patho test 2 (no quizzes)

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intracellular compartment (ICF)

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intracellular compartment (ICF)

fluid within cells, 2/3 of body water

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site of ­ K+

intracellular compartment

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moderate amounts of Mg 2+

intracellular compartment

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extracellular compartment (ECF)

fluid within cells, 1/3 of body water

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found in interstitial/tissue spaces, within blood cells

extracellular compartment

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site of ­ Na+, Cl-, moderate amounts of HCO3-

extracellular compartment (ECF)

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third space =

when transcellular compartment contains large amounts of fluid

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8

capillary filtration pressure

pushes water out of capillary to interstitium

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9

capillary colloidal osmotic pressure

pulls water back into capillary

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10

interstitial hydrostatic pressure

opposes outward water movement

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11

tissue colloidal osmotic pressure

pulls water out of capillary

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12

lymphatic system

accessory route to return interstitial fluid to the circulation

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13

compulsive water drinking

psychogenic polydipsia

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14

psychogenic polydipsia is seen in people with

psychiatric disorders

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15

neurogenic DI (diabetes insipidus)

defect in synthesis/release of ADH

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16

nephrogenic DI (diabetes insipidus)

kidneys don’t respond properly to ADH

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syndrome of inappropriate secretion of ADH (SIADH)

ADH secreted despite normal OSM, decreases urine output, transient or chronic condition, dilution hypoatemia

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hypertonic (translocational) hyponatremia

water shifts from ICF to ECF with hyperglycemia

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hypotonic (dilutional) hyponatremia

caused by water retention, water intoxication

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hypovolemic hypotonic hyponatremia

sweating in hot weather (lose water + salt)

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euvolemic hypotonic hyponatremia

retain water with dilution of Na+ while maintaining ECF (e.g., SIADH)

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hypervolemic hypotonic hyponatremia

seen with edema-associated disorders, e.g., heart failure, cirrhosis, renal disease

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where is most fluid found?

intracellular compartment

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primary source of water loss

urine

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25

Na+ (sodium) regulates

extracellular fluid volume and osmolarity

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26

Na+ (sodium) is regulated by

aldosterone and antidiuretic hormone (ADH)

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Calcium, Ca2+ is regulated by

PTH

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28

Regulate K+

insulin, epinephrine, aldosterone, and glucocorticoids

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29

respiratory acidosis acute disorders of ventilation

problem with respiratory center of medulla, lung disease, respiratory muscle weakness, airway obstruction

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respiratory acidosis choric disorders of ventilation

bronchitis, emphysema

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respiratory acidosis increased CO2 production

exercise fever, sepsis

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functions of the main electrolytes (ions)

transmit nerve signals, and contract muscles including the heart

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causes of edema

increase in capillary filtration pressure, decrease in capillary colloidal osmotic pressure, increase capillary permeability, obstruction to lymph node

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LDL

1° carrier of cholesterol

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HDL

50% protein, little cholesterol

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VLDL

higher amounts triglycerides, lower amounts of cholesterol

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lipoproteins are made in the small intestine

chylomicrons

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38

transport absorbed fats to skeletal muscle and adipose

chylomicrons

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39

small, spherical dilation of vessel at bifurcation, eg circle of willis

berry aneurysm

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40

involves entire circumference of vessel; gradual, progressive dilation of vessel

fusiform aneurysm

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extends over part of circumfernce of vessel and appears sac like

saccular aneurysm

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42

false aneurysm resulting from tear in intima layer of aorta the creates a blood filled cavity

aortic dissection

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43

inflammatory injury and necrosis of blood vessel walls, may result in injury from direct injury to vessel

vasculitides

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44

small vessel vasculitides

arterioles, venules, capillaries

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45

small vessel vasculitides

mediated by type III immune complex hypersensitivity reaction, commonly involve the skin

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46

medium sized vessel vasculitides

produce necrotizing damage to medium sized muscular arteries of major organ systems

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large vessel vasculitides

involve large elastic arteries, involve infiltration of vessel wall with giant cells and mononuclear cells

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48

Thromboangiitis obliterans (Buerger disease)

affects medium sized arteries, usually plantar and digital vessels

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Buerger disease is common in

male smokers, 25-40 years, tobacco may trigger immune response

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50

Buerger disease

pain associated with intermittent claudication, sensitivity to cold; area can become cyanotic

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51

Raynaud disease

vasospasm of arteries & arterioles in fingers (& toes), seen in healthy young women, begins with stress or cold

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 venous thrombosis (thrombophlebitis)

presence of thrombus in vein with accompanying inflammatory response in vessel wall, more common in lower extremities, associated with blood stasis and vessel wall injury

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a symptom of peripheral arterial disease

claudication (calf pain with walking)

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54

stable angina

angina pectoris

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angina pectoris

symptomatic paroxysmal chest pain/pressure associated with transient

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prinzmental angina is caused by

spasms of coronary arteries; mechanism uncertain

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silent myocardia ischemia

absence of anginal pain

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silent myocardia ischemia is seen in patients that are otherwise

asymptomatic, with previous MI, with recurring angina episodes, or with

autonomic neuropathy (diabetics)

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ST segment elevation

transmural injury

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ECG changes

T wave inversion due to altered myocardial repolarization

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ST segment elevation

transmural injury

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Depression

subendocardial injury

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abnormal Q wave

no depolarizing current conduction after injury

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mitral valve prolapse

floppy mitral wave

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mitral valve prolapse is

mucinous degradition of mitral valve leaflets to become floppy so that they balloon back into L-atrium during systole

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mitral valve stenosis

incomplete opening, commonly the result of rheumatic fever

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mitral valve stenosis results in

left atrium dilation and pulmonary congression

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mitral valve regurgitation

incomplete closure, associated with rheumatic fever, rupture of chordae tendinae/papillary muslces

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70

dialated cardiomyopathies

result in progressive cardiac hypertrophy and dialation with lower pumping ability of one or both ventricles, can result from infections, alcohol/toxic agents, neuromuscular or immunological disorders, genetic influences

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hypertrophic cardiomyopathies

excessive ventricular growth/hypertrophy

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72

restrictive cardiomyopathies

not common in western countries, ventricular filling is restricted because of rigidity of ventricular walls

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73

peripiartum cardiomyopathy risk factors

maternal age, african-american, multifetal pregnancy, preeclampsia and gestational hypertension

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peripartum cardiomyopathy is similar to

dialated cardiomyopathy

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in most cases of peripartum cardiomyopathy

½ cases heart returns to normal within 6 mos; remainder of cases can result in maternal death with another pregnancy

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kawaskai disease

mucocutaneous lymph node syndrome; acute febrile disease affecting skin, brain, eyes, joints, liver, lymph nodes & heart; results in vasculitis (inflammation of blood vessels)

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77

coarctation of the aorta

narrowing of the aorta proximal of distal to the ductus arteriosus

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coarctation of the aorta symptoms

disparity in pulsations and BP in arms bounding and legs (weak), surgically remediation between 2-4 years

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transposition of the great vessels

aorta originates in right ventricle/pulmonary artery originates in left ventricles

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80

transposition of the great vessels survival depends

on communication between R/L sides of heart via patent ductus arteriosus or septal defect

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patent ductus arteriosus

persists after birth should close after 24-72 hours and become permanetely sealed by 2-3 weeks, treated surgically or with drugs that prevent prostaglandin synthesis

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endocardial cushion defects

cushions form the AV canals, upper part of ventricular septum and lower part of atrial septum, common in Down’s syndrome children, may be partial or complete AV canal defects

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83

Four asociated conggenital heart defects that are present in tetralogy of fallot

Ventricular septal defect, dextroposition or shifting to the right of aorta so that it overrides the right ventricle, narrowing of pulmoary outflow channel, hypertrophy of right ventricle

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84

function of heart is supra-normal but inadequate because of high metabolic demands

high output

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inadequate because of disordes that impair pumping abilty of heart

low out put

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imparied ejection

systolic failure

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imparied filling

diastolic failure

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congestion in peripheral circulation

right side failure

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congestion in pulmonary circulation

left side failure

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AV node block

partial or complete interruption of impulse transmission from the atria to the ventricles

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tachycardia

your heart is beating much faster than normal,

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92

bradycardia

heart is beating slower than normal

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heart flutter

heart palpitations

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94

renin-angiotensin-aldosterone system

increases Na+ absorption and decreases GFR

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95

myoglobin

released quickly, elevated within 1 hour of myocardial cell death, not cardiac specific

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96

creatine kinase MB

isoenzyme specific for myocardial tissue, rises within 4-8 hours of injury, returns to normal within 2-3 days

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troponin I & T

rise within 3 hrs of MI, remainc elevated for 7-10 days

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98

cause of cardiac tamponda

increased fluid, blood or pus in pedicardial sac, due to tramua, surgrey, cancer, uremia, cardiac repture with MI

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cardiac tamponade relief

echocardiogram can evaluate condition, to remove fluid from pericardial sac

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stenosis

narrowing of a valvular orifice, failure of valve to open properly

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