopathy

two types

A

change in Hgb structure and function

sickle cell anemia

thalassemia

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182
Q

diagnosis of testicular cancer

A

ultra sound, sometimes needly biopsy

retroperitonal lymph node dissection

CT of pelvic, abdomen, chest

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183
Q

T/F most myocardial infarctions are caused by HTN

A

false, caused by atherosclerotic plaque rupture

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184
Q

at what GFR is anemia usually found

A

<30mL/min

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185
Q

I added an extra card because I didn’t want there to be an unlucky number

A

Don’t judge me

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186
Q

TURP benefits vs risk

A

benefits: 75-96% chance of improvement, significant reduction in symptoms, low mortality, 5% max risk of complications
risks: incontinence, impotence, retrograde ejaculation

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187
Q

symptoms of

acute

subacute

chronic

ischemia

A

acute: acute coronary syndrome
subacute: angina

chronic : CHF

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188
Q

three causes of Cushings

A

iatrogenic

secondary adrenal hyperplasia

primary adrenal hyperplasia

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189
Q

T/F prostate cancer is rare and always life threatening

A

false, it is second most fatal cancer among men and 70% of men age +70 show prostate cancer

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190
Q

what two effects of cortisol are considerd to improve resistance to stress

A

increased glucose availibility

increased blood pressure

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191
Q

what is the most common location of aneurysm in the brain

A

anterior cerebral or communicating artery

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192
Q

are antibiotics always needed for cystitis

A

no, they are generally needed but they are always needed for pyelonephritis

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193
Q

how is HDL increased

A

weight loss and exercise

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194
Q

visious cycle of CHF

A

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

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195
Q

descrive the RAA pathway (5)

A
  • 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
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196
Q

STEMI treatment

A

reperfusion

supportive measures similar to NSTEMI

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197
Q

what is the function of aldosterone II

A

triggers vasoconstriction

aldosterone production and release from the adrenal cortex

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198
Q

recyclining function of RE macrophages

A

amino acids and iron from hemoglobin is recycled into the bone marrow to make new RBCs

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199
Q

who is usually victim of idiopathic cardiomyopathy

A

young and healthy people, generally with a precipitating even (viral infection, pregnancy)

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200
Q

chronic heart failure 9CHF) definition

A

ventricular function insufficent to meet the metabolic and blood flow demands

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201
Q

describe the negative feedback loop that regulates adrenal function

A

pituitary secretes ACTH

adrenal cortex secretes cortisol

cortsol inhibits ACTH secretion

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202
Q

five chronic complications of DM

A

CAD

PVD

nephropathy

neuropathy

retinopathy

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203
Q

orthopnea

A

the inability to sleep supine without breathing issues

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204
Q

three causes of ischemia

A

vessel stenosis or occulsion

vasospasm

pump failure

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205
Q

what is the most common form of renal and ureteral stone removal

how effect is it

A

lithotripsy

90-90%

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206
Q

five factors the kidney fails to regulate in renal failure

A

fluid balance

electrolyte balance

acid-base balance

excretion of nitrogenous waste

excretion of drugs

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207
Q

which are more prominent, alpha or beta cells?

A

alpha (75% to 20%)

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208
Q

why is stroke prognosis difficult to predict

A

one area can be damaged but other areas can be repurposed to compensate

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209
Q

what type of stroke is most common

A

ischemic (85-90% vs 10-15%)

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210
Q

what is the progression of chronic renal disease

A

gradual loss of nephrons

gradual decline of GFR

leads to end stage renal disease

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211
Q

what is required to for a renal stone

A

super saturation of urine with insoluble material

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212
Q

reduced hgb production is indicative of what?

A

bone marrow issue

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213
Q

medical treatment of BPH

A

alpha blocker drugs

5-alpha reductase inhibitors

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214
Q

where are T3 receptors found

A

in alll most all human tissue

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215
Q

what drug will cause hypothyroid

A

amiodirone

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216
Q

what are three general symptoms associated with HTN

A

Headaches

malaise/fatigue

symptoms of complications

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217
Q

what typpe of diabetics are most likely to have DKA

A

type one

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218
Q

what is the effect of statin drug treatment

A

reduction of endogenous cholesterol synthesis

lowers LDL

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219
Q

T/F BPH is not a precancerous condition

A

true, the incidence of BPH and prostate cancer are independent

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220
Q

what must be monitored during statin treatment due to the liver damaging side effects

A

liver enzymes

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221
Q

two branches of peripheral vascular disease

A

atherosclerotic

vasculitis

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222
Q

treatment of aplastic anemia

A

immunosuppresion

bone marrow transplant

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223
Q

B12 is important to the synthesis of what

A

nucleic acid synthesis

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224
Q

why are AMIs more common in the AM

A

BP is higher

increased blood viscosity

cortisol secretion is at its highest

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225
Q

T/F most chronic conditions are no effected by cortisol

A

false, many (such as DM and HTN) can be exacerbated by cortisol

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226
Q

four causes of isolated seizures

A

drug withdrawl

high fever

infections

vasovagal or orthostatic syncope

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227
Q

what is the long term concern with BPH

A

obstruction can cause renal damage from bilateral hydronephrosis

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228
Q

two types of mechanical assist devices used in cardiogenic shock

A

balloon pumps

LVADs

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229
Q

criteria for moderate chronic renal disease

symptoms or restrictions

A

GFR 20-60 mL/min

some dietary restrictions may be needed

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230
Q

what causes symptoms in brain abcesses

A

increased ICP

destruction of brain tissue

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231
Q

describe the course of recovery for GBS

A

recovery begins 1-4 weeks after onset

can take months or a year to complete

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232
Q

hydronephrosis

A

dilation of the renal collecting system due to outflow obstruction

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233
Q

what is the hallmark of type II DM

A

insulin resistance

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234
Q

multi centric cancer

A

multiple cells turn cancerous, not just a single cell that divides

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235
Q

why is it dangerous to give folate to treat pernicious anemia

A

folate will correct the anemia but not the neurlogical damage

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236
Q

three Ps of diabetes

A

polyuria

polydipsia

polyphagia

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237
Q

explain why endocrine systems are homeostatic

A

they respond to outside challenges to maintain homeostasis

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238
Q

why do RBCs need to flexible?

why is this relevant?

A

RBCs neet to fit through small vessles

as people get older RBCs are less flexible and more likely to clot

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239
Q

important questions to ask in anemai

A

diet

menstruation

GI distress

medication

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240
Q

common name of HMG-CoA reducatse inhibitors

A

statins

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241
Q

two RBC enzyme deficiencies

A

G6pD

PKD

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242
Q

what causes the oxidation of LDL in fatty streaks

A

monocytes

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243
Q

supportive measures for STEMI

A

aspirin

oxygen

decrease myocardial oxygen demand

control arrhytmia

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244
Q

why is neutrophil count important in cancer treatment

A

chemo decreases bone marrow function

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245
Q

parkinsons disease

A

loss of extrapyramidal motor neurons

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246
Q

bilirubin is an indicator of what

A

liver function

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247
Q

three most common causes of dementia

A

alzheimers

vascular dementia from multiples infarcts

lwey body dementia

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248
Q

how can thrombopphlebitis (DVT) can an embolic stroke

A

passing between a atrial septal defect

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249
Q

two types of ischemic strokes

A

thrombotic

embolic

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250
Q

four types of generalized seizures

A

tonic-clonic

absence

myoclonic

febrile

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251
Q

four groups of drugs used to treat HTN

A

diuretics

sympathetic receptor blocker

direct vasodilators

RAA blockers

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252
Q

why can radioactive iodine be used to ablate the thyroid

A

because the thyroid is the only place where iodine is stored in the bdoy

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253
Q

T/F arterial blood flow interruption is a common probelm

A

true

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254
Q

what is the treatment for type I DM

type II

A

type I = insulin

type II = insulin plus other stuff

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255
Q

what is the most common type of hyperthyroidism (60-80%)

A

graves disease

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256
Q

what is neurological condition is caused by an excess of dopamine

A

psychosis

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257
Q

what is needed to gain access for hemodialysis

A

av fistula or prosthetic arteriovenous graft

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258
Q

what is the effect of sympathetic stimulation of alpha receptors in response to decreased BP

A

increased peripheral resistance through vasoconstriction

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259
Q

if there is a coexisting B12 deficiency what will folate treatment do

A

correct anemia but not neurodegeneration

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260
Q

paracrine

A

chemical signalling to nearby cells

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261
Q

NSTEMI treatment

A

supportive measures

anticoagulation

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262
Q

three strategies for treatment of BPH

A

observation

medical treatment

surgical treatment

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263
Q

three categories of neurotransmitter diseases

A

disorders of

deficiency of a neurotransmitter

excess of a neurotransmitter

imbalance of neurotransmitters

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264
Q

what type of hormones will dissolve in blood

what type of hormones will need a carrier

A

water soluable

lipid soluble

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265
Q

most current guidelines for blood pressure

Normal

elevated

Stage 1

Stage 2

A

normal: 120/80

elevated: systolic >120, diastolic >80

stage 1 HTN: >/= 130/80

stage 2 HTN: >/= 140/90

266
Q

what is the protein structure of hemoglobin

A

a protein tetramer with alpha and beta or alpha and gamma polypeptide chains and one oxygen carrying heme group

267
Q

when are statins contraindicated

A

pregnacy

children

268
Q

two key elements manipulated to regulate blood pressure

A

sympathetic nervous system input

renal blood flow

269
Q

what is the progression of myasthenia gravis

A

85% will develop generalized muscle weakness notably with repetitive muscle use

270
Q

cobalamin

A

B 12

271
Q

common clinical indications of CNS infection

A

signs of infection (fever, malaise)

alteration of CNS function (AMS, SZ)

272
Q

symptoms associated with primary temporal lobe tumor

A

sz

olfactory and gustatory hallucinations

deja vu/jamais vu

273
Q

what angiotensin II a potent actor on BP

A

it triggers the aldosterone production to increase blood volume

it acts on the blood vessels to increase peripheral resistance

274
Q

Dr Dodges suggested take home messages regarding HTN

A
  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
Q

two PCSK9 drugs

A

alirocumab (praluent)

evolcumab (repatha)

276
Q

what nervous system are many of the symptoms of hyperthyroidism related to

A

sympathetic nervous system

  1. restlessness
  2. insomnia
  3. tremor
  4. weight loss
  5. heat intolerance
277
Q

G6PD homozygotes are at risk for hemolysis triggered by what three factors

A

certain diseases (infection, diabetes)

certain foods (fava beans)

certain drugs (sulfa, aspirin)

278
Q

common symptoms of MS

A

limb weakness, numbness, paresthesia

spastic paraparesis

optic neuritis

diplopia

loss of sphincter control

vertigo

279
Q

what are the symptoms associated with dementia

A

loss in

memory, reasoning, judgement, abstraction, learning, language

280
Q

pheochromocytoma

5 primary symptoms

A

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
Q

treatment strategy for bladder cancer

A

transurethral resection

partial or radical cystectomy

chemo and radiation

282
Q

what is the most common type of epilepsy

when does it usually start

A

primary (idiopathic or constitutonial)

usually before age 20

283
Q

symptoms associated with primary brain stem or cerebellar tumor

A

ataxia

nystagmus

cranial nerve palsies

284
Q

symptoms of acute MI

A

squeezing pressure chest pain

can be felt in the stomach or left arm, face, shoulder

anxiety

diaphoresis

GI distress

285
Q

what components of blood come from the myeloid line

A

erythrocytes

megakaryocytes (platelets)

granulocytes (N, B, E-phils) and monocytes

286
Q

three treatment options for MG

A

thymectomy (if present and the patient is between puberty and 60)

acetylcholinesterase inhibitors

immunosuppresive drugs

287
Q

mitigating factors to consider in treatment of HTN

A

other medical conditions

RAA work less well on african americans

cost

288
Q

four common RAA blockers (examples)

A

angiotensin converting enzyme (ACE) inhibitors (catopril, benazopril)

angiotensin II receptor antagonist (losartan)

aldosterone antagonist (spironolactone)

renin inhibitor (aliskiren)

289
Q

three ways gastric disfunction can cause b12 deficiency

A

pernicious anemia

gastric atrophy

gastric surgery

290
Q

three facts about peptide/protein/glycoprotein hormones

A

water soluble

interact with cell membrane

work through second messanger

291
Q

what is the functional unit of the kidney

A

the nephron

292
Q

how long does the tonic phase of a tonic clonic sz last

clonic phase

A

1minute

2-3 minutes

293
Q

what has been the primary reason for decreasing number of cardiac death since the 1970

A

decreased in smoking

improved treatment

294
Q

two divisions of cardiovascular disease

A

peripheral vascular disease

heart disease

295
Q

treatment dilemma for prostate cancer

A

if the gleason score is low its caught early laproscopic surgery or “watch and wait” may be done

296
Q

what age is mostly likely for the onset of MS

A

20-40

297
Q

acute vs chronic renal failure

A

acute: sudden reaction, hours or days
chronic: gradual decline in function over months or years

298
Q

primary adrenal hyperplasia causes

A

idiopathic

neoplasm

congenital

299
Q

three ways to decrease BP by decreasing CO

A

reduce HR

reduce contractility

reduce venous return/decrease blood volume

300
Q

what is the key component of ischemia

A

O2 supply is not sufficient for demand

301
Q

what makes up the nephron

A

glomerulus

bowmans capsule

proximal tubule

distal tubule

loop of henle

collecting duct

302
Q

medication to decrease urate stones

A

allopurinol to decrease uric acid

decrease protein

303
Q

T/F 30% of AMIs are asymptomatic

A

treu

304
Q

what constitutes a “hypertensive emergency”

A

200/140

305
Q

what are the current treatment goals for alzheimers

A

slow the progression of disease

reduce plaques with anti amyloid drugs (possibly not beneficial)

306
Q

what is the most common cause of death in the US

A

cardiovascular disease

307
Q

three endocrine conditions associated with HTN

A

cushings

pheochromcytoma

congenital adrenal hyperplasia

308
Q

what is considered the unifying element in the pathogenesis of atherosclerosis

how was this decided

A

inflammtion

inflammatory markers correlate to CV disease risk

309
Q

what triggets the production of EPO

A

decreased oxygen saturation in the blood

310
Q

three conditions associated with pregnancy induced HTN

A

toxemia

pre-eclampsia

eclampsia

311
Q

NSTEMI is indicative of what

A

ischemia that is subendocardial rather than transmural

312
Q

foam cells

A

monocytes that become macrophages and ingest oxidized LDL

313
Q

what common HTN treatment will cause annoying dry cough

A

ACE inhibitors

314
Q

unstable angina

A

angina that occurs with minimal activty or at rest

315
Q

two methods for reperfusion in response to STEMI

A

percutaneous coronary intervention

thrombolytic therapy

316
Q

T/F more than 50% of AMI death occur suddenly

A

true

317
Q

what causes graves disease

A

auto-antibodies that bind and active TSH receptors

318
Q

fatty streaks

A

LDL accumulation under endothelium

319
Q

folate deficiency treatment

A

daily folic acid tablets

320
Q

diastolic reading

A

pressure at which flow returns to normal in an occluded artery

321
Q

three causes of bone marrow toxicity

A

pharmacological

environmental

immunologic

322
Q

5 types of meningitis

A

acute

purulent

septic

chronic

aseptic

323
Q

diagnosis of prostate cancer

A

digital rectal exam

ultrasound

biopsy

prostate specific antigen screen

324
Q

what percent of the following have cardiovascular disease

people at age 20

people over 75

total population

A

5%

75%

20%

325
Q

what are the risk factors for CNS tumors

A

radiation exposure

no other risk factors known

326
Q

what gender is mostly likley to get renal cell carcinoma

A

2:1 men over women

327
Q

four small neurpeptide hormones

A

GnRH

TRH

vasopressin

somatostatin

328
Q

differniate between homozygous and heterozygous thalassemia

A

homozygotes have signifcant disease (major)

heterozygotes are mildly anemia or asymptomatic

329
Q

autocrine

A

chemical signaling of cells among the same type

330
Q

what portion of brain tumors are malignant

how many deaths per year

A

50%

13000/year

331
Q

radiation options for CNS tumor treatment

A

whole brain vs focused radiation (gamma knife)

332
Q

what is the gender ratio of patients with graves disease

A

female 8:1

333
Q

what drug can stop the relase of T3 and T4

A

potassium iodine

334
Q

where does glucagon like peptide naturally come from

what does it do

A

L cells in the intestine

opposes insulin

335
Q

atherosclerotic process

A
  • fatty streaks
  • monocyte aggregation
  • LDL oxidation
  • formation of foam cells
  • inflammation leading to LDL accumulation
336
Q

when is cardiogenic shock the more common cause of MI mortality

A

in the case of large infarctions

337
Q

CHF signs on CXR

A

cardiomegaly, pulmonary edema

338
Q

what is the risk of decreasing blood pressure too low

A

toxicity

orthostatic hypertension

339
Q

most bladder cancers are _____ with____

A

transitional cell carcinomas

multi-cell centric organism

340
Q

what is the immunosuppressive treatment of aplastic anemia

how often is it successful

A

antilymphocyte or antithymocyte globulin

50-70%

341
Q

three lifestyle issues that increase risk of atherosclerosis

A

obesity

physical inactivity

atherogenic (inflammatory) diet

342
Q

four strategies to prevent future strokes

A

reduce the chances of repeat embolis

control HTN

control DM

treat atherosclerosis

343
Q

two supportive treatments for UTI

A

hydration

vitamin C (cranberry juice)

344
Q

what causes BPH

A

unknown, but it does seem to require androgens and aging

345
Q

atherosclerosis

A

vessel narrowing due to fatty deposits in the arteries related to lipid metabolism and cholesterol

346
Q

10-15% of MG patients have a ____

3-8% will have or will develop ____

A

thymoma

hyperthyroid (graves disease)

347
Q

what is the main cause of cardiovascular disease

A

atherosclerosis

348
Q

what cells come from the lymphoid line

A

NK cells

dendritic cells

T & B lymphoctyes

349
Q

diagnosis of renal cell carcinoma

A

symptoms or hematuria leading to abdominal chest CT and cytology

350
Q

two diseases caused by a deficiency of a specific neurotransmitter

A

parkinsons (dopamine)

myasthenia gravis (acetylcholine)

351
Q

stable angina

A

recurring episodes of chest pain brought on by exertion and relieved by rest

352
Q

what cells break down RBCs

A

reticuloendothelial cells found in the spleen and liver

353
Q

why would you check for hyperthyroidism in new onset a fib

A

because hyperthyroid can trigger arrhytmias

354
Q

what is the main complication for peritoneal dialysis

A

infection through the port

355
Q

Gaba vs glutamate

A

Gaba is a inhibitor of APs, glutamate excites APs

356
Q

lipoproteins

A

macromolecule consisting of lipid and protein

357
Q

what causes chronic anemia with ESRD

A

a deficiency in erythropoeitin

358
Q

what is the primary condition associated with upper UTI

A

acute pyelonephritis

359
Q

how do sympathetic receptors blockers function to lower HTN

A

block alpha and beta receptors

360
Q

prognosis for:

pituitary tumors

meningiomas

astrocytomas

A

pituitary good

meningiomas usually good

astrocytomas usualyl bad

361
Q

three drugs used in the treatment of stable angina

A

nitrates

beta blockers

calcium channel blockers

362
Q

criteria for mild CRD

symptoms or restrictions?

A

GFR +60mL/min

none

363
Q

what is the most common pathogen associated with UTI

A

E. Coli or other coliforms

364
Q

5 locations in the body with especially high numbers of T3 receptors

A

brain

heart

muscle

kidneys

gonads

365
Q

increasd hgb loss means

A

accelerated destruction or loss from vasculature

366
Q

six disorders that will cause neurollogical disorders

A
  1. vascular
  2. neoplastic
  3. infectious
  4. degenerative
  5. neurotransmitter
  6. seizure disorders
367
Q

the hydraulic equation

define the variables

A

BP = CO x PVR

BP = cardiac output x peripheral resistance

368
Q

HDL

A

removes LDL cholesterol and triglycerides

369
Q

what will microinfarctions from sickle cell cause

A

leg ulcers

functional splenomegaly

shortened life span

370
Q

symptoms associated with primary frontal lobe tumor

A

personality changes

decreased intellect

371
Q

four options for ureteral stone treatment

A

supportive

ureterscopic retrieval

surgical removal

lithotripsy

372
Q

medication used to decrease glucagon secretion

A

glucagon like peptide 1

373
Q

two main types of hyperthyroidism

A

graves disease

toxic nodular goiter

374
Q

T/F complete control of glucose is bad

A

true, it decreases longevity

375
Q

megaloblastic anemia

A

Large RBCs, hypersegmented neutrophils caused by impaired DNA synthesis

376
Q

dyslipidemia related to atherosclerosis

A

high LDL

low HDL

377
Q

where are other ACTH secreting cells located beside the pituitary

A

small cell lung cancers

378
Q

four problems that would lead to decreased erythropoesis in the RBCs

A

nutritional deficiencies

loss of stimulation

toxicity

neoplasm

379
Q

PCI

A

stent placement

380
Q

what is required for reabsorption of the ultrafiltrate in the kidneys

A

energy

381
Q

what is the evolutionary benefit to G6PD deficieny

A

heterozygotes have increase survival rate with malaria infection

382
Q

ALS

A

amyotrophic lateral sclerosis, loss of upper and lower motor neurons

383
Q

thee factors that influence PVR

A

arterial diameter

arterial length

elasticity

384
Q

two indications of aseptic meningitis

A

more benign course

usually caused by viral infection (herpes, mumps, enteroviruses)

385
Q

Do RBCs have a nucleus?

why is that important in transfusion

A

no

because we don;t have to match HLA-1 antigens just blood type

386
Q

what is the first symptom of GBS

how does this progress

A

usually leg weakness

motor loss comes first, then sensory

387
Q

primary hyperthyroid

A

the 99% of hypothyroidism that is caused by failure of the thyroid galdn

388
Q

three systems that patients will often loss RBCs through (example of disoder)

A

GYN (heavy period)

GI (cancer, ulcer)

GU (cancer)

389
Q

two common sources of embolic strokes

A

carotid

cardiac

390
Q

four treatments for atherosclerosis

A

lifestyle changes

treatment of hyperlipidemia with statins

treat HTN

treat diabetes

391
Q

benign prostatic hypertrophy

A

noncancerous enlargement of the prostate

392
Q

two histological descriptors of iron deficient anemia

A

microcytic (small)

hypochromic (pale colored)

393
Q

four triggers for GBS

A

food poisoning caused by campylobacter jejuni

cytomegaloy virus/epstein barr

mycoplasmic pneumonia

some vaccinations

394
Q

why is a good HLA match needed for bone marrow transplant

A

a poor match will produce graft versus host disease as the graft produces lymphocytes that react to antigens

395
Q

what is the main complication associated with nephrolithaisis

A

ureteral occlusion which can cause severe back or flank pain and can cause hydronephrosis

396
Q

partial sz (retain consciousness)

A

partial (single muscle group/limb)

complex (sensory hallucinations with increased or decreased motor function

397
Q

what is a common accompaniment with lewy body dementia

A

hallucinations

398
Q

three examples of neuronal loss disorders

A

dementia

ALS

parkinsons

399
Q

two agents that improve survival with CHF

A

beta blockers

ACE inhibitors

400
Q

four dietary sources of iron

A

meat, seafood, beans, spinach

401
Q

aplastic anemia

A

an autoimmune disorder that causes the loss of hemopoietic cells

402
Q

two types of prostate cancer

A

isolated malignant foci

progressive cancer

403
Q

what is the effect of folic acid on fetal development

A

assist in neural tube development and decreases ther risk of anencephaly or spina bifida

404
Q

four common MS treatments

A

corticosteriods (prednisone, medrol)

interferon beta 1a

immunosuppresants

IVIG

405
Q

five non-insulin treatments of DM

A

reduce insulin resistance

stimulate secretion fo endogeneous insulin

reduce glucagoon

reduce glucose absorption

enhance urinary secretion

406
Q

how many AMIs occur yearly

what percent are fatal

A

1.1 million

20-40%

407
Q

two special categories of CVA

A

TIA

silent strokes

408
Q

two sources of cholesterol

A

exogenous (diet and absorption)

endogeneous (production of cholesterol from the liver)

409
Q

why is the age related risk for athersclerosis different for men and women

A

women haver higher HDL

estrogen raises HDL

410
Q

what is the cause of goiters

is there a gender bias

what may be a contributing factor

A

unknown

no, 1:1

low iodine may contribute

411
Q

differentiate between blood, plasma, and serum

A

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
Q

limitation of prostate ultrasound for cancer ID

A

most prostate cancers look the same as prostate tissue

413
Q

five important functions of the renal system

A

fluid balance

electrolyte balance

acid-base balance

excretion of nitrogenous waste

excretion of toxins and drugs

414
Q

NSTEMI supportive treatments

A

rest

oxygen

sedation/analgesia

control of arrhytmia

415
Q

three pronged approach to preventing sz

A

enhance inhibitory CNS influences (GABA)

reduce excitatory CNS influences (glutamate)

modulate ionic conductance

416
Q

acute coronary syndromes

A

acute MI with ST segment elevation

acute MI without St elevation

unstable angina

417
Q

T/F HTN is generally asymptomatic

A

true

418
Q

what type of feedback loop primarily regulates the endocrine system

how is regulation accomplished

A

negative

secretion of inhibiting or enhancing factors

419
Q

endocrine

A

chemical signaling between distant cells by ductless glands

420
Q

erythropoetin

A

cytokine that stimulates the production of erythrocytes

421
Q

4 key principles of CNS infections

A

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
Q

what is the fucntion of C peptide after it is removed from proinsulin

what would high levels of c peptide indicate?

low?

A

nothing

high levels = type 2 DM

low = type 1 DM

423
Q

how would treatment differ for a patient with BP <200/140 vs >200/140

A

over 200/140 needs hospitalization due to stroke or MI concerns

below 200/140 can be managed outpatient

424
Q

CHF signs on echocardiogram

A

ventricular ejection fraction

425
Q

T/F gamma hemoglobin production is turned off in adults

A

true

426
Q

major endocrine glands (10)

A
  1. pineal gland
  2. parathyroid
  3. thyroid
  4. hypothalamus
  5. pituitary
  6. thymus
  7. kidney
  8. adrenal
  9. pancreas
  10. ovary/testes
427
Q

what causes DKA

A

hyperglycemia >300mg/dl causes keto acids to accumulate

428
Q

two conditioned associated with renal hypertension

A

narrowed renal artery

chronic renal disease

429
Q

what is the maximum time limit before recovery for a TIA

A

24 hours

430
Q

what do beta blockers do in treating hyperthyroid

four results of treatment

A

block sympathetic pathways

rapid reduction in anxiety, restlessness, tremor, palpitations

431
Q

what are three other minerals that can form renal stones

A

uric acid from gout

cystine

struvite

432
Q

C reactive protin

A

an inflammtion marker related to heart disease

433
Q

special consideration for renal tumors and spread

A

this cancer has a high likelihood to invade the vena cava to form embolism and mets

434
Q

why is early detection of prostate cancer important

A

because cancers with distant metastases have a 5-10% chance of survival

435
Q

why is time a necessary to determine the fullt extent of damage caused by a stroke

A

the infarcted area can be under perfused so the extent of the infarcted tissue might not be known for weeks

436
Q

common ischemic stroke symptoms

A

usually none other than mild neurological deficits, possibly a mild head ache and decreased LOC

437
Q

are there any specific symptoms for ESRD

A

no, generally the patient just feels like crap

438
Q

what is the most common source of cardiac emboli

A

mural thombi from atrila fibrillation

439
Q

T/F G6PD and PKD defiency are both autosomal dominant

A

false, they are autosomal recessive

440
Q

why can FSH, LH, TSH, and HCG cross react with each other

A

they have receptors in the same family

441
Q

four risk factors for dementia

A

age

female

head injury

chronic disease (athersclerosis, DM)

442
Q

what is a currently available treatment for testicular cancer that is very effective

A

external beam radiation with chemo

443
Q

possible changes associated with recurrent silent stroke

A

change in mood/personality

vascular dementia

444
Q

symptoms of bladder cancer

what is the most common

A

hematuria

irritative voiding symptoms

pain or masses in advanced disease

hematuria (85-90%)

445
Q

classic GI causes of chronic bleeding

A

peptic ulcer or cancer

446
Q

time constraint for hemodialysis

A

3-5 hours 3x per week

447
Q

criteria for severe chronic renal disease (End stage)

A

GFR <20mL/min

renal replacement therapy needed

448
Q

what causes jaundice

A

high levels of bilirubin

449
Q

three treatments of cardiogenic shock

A

vasopressors (maintain pressure)

inotropic agents to improve contractility

mechanical assist deveices

450
Q

two factors related to renal blood flow that can be manipulated to regulate BP

A

renin-angiotensin-aldosterone pathway

total vascular volume

451
Q

surgical treatment of BPH

A

prostate resection

452
Q

T/F drugs are also found dissolved in blood

A

true

453
Q

step down strategy for HTN treatment

A

decreasing dose based on stable normal pressures attained through lifestyle changes

454
Q

dyspnea as it relates to CHF

A

air hunger with minimal exertion

455
Q

what side of the face will have deficits from a right sided stroke?

what side of the body>

A

ipsilateral face

contralateral body

right stroke will cause right facial deficits and right peripheral deficits

456
Q

specific symptoms associated with primary CNS tumor

A

focal neurological deficits dependent of the location

457
Q

PCSK9 inhibitors

A

new drug that stimulated production of an enzyme show to decrease LDL and decrease risk of heart disease

458
Q

what gender is most likely to form renal stones

A

men 3:1 over women

459
Q

T/F heterozygous Hgb is usually asymptomatic

A

true

460
Q

typical anginal episode

A

lasts 2-15 minutes

substernal pain with radiation

intiated by lifting, eating, emotions, cold weather

461
Q

three types of steroid hormones

A

estrogens

androgens

progestins

462
Q

causes of hemolysis

A

defect in RBC size shape or function

outside destructrion of normal RBCs

463
Q

symptoms associated with primary parietal lobe tumor

A

sensory or motor deficits

spontaneous pain symdromes

464
Q

symptoms associated with cystitis

A

frequency

urgency

painful urination

hematuria

465
Q

two key RAA hormones

A

Angiotensin II

aldosterone

466
Q

what was the mean survival of a diabetic patient before 1922

after

what changed?

A

5 year <5%

increaed to 30-40 years

insulin was discovered

467
Q

five hypothyroid symptoms

A
  1. cold intolerance
  2. hair loss
  3. weight gain
  4. weakness
  5. dry skin
468
Q

symptoms associated with primary occipital lobe tumor

A

visual field defects

visual agnosia (cant recognize what you are seeing)

469
Q

thyroid storm

A

acute high levels of T3 and T4 that can cause hypotension and fever

470
Q

classic urinary causes of anemia

A

renal cell carcinoma

bladder carcinoma

471
Q

what percent of renal stones are made from calcium

A

75-85%

472
Q

what is a lesser known issue with statin?

what is the result

A

muscle weakness

reduction in activities

473
Q

T/F 20% of prostate cancer patients will not have elevated PSA

A

true, elevated PSA isn’t a very specific marker

474
Q

prostate cancer symptoms

A

none in the early stages oher than BPH

late stages include pain and urinary obstruction

475
Q

the useful conbinations of drugs used in intitial treatment of HTN

A

ACE inhibitor + diuretic

Beta blocker + diuretic

beta blocker + alpha blocker

476
Q

three examples of post meningitis deficits

A

hearing loss

impaired cognition

epilepsy

477
Q

what is the most common medication for type II DM

A

metformin (glucophage)

478
Q

three types of MS

A

relapsing-remitting

primary progressive

secondary progressive

479
Q

what symptoms are associated with pyelonephritis

A

frequency

urgency

painful urination

hematuria (same as cystitis)

plus

flank pain

fever

480
Q

cushing syndrome

A

a cluster of symptoms caused by excess cortisol

481
Q

what two factors increase water retention in response to decreased blood pressure

A

decreased glomerular filtration

aldosterone production

482
Q

CBC

A

complete blood count (RBCs, WBCs, platelets, hemoglobin and hematocrit)

483
Q

two types of leukemia

A

myeloid (acute or chronic)

lymphoid (acute or chronic)

484
Q

two long term control options for hyperthyroid

A

thyroid excision or destruction

continued antithyroid drugs

485
Q

three types of gliomas

which is the most common

A

astrocytoma (common)

oligodendrogliomas

ependymomas

486
Q

what is the shelf life of venous access for hemodialysis

A

3 years at about 30-80% failure

487
Q

what drugs stop the production of T3 and T4

when are they most effective

A

thioamides

when combined with beta blockers and potassium iodine

488
Q

four functional factors of red blood cells

A

Hemoglobin

size, shape

flexibility

longevity

489
Q

what is the median survival of a low grade (I-II) astrocytomas

Grade III?

Grade IV?

A

5-10 years

3 years

<1yr

490
Q

what is sequela of stroke that can lead to early disfunction

A

increased intracranial pressure

491
Q

two methods to reduce cardiac out in HTN treatment

A

block beta 1 sympathetic action

reduce blood volume

492
Q

three characteristics of relapsing-remitting MS

A

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
Q

what is the treatment for idiopathic cardiomyopathy

A

spontaneous remission, but LVADs or transplant can be required

494
Q

what is the function of the adrenal cortex

A

secretes glucocorticoids, androgens, mineralocorticoids

495
Q

specific name for grade IV astrocytoma

A

glioblastoma multiforme

496
Q

idiopathic (hereditary) hypercaluria

A

hereditary high calcium related to kidney stones

497
Q

BNP

A

brain natriuretic peptide

498
Q

what are two methods of lowering T3 and T4 in hyperthyroidism

A

prevent hormone release

stop T3 and T4 production

499
Q

three peripheral vascular disease associated with the effects of chronic atherosclerosis

A

renal artery stenosis

femoral/popliteal stenosis

aortic aneurysm formation

500
Q

where is erythropoietin produce

A

the juxtapoglomerular cells of the kidneys

501
Q

white pulp of the spleen

A

lymph tissue

502
Q

peritoneal vs hemodialysis

A

the peritoneum is used as the dialyzing membrane

“kidney machines” that filter and replace blood

503
Q

treatment of stable angina

A

acute treatment with vasodilation

decrease frequency of attacks

504
Q

PSA levels

normal

moderate

high

what percent of patients with high PSA have prostate cancer

A

<4ng/mL

>4.1 - 10ng/mL

> 10ng/mL

50-70%

505
Q

four types of receptor hormone interactions

A

agonists (stimulate receptors)

antagonists (block receptors)

down regulation

change receptor affinity

506
Q

what percent of the body’s oxygen is used by the kidneys

what percent of rest cardiac output

A

7%

20-25%

507
Q

what is the preferred method of treatment to definatively cure hyperthyroid

what makes it good

A

ablation wth radioactive iodine

because it spares the parathyroid

508
Q

two primary sympathetic receptors manipulated to control BP

A

Alpha 1 vascular receptors

Beta 1 cardiac receptors

509
Q

three things needed to diagnose BPH

A

symptoms plus enlarged prostate and trans rectal ultrasound

510
Q

anticoagulation therapy for NSTEMI

A

heparin

antiplatelets

511
Q

AMI prognosis factors

A

age

size of vessel

prior infarctions

nature of treatment

512
Q

when you spin out blood what is the “buffy coat”

A

white blood cells

513
Q

irritative BPH symptoms

A

urgency

frequency

nocturnal voiding

514
Q

5 lipid lowering agents

A

niacin

bile acid binding agents

HMG-CoA reductase inhibitors

fibric acid derivatives

inhibitors of sterol absorption

515
Q

acute myocardial infarction

A

mycardial death due to abrupt reduction in coronary blood flow almost always caused by atherosclerosis

516
Q

why is it imporant to know the amount of a hormone that is bound vs free

A

a bound hormone can’t do anything

517
Q

three common side effects of HTN treatment

A

electrolyte imbalances

annoying dry cough

malaise, fatigue

518
Q

T/F cardiovascular illness is the most common serious disorder in the US

A

true

519
Q

two main causes of MI mortality

A

cardiac arrhythmia (v fib)

pump failure (cardiogenic shock)

520
Q

types of myeloproliferative disorders

A

leukemia

lymphoma

multiple myeloma

polycythemia

thromocythemia

521
Q

describe the etiology of type II DM

A

a very slow loss of beta cells causd by genetic or obestity

522
Q

CHF signs

A

peripheral edema, JVD

523
Q

other oxygen transport issues related to heart damage that arent ischemia

A

hypotension

chronic anemia

increased metabolism

524
Q

what are three factors that will increase saturation of urine and kidney stone formation

A

low urine flow

production of minerals is high

urine concentration of minerals is high

525
Q

what is the result from blocking beta 1 sympathetic action

A

reduced cardiac rate and contractility

526
Q

CHF treatment strategy II

A

reduct cardiac remodeling (aldosterone antagonists)

treat hyperlipidemia (statins, even if lipids are normal)

527
Q

two types of lymphoma

A

hodgkins

non-hodgkins

528
Q

treatment of v fib

A

cardioversion (defibrilation)

529
Q

how is meningitis treated

A

antimicrobial drugs

prevention through vaccines or prophylactics

530
Q

what links receptors of the same “family)

A

they have a similar structure

531
Q

what is the effect of thyrotropin (TSH)

A

increased T3 and T4

532
Q

three risk factors associated with renal cell cancer

A

smoking

obesity

genetic factors

533
Q

define diabete mellitus

A

a disorder characterized by chronic hyperglycemia due to relative or absolute deficiency of insulin, or resistance to insulin

534
Q

why drugs used to treat HTN will cause low potassium?

high?

A

diuretics

ACE and aldosterone inhibitors

535
Q

why are growth abnormalities present in beta thalassemia

A

there is an overgrowth of bone marrow that can cause pathologic fractures or “chipmunk facies”

536
Q

what is the benefit of PCSK9 treatment

drawback?

A

produce better lipid reduction that statins

very expensive

537
Q

what causes pernicious anemia

A

auto antibodies against intrinsic factor

538
Q

myeloproliferative disorders

A

cancers that will displace normal bone marrow

539
Q

what is the treatment for hepatosplenomegaly caused by thalassemia

A

eventually splenectomy, which will increase risk of infection

540
Q

what is the result of increased sodium and water retention in response to low BP

A

increasd blood volume, which increases cardiac output

541
Q

what is the main condition associated witha lower UTI

A

acute cystitis

542
Q

how common is hashimotos

is there a gender bias

A

1-4/1000

females 1:4

543
Q

four causes of hypothyroid

A

post thyroidectomy/ablation

hashimotos thyroiditis

Drug induced

dietary iodine deficiency

544
Q

thee common vasodilators (examples)

A

calcium channel blockers (diltiazem, amlodipine)

arterial (hydralazine, minoxidil, diazoxide)

arterial and venous (nitroprusside)

545
Q

two types of strokes

A

ischemic strokes

hemorrhagic strokes

546
Q

what is the most likely cause of a TIA

A

small emboli from heart or carotids

547
Q

what is the mortality rate for acute renal failure

A

50%, usually due to the disorder that caused renal failure

548
Q

what is insulin

what compound is it derived from

how does this happen

A

a small protein

conversion of proinsulin into insulin

removal of connecting C peptide

549
Q

based on new HTN guidelines how many people are afflicted

A

103million

550
Q

how does insulin promote anabolism

A

increase glycogen production and storage

promotes triglyceride synthesis in fat cells

incrases protein synthesis in muscle

551
Q

what happens in hashimotos

A

the thyroid is infiltrated with T and B cells

552
Q

T/F pregnancy and lactation can caused anemia through loss of RBCs

A

false, they cause increased demand

553
Q

obstructive BPH symptoms

A

decreased force and caliber

difficulty intiting flow

incomplete voiding

straining

post void dribbling

554
Q

two HTN treatment strategies

A

reduce cardiac output

reduce peripheral vascular resistance

555
Q

what will the response to T3 be

A

increased…

energy utilization

protein synthesis

sensitivity to other hormones

556
Q

4 conditions associated with ESRD

A

diabetes

HTN

glomerulonephritis

cystic disease

557
Q

target cell

A

the end-target of a hormone that produces a response within the cell

558
Q

what symptoms are associated with passing a ureteral stone

what determines the pain

A

pain and hematuria

depends on the location of the stone

559
Q

three facts about aldosterone

A

most potent natural mineralocorticoid

helps with sodium and fluid retention

also induces cardiac growth

560
Q

occurance of MS

A

350,000, 2-1 women to men

561
Q

what are the two pathological processes related to degenerative neurological disorders

A

gradual loss of neurons

gradual loss of axons

562
Q

what are the risks of major thalassemia

A

severe anemia

hepatosplenomegaly

growth abnormalities

563
Q

what is the histological pathophysiology of alzheimers

A

plaques of beta amyloid

tangles of tau proteins

564
Q

5 protein/glycoprotein hormones

A

FSH

LH

TSH

HCG

Insulin

PTH

565
Q

speficific treatment for prolactinomas

A

dopaminergic drugs

566
Q

what is the preferred imaging method for brain tumor

how might the histology of the tumor be idenified

A

MRI over CT

tissue biopsy via needle or craniotomy

567
Q

four causes of secondary epilepsy

A

intracranial neoplasms

post head trauma

post meningitis

others

568
Q

how is bladder cancer usually found

A

hematuria leads to biopsy

569
Q

what is the effect of angiotensin to released in response to renin production

A

aldosterone production leading to increased salt and water retention

increased peripheral resistance

570
Q

why are PSA screening controversial

A

because it has not improved survival

571
Q

pathophysiology of stable angina

A

unmet oxygen demand cuased by coronary atherosclerosis, anemia, fever, hyperthyroid

572
Q

myasythenia gravis

A

a chronic autoimmune disease caused by antibodies against acetylcholine receptors at the neuromuscular junction

573
Q

what causes GBS

A

autoimmune antibodies produced against myelin

574
Q

four typical settings the lead to acute renal failure

A

severe burns

severe trauma

severe infections

severe heart disease

575
Q

what triggers beta cell loss in type I DM

A

can be a virus or toxin such as mumps or coxsackie, as well as a genetic predispostion

576
Q

age range for increased atherosclerosis risk for men and women

A

>/=45 men

>/= 55 for women

577
Q

renal failure

A

decrease in renal function until excretion is unable to regulate blood composition

578
Q

what is needed to extract dietary b12

A

low gastric pH and intrinsic factor

579
Q

4 types of prostatectomy

A

transurethral (TURP)

retropubic

perineal

laproscopic (robotic)

580
Q

of the 75% of the patients who have HTN and are aware of it, how many are getting treated?

how many are controlled?

A

50% are being treated

25% are under control

581
Q

distinguish between treatments for mild and severe HTN

A

mild to moderate HTN usually uses one drug

severe HTN uses multiple drugs

582
Q

four features of the post-ictal phase

A

headache/confusion

fatigue

muscle soreness

duration of up to several hours

583
Q

two regulators of thyroid function

A

thyrotropin-releasing hormone (TRH)

thyrotropin (TSH)

584
Q

what is expected with alzheimers progession of disease

A

steady loss of memory, speech, motor function

average life span of 7-8 years

585
Q

T/F vitamin B deficiency can cause dementia

A

true

586
Q

5 general categories of hormones

A

amino acid

neuropeptides

proteins/glycoproteins

Steroids

Vitamin deriviatives

587
Q

what causes cushings disease

what is the distinction between this and secondary adrenal hyperplasia

A

an ACTH secreting tumor on the pituitary

there isn;t one

588
Q

how do chronic renal failure cause anemia

A

loss of EPO resulting in moderate anemia

589
Q

where do RBCs come from

does all bone marrow produce RBCs

A

bone marrow

no, mostly in the hips, sternum, long bones

590
Q

what cells in the pancreatic islets that secrete insulin

glucagon

A

beta cells

alpha cells

591
Q

risk of thrombocythemia

A

increased clotting

592
Q

classic cause of anemia from gyn

A

uterine (heavy period, leiomyoma

593
Q

three methods to reduce peripheral resistance in HTN treatment

A

block alpha 1 sympathetic action

block central sympathetic action

directly dilate the blood vessels

594
Q

what % of testicular cancer is assocatied with cryptoorchism

can orchiplexy resolve this

A

5%

no

595
Q

what is an important consideration when treating hemorrhagic stroke

A

anticoagulation and antithrombolytics are contraindicated in hemorrhagic stroke

596
Q

what is the function of the adrenal medulla

A

secretes epi/norepinephrine

597
Q

what is the most common cause of hypothyroid

A

hashimotos thyroiditis

598
Q

how do diuretic function to decrease blood pressure

A

lower blood volume

599
Q

five symptoms of DKA

A

tachycardia

dehydration

SOB

lethargy

coma

600
Q

what is the risk of TIA

A

they can progress to a full stroke without treatment

601
Q

what accounts for the 1-4% fatality rate of GBS

A

pulmonary complications or cardiac arrhythmias

602
Q

who is more likely to get bladder cancer

what are two risk factors associated with bladder cancer

A

men over women 3:1

smoking or exposure to industrial dyes/solvents

603
Q

modulate ionic conductance in seizure treatment

A

decreases the permeability of the cell membrane

604
Q

T/F a small number of RBCs are lost through the GI, Urine, Skin

A

true

605
Q

preventing the recurrance of MI

A

lifestyle changes

beta blockers

statins

ACE inhibitors

antiplatelet drugs

606
Q

limbo goal for high risk hypertensives

A

trying to go as low as is safely possible for people with severe comorbities (diabetes, CAD, CVA)

607
Q

two parts of the adrenal gland

A

medulla

cortex

608
Q

three questions to ask when considering bone marrow deficiency in anemia

A

enough stem cells

enough nutrients to make RBCs (iron, folate)

enough stimulation (EPO)

609
Q

five effects of cortisol

A

increases glucose production

raises blood pressure

raises blood sugar

lowers lymphcyte and monocyte levesl

610
Q

what is the intitial event of an acute MI

A

a plaque rupture

611
Q

how long do RBCs last before being broken down

A

100-120 days

612
Q

two other symptoms of diabetes that aren’t the 3 Ps

A

weight loss despite increased appetite

fatigue

613
Q

what diagnoses for cushings have a good prognosis?

poor?

A

good: cushings disease and iatrogenic cushings
bad: adrenal carcinoma and small cell lung cancer

614
Q

what are the common causes of encephalitis (examples)

A

viruses

rabies, measels, polio, herpes, west nile

615
Q

what does tight management of DM entail

A

diet

frequent blood assays

medication 3-4 times daily

flexible dosing

616
Q

long feedback look

A

a feedback loop where the end hormone produce by trophic stimulation will inhibit production at the hypothalamus and pituitary

617
Q

Gullian barre syndrome (acute, idipathic polyneuropathy)

A

rapidly progressive motor paralysis with likely spontaneous recovery

618
Q

what are the signs of hypervolemia based on the amount of blood lost

A

10-15% initial signs of vascular instability

greater than 30% orthostatic hypertension

greater than 40% hypovolemic shock

619
Q

what methods can be used to reduce infarction

A

anticolagulation with IV heparin

IV thrombolytic therapy

cerebreal artery catherization and angioplasty

620
Q

treatment for b12 deficiency

A

large oral doses of B12

intramuscular B12

621
Q

which is more relevant, long or short feedback loops?

why?

A

long, because they work on the hypothalamus and the pitutiary

622
Q

what wil happen if the thyroid gland is dysfunctional

what can also happen?

A

TRH and TSH will be produced in high amounts

prolactin can also be produced

623
Q

success rates of conventional seizure treatment

A

70% seizure free on one drug

20% sz on 2 or more drugs

remaining 10% unresponsive

624
Q

how are hormones sent through out the body

A

dissolved in blood or bound to carriers

625
Q

what is the main task of the thyroid

A

to produce T3 ad T4

626
Q

exophthalmos

cause

A

protrusion of the eyes found in 20-40% of Graves patients

caused by lymphcytic infilitration of the eyes

627
Q

what is the treatment for GBS

is this time sensitive?

A

IVIG

plasmapheresis

yes time is a factor, hours matter

628
Q

what is the 5 year survival rate once diagnosed with CHF

A

50%

629
Q

three common diuretics (examples)

A

thiazides (hydrochorthiazide)

loop diuretics (furosimide)

potassium sparring diuretics (spironolactone)

630
Q

prognonsis for stable angina

A

some will improve, but most will develop CHF or have progress to acute cononary syndrome within 3-5 years

631
Q

evaulation of elevated PSA

A

rectal exam/ultrasound with lesion biopsy

if there are lesions, determine gleason score

632
Q

seizure

A

abnormal or excessve and synchronized discharge of CNS neurons

633
Q

what is the most common neurological disorder in the US

incidents per year

deaths

A

CVA (stroke)

500,000/yr

150,000 deaths/yr

634
Q

four methods to prevent ESRD

A

control HTN

control glucose

recognize and avoid drug toxicity

better treatment of acute renal failure

635
Q

CHF lab signs

A

elevated BNP

636
Q

CHF treatment strategy I

A

reduce cardiac work load (limit activity, reduce weight, control HTN)

reduce blood volume (decrease Na, diuretics)

637
Q

medications to reduce calcium stone formation

A

thiazide diuretics to reduce calcium levels

638
Q

causes of folate deficincy

A

not enough fruits and veggies

increased demand (pregnancy, hemolytic anemia)

malabsorption of folate

639
Q

define TIA

A

stroke like deficits that with occur and resolve rapidly, usuallly within 60minutes

640
Q

three types of non-seminoma

A

embryonal cell

teratoma

choriocarcinoma

641
Q

two general nutrition deficiency that cause anemia

A

anemia of chronic disease

starvation

642
Q

two stratgies to reduce insulin resistance

A

weight loss

medication (biguanides and thiaxolidinediones)

643
Q

T/F CNS tumors commonly form from neurons

A

false, they usually come from support cells

644
Q

three CNS infections that can cause neurologic symptoms

A

meningitis

encephalitis

abscess

645
Q

three disease that can be triggered by hyperthyroid

A

acute chest pain (MI)

CHF

Arrhythmia

646
Q

variant (prinzmetal) angina

A

extreme fatigue associated with minimal exertion related to coronary vasospasm

647
Q

ejection fraction

A

fraction of ventricular volume eject by each beat of the heart, normally 50-65%

648
Q

agranular leukocytes (mononuclear)

A

monocytes

lymphocytes

649
Q

two disorders caused by an imbalance of neurotransmitters

A

chronic depression or psychosis

650
Q

secondary hyperthyroid

A

failure of the pituitary to release TSH

651
Q

four types of renal/GU cancer

A

prostate cancer

bladder cancer

renal cell carcinoma

testicular cancer

652
Q

supportive treatment for ureteral stones

A

analgesia

enhanced urine flow

653
Q

what is the goal of HTN treatment

A

maintenance of 120/80 BP for high risk patients

<135/85 for mild to moderate risk patients

654
Q

four phases of a tonic-clonic seizure

A

LOC, tonus or clonus, apnea, flaccid coma, post ictal

655
Q

short feed back loop

A

a feedback loop where a trophic hormone from the pituitary inhibits production of stimulating factors from the hypothalamus

656
Q

three possible treatment plans for cushings

A

stop glucocorticoids

surgery

antiglucocorticoid medication

657
Q

what is the effect of sympathetic activation of Beta receptors in response to Decreased BP

A

increased cardiac output through contractility

658
Q

three treatment for prostate cancer

A

radical prostatectomy

radiation thearpy

medical treatment

659
Q

three general treatment options for CNS tumors

A

surgery, chemo, radiation

660
Q

four factors to prevent CHF

A

lipid control

HTN treatment

lifestyle changes

prevent or reduce damage from AMI

661
Q

what are the three clinical manifestations of aplastic anemia

A

anemia

leukocytopenia (chronic infection)

thrombocytopenia (no clotting factors0

662
Q

three specifict nutrient deficiencies that will cause anemia

A

folate

b12

Iron

PAS 753 (Molecular Pathophysiology) (17 decks)

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