Midterm Road Map PDF

**MIDTERM ROAD MAP\ \ There will be 50 questions for a total of 85 points. You'll have 2 hours to complete (plenty of time!). The questions will consist of multiple choice, select all that apply, T/F, and one short answer.\ ** Genetic Terms such as aneuploidy, euploid, genotype, genetics Aneuploid...

**MIDTERM ROAD MAP\ \ There will be 50 questions for a total of 85 points. You'll have 2 hours to complete (plenty of time!). The questions will consist of multiple choice, select all that apply, T/F, and one short answer.\ ** Genetic Terms such as aneuploidy, euploid, genotype, genetics Aneuploidy:: condition in which the number of chromosomes iis not ex exact multiple (down syndrome) Euploid: in which the numbers are the same, think EUPLOID\= 20 OR a decrease in DBP of \>=10 within 3 minutes of laying/sitting\ \-\--S/S dizziness, blurring/loss of vision, syncope (fainting) \- Preload: volume of blood returning to the heart from the veins\ - Afterload: arterial pressure that the left ventricle must pump against during each contraction\ - Thromboembolism: a nonmobilized blood clot\ - Embolus: a mobilized bolus of some kind of matter\ - Atherosclerosis: plaque formaton in artieries \#1 cause of arteriosclerosis: thickening of arterial walls How does one assess for orthostatic hypotension? By doing orthostatic blood pressures THROMBUS: stationary blood clot EMBOLUS: mobilized bolus of some kind of matter What are the risk factors for the development of atherosclerosis? -smoking, hypertension, diabetes, increased LDL, decreased HDL, autoimmunity What is the pathophysiology of Superior Vena Cava syndrome? ads to venous distention in upper extremities and head.\ -All the blood gets backed up from a compression of the vein that returns blood from the upper body back to the right atrium of the heart.\ -Causes swelling and redness/purpleness of the face and arms.\ causes: cancer, pacemaker wires, central venous cath What is the pathophysiology of coronary artery disease? Common causes? Reduced blood supply to the heart due to atherosclerosis. Primary cause of heart disease in the US. Risk factors include advanced age, male gender, family history, dyslipidemia, hypertension, smoking, diabetes, obesity, sedentary lifestyle, and atherogenic diet. Know the different types of angina (stable, unstable, variant) What makes them worse/better? - Stable Angina: recurrent predictable chest pain caused by chronic coronary obstruction; occurs during exertion or stress (starts with exertion) "STABLE" Relieved by rest or sublingual nitroglycerine Unstable Angina: "UNSTABLE" unpredictable (high risk for MI) - Variant Angina: ***[Variant Angina]** (Prinzmetal):* unpredictable chest pain caused by abnormal vasospasm of coronary arteries; can occur at rest - Often relieved by medications that prevent arterial spasms Difference between NSTEMI and STEMI- how do we know if a patient is having one over the\ other? What cardiac-specific labs do we draw to assess for an MI? Labs: Troponin NSTMI: partial blockage STEMI: complete blockage Valvular stenosis vs Valvular regurgitation- What is physically happening with each and where is\ blood moving abnormally? What would we hear? Valvular Stenosis: The valve is too narrow, and blood has difficulty moving **forward**. You'll hear a **harsh, turbulent murmur** as blood is forced through the tight opening. Valvular Regurgitation: **Valvular regurgitation**: The valve doesn't close properly, so blood leaks **backward**. You'll hear a **blowing, \"whooshing\" murmur** from the backflow of blood. Left-sided vs Right-sided heart failure- compare and contrast the symptoms (for example, is dyspnea seen in a patient with Left-sided, Right-sided HF, or both?) **Left-sided heart failure** and **right-sided heart failure** each affect different parts of the circulatory system, leading to distinct symptom patterns, though there is some overlap. Here\'s a comparison of the symptoms associated with each type: **1) Left-Sided Heart Failure** - **Mechanism**: In left-sided heart failure, the **left ventricle** cannot effectively pump blood to the systemic circulation. This leads to blood backing up into the **lungs**, causing pulmonary congestion and respiratory symptoms. - **Types**: - **Systolic heart failure (HFrEF)**: The left ventricle cannot contract well, leading to reduced ejection fraction. - **Diastolic heart failure (HFpEF)**: The left ventricle cannot relax properly and fill with enough blood. - **Symptoms**: - **Dyspnea (shortness of breath)**: - Most commonly associated with **left-sided heart failure**. - Occurs due to fluid buildup in the lungs (pulmonary edema), making it harder to breathe, especially during exertion or while lying down (orthopnea). - **Orthopnea**: Difficulty breathing while lying flat, relieved by sitting up. - **Paroxysmal nocturnal dyspnea (PND)**: Sudden nighttime episodes of shortness of breath, often causing the patient to wake up gasping for air. - **Pulmonary congestion**: Symptoms such as wheezing, coughing, and crackles (rales) heard on lung auscultation due to fluid accumulation in the lungs. - **Fatigue and weakness**: Reduced blood flow to the body means that tissues and organs don\'t receive enough oxygen and nutrients. - **Cyanosis**: A bluish tint to the skin, lips, or fingertips due to poor oxygenation. - **S3 heart sound** (ventricular gallop): An abnormal heart sound due to rapid filling of the left ventricle in systolic heart failure (HFrEF). - **Nocturia**: Increased urination at night due to improved renal perfusion when lying down. **2) Right-Sided Heart Failure** - **Mechanism**: In right-sided heart failure, the **right ventricle** cannot effectively pump blood to the lungs. This causes blood to back up in the **systemic venous circulation**, leading to fluid buildup in the body. - **Primary cause**: Often a consequence of left-sided heart failure, as increased pressure from the lungs due to pulmonary congestion strains the right side of the heart. It can also be caused by conditions like pulmonary hypertension or right ventricular myocardial infarction. - **Symptoms**: 1. **Peripheral edema**: - **Swelling in the legs, ankles, and feet**, caused by fluid buildup in the tissues. This occurs because blood backs up into the systemic veins. 2. **Ascites**: Accumulation of fluid in the abdomen, leading to abdominal swelling and discomfort. 3. **Hepatomegaly**: Enlargement of the liver due to congestion of the hepatic veins, which can cause right upper quadrant pain. 4. **Jugular venous distension (JVD)**: Visible bulging of the jugular veins in the neck due to increased venous pressure. 5. **Weight gain**: Due to fluid retention (edema). 6. **Anorexia and nausea**: Caused by congestion in the gastrointestinal tract. 7. **Fatigue**: Reduced blood flow to muscles and tissues, leading to tiredness and weakness. 8. **Nocturia**: Increased urination at night due to fluid shifts when lying down. **Comparison of Symptoms** **Symptom** **Left-Sided Heart Failure (LHF)** **Right-Sided Heart Failure (RHF)** ----------------------------------- --------------------------------------------------------------- ----------------------------------------------- **Dyspnea (shortness of breath)** Very common, especially on exertion or lying flat (orthopnea) Can occur, especially if RHF follows LHF **Pulmonary congestion** Yes (fluid backs up into lungs) No (fluid backs up into systemic circulation) **Peripheral edema** Not typical in isolated LHF Very common (legs, ankles, feet) **Ascites (abdominal swelling)** Rare Common **Jugular venous distension** Uncommon in isolated LHF Common **Hepatomegaly** Rare Common **Fatigue** Common (due to poor systemic circulation) Common **Nocturia** Common Common **Weight gain (fluid retention)** Can occur, especially in severe LHF Common **Can Dyspnea Occur in Both Left-Sided and Right-Sided Heart Failure?** - **Yes**, dyspnea is most commonly associated with **left-sided heart failure** because of the fluid buildup in the lungs. However, patients with **right-sided heart failure** may also experience dyspnea, particularly if the right-sided failure is a result of left-sided heart failure (which is common). In pure right-sided heart failure (e.g., due to pulmonary hypertension or cor pulmonale), dyspnea may be less pronounced unless there is coexisting lung disease. **Overlap of Symptoms:** - **Left-sided heart failure** often leads to **right-sided heart failure** because the fluid buildup in the lungs increases pressure on the right ventricle. When both sides are affected, patients may exhibit a combination of symptoms, including **pulmonary symptoms (dyspnea, orthopnea)** from left-sided failure and **systemic congestion (edema, ascites)** from right-sided failure. Left Sided Heart Failure: Paroxysmal nocturnal dyspnea Orthopnea Crackles heard in the lungs Right Sided Heart Failure: jugular venous distension (JVD) Severe leg edema Hepatomegaly Both: Edema Renal Injury Systolic vs diastolic heart failure- what is specifically "failing" in both? Systolic heart failure: left ventricle fails, low EF The heart FAILS to PUMP Diastolic: left ventricle is still The heart FAILS to FILL Know the different kinds of anemias covered in class- what are the causes, what are the signs\ and symptoms, and what is seen in blood smears to diagnose each. Macrocytic/Normochromic: Pernicious anemia, folate. Deficiency anemia Microcytic/Hypochromic: Iron deficiency anemia, sideroblastic anemia Normocytic/Normochromic: Sickle cell anemia, aplastic anemia, posthemorrhagic anemia Iron Deficiency Anemia: - Insufficient iron impairs hemoglobin synthesis. - Microcytic, hypochromic RBCs - Result of low hemoglobin concentration in cells - Very common - Ranges from mild to severe - Occurs in all age groups, but more common in women of childbearing age - Estimated that one in five women is affected - Proportion increases for pregnant women - Frequently a sign of an underlying problem Pernicious Anemia: Vitamin B 12 deficiency - The basic problem is the lack of absorption of B12 due to a lack of intrinsic factors. - Intrinsic factor secreted by gastric mucosa - Required for intestinal absorption of B~12~ - Characterized by very large, immature, nucleated erythrocytes (Macrocytic-normochromic) - Carry less hemoglobin - Shorter lifespan 218-391-5018 What causes DIC? - Excessive clotting in circulation - Thrombi and infarcts occur - Clotting factors are reduced to dangerous level. - Widespread, uncontrollable hemorrhage results. - Very poor prognosis with a high fatality rate - Complication of many primary problems - Infections- SEPSIS - Obstetric complications, e.g., abruptio placentae - Carcinomas - Major trauma Define shock\ What are the signs and symptoms of someone in septic shock? -shivering, extreme pain, pale skin sleepy/confused, impending doom, shortness of breath What is the most common cause of MODS? - Sepsis is primary cause - Diagnosed when a 2^nd^ organ system shows signs of failing - Hypoperfusion to organs caused by: - Shock/ extensive vasodilation - Clot formation - Lack of perfusion leads to cell injury and death