The Importance of Effective Communication in the Workplace, Exams of Pathophysiology

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Pathophysiology Exam 4 (Modified) (580 Questions with Complete Answers) 2024- 2025 Latest Updated Graded A+. normal metabolism requires _____ supply - Answer oxygen myocardial ischemia is defined as - Answer insufficient oxygen supply what are contributors to myocardial oxygen supply - Answer -patency of coronary arteries -hemoglobin -fraction of inspired oxygen in the blood what are the etiologies of decreased myocardial oxygen supply - Answer - atherosclerosis (#1) -vasospasm -emboli -anemia -hypoxia what is the formula for expression of myocardial oxygen demand - Answer expression of demand = (MVO2) Myocardial oxygen consumption what are the factors of myocardial oxygen consumption - Answer -HR (cronotropy) -ventricular contractility (inotropy) -wall stress (preload and afterload) what are some etiologies of increased myocardial oxygen demand - Answer -tachycardia -thickened LV wall (LVH) -increased systemic activity where do the coronary arteries originate - Answer root of the aorta near the aortic valve perfusion (filling) of the coronary arteries occurs during which phase of the cardiac cycle - Answer diastole the myocardium uses which percentage of the oxygen delivered to the muscle - Answer 70% (very high O2 extraction) describe coronary venous drainage - Answer coronary sinus drains coronary veins to the right atrium where is the coronary sinus located - Answer posterior to the AV groove describe the location of the coronary arteries - Answer they lie on the surface of the heart what are the two main coronary arteries - Answer left main and right coronary artery what arteries does the left main artery give rise to - Answer left anterior descending and left circumflex what does the right coronary artery give rise to - Answer posterior descending artery what structures does the left anterior descending artery supply - Answer - anterior wall of LV (60% of contractility) -LA (>50%) -anterior 2/3 of interventricular septum -apex -papillary muscle what does the left circumflex artery supply - Answer posterior-lateral walls of the left ventricle and atrium what does the right coronary artery supply - Answer -most of right atrium and right ventricle -SA node -AV node -bundle of His describe how high cholesterol can be a risk factor for coronary artery disease - Answer -total cholesterol >200 -high LDL describe how smoking can increase risk of coronary artery disease - Answer -increases LDL -damages endothelium of coronary vessels -vasoconstricts coronary arteries what is the mnemonic for risk factors of atherosclerosis - Answer Bmi > 30 Age > 65 DM Hypertension Etoh A bad lipoprotein profile Relatives Tobacco what is angina - Answer chest pain associated with myocardial ischemia or infarction what is ischemia - Answer transient, reduced/inadequate blood flow that does not cause cell death what is infarction - Answer permanent, no blood flow, causes cell death what are the different types of angina - Answer -stable -unstable -variant/prinzmetal -silent ischemia what is stable angina - Answer occurs with exertion & relieved by rest what is unstable angina - Answer chest pain unrelieved with nitroglycerine or rest; may crescendo (increase) what is variant/prinzmetal angina - Answer caused by coronary artery vasospasm; occurs at rest with or without precipitating factors what is silent ischemia angina - Answer asymptomatic myocardial ischemia associated with DM, elderly, heart transplant patients what is the mnemonic for angina pain - Answer Provocation Quality Region/radiation Severity Timing describe EKG changes for infarction - Answer ST elevation describe EKG changes for ischemia - Answer ST depression T wave inversion on an EKG can accompany (infarction/ischemia) - Answer both! trick question! what are common cardiac markers - Answer creatinine kinase and troponin what is creatinine kinase - Answer intracellular enzyme found in muscle cells what is a CK-MV measurement - Answer Ck with the isoenzyme MB; MB is more specific to the cardiac muscle describe troponin - Answer -protein necessary for skeletal and cardiac muscle contraction -has a high specificity for cardiac myocytes describe what information we can obtain from cardiac biomarkers and why - Answer very predictable time-line... so alterations could signal alternate diagnosis or ongoing ischemia what is acute coronary syndrome - Answer spectrum of clinical presentations of coronary artery disease (stable angina, unstable angina, acute MI) describe the plaques seen in chronic stable angina - Answer -stable plaques -large BUT subtotal (>70%) blockage of vessel -fibrous caps that have not ruptures describe the presentation of chronic stable angina - Answer -intermittent anginal episodes brought on by exertion -brief duration (<10 min) chest pain -may recover over a long period with same pattern of exertion onset, duration, and intensity -resolves with rest why does chronic stable angina resolve with rest - Answer fixed flow-limit allows adequate supply when at rest people with chronic stable angina only experience symptoms when? - Answer in the setting of exertion is chronic stale angina an ischemic or infarction condition? - Answer ischemic describe the EKG of a chronic stable angina patient - Answer -little or no EKG changes -minimal ST segment depression or T wave inversion -EKG returns to baseline when the pain is relieved what are the cardiac markers for chronic stable angina - Answer none! trick question! is chronic stable angina a true acute coronary syndrome emergency? - Answer nope describe the plaques found in unstable angina - Answer -unstable plaques with fibrous caps that rupture -90% occlusion (but still sub-total); without infarction describe the presentation of unstable angina - Answer -can experience it at rest -cannot tolerate much or any exertion -episodic chest pain secondary to plaque rupture and ischemia but for durations <30 minutes myocardial cells can withstand ischemic conditions for approximately how long? - Answer 20 minutes describe infarction changes - Answer -irreversible cell death and impaired contractility -physical changes begin to occur in the heart 3-6 hours after infarction what stimulates MI - Answer catecholamine release, which stimulates the SNS stimulation of the SNS during MI causes - Answer -diaphoresis -vasoconstriction or peripheral blood vessels -skin appears ashen, clammy, and cool to the touch MI can rapidly progress to - Answer heart failure describe the pathogenesis of MI over 24 hours - Answer -within 24 hours, leukocytes infiltrate the area of cell death -fever -systemic inflammatory process caused by myocardial cell death describe day 4 of MI pathogenesis - Answer proteolytic enzymes of neutrophils and macrophages remove necrotic tissue, making a thinner wall describe what happens past day 4 of MI - Answer -collagen matrix laid down and cardiac remodeling occurs -repair NOT regeneration does repaired heart tissue have functionality? - Answer no... it has little to no compliance or recoil describe Q waves seen in MI - Answer -develop within 2 hours of onset of MI, thought can take 12-24 hours to appear -remain forever and will show in the pattern of infarct distribution -sign of old MIs STEMI are commonly referred to as - Answer Q wave MIs NSTEMI are commonly referred to as - Answer Non-Q MIs describe the potential dysrhythmias that can occur in the first 24 hours of MI - Answer -PVC can progress to Vtach and Vfib -most common complication in sudden death -life-threatening dysrhythmias seen most often with anterior MI dysrhythmias are present in ______% of patients with MI - Answer 80% besides dysrhythmias, what else can occur within the firsdt 24 hours of an MI - Answer cardiogenic shock from acute LV failure describe cardiogenic shock - Answer -hypotension (from cardiac tissue ischemia to end-organ tissue ischemia) -flash pulmonary edema (acute RHF) -reflexive tachycardia what are complications of MI that can occur days 1-31 - Answer - ventricular septal defects -free wall rupture -papillary muscle rupture describe ventricular septal defect complications of MI - Answer -rupture through interventricular septum -L to R shunt of blood causes a murmur -likely death describe free wall rupture complication of MI - Answer -blood escapes to pericardial space -leads to cardiac tamponade -death without intervention describe papillary muscle rupture complication of MI - Answer -makes mitral valve incompetent -mitral regurgitation -holosystolic murmur what are the complications that can occur on days 3-14 after MI - Answer acute pericarditis describe acute pericarditis complication of MI - Answer -inflammation of pericardium -may result in pericardial effusion -may cause cardiac tamponade -pericardial frictional rub -widespread EKG changes in ST elevations or depressions describe Prinzmetal Angina - Answer vasospastic event (not from plaque or thrombus) in response to possible cold or emotional stress describe the EKG changes of prinzmetal angina - Answer can have ST elevation but rarely for any length of time what are the cardiac biomarkers for prinzmetal angina - Answer no troponin spill describe an EKG test for coronary artery disease - Answer -static, single moment of patient presentation at rest -ST depression or T wave abnormalities seen in stress test -St elevations and/or symptomatic can call for urgent cardiac catheterization describe stress testing for cardiac evaluation of coronary artery disease - Answer -truly dynamic evaluation of coronary perfusion -uses injected nuclear tracer to image patient muscle tissue perfusion while patient is physically challenged describe echocardiogram testing for coronary artery disease - Answer - dynamic but not under cardiac challange -shows wall motion abnormalities, pump function, valve abnormalities -stress echo is a dynamic test while patient is performing physiologic stress describe cardiac catheterization for cardiac evaluation - Answer -ultimate test to characterize coronary artery circulation -radiopaque dye injected into coronary arteries that is visible to X-Ray -diagnostic, but allows for immediate coronary intervention -expensive, limited availability, invasive, risk of complications what are standard MI treatments - Answer Monitor/morphine Oxygen Nitroglycerine Aspirin describe the physiology of takotsubo cardiomyopathy - Answer -apical ballooning -reversible myocardial changes -presents like a STEMI, but no evidence of CAD on angiography what does the cardiac conduction system control - Answer rate and rhythm of electrical impulse conduction in the heart what is automaticity - Answer cells with the capability of spontaneously initiating action potentials and conducting impulses what cells in our body have automaticity - Answer ONLY cardiac muscle cells (myocytes) a hierarchy exists in the cardiac conduction system... which cells have the highest priority of automaticity - Answer SA node myocytes the bachmann bundle conducts signals where - Answer right to left atrium and down to the AV node if the SA node was damaged, what can point to the region that has taken over automaticity - Answer the rate of the heart what is the normal HR created by the SA node - Answer 60-100 BPM what is the normal HR created by the AV node - Answer 40-60 BPM what is the HR created by the atria (fibrillation) - Answer > 350 BPM woah slow down there champ what is the HR created by the ventricles - Answer 20-40 BMP where is the SA node located - Answer in the right atrium what is the function of the SA node - Answer -starts off the conduction pathway -causes contraction of right atrium -sends impulse to LA via Bachman's bundle that causes LA contraction -sends impulses to ventricles by way of AV node where is the AV node located - Answer lower portion of the RA what is the function of the AV node - Answer -delays passage of electrical impulse to the ventricle -passes impulses through the bundle of His what is the delay in the AV node responsible for - Answer coordinated contracting of both atrium first to prime the filling of the ventricles before they pump describe the bundle of His - Answer -separate into R and L bundle branches -conducts impulse toward the apex of heart -bundle branches pass impulses to purkinje fibers the left bundle branch sends impulses to - Answer left ventricular contraction the right bundle sends impulses for - Answer right ventricular contraction describe purkinje fibers - Answer -initiates ventricular conduction -once impulse enters this system, it spreads immediately to the ventricle -APs move upward from apex what is an action potential - Answer brief reversal of electric polarity ACROSS the cell membrane how does an action potential occur - Answer movement of ions in and out of the cells what are the main ions involved in an action potential - Answer sodium, potassium, calcium describe depolarization in an action potential - Answer moving from negative to less negative (positive) ... causing contraction describe repolarization in an action potential - Answer moving towards more negative ... relaxation describe the threshold for action potentials - Answer polarity must depolarize to a threshold level for contraction of occur what does the P wave represent in an EKG - Answer atrial depolarization ... not the SA node firing what does the QRS complex represent in an EKG - Answer depolarization of ventricles what does the T wave represent in an EKG - Answer repolarization of ventricles describe the PR interval - Answer impulse arrives in AV node, impulse passes bundle of his, impulse passes bundle branches, impulse passes Purkinje fibers describe the ST interval in an EKG - Answer ventricular ejection what waves are involved in ventricular filling / diastole - Answer P wave, PR interval, half of ST interval what waves are involved in systole - Answer QRS complex, part of ST interval what are different types of disorders that can occur in the cardiac conduction system - Answer -disorders of rhythm -disorders of impulse conduciton what are the potential causes of disorders of the cardiac conduction system - Answer -congenital defects -degenerative changes in system -myocardial ischemia and MI -fluid and electrolyte imbalances -effects of drug ingestion what are the different types of sinus node dysrhythmias - Answer -sinus bradycardia (HR < 60) -sinua tachycardia (HR > 100) -sinus dysrhythmia/sick sinus -extra premature impulse initiated by purkinje fibers in ventricles -P wave absent -QRS dysmorphic (widened/bizarre) what do PVCs cause - Answer since they occur early before a regular heart beat, it causes a compensatory pause before the next normal beat can initiate what are the different patterns of PVCs - Answer -bigeminy: every other complex -trigeminy: every third complex -couplets: two in a tow -triplets: three in a row if PVCs are limited in frequency and asymptomatic, they are usually considered - Answer benign describe uni-focal PVCs - Answer when all PVCs look alike, they are monomorphic and usually initiated by the same focus area of the ventricle describe multifocal PVCs - Answer stimulus occurring from different foci in the ventricle area ... typically more concerning than monomorphic occasional, random, scattered ectopy without symptoms are almost always considered - Answer benign ... usually caused by heightened sympathetic tone what are common treatments for PVCs or PACs - Answer -usually none -stope caffeine -reduce stress -treat sleep apnea -low dose beta blocker (last resort) describe atrial fibrillation - Answer -supraventricular rhythm -multiple uncoordinated ectopic sites firing atrial contractions -SA node not managing HR describe the EKG presentation of Afib - Answer -no discernable P wave -baseline appears jagged and random -irregularly irregular heart beat (seen as variable R to R) what is the hearts response to Afib - Answer tachy ventricular response ... >120 ... can make this an emergent event what are the three different types of Afib - Answer -paroxysmal -persistant -permanent describe paroxysmal Afib - Answer recurrent / self-terminated / less than 7 day bouts describe persistant Afib - Answer < 7 days and broken with medication or cardioversion describe permanent Afib - Answer does not respond... requires V rate control and anticoagulant what are some causes of Afib - Answer -anything that damages the heart -MI -dilated LA from valvular disease, COPD -HTN -CHF -electrolyte disturbance -sometimes in random healthy individual what are treatments for emergent Afib - Answer -if occurs with rapid ventricular response (>100 BPM) or any V response with associated symptoms of chest pain or syncope -will need cardioversion if having signs of hypo perfusion what is cardioversion - Answer intervention to convert back to NSR describe electrical cardioversion - Answer unlike lethal ventricular arrhythmias; it is a lower energy and synced describe chemical cardioversion - Answer adenosine which transiently stops all AV node conduction describe non emergent treatments for Afib - Answer -still need to go to the ER or cardiologist -can still attempt cardioversion via carotid massage, slow controlled medication treatment, and non-emergent cardioversion what does a carotid massage do - Answer parasympathetic stimulation both emergent and non emergent Afib need ... - Answer a workup for treatable underlying cause patients can live their entire ives in Afib if ... - Answer they are vent rate controlled (naturally or medically) chronic Afib patients are at risk for what - Answer clot formation in the LA from dis-coordinated contracting and emptying that can become embolic (CVA) ... most will require long term anticoagulation describe Atrial flutter - Answer -supraventricular rhythm -tachy, regular saw tooth EKG with no isoelectric line -fast REGULAR rate of 240-300 or more describe ventricular response to atrial flutter - Answer is often irregular dependent on nodal conduction .. can be fixed or variable what is atrial flutter caused by - Answer atrial re-entry conduction what is atrial re entry conduction - Answer tachycardia (not ectopic atrial pacer) what are the symptoms of atrial flutter - Answer -palpitations -light headed -shortness of breath -fatigue IF rapid ventricular response: -hypotension -syncope -chest pain atrial flutter is typically seen in patients with what conditions - Answer - COPD -pulmonary HTN -heart failure most Vfib has progressed from - Answer Vtach .. certain death without intervention what are the different types of Atrioventricular blocks - Answer first degree, second degree, third degree describe first degree AV blocks - Answer prolonged PR (>200 ms), 1 P to 1 QRS describe second degree AV blocks - Answer -intermittent failure of P to transmit QRS -some P with QRS, some P without QRS -2 types (Weckeback Mobitz 1 and Mobitz 2) describe third degree AV blocks - Answer -NO connection between P and QRS complexes -QRS fire on own as escape rhythm -also known as complete heart block describe the symptoms of first degree AV block - Answer asymptomatic, low severity describe the symptoms of second degree AV block - Answer -mostly asymptomatic -Mobitz 1 less severe -Mobitz 2 high chance of progressing to third degree describe the symptoms of third degree AV block - Answer -highly symptomatic -syncope, dyspnea, chest pain as no CO -requires emergent pacemaker What is the pacemaker? - Answer -small, implantable battery operated device -senses HR -paces the atria, ventricle, or both HR is below programmed threshold rate what are the two components of a pacemaker - Answer generator and leads describe the generator of the pacemaker - Answer contains the battery and program to sense/trigger the heart beat .. implanted under the skin describe the leads of the pacemaker - Answer -wires/electrodes that connect the heart to the generator -carry heart sensory to the device and electrical impulses to the heart what is heart failure - Answer inability of the heart to maintain sufficient cardiac output to meet metabolic demands of tissues and organs what are the different categories of heart failure causes - Answer impaired cardiac function or excess work demand list some impaired cardiac function causes of heart failure - Answer - cardiomyopathies -MI -myocarditis -stenotic valvular disease -regurgitant valvular disease -congenital heart defects list some types of excess work demands causes of heart failure (i know this is a poorly worded question just work with me i am tired) - Answer - systemic HTN -pHTN -coarctation of aorta -anemia -renal failure what is chronotropy - Answer heart rate define inotopy - Answer contractility ; strength of each contraction Define stroke volume - Answer amount of blood pumped from left ventricle with each contraction define ejection fraction - Answer % of blood pumped from the left ventricle with each contraction what are the two types of heart failure - Answer systolic and diastolic describe systolic heart failure - Answer -cannot pump -impaired LV contractility causes decreased emptying -enlarged/dilated ventricle chambers -EF < 40% -can be caused by MI, cardiomyopathy, AS, Arrythmias describe diastolic heart failure - Answer -cannot fill -impaired LV relaxation, decreasing filling -stiffer smaller ventricle chambers -decreased ability of ventricles to contract -EF >50% but actual SV is low -caused by HTN, cardiomyopathy, AS is it uncommon for a disease process to have a mixture of both systolic and diastolic heart failure? - Answer no. in fact it is quite common what are the different compensatory mechanisms to maintain CO in heart failure - Answer -frank starling mechanism -SNS activation -RAAS activation -natriuretic peptides all compensatory mechanisms often feed - Answer hemodynamic changes that actually worsen heart failure long term what is the frank starling compensatory mechanism - Answer -increasing filling of a ventricle, greater the volume of blood ejected during systole to increase force of next contraction -loading a rubber band to increase snap what are potential determinants of the frank starling mechanism over time - Answer -increased wall tension and increase thickness -may stiffen walls (decrease contractility), shrink cavity (decrease filling), and increase myocardial oxygen requirements 0results in ischemia -poor peripheral tissue perfusion describe pulmonary congestion in LHF - Answer -cyanosis -pulmonary edema -cough -orthopnea -paroxysmal nocturnal dyspnea what is pulmonary edema defines as - Answer abnormal accumulation of extravascular fluid in the lung parenchyma which leads to diminished gas exchange at alveolar level pulmonary edema can progress to - Answer respiratory failure describe the signs and symptoms of pulmonary edema - Answer -hypoxia -dyspnea and tachypnea -inspiratory rales or crackles -pink frothy sputum describe the fluid seen in pulmonary edema - Answer plasma like transudate which eventually can lead to alveoli filling with hemosiderin- laden macrophages later in the process what are the backward effects of RHF - Answer increase pressure behind the pump causes systemic venous congestion what are the forward effects of RHF - Answer low cardiac output describe congestion of peripheral tissues in RHF - Answer -jugular distension -dependent edema in lower extremities -weight gain from fluid accumulation -liver and GI tract congestion (ascites) -hepatomegaly and splenomegaly -anorexia what is ascites - Answer distended abdoment what is cor pulmonale - Answer right sided heart failure caused specifically by isolated pHTN due to lung disease (as opposed to most RHF being caused by LHF) what are the different functional classifications of patients with heart diseases - Answer class I to class IV define class I heart disease - Answer pt with cardiac disease but without resulting limitations in physical activity define class II heart disease - Answer patients with heart disease who have slight limitations of physical activity define class III heart disease - Answer patients with cardiac disease who have a marked limitation of physical activity define class IV heart disease - Answer patients with cardiac disease who are not able to carry out any physical activity without discomfort what are the three macronutrients - Answer -carbohydrates -proteins -fats what are the micronutrients - Answer -vitamins -minerals how much of your plate should be fruits and vegetables - Answer half of it! fill it up!!!! at least half of your grains should be _______ - Answer whole grains what dairy products should we be intaking - Answer fat free or low fat foods high in _________ and ______ should be reduced - Answer - saturated fat -sodium what types of foods are high in saturated fats - Answer red meats, cheeses which macronutrient should make up the smallest percent of your total calorie intake - Answer protein how are carbohydrates used - Answer -directly for cell energy -can be stored as glycogen in muscles and liver -be converted to fats for energy storage -provide carbon skeleton to synthesize non essential AA amount of protein needed for an individual is dependent on - Answer -level of fitness (greater activity = more protein) -exercise type, intensity, duration -total calories how many grams of protein are needed per kilogram of body weight - Answer 0.8 what are the functions of protein - Answer -12-15% of body mass -hemoglobin & myoglobin -activates vitamins (enzymes) -tissue synthesis (anabolism) -antibody production for immunity -maintain fluid balance -key component for hair, skin, nails, bones, tendons, ligaments, enzymes -acid base balance high protein need are seen in what populations - Answer -growing adolescent athletes -resistance training athletes -endurance training programs -wrestlers and football players 1.2 - 1.8g/kg BW if training 2-6 hours a day what are lipids - Answer -energy reserve -protect vital organs and thermal insulation -transport medium for fat-soluble vitamins -hunger suppressor describe trans fatty acids - Answer -deprived from partial hydrogenation of unsaturated corn, soybean, or sunflower oil -longer shelf life exposure to gluten in sensitive individuals can cause - Answer -increase risk of colon cancer -skin problems -fatigue -constipation -diarrhea what is a major concern for people with gluten intolerance - Answer cross contamination describe diabetes - Answer pancreas produces no or insufficient insulin or cells are insulin resistant; glucose cannot be absorbed or used by the cells uncontrolled diabetes can cause - Answer -kidney failure -poor circulation (wound healing) -neuropathy -vision loss -diabetic coma (could lead to death) describe the diet for diabetes - Answer -controlled carbohydrate intake -but DO NOT eliminate carbohydrates how many grams of carbohydrate are considered 1 carbohydrate serving - Answer 15 grams kidney disease is often caused by poorly controlled - Answer DM and HTN what are the nutrients of concern for kidney disease - Answer -protein -potassium -phosphorus -sodium pts with kidney disease may need to limit (in terms of diet) - Answer - protein (need INCREASED for pts on dialysis) -sodium -potassium -phosphorus low sodium diets are used for what population of pts - Answer -HTN -CKD -CHF -CVD -liver disease describe a low sodium diet - Answer -avoids processed meats and canned vegetables -limits cheese -no salt packets -focus on fresh fruits when are high calorie/high protein diets used - Answer -for pts with unintentional weight loss -beneficial for patients with high energy expenditure in PT describe a high calorie/high protein diet - Answer -6 smaller meals/day -peanut butter, chocolate milk -nutritional supplements -mashed potato v baked potato -whole milk v non fat milk what vitamins & minerals are important for injury repair - Answer -Vit C builds collagen -Vit A part of immune function and cell growth -Zinc for wound healing -calcium & vit D for bone health -iron allows for oxygen to reach tissues by way of hemoglobin describe strategies when eating for recovery - Answer -eating every 2-4 hours -include complete protein with each snack/meal -veggies with each snack/meal -whole grains -nuts -avocados -anti inflammatory foods -Vit C and zinc if open wound -HMB may help preserve LBM when would a mechanical soft diet be used - Answer for pts with difficulty chewing and swallowing when would a GI soft diet be used / what is it - Answer -used when a pt experienced recent GI surgery -low fiber/low residue what is dysphagia - Answer difficulty swallowing what types of foods are used in a dysphagia diet - Answer -softer foods -pureed foods -thickened liquid what are some medical nutrition therapies for nausea/vomiting - Answer - wait 30 min before and after eating to drink -cool foods have less odor -cooking foods in microwave -smaller meals -ginger -dry, starchy, salty goods describe the enteral nutrition - Answer -tube feeding -formula administered via tube into GI tract -preferred if GI is functioning descrive parenteral nutrition - Answer solution administered directly into the bloodstream to bypass GI tract what is a nasogastric tube - Answer -enteral nutrition -most common for short term -can also be used for suction -pt unable to eat when this is in place describe an orogastric tube - Answer -threaded through mouth into esophagus -enteral nutrition -short term use describe a nasoenteric tube - Answer -threaded through the nose and into the small intestine -used if delayed gastric emptying -may reduce risk of aspiration when is bariatric surgery used - Answer -only for severe obesity (gastric bypass, banding, sleeve) -often dramatic improvements in diabetes, blood lipid profile, BP who is eligible for bariatric surgery - Answer -BMI >40 -BMI >35 with at least 1 co morbidity -repeated failed weight loss attempts -psychologically able to handle consequences -strong motivation to comply with post surgery treatment plan describe gastric bypass - Answer -size of stomach reduced from cantaloupe to egg -weight loss achieved by reducing intake and malabsorption of nutrients -lifelong need for vitamin and mineral supplements -it is possible to regain all weight due to stomach stretching describe gastric banding - Answer -weight loss due to earlier satiety -liquids travel through opening uninhibited (avoid drinking calories) -reversible and adjustable -no malabsorption of nutrients -vit/mineral needed describe a gastric sleeve - Answer -no malabsorption -weight loss due to reduced intake and reduced ghrelin production -supplements needed to decrease intake what are the consequences of rapid weight loss - Answer -typically excessive lean tissue loss -BMR lowered -rapid weight gain often follows -feelings of being deprived much more common what is the goal of weight inclusive approaches - Answer goal is not to reduce body weight, but to improve relationship with food what are some healthy habits that can counteract BMI risks for mortality - Answer -intake of at least 5 servings of fruits/veggies -physical activity >12 times per month -moderate alcohol consumption (1=women, 2= men) -non smoker describe the function of the endocrine system - Answer maintains homeostasis using chemical messengers called hormones produced by endocrine glands that regulate normal metabolic function define a hormone - Answer chemical messenger secreted by one cell type, altering the function of another cell type, often far from the original secreting cell compare the onset of nervous system v endocrine system effects - Answer -nervous system is FAST ... milliseconds .. she is SPEED -endocrine system is SLOW .. takes hours to days to onset .. slow and steady wins the race compare the duration of effects of nervous system v endocrine system - Answer -nervous has a short millisecond long duration -endocrine has a longer duration, from seconds to hours to day compare the targeting of the effects of the nervous system v endocrine system - Answer -nervous system is very specific -endocrine system is non specific (as carried by blood stream) compare the signal of the nervous system v endocrine system - Answer - nervous is electrical (action potentials) -endocrine are chemicals (hormones) compare the spread of the nervous v endocrine system effects - Answer - nervous is spread by neurons -endocrine is spread via the blood stream compare the receptors of the nervous v. endocrine system - Answer - nervous: neurotransmitters released at synapse to post synaptic membrane -endocrine: hormone travels diffusely until reach target cell receptor differentiate, generally, the endocrine v. nervous system - Answer endocrine system provides longer-term, wide-spread control of homeostatic process, whereas the nervous system offers shorter term and localized effects over homeostatic processes most of the control of hormone production is through ______ feedback loops - Answer negative what are factors that influence a target cells responsiveness to a hormone - Answer -hormone concentration -abundance of receptors at target cell -influence of other hormones present what are the two different types of effects that a hormone can have - Answer excitatory or inhibitory .... both can exits in different target cell types describe how a hormone interacts with a target receptor - Answer - hormones have specific molecular configuration that targets a specific receptor on a target cell -lock and key specificity -target cell will only respond to a specific hormone if it contains specific receptors for the hormone on its cell surface what are two terms we used to describe increases or decreases in sensitivity to a messenger hormone - Answer up regulation or down regulation overview up regulation - Answer -persistently low levels of messenger hormone -increase in number of surface receptors of target cell -target more sensitize to hormone -heightens reactivity to condition of chronic low levels of hormone overview down regulation - Answer -persistently high levels of messenger hormone -results in decrease in number of surface receptors of target cell -target less sensitive to hormone -prevents over reacting to constant high levels of hormone what are the two types of local hormones - Answer paracine and autocrine define paracrine local hormones - Answer local hormones that act on neighboring cells describe secondary hypothyroidism - Answer less common, pathology is related to pituitary gland or hypothalamus, while the thyroid gland itself is normal what is the main cause of hypothyroidism world wide - Answer lack of iodine in diet what is the main cause of hypothyroidism in the US - Answer Hashimoto's thyroiditis describe some iatrogenic causes of hypothyroidism - Answer -surgical resection of thyroid tumor -treatment of grave's disease with radioactive iodine what is the name of the collection of substances in connective tissue seen in hypothyroidism - Answer myxedema how do we monitor hypothyroidism management - Answer monitoring periodic TSH levels -if high, then we need more thyroid hormone -if TSH low, then we need less thyroid hormone how do we treat hypothyroidism - Answer exogenous thyroid medication (Synthroid) describe myxedema coma - Answer -rare and extreme complication from long standing uncompensated hypothyroidism -causes multiple organ abnormalities and progressive mental deterioration -can be fatal if not treated describe hyperthyroidism - Answer -aka thyrotoxicosis -increased metabolic rate and oxygen consumption -increased use of metabolic fuels (heat intolerance) -increased sympathetic nervous system responsiveness describe how increases SNS responsiveness presents in hyperthyroidism - Answer -palpitations -nervousness -irritability -weight loss -diarrhea what is the number one cause of hyperthyroidism in the US? what percent of cases does it make up? - Answer Grave's disease (>60% of all cases) besides Grave's disease, what are some other causes of hyperthyroidism - Answer -thyroid nodules -thyroiditis -iantogenic describe thyroid nodules as a cause for hyperthyroidism - Answer - hormone producing growths on thyroid -benign -more common in older adults describe thyroiditis causes of hyperthyroidism - Answer -inflammation of the thyroid -causes stored thyroid hormone to leak out of the thyroid gland describe iatrogenic causes of hyperthyroidism - Answer excess thyroid medicine used as replacement for hypothyroidism describe medical management of hyperthyroidism - Answer -antithyroid medicine to reduce TH release by blocking iodine used in synthesizing T3 and T4 -beta blockers to reduce symptoms of SNS describe radioiodine therapy for hyperthyroidism - Answer -oral administration fo radioactive iodine -slowly destroys thyroid cells -causes hypothyroidism in 80-90% of cases describe surgery as a treatment for hyperthyroidism - Answer -excision of thyroid nodules -partial removal of hypertrophic thyroid gland (goiter) what is Graves Disease - Answer -hyperthyroidism with goiter, and opthalmopathy -autoimmune disorder -lymphocytes produce an antibody that binds to the TSH receptor on the thyroid -triggers hypertrophy of thyroid tissue causing goiter -more common in women than men what is thyroid storm - Answer -life threatening complication of undiagnosed or untreated hyperthyroidism -multi system exaggerated presentation of thyrotoxicosis what can cause thyroid storm - Answer -thyroid surgery -sudden termination of anti thyroid meds -acute illness -MI, hyperglycemia, stroke what are the symptoms of thyroid storm - Answer -very high fever -CV effects: tachycardia, HF, angina -CNS: agitation, restlessness, delirium what are treatments for thyroid storm - Answer -beta blockers -medications to block synthesis, release and T3/T4 activation peripherally what hormone is secreted from the parathyroid gland - Answer parathyroid hormone what does parathyroid hormone do - Answer increases serum calcium levels by stimulating and increasing osteoclastic activity that results in resorption of bone that releases calcium into the blood stream what is primary hyperparathyroidism - Answer excessive, uncontrolled production of PTH what does primary hyperparathyroidism cause - Answer hypercalcemia with significant renal and skeletal complications over time (groans, stones, bones) -kidney stones -osteoporosis -fractures, abnormal remodeling how do you treat primary hyperparathyroidism - Answer surgical removal of adenonas, often difficult due to small size and location on thyroid describe the effects of pheochromocytoma - Answer -adenoma intermittently produces excess amounts of epi/norepi with no feedback controls -causes vasoconstriction leading to HTN (sometimes malignant) -increases chronotropy (tachycardia) and inotropy of heart what are the symptoms of pheochromocytoma - Answer -headache -palpitations -diaphoresis/flushing what are the signs of pheochromocytoma - Answer -HTN (unresponsive to treatment, life threateningly high, episodic) -tachydardia -weight loss -angina -cardiomyopathy from undiagnosed describe how to diagnos pheochromocytoma - Answer 24 hour urine collection or an MRI/CT to visualize the tumor what is treatment for pheochromocytoma - Answer -surgical resection (physical manipulation of the tumor can cause a large release of catecholamine) -hypertensive crisis -coronary vasospasm -cerebral vasospasm describe the glucocortidoids (cortisol) - Answer -aid in regulating the metabolic functions of the body -inflammatory control -essential for survival in stress situations describe primary adrenal cortical insufficiency - Answer -any disease that causes direct injury to adrenal cortex -cortisol levels are LOW -ACTH levels are high because of lack of feedback inhibition what is Addison's disease - Answer -autoimmune process causing adrenal cortical insufficiency -classic example of primary adrenal cortical insufficiency describe secondary adrenal cortical insufficiency - Answer -occurs as a result of hypopituitarism or because pituitary gland has been removed -acute adrenal crisis what are the signs and symptoms of Addison's disease - Answer - hyperpigmentation -anorexia and weight loss -fatigue and muscle weakness -GI disturbances -myalgia, arthralgia, abdominal pain -orthostatic hypotension -hyponatremia -hyperkalemia how do you treat Addison's disease - Answer glucocorticoid therapy (hydrocortisone) how do you diagnose Addison's disease - Answer ACTH stimulation test what is Addisonian Crisis - Answer -endocrinologic emergency with a high mortality rate secondary to physiological derangements from an acute deficiency of cortisol -occurs in pt with adrenal insufficiency pts with Addisonian crisis usually have undergone what? - Answer an acute stress event what is Cushing's syndrome - Answer constellation of symptoms related to excess cortisol describe exogenous Cushing's syndrome - Answer -most common cause is exogenous iantrogenic corticosteroid prescription -chronic steroid use is an effective treatment for many auto immune conditions and anti inflammatory disorders describe endogenous Cushing's syndrome - Answer -ACTH producing tumors (pituitary, adrenal, ectopic) -Cushing's Disease: ACTH dependent cortisol excess due to a pituitary adenoma -Cushing's disease is responsible for 80% of spontaneous endogenous Cushing syndrome what are the signs and symptoms of Cushing's syndrome - Answer - altered fat metabolism -muscle weakness -muscle wasting -purple stirae (stretch marks) -osteoporosis -derangement in glucose metabolism -hypokalemia -gastric acid secretion -hirsutism, mild acne, and menstrual irregularities what is dwarfism and how is it related to HGH? - Answer failure to attain normal adult stature from childhood; hyposecretion of HGH what is giantism and how does it relate to HGH? - Answer development of abnormally large stature from childhood .. hyper secretion before epiphyseal closure ... high HGH what is acromegaly and how does it relate to HGH - Answer gradual enlargement of flat bones, hands, feet, nose, lips, brow, tongue, and abdominal organs in adult hood ... hyper secretion of HGH after epiphyseal closure ... high HGH what are the cells involved in producing pancreatic digestive enzymes - Answer exocrine acini describe islets of langerhans in the pancreas - Answer pockets of endocrine tissues that secrete multiple hormones describe the function of exocrine acinus of the pancreas - Answer secretes digestive enzymes through ducts that pass into small intestine and break down ingested food what are the different pancreatic peptides - Answer lipase, amylase, protease describe the role of lipase - Answer works with bile to break down fats what are different causes of DM - Answer -abnormal insulin production (type 1) -impaired insulin use (type 2) -combination of both both type 1 and type 2 diabetes can make a person _________ - Answer hyperglycemic what classifies as pre diabetes - Answer hyperglycemia that does not meet the criteria for DM what classifies as type 1 DM - Answer -insufficient insulin production -autoimmune destruction of pancreatic beta cells -frequently leads to absolute insulin loss -idiopathic what classifies as type 2 DM - Answer -insulin resistance of the receptors to insulin -chronically will have decline in pancreatic beta cell secretion of insulin what classifies as gestational DM - Answer impaired glucose regulation during pregnancy what percent of the population has DM? of this percent, what percent has type 2 diabetes? - Answer 10% 90% of these cases are type 2 describe the ranges for fasting blood glucose and how they relate to diabetes - Answer 70-100 = normal 100-125 = impaired over 126 = diabetes describe different findings for random (casual) blood glucose tests - Answer > 200 = diabetes -will rise after eating, but will normally return to <180 within 2 hours what would diabetic HA1C levels be for diabetes - Answer > 6.5% what is glucose tolerance testing for DM - Answer -done during pregnancy -give a person glucola -2 hours post loa - glucose > 200 = potential diabetes what is glycosylated hemoglobin testing - Answer -percent of hemoglobin in blood that has glucose attached to it -reflects a 3 month average glucose level what are the different ranges for HA1C and how do they relate to diabetes? - Answer normal = 4-6% type 2 DM = 6.5% <7% = recommended in diabetes what is a typical pattern of blood sugar checks - Answer -upon arising in the morning -immediately before each meal -two hours after a meal -before bed at night describe type 1 DM. what does it require? - Answer -idiopathic or auto immune destruction of beta cells in the pancreas resulting in absent or low insulin -still have high circulating levels of glucose -requires exogenous insulin describe the incidence of type 1 DM - Answer age 4-6 age 10-14 what are the three classic symptoms of type 1 DM - Answer -polyuria -polydispia (drinking all the time) -polyphagia (eating all the time) what percent of the population over the age of 65 have type 2 DM? - Answer 25% describe who type 2 DM is seen in - Answer -most commonly in people over the age of 45 -increasingly seen in children, adolescents, and younger adults due to rising levels of obesity, physical inactivity, and energy dense diets what is the first-best, long term treatment for type 2 DM? - Answer diet, weight loss, and exercise describe insulin resistance seen in type 2 DM - Answer -initially a lack of functional receptors on somatic cells, which leads to decreased cellular response to insulin -hyperglycemia despite availability of insulin -later, insulin is ineffective and is countered by an increase of insulin production to maintain glucose homeostasis, which leads to burn out of beta cells, which decreases insulin production is type 2 DM treated with insulin? - Answer no. it is treated with oral medications that modify the body's ability to process glucose what are risk factors for type 2 DM - Answer metabolic syndrome describe the onset of type 2 DM - Answer -gradual -hyperglycemia may be undetected for years -often discovered with routine blood work -at time of diagnosis, 50-80% of beta cells are no longer secreting insulin -average time a person has had DM before diagnosis is 6.5 years what are the manifestations of type 2 DM - Answer -nonspecific -fatigue -recurrent infections (UTI, candida infections) -prolonged wound healing -visual problems what is metabolic syndrome? what does it increase the likelihood of - Answer -caused by obesity and lack of physical exercise -increases likelihood of type 2 DM & microvascular complications what are medications for type 2 DM - Answer -oral hypoglycemic agents -Metformin is most common what are risk factors for gestational diabetes - Answer -family history of DM -glycosuria -large of heavy for date infant -obesity -GI motility (gastroparesis) -autonomic dysfunction (postural hypotension) 30-60% of males with diabetes have - Answer impotence what is the leading cause of end stage renal failure - Answer diabetic nephropathies from untreated hyperglycemia what is the leading cause of acquired blindness in the US - Answer diabetes from retinopathies what are examples of macrovascular complications from untreated hypertension? give associated statistics. - Answer -CAD, CV disease -cerebrovascular disease, TIA/CVA -PVD, limb ischemia, poor wound healing -risk if two to four times higher in diabetics -50-75% of type 2 diabetics will die from a macrovascular complication (MI, CVA) describe diabetic foot ulcers in DM - Answer -accounts for >50% of surgical amputations (non traumatic) of lower extremities -diabetic neuropathy causes pts to be unable to feel pain of repetitive trauma -peripheral vascular disease leads to inadequate circulation leading to slow wound healing describe hypoglycemia and how it relates to DM - Answer -blood glucose less than 45-60 -most common in type 1 (rare in type 2) -rapid onset of manifestations reflect glucose needs of the nervous system -treat with concentrated sugar or glucagon what are the symptoms of low hypoglycemia (<70) - Answer -increased HR -headache -shakiness -anxiety -diaphoresis (cold skin) -hunger -irritability what are the symptoms of very low hypoglycemia (<55) - Answer - confusion -seizures -loss of consciousness in general , symptomatic hypoglycemia is uncommon in ___________ - Answer non diabetics it can often be difficult to discern diabetic presentation of _______ v ________ - Answer hyperglycemia v hypoglycemia what is diabetes insipidus - Answer -decreased release or decreased response to ADH (often resulting from a tumor, trauma, or surgery on hypothalamus or pituitary) -can cause electrolyte imbalances -body is unable to regulate fluids what are symptoms of diabetes insipidus - Answer extreme thirst & excessive urination of extremely dilute urine