Exam 2 - Quizzes / Study Guide / Assignment 2

Which of the following is not an ischemic stroke?

Hemorrhagic stroke

none of the above

Embolic stroke

Thrombotic stroke

Hemorrhagic stroke

Of all strokes, 85% are _____ and the about 5% are ____________ strokes?

Ischemic, Hemorrhagic

Which of the following is not a hemorrhagic stroke?

subarachnoid stroke

all of the above

Embolic Stroke

Intracerebral stroke

Embolic Stroke

An ischemic stroke that occurs when a clot from the carotid or other larger artery travels to the brain and lodges into a smaller cerebral artery or arteriole is categorized as

embolic stroke

Cerebral blood flow is maintained constant over a large range of blood pressures. This mechanism is termed as ____________

autoregulation

The most common cause of intracerebral hemorrhagic stroke is ___________________

hypertension

What is the most common cause of thrombotic ischemic strokes?

atherosclerosis

The cardiologist informs Mr. Smith that he has coronary artery disease and significant blockages in his coronary arteries. His cardiologist also tells him that he is likely at a high risk of stroke as well. Is that true of false?

true

Which of the following is FALSE about hemorrhagic strokes?

explosive entry of blood structurally disrupts neurons

immediate cessation of neuronal function

autoregulation maintains blood flow to rest of the brain

white matter fiber tracts can split

autoregulation maintains blood flow to rest of the brain

Which of the following are not clinical signs and symptoms of stroke?

loss of balance

droopy face

chest pain

arms weakness (unilateral)

slurred speech

chest pain

What layer of the artery is the nitric oxide released from?

Endothelial cell (tunica intima)

Which layer of the artery does nitric oxide act on to cause vasodilation?

smooth muscle layer (tunica media)

Fat stored _____ is called visceral fat

around internal organs

Which of the following is true for insulin:

• Increases lipid synthesis

• All of them

• Decreases fat breakdown

• Increases glycogen synthesis

• All of them

T/F: While waist circumference does not inform us about the exact fat % of an individual, it is positively associated with increased risk of Cardiovascular events.

true

Which of the following is not symptom of metabolic syndrome

• fasting glucose less than 100

• triglycerides over 150

• HDL below 40

• blood pressure higher than 130/85

fasting glucose less than 100

Tissues that insulin acts on:

Skeletal muscle, liver, adipose tissue

As a result of insulin release and its action on skeletal muscle, all of the following occur in a healthy individual except:

• absorb glucose into cells

• stop using fat as energy source

• store glucose as glycogen

• Breakdown glycogen for energy

Breakdown glycogen for energy

In a healthy adult undergoing oral glucose tolerance test, the glucose peaks at _____ and insulin peaks at 30-60 minutes following the drink. As a result of insulin release, blood glucose goes back down to normal levels in ____ (time).

30 min, 2-3 hrs

Which of the following blood tests need to be performed to show whether someone is insulin resistant or not?

• fasting glucose levels

• Insulin levels

• all of the above can indicate insulin resistance

• HbA1c level

Insulin levels

Action of glucagon:

Breakdown glycogen, generate new glucose from liver (gluconeogenesis), breakdown protein

increase blood glucose

HbA1c level that indicates diabetes:

Over 6.5%

Which of the following is correct regarding gestational diabetes?

• There is no risk of gestational diabetes after end of pregnancy

• White American women have the highest risk of gestational diabetes

• OGTT can be used to diagnose gestational diabetes

• It is diagnosed in first trimester of pregnancy

• OGTT can be used to diagnose gestational diabetes

Which of the following is TRUE about obesity prevalence in children?

• Childhood obesity has decreased since the 1990s

• Childhood obesity has no correlation with adult obesity

• Only 10% of obese adolescents become obese adults

• Overweight children doubled between 1990–2000

• Overweight children doubled between 1990–2000

Which of the following is not a clinical manifestation associated with obesity?

• Increased bone mineral density

• Fatty liver

• Orthopedic disorders

• Sleep apnea

• Increased bone mineral density

Type 2 diabetes is often considered a "lifestyle disease" because it is strongly associated with:

unhealthy diet and physical activity

When an individual becomes insulin resistant, all of the following maladaptations occur in that person EXCEPT?

• glucose rapidly enters cells

• insulin secretion by pancreas increases, in order to try to reduce glucose to normal levels

• Lipolysis is not inhibited (adipose tissue unable to listen to the insulin signal)

• glucose uptake by muscle and liver is impaired

• glucose rapidly enters cells

HbA1c indicates average glucose levels over ~

2-3 months

Which hormone increases blood glucose by stimulating glycogenolysis and gluconeogenesis?

glucagon

Which of the following is a microvascular complication of T2D?

• Atherosclerosis

• Stroke

• Myocardial infarction

• Diabetic nephropathy 

Diabetic nephropathy 

T/F: If a patient with type 1 diabetes is unable to secrete any insulin from their pancreas (and they are not yet taking any exogenous insulin shots), they will quickly lose weight since they are unable to store all energy sources as glycogen, fat and protein synthesis. 

true

According to the National Kidney Foundation, which of the following is a primary diagnostic criterion for Chronic Kidney Disease (CKD)?

GFR < 60 ml/min for 3 or more months

What is a major clinical manifestation of the hematologic changes associated with CKD? (Hematologic changes are changes in the blood)

Anemia due to decreased erythropoitin

Which mechanism is primarily responsible for long-term blood pressure regulation within the kidneys?

RAAS System

If a blood sample from a very dehydrated person was centrifuged, the plasma volume would decrease and red blood cell volume would remain at 45% (True/False).

True

Thus, hematocrit for this blood sample would be higher than normal (True/False).

True

Functions of the Kidney:

maintain bone, long term regulation of BP, filter out excess metabolites

Leading causes of CKD

hypertension

a major contributor to waste production (that is filtered out by the kidneys)?

protein

How does the cardiovascular risk associated with diabetes differ between sexes?

Diabetic women are 2x as likely to have a heart attack as men

non-genomic vascular action of estrogen?

Increase Nitric Oxide for vasodilation

Following menopause, what is a primary physiological change observed in women’s autonomic regulation? (list 3)

resting MSNA increases, increasing blood pressure

insulin resistance, therefore weight gain

reduced nitric oxide and increased inflammation and oxidative stress

In terms of clinical presentation, how does coronary artery disease (CAD) often differ in women compared to men?

women have uniform plaque build-up, which erodes slowly

Hematocrit is the percentage of red blood cells in the blood. Hypothetically, if I donate 1 L of blood at the blood drive, and my initial total volume of blood was 5 L, what will happen to my hematocrit level right after the blood donation.

no change

Which institutional body is responsible for governing the ethics of research involving human subjects?

The Institutional Review Board (IRB)

What information must be clearly indicated on an "Informed Consent" form for a participant?

All potential risks and what the team has done to minimize them

When conducting research with "vulnerable groups" such as prisoners, what is a primary ethical concern regarding consent?

The potential for coercion or the feeling that participation is not truly voluntary

define T1D

high blood glucose due to lack of insulin production, caused by the immune system attacking beta cells in the pancreas.

define T2D

high blood glucose (hyperglycemia) due to insulin secretion/action. Insulin is unable to bind to insulin receptors on cells

define prediabetes

blood glucose is higher than normal but not high enough to be T2D, caused by insulin resistance.

define gestational diabetes

high blood glucose during pregnancy when one did not have diabetes prior. Usually happens after 20 weeks. Body is not capable of making and using insulin properly

What is the benefit of exercising in T2D? What exercise (aerobic, resistance, swimming, Pilates, HIIT) is better for these patients and why?

T2D patients should exercise because it directly combats their insulin resistance. It

helps cells respond better to insulin, help muscles take up glucose, increases

cardiovascular health, and lower high blood sugar levels. A combination of aerobic and

resistance training would be best (walking, cycling, swimming, lifting weights, etc.)

because they use glucose, improve insulin sensitivity, and build muscle, while not being

too high impact for T2D patients.

action of glucagon and where it’s released from

raises blood glucose; released from alpha cells in pancreas

action of insulin and where it’s released from

lowers blood glucose; released from beta cells in pancreas

What time of the day do you think glucagon is released in most people?

in a fasted state; morning (when blood glucose is low)

if α-cells in the pancreas (which release glucagon) malfunction and keep releasing glucagon without a break, what would happen to:

(a) blood glucose levels after 1 day,

(b) adipose tissue levels after 1 day,

(c) total body weight after 2 weeks?

• (a) Blood glucose levels after day 1 would be high. Glucagon tells the liver to break

  down glycogen, rising blood glucose

• (b) Adipose tissue levels after day 1 would be lower. Glucagon promotes the

  breakdown of fat.

• (c) Total body weight after 2 weeks would be lower. Ongoing fat loss and probably

  also dehydration from high blood glucose would cause body weight to lower.

Know 6 vascular actions of Nitric Oxide:

1. Reduce platelets stickiness

2. Prevents formation of plaque

3. Inhibits proliferation of smooth muscle cells in arterial wall

4. Restricts the release of superoxide radicals

5. Reduces oxidation of LDL cholesterol

6. Dilation of blood vessels 

Fasting Plasma Glucose Levels : normal/prediabetes/diabetes

Less than 100 mg/dl = normal

100-125 mg/dl = prediabetes

More than 126 mg/dl = diabetes

T2D is sometimes called “___” disease

lifestyle

Insulin actions on muscle

• Increase Glucose metabolism

• Increase glycogen synthesis

• Increase muscle mass

insulin actions on liver

• Decrease glucose synthesis 

• Increase glycogen synthesis

• Increase lipid accumulation

• Increase inflammation

What race is most likely to have metabolic syndrome

hispanic

*KNOW (3) SYMPTOMS OF METABOLIC SYNDROME FOR EXAM:

• BP over 130/85

• Fasting blood glucose over 100

• Waist larger than 40in (men) or 35in (women)

• HDL cholesterol under 40 (men) or 50 (women)

  • Total cholesterol under 200 is normal (over = bad)

• Triglycerides over 150

T/F: exercise w/o weight loss still prevents the progression of CVD

true

___ is the leading cause of preventable death, next to smoking

obesity

Stroke treatment

• A, antiplatelet and anti-coagulants

• B, blood pressure lowering medication

• C, cholesterol lowering, cessation of smoking

• D, diet changes

• E, exercise (rehab → slow progressive gain of function/movement → exercise)

Jesse Pinkman takes his grandmother to the cardiologist. The cardiologist looks at both of their hearts and provides these numbers. Jesse:  end diastolic volume is 100 ml and stroke volume is 50 ml. Grandma: end diastolic volume is 50 ml and stroke volume is 25 ml. What is the ejection fraction for each of them? Are they healthy or have heart failure?

• Jesse EF = 50% → borderline normal (likely healthy or mild dysfunction)

• Grandma EF = 50% → borderline normal, but lower heart volume may indicate potential cardiac limitation

Ejection fraction (EF) =

stroke volume (SV) /

end diastolic volume (EDV)

normal ejection fraction (EF) %

40-50%

Ejection fraction (EF) % for heart failure

less than 40%

Acute treatment for myocardial infarction (MI)

restore bloodflow via:

• nitroglycerin + asprin pill

• balloon therapy

• stents in coronary artery

• bypass surgery

Causes leading to MI (myocardial infarction)

• atherosclerosis

• thrombus formation

• clot from another artery dislodges and travels to coronary artery

• vasospasm

• sever vasoconstriction (show shoveling)

• treatments (cancer)

long-term treatment for myocardial infarction (MI)

keep coronary arteries open via:

• anti-clotting meds (asprin)

• BP meds

• ACE inhibitors

Q:  A patient with heart failure symptoms but a normal ejection fraction most likely has:

Diastolic heart failure (HFpEF)

Q. Why does a reduced ejection fraction limit exercise capacity?

Stroke volume and cardiac output cannot increase adequately

Q. End-diastolic volume (EDV) refers to:

The volume of blood in the ventricle at the end of diastole

T/F: During menopause, absence of estrogen causes obesity and beta-cell dysfunction.

True

What are the metabolic actions of estrogen?

• energy balance

• adipose health

• beta cell function

• insulin sensitivity

• lipid homeostasis

• energy homeostasis

• macrophage polariszation

T/F: Coronary artery disease has a different pattern of fatty plaque build up in males and females.

True

What are the 3 principles of bellmont report?

beneficence

respect for persons

justice

True or False: Hispanic adults have the second highest risk of deaths due to heart disease.

False; Black

Q: Explain how long-term hypertension increases the risk of developing heart failure (HF).

Chronic hypertension → increased pressure (afterload)

Heart must work harder → left ventricular hypertrophy

Over time → heart weakens and cannot pump effectively

modifiable risk factors for heart failure

physical inactivity, high fat/carb diet, smoking

non-modifiable risk factors for heart failure

Age, Race, Family history, Gender (men > 40–60 yrs; women > postmenopause)

metabolic risk factors for heart failure

hypertension, obesity, high cholesterol, type 2 diabetes

Q: How does functional limitation change from Class II to Class IV heart failure?

As heart failure gets worse, people reach vo2max quicker from everyday activities

• daily activities like using the restroom or putting on a shirt are difficult (these patients reach their VO₂ max during those activities)

Q: Why do patients with advanced heart failure reach VO₂ max during simple daily activities?

limited cardiac output;

the heart cannot provide sufficient cardiac output to satisfy the metabolic needs of the body

Q: How does myocardial infarction contribute to the development of heart failure over time?

bc the rest of the cardiac muscle has to overwork to pump blood and meet the metabolic needs of the body

Q: What are the 3 beneficial effects of estrogen in premenopausal women?

prevents vascular dysfunction,

increases nitric oxide,

reduces oxidative stress

Q: What are the unique risk factors in women that increase their risk of CVD?

• “Gestational Diabetes”

• “greater number of childbirths”

• “Menopause (lack of estrogen)”

• “pre-mature menopause (before the age of 40 yrs)”

• “differences in plaque build up and coronary artery disease, different structural changes”

What causes gestational diabetes?

The hormones released by the placenta during pregnancy tend to impair the action of insulin in the mother, leading to insulin resistance.

What race has the highest risk of gestational diabetes?

asian/pacific islanders

therapeutic drugs for treatment of T2D

• “Metformin

• “Thiazolididiones (TZDs)

• “Sulfonylureas

• “Insulin injections

therapeutic drugs for treatment of heart failure

• ACE inhibitors (↓ BP, inhibit RAAS)

• Diuretics (↓ blood volume)

• Anticoagulants/antiplatelets (prevent clotting)

• Statins (lower cholesterol)

What receptor is involved with glucose uptake by the cells?

insulin receptor, which enables glucose uptake via GLUT transporters

In what form does the body store excess glucose?

What are the two major sources of this storage?

glycogen;

muscle and liver

Name 3 of the leading causes of CKD.

T2D

hypertension

atherosclerosis in renal artery

What are the metabolic risk factors for developing CKD?

hypertension, type 2 diabetes, obesity, and high cholesterol

What are 2 ways of determining healthy kidney function?

• “Urine test to assess albumin-creatinine ratio”

• “Blood test to determine albumin-creatinine ratio”

What is the smallest functional unit of the kidney?

nephron