Clin Med Exam #2

cardiac arrhythmias

variations in normal heartbeat

SA node

which node is the originator

sinus tachycardia

> 100 bpm

sinus bradycardia

< 60 bpm

premature atrial contractions

early heartbeat --> pause --> normal rhythm (can be caused by stress, caffeine, drugs)

premature ventricular contractions

extra, abnormal heartbeats that disrupt the regular ventricular rhythm of the heart

atrial flutter

250-350 bpm

- sawtooth pattern

atrial fibrillation

350-600 bpm

heart block

blockage of the electrical conduction system of the heart

1st degree

which degree of AV blocks

- prolonged period between P and R wave

2nd degree type 1

which degree of AV blocks

- P QRS interval gets longer and longer and then suddenly there is a P wave with no QRS complex

2nd degree type 2

which degree of AV blocks

- fixed pattern where a QRS wave is skipped

3rd degree

which degree of AV blocks

- P and QRS don't agree

ventricular tachycardia

> 100 bpm with at least 3 irregular beats in a row

ventricular fibrillation

- life threatening

- ventricles quiver resulting in no beat or blood pump

pacemaker, radiofrequency catheter ablation, and medications

what are some managements for arrhythmias

electromagnetic interference

pts with a pacemaker are at risk for what

congestive heart failure

chronic progressive condition in which there is inadequate function of the pumping mechanisms within the heart

systolic

which type of heart failure, systolic or diastolic

- can fill but the walls are thin and weak so heart cannot PUMP

diastolic

which type of heart failure, systolic or diastolic

- chambers have trouble relaxing and are often stiff and enlarged so cannot FILL

left

is this left or right sided heart failure

- pulmonary congestion

- increased fluid pressure is transferred back through lungs

right

is this left or right sided heart failure

- systemic venous congestion

- blood backs up in bodys veins

cor pulmonale

right sided heart failure due to lung disease that produces pulmonary HTN

diuretics

congestive heart failure can be treated using what drug class

NSAIDs

what are contraindicated in pts with congestive heart failure

cardiomyopathy

disease of the heart muscle inherited or acquired where the muscles do not contract normally

dilated

what is the most common type of cardiomyopathy

dilated

which type of cardiomyopathy

- chambers enlarge and loose contractility

- adults 20-60

- unknown cause

hypertrophic

which type of cardiomyopathy

- most common cause of sudden cardiac arrest in athletes

- heart muscles cells enlarge and cause the walls of the ventricles to thicken

restirctive

which type of cardiomyopathy

- usually older adults

- ventricles become stiff and rigid so atrias become enlarged

- abnormal/scar tissue replaces the normal heart muscle

arrhythmogenic right ventricular dysplasia

which type of cardiomyopathy

- rare

- occur if the muscle tissue in the right ventricle dies and is replaced with scar tissue

unclassified (broken heart syndrome)

which type of cardiomyopathy

- stress induced

- loses ability to contract

valvular disease

any disease process involving one or more of the 4 valves of the heart

stenosis

is this valvular stenosis or incompetence

- too narrow or hardened to open fully

- forces blood back into adjacent heart chamber

- greater tendency to clot

incompetence

is this valvular stenosis or incompetence

- allows blood to leak into chamber it previously came from because can't close completely

acute

does acute or subacute infective endocarditis

- develops suddenly and may become life threatening with days

subacute

does acute or subacute infective endocarditis

- develops gradually and subtly over a period of wks to months

yes

is antibiotic prophylaxis indicated for pts at high risk for infective endocarditis

increase

does glucagon increase or decrease blood glucose

decrease

does insulin increase or decrease blood glucose

GLUT-4

insulin acts on what

diabetes mellitus

term used to describe a group of metabolic diseases characterized by hyperglycemia and the inability to produce and/or use insulin

type 1

which type of diabetes is

- failure to make insulin

type 1

which type of diabetes is

- younger often sudden onset

type 1a

which type of diabetes is

- genetic, autoimmune, and environmental factors

- unknown etiology

- destruction of beta cells

type 1b

which type of diabetes is

- not immune mediated

- absolute lack of insulin production

type 2

which type of diabetes is

- insulin resistance

type 2

which type of diabetes is

- not immune mediated, higher genetic component

- defects in insulin receptors

- often slow, insidious onset

< 100 mg/dL

normal fasting blood sugar =

> 126 mg/dL

diabetic fasting blood sugar =

> 200 mg/dL

diabetic random blood sugar + S&S of DM =

< 140-180 mg/dL

diabetic postprandial blood sugar =

> 200 mg/dL

diabetic oral glucose tolerance test =

140-199 mg/dL

prediabetic oral glucose tolerance test =

≥ 6.5%

diabetic HbA1C =

1:1

what is the usual ration of insulin to C-peptides

low, high

type 1 DM usually has low or high c-peptides with low or high blood glucose

high, low

type 2 DM usually has low or high c-peptides with low or high blood glucose

polyuria, polydipsia, and polyphagia

what are the hallmark S&S of hyperglycemia

microvascular

are micro or macrovascular complications due to

- nonocclusive microcirculatory disease

- impaired autoregulation of blood flow and vascular tone

macrovascular

are micro or macrovascular complications due to

- high triglycerides

- low LDL

- small atherogenic LDL

hyperglycemia

are ocular issues usually related to hyper or hypoglycemia

gastroparesis

delayed gastric emptying

diabetic ketoacidosis

acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy

type 1

which type of DM is treated by insulin daily

weakness, tachycardia, pallor, altered mental status, and unconsciousness

what are some signs of hypoglycemia

sulfonylureas, glinides, incretiin analogues, DPP-4 inhibitors, biguanides, thiazolidinediones, alpha glucosidase inhibitors, and sodium glucose co-transporter 2

what are some drug classes that can be used to treat type 2 DM

right

is the right or left adrenal gland pyramidal shaped

left

is the right or left adrenal gland semilunar shape

superior, middle, and inferior suprarenal artery

what is the arterial supply of the adrenal gland

inferior vena cava

what is the venous drainage for the right adrenal gland

renal vein or inferior phrenic vein

what is the venous drainage for the left adrenal gland

adrenal hypoplasia

hypoplasia or absence of the fetal cortex with a poorly formed medulla

adrenal heterotopia

normal adrenal gland in an abnormal location

aldosterone

what is secreted in the zona glomerulosa

glucocorticoids

what is secreted in the zona fasciculata

androgens (DHEA)

what is secreted in the zona reticularis

cholesterol

are hormones secreted by the adrenal cortex are derived from what

HPA axis

the release of cortisol is determined by what

hypothalamus

CRH is produced by what

anterior pituitary

ACTH is produced by what

adrenal cortex

cortisol is produced by what

adrenal cortex

aldosterone is secreted from where

aldosterone

what hormone helps with Na reabsorption and K excretion

renin

What converts angiotensinogen to angiotensin I?

ACE

What converts angiotensin I to angiotensin II?

chromaffin cells

the cells in the adrenal medulla that secrete epinephrine and norepinephrine

cushing syndrome

glucocorticoid excess =

obesity w/ moon like facies, growth failure, hirsutism, acne, HTN, glucose intolerance, etc.

what are some clinical findings for glucocorticoid excess

urinalysis

what is the best screening test for glucocorticoid excess

HTN, headache, tachycardia, fatigue, proximal muscle weakness, polyuria, and polydipsia

what are the clinical findings of mineralocorticoid excess

ambiguous genitalia

what is the clinical finding in newborn girls for androgen exceess

HTN, orthostatic hypotension, tachy or bradycardia, arrhythmias, headache, fatigue, visual blurring, sweat, heat intolerance, weight loss, abdominal pain, polyuria, & polydipsia

what are the clinical findings for catecholamiine excess

pheochromocytoma

tumors that arise from the neural crest derived chromaffin cells found in adrenal medulla

acute/crisis insufficient adrenal activty

acute stress occurring in pts w/ chronic adrenal insufficiency of any type

addisons disease

primary chronic adrenal insufficiency =

hypothalamic or pituitary disease and exogenous corticosteroids

secondary chronic adrenal insufficiency =

impaired hypothalamic response usually chronic corticosteroid use

tertiary chronic adrenal insufficiency

circulatory collapse w/ abdominal pain, profound hypoglycemia, elevated core temp, cardiac dysrhythmias, and n/v

what are the hallmark signs of acute adrenal crisis

proximal convoluted tubule

what part of the nephron

- absorbs 2/3s of glomerular filtrate