Systemic Final

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Systemic Final
2012-12-08 17:10:46
Systemic Final

Systemic Final
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  1. Explain kidney/renal disease
    • Increased fluid volume passes through the kidney -> impairment of filtration (microalbuimuria, hypertensive nephrosclerosis) -> reduction of BP will give improved renal function
    • -Higher risk in DM and chronic renal disease Px
  2. Peripheral artery disease
    • The insufficient tissue perfusion of extremities (lower extremities affected more than upper) due to existing atherosclerosis
    • -Sxs: pulseless, paralysis, parethesia, pain, pallor
  3. Hypertension
    • Elevated BP (>140/90 due to vasoconstriction and changed endothelial function) leading to target organ damage
    • (>130/80 for DM or chronic kidney disease Px)
    • -Optic nerve swelling, hemorrhages, exudates/cotton wool spots, macular star (malignant hypertension)
  4. Pharmacotherapy for hypertension that targets the kidneys?
    Thiazide Diuretics, ACEi (Angiotensin conversting enzyme inhibitor), ARB (Angiotensin receptor blockers)
  5. Pharmacotherapy for hypertension that targets the heart?
    Calcium channel blockers, beta blockers (BB)
  6. Coronary artery disease
    • The number 1 killer in NA that affects men more than women. Is the accumulation of atheromatous plaques w/i artery walls of the myocardium -> less blood and O2 supply -> ischemia in myocardium
    • -asymptomatic until >70% blocked (dyspnea, angina, palpitations, light-headed, faint, nausea)
    • -Sxs increased by 4 Es: exertion, eating, excitement (stress), exposure to cold
  7. Coronary artery disease risk factors
    • -hypercholesterolemia (elevated serum LDL esp)
    • -smoking
    • -hypertension
    • -hyperglycemia (DM)
    • -hereditary factors
  8. Tx of Coronary Artery Disease
    • -cholesterol lowering meds
    • -anticoagulants and aspirin (prevents clots)
    • -thrombolytics (dissolve clots)
    • -ACEi, BB, Calcium channel blockers (lower BP and heart workload)
    • -nitroglycerin (vasodilators)
  9. Hollenhorst Plaque
    • Cholesterol emboli that is normally dislodge from the carotid arteries and is trapped in a retinal artery
    • -could have transient vision loss (~20mins) that will return when the vessel is unobstructed
    • -A sign of severe atherosclerosis
    • -could be a warning sign for stroke or TIA
  10. Angina Pectoris
    • -chest pain caused by coronary artery disease or myocardial
    • ischemia. Pain results from myocardial cells switching from aerobic to anaerobic metabolism-exacerbated with 4Es: exertion, eating, excitement (stress), exposure to cold -Sxs subside with rest and/or nitro
    • -Tx: nitroglycerin to lower BP, alter diet, cease smoking, treat HT, DM, obesity, hyperlipidemia, Aspirin, BB (lower HR and contractility)
  11. Myocardial infarction
    • -heart attack caused by coronary artery blockage and occlusion for >4-6 hrs -> irreversible myocardial necrosis (reperfusion may reverse some damage)
    • -heart is dying
    • -Sxs: chest pain, respiratory difficulty, anxiety, shock (lightheadedness, diaphoresis/sweating), nausea
    • -50% do NOT display classic Sxs (older ppl, women, DM Px)
    • -MONA: morphine, O2, nitro, aspirin
  12. Coarctation of the aorta
    • -is a congenital defect in which the aorta b/t upper and lower body is narrow -> hypotension in legs and hypertension in arms and head, heart is stressed and damaged
    • -Sxs: HA (high BP in upper body), leg pain (not enough blood)
  13. Pulmonary stenosis
    • -is a congenital defect in which the pulmonary valve is narrower so the R ventricle works harder and hyptertophies but the lungs do not receive as much blood -> cyanosis (blue baby) and dyspnea
    • -Tx: balloon valvuloplasty to enlarge the valve
  14. Patent ductus arteriosus
    • -ductus arteriosus stays open 72 hrs after birth -> O2 rich and poor blood mix and the lungs have large blood volume load
    • -Sxs: pulmonary hypertension, dyspnea, fatigue, poor feeding
    • -Tx: PDA may spontaneously close, Indomethacin stimulates PDA closure, good nutrition, Surgery
  15. Tetralogy of Fallot
    • -4 congential heart defects (pulmonary stenosis and R ventricular hypertrophy, ventricular septal defect, over-riding aorta)
    • -most common cause of blue baby syndrome
  16. Heart Valve Disease
    • The valves are affected so that their is stenosis (less blood flow) or regurgitation (backflow)
    • -left side valves are more commonly affected (mitral and aortic)
    • -Sxs: none, weakness, fatigue, syncope, tachycardia, chest discomfort, dypsnea, heart murmurs, swelling feet, pulmonary edema
  17. Bacterial endocarditis
    • inflammation of the endocardium (inner membrane of the heart muscle and valves) due to bacteria pooling
    • -Sxs: stroke, gangrene, roth spots, conjunctival petechiae, chronic renal failure, hemorrhagic lesions
  18. Rheumatic heart disease
    • The chronic heart valve damage that occurs after Rheumatic Fever that could eventually lead to heart failure
    • Polyarthritis, carditis, skin lesions, Syndenham's chorea due to stroptococcal infection (strep throat in upper respiratory), pancarditis (esp for the heart valves, mitral valve)
    • -Tx: Ab, steroids, Aspirin (anti-inflam), digitalis and diuretics if heart failure occurs, valve surgery
  19. Pericarditis
    • inflammation of the pericardium due to infection, RA, lupus, truama, MI, tumor or radiation or idiopathic
    • Sxs: chest pain (worsened when lying down, coughing or swallowing and relieved by sitting forward), cardiac tamponade (heart compression), fever
    • Tx: NSAIDs, steriods (pain and inflammation), Ab (for infective causes)
  20. Arrythmias
    • Heart rate is irrgular/fluctation
    • -tachycardia (>100 beats/min)
    • -bradycardia (<60 beats/min)
  21. Atrial fibrillation
    • -atria quiver instead of beating effectively -> blood isn't pumped completely out of atria -> may pool and clot -> risk of stroke
    • -tx: reassurance for minor cases, drugs, defibrillator, coumadin (anticoagulant), digoxin (stimulates L ventricle contraction, Verapamil (CCB slows HR), Lopressro (BB slows HR,vasodilation), pacemaker
  22. Ventricular fibrillation
    • Ventricles quiver due to electrocution, drowing or MI -> heart pumps little blood
    • -more serious heart arrrhythmia, death in minutes
  23. Mxyoma
    • primary benign cardiac tumor
    • -Tx: monitor if small and no Sxs, Surgery if flow problems and arrhthmias
  24. Angiosarcoma
    • primary malignany cardia tumor
    • -Tx: open heart surgery
  25. Congestive heart failure
    • when the heart pumping is insufficient to supply enough blood/O2 to the body -> fluid build up in lungs and tissues  and heart enlarges and beats faster
    • -most commonly due to CAD
    • -L sided heart failure -> pressure builds in lungs, pulmonary edema, dypsnea, cough and fatigue
    • -R sided heart failure -> pressure builds in veins -> edema in organs, nauseated, no appetite, renal failure
    • -exertion increases Sxs
  26. Congestive heart failure Tx
    • -stop smoking, limit alcohol, limit fluid intake**, maintain good diet, control HT, manage DM
    • -diuretics (for edema), digitalis (inotropic makes heart contrat stronger and slows HR), nitroglycerin (vasodilator), CCB BB ACEi ANGIIblockers (decrease BP)
  27. Calcium channel blockers
    -helps decrease arrhythmias
  28. Beta Blockers
    -slows HR and dilates vessels
  29. ACEi
    helps keep vessels open
  30. Angiotensin II receptor blockers
    helps keep vessels open
  31. Coumadin
  32. Giant Cell Arteritis
    • Inflammation of the large and medium vessels (esp temporal artery) that impairs blood flow and increases the risk of embolis
    • -Dx: elevated ESR, temporal artery biopsy
    • -Sxs: HA, scalp tenderness, Jaw claudication pain, pain and stiffness worst in MORNING, Arteritic anterior ischemic optic neuropathy
  33. Arteritic Anterior ischemic optic neuropathy
    • bilateral vision loss that is due to giant cell arteritis causing damage to the blood vessels supplying the optic nerve, leading to ischemia and death of the nerve
    • -optic disc is swollen, pale and Px has flame-shaped hemorrhages, cotton-wool exudates, GCA Sxs (HA, jaw claudication, temporal tenderness, stiffness worse in morning)
    • Tx: treat GCA with prednisone (corticosteroid that will reduce inflammation) and Plavix (blood thinners)
  34. Non-arteritic anterior ischemic optic neuropathy
    • Unilateral vision loss and optic disc changes that are due to atherosclerosis, HT, DM, MI
    • -the optic nerve is spared
  35. Transient Ischemic Attack
    • -temporary focal brain or retinal ischemia leading to temporary loss of function
    • -warning that a full-on stroke may occur
    • -Sxs: diplopia, vision loss, vestibular dysfunction, motor (weak, uncoordinated), sensory (numb, tingling), speech and cognitive dysfunction
    • -Mx: blood tests, ECG, imaging w/i hours
  36. Causes of transient ischemic attacks
    • -atherosclerosis
    • -embolisms
    • -arterial dissection
    • -Giant cell arteritis
    • -sympathomimetic drugs (cocaine)
    • -mass lesions
  37. Cerebral vascular accident
    • disruption of blood supply to or w/i brain causing death of brain cells (caused by cerebral thrombosis, embolism, arterial stenosis, hemorrhage)
    • -Sxs: can't do STRoke (Smile, Talk, Raise both arms)
    • -Tx: tPA clot buster (contraindicated for hemorrhagic CVA), surgery, treat underlying disease, rehab
  38. Aneurysmal vascular disease
    • An abnormal bulge in a blood vessel wall (most common are thoracic and abdominal) that could lead to atherosclerotic plaque, thrombi and emboli, pain, aneurysm rupture (fatal)
    • -Risk: HT, atherosclerosis, smoking, male, obesity, sedentary
  39. Varicose veins
    • the incompetent valves allow blood to flow away from the heart leads to the formation of dilated, tortuous superficial veins -> risk of leg ulcers, CHF, DM
    • -Sxs: asymptomatic, dull ache, warm to touch, edema, itch, heavy leg sensation leg fatigue
  40. Superficial Thrombophlebitis
    • inflammation of superifical leg veins with thrombus
    • -Risk factors: abnormal veins, blood clotting, stasis of blood
    • -Sxs: vein is painful and tender to touch, firm and swollen, surround is warm and red
  41. Deep vein thrombosis
    • thrombus in deep vein that could more easily break off than superficial vein thrombosis
    • -Sxs: none, calf swelling, calf pain (noticable or worse when standing or walking)
  42. Deep vein thrombus Tx
    • anticoagulant (heparin, warfarin)
    • foot elevation
    • thrombolytic
    • analgesisc (pain)
  43. Clotting cascade
    the conversion of soluble fibrinogen into insoluble fibrin via the intrinsic (plasma) and extrinsic (tissue) pathways that convert inactive proteins into catalytically active proteases
  44. Gilbert's syndrome
    • excess free bilirubin in the blood leading to jaundice, abdominal pain, poor appetite, fatigue and weakness
    • Tx: none, phenobarbital to reduce bilirubin if severe
  45. Bilirubin
    • formed from the destruction of old rbcs and transported to the liver were it is excreted in the bile (for fat digestion) or urine (for excretion of waste)
    • It is bad to have bilirubin not transported to the liver (indirect bilirubin that is non-functional)
  46. General liver disease presentation
    • GI (appetite, ascites, ab pain, dark urine, stool)
    • Aching joints and emaciation (build up of waste)
    • pruritis in skin, spicer angiomas (infection and bvs break down)
  47. Hepatitis A
    • Viral inflammation of the liver
    • -travels through contaminated food or H2O
    • -at risk during traveling, sex
    • -Tx: avoid stressing liver (alcohol)
  48. Hepatitis B
    • Viral inflammation of the liver
    • -travels through infected blood
    • -at risk during child birth, health care workers, hemodialysis, sex
  49. Hepatitis C
    • Viral inflammation of liver
    • -through direct contact with blood
    • -at risk during child birth, health care workers, hemodialysis, sex
    • -no vaccine
  50. Hepatitis D
    • viral inflammation of the liver
    • -only in ppl already infected with Hep B
    • -at risk Px with Hep B or hemodialysis
    • -get Hep B vaccine
  51. Hepatits E
    • viral inflammation of liver
    • -through contaminated food or H2O
    • -no vaccine, but resolves on its own in several weeks to months
  52. Heptatis
    • Inflammation of the liver due to virus, alcochol, or autoimmune causes
    • -Sxs: fatigue, HA, jaundice, ascites, pain, low grade fever, loss of appetite, nausea, vomitting diarrhea
  53. Cirrhosis
    • widespread nodules and fibrosis of liver due to hepatitis, chronic alcoholism, drugs, toxins, infections, Wilson's, galactosemia, hemochromatosis, glycogen storage diseases, congestive heart failure
    • -leads to edema, ascites, bruisng and bleeding, jaundice, pruritis, gallstones, toxins in blood or brain, sensitivity to meds, portal hypertension
  54. Wilson's Disease
    • genetic disease that increases copper absorption and decreases copper excretion
    • -Sxs: liver (jaundice hepatitis, cirrhosis), CNS (tremors, coordination), blood and bones (anemia, osteoarthritis), kidneys (pee out lots of nutrients), Kayser-Fleischer ring
    • -Tx: D-penicillamine/trientine hydrochloride (remove copper), zinc acetate (copper excretion), Vit B-6, low copper diet, liver surgery
  55. Multiple Sclerosis
    • Auto-immune disease of the CNS (specifically the myelin)
    • -Demyelination -> scar tissure (sclerosis)
    • -Optic nerve commonly affected! MS disrupts conduction from eye to brain
    • -Sxs: Vision, speech, constinence, STM, paralysis depression, anxiety
    • -Tx: no cure, interferon Beta 1 drugs (slow progression), steroids (decrease relapse)
  56. Intranuclear ophthalmoplegia
    • Median longitduinal fasciculus lesion -> supranueclear gaze palsy -> horizontal dysconjugate eye mov'ts (pursuits and saccades affected, poor adduction, poor abduction
    • -Sxs: diplopia
  57. Parkinson's Disesase
    • Free radical build up, triggers, and genertics -> progressive neurodegenerative CNS disease, loss of dopamine-producing cells in the substantia nigra -> mov't disorder, paralysis, shaking
    • -Sxs: tremors, rigidity, bradykinesia, impaired coordination, dry eye, poor saccade convergence pursuits, reduced CSF
    • -Tx: levodopa
  58. Huntington's Chorea
    • AD inheritance (chromosome 4) of basal ganglia degeneration -> protein build-up, reduction of ACh and GABA, overaction of dopamine
    • -No cure
  59. Amyotrophic Lateral Sclerosis (ALS)/Lou Gehrig disease
    • fatal, progressive motor neuron disease
    • -> upper (tight, stiff, hyperreflexia) and lower  (cramps, twitches, weakness, fasciculations) motor neuron damage
    • -ALS could be due to excess glutamate, autosomal dominant
    • -No cure, riluzole (decreases glutamate, only slows progression)
  60. Myasthenia Gravis
    • Neuromuscular junction disease where antibodies destory, alter, block AChR -> muscle weakness during periods of activity and improves after rest
    • -Sxs: Diplopia, ptosis, facial expression, chewing, talking, swallowing
    • -Dx: Blood test (AChR antibody), CT scan (EOM, thymus), Edrophonium chloride (blocks ACh breakdown temporarily)
    • -Tx: Neostigmine (anti AChase), Prednisone (immunosuppressive, inhibits abnormal antibodies), thymectomy (remove thymus producing abnormal antibodies), plasmapheresis (remove abnormal antibodies)
  61. Muscular dystrophy
    • skeletal muscle degeneration due to defective dystrophin protein that normally keeps muscle cells intact
    • -Sxs: muscle weakness, loss, deformities, contracture, pseudohypertrophy, cardiac and respiratory arrest
  62. Marfan's Syndrome
    • -inborn problem with protein metabolism (mutation in gene fibrillin-1)
    • -elongation of bones, arachnodactyly, scoliosis
    • -ectopia lentis, glaucoma, retinal detachement, blue sclera
  63. Galactosemia
    • -inborn problem with converting galactose into glucose
    • -galactose-free diet
    • -hypoglycemia, bilateral cataract, cognitive dysfunction, renal and hepatic dysfunction
  64. Glycogen Storage Disease
    • -inborn error of glycogen metabolism
    • -hypoglycemia, elevated cholesterol, stunted growth and osteoporosis, clotting problems
    • -Tx: provide glucose source, liver transplant
  65. Phenylketonuria (PKU)
    • -most common inborn error of metabolism where phenylalanine is not metabolised because lack of phenylalanin hydroxylase (PAH) -> CNS damage, mental retardation
    • -TX: low phenylalanine diet
  66. Tay-Sachs Disease
    • -inborn error of lipid metabolism (absent Hex-A enzyme)
    • -progressive CNS destruction (blindness, cognitive delay, demetia, deafness)
    • -constricted fields (startle effect), and macular cherry red spot (pale, no vasculature)
    • -fatal <5years
    • -TX: none