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on 19-Apr-2016 (Tue)

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Flashcard 1332566691084

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#exam #nephrology
Question
What are causes of renal artery stenosis?
Answer
  • athrosclerosis
  • ​fibromuscular dysplasia


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Flashcard 1333262683404

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#exam #nephrology
Question
What triggers ADH release?
Answer
• Hypernatremia (osmotic stimulus)
• Non‐osmotic stimuli (inapproriate)
– Low volume states: real or “effective”
– Stress states: surgery, pain
– SIADH states: cancers, drugs, brain or respiratory disease
– Other states: Pregnancy, low cortisol, low thyroid


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Flashcard 1333273955596

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#exam #nephrology
Question
hyponatremia rx
Answer
• Restrict fluid/water intake
• Remove underlying cause (ADH)
• If acute and symptomatic → rapid partial correction to reduce cerebral edema (can use hypertonic saline)
• If chronic and severe (<120 mmol/L ) treat slowly as rapid correction can cause devastating brain injury


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Flashcard 1333290470668

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#exam #nephrology
Question
hyperkalemia s&s
Answer
• Muscle weakness, stiffness (cells are depolarized)
• ECG changes:
– Small or absent P waves
– Broad QRS
– Peaked T‐waves

• Arrhythmias
[K+] > 7.0 mmol is life‐threatening


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Flashcard 1333309869324

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#exam #nephrology
Question
met acid causes w/ ↑ AG
Answer
**• Lactic acidosis
• Ketoacidosis

--diabetic
--alcoholic
--starvation
• Toxins
– Methanol
– Ethylene glycol
– Salicylates
• Severe chronic kidney disease**


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Flashcard 1333336870156

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#exam #nephrology
Question
What is nephrotic syndrome a constellation of?
Answer
Constellation of:
Hypoalbuminemia
Edema
Lipiduria and Hypercholesterolemia

Proteinuria > 3.5 g/day

Typical Pathology:
• Non‐proliferative Disease (structural abn - glomerulonephropathy)

Nephrotic Syndrome can ONLY be caused by a glomerular disease

No RBC cast


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Flashcard 1334165507340

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Question
What is the approach to edema?
Answer
edema = Alterations in Starling (hydrostatic & oncotic) forces:
Increased hydrostatic pressure (Na+ retention)
• Heart failure
• Drugs: Eg. CCBs, NSAIDs, Thiazolidinediones, Minoxidil
Decreased oncotic pressure (hypoalbuminemia)
• Protein loss: nephrotic syndrome, protein losing enteropathy
• Reduced albumin synthesis: liver disease
Increased capillary permeability
• Diabetes
• Malnutrition

Approach: hx, p/e, labs, investigations


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Flashcard 1334171274508

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#exam #nephrology
Question
What is going on pathologically with nephrotic syndrome?
Answer
it's a non-proliferative injury to the glomerular basement membrane that causes significant protein (albumin) leakage into the urine


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Flashcard 1334175730956

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#nephrology
Question
How do you measure urine protein excretion?
Answer
Screening: (qualitative test)
• Urine dipstick

Quantitative:
• Albumin to Creatinine ratio (ACR)
--Spot sample (First morning specimens most accurate)
• 24 hour urine collection
--gold standard
--Normal value < 150 mg protein excreted per day


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Flashcard 1334177565964

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#nephrology
Question
How does proteinuria cause edema?
Answer
• Hypoalbuminemia → increased water and salt retention
--↓ oncotic pressure results in volume depletion, ↓ CO
--activation of RAAS

• Primary defect in the collecting tubule → uncontrolled water and salt retention


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Flashcard 1334179400972

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#nephrology
Question
What is the possible mechanism of hypoalbuminemia in nephrotic syndrome?
Answer
--Proteinuria
--not enough replacement from liver synthesis ← TNF & IL-1 may directly suppress hepatic synthesis


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Flashcard 1334181235980

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#nephrology
Question
What is the mechanism for hyperlipidemia/lipiduria in nephrotic syndrome?
Answer
• Hepatic lipoprotein synthesis stimulated by decreased oncotic pressure
• Further exacerbated by impaired metabolism and diminished clearance
• Increased risk of atherosclerosis and cardiovascular disease


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Flashcard 1334183070988

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#exam #nephrology
Question
Urinalysis of patient with nephrotic syndrome shows [...] and [...]
Answer
Oval fat bodies
fatty casts


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Flashcard 1334184905996

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#exam #nephrology
Question
Urinalysis under polarized light of patient with nephrotic syndrome shows [...] with [...] appearance
Answer
Oval fat bodies
Maltese cross


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Flashcard 1334186741004

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Question
What are other features of nephrotic syndrome?
Answer
Hypercoaguable state due to increased urinary loss of anticoagulants antithrombin III, protein C and protein S
• Increased risk of venous thromboembolism Eg. DVT, PE
• 30% of patients have renal vein thrombosis

NB: always be on lookout for these in pt w/ nephrotic syndrome


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Flashcard 1334188576012

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#exam #nephrology
Question
What are the causes of nephrotic syndrome?
Answer
3 pathologic causes: (can be primary/secondary to an underlying ds)
--minimal change
--focal segmental glomerulosclerosis (FSGS)
--membranous

2 secondary causes:
--DM
--amyloid/multiple myeloma


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Flashcard 1334190411020

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#nephrology
Question
Minimal change disease is the most common cause of [what condition] in [who]
Answer
nephrotic syndrome
children


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Flashcard 1334192246028

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#exam #nephrology
Question
What are the main secondary causes of minimal change ds?
Answer
– NSAIDs
– Hodgkin lymphoma


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Flashcard 1334194343180

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#nephrology
Question
What can you see on pathology of minimal change ds?
Answer
No difference in appearance from normal glomerulus on light microscopy


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Flashcard 1334196178188

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#nephrology
Question
FSGS has worse response to [...] and [...] compared to minimal change and membranous ds
Answer
FSGS has worse response to treatment and poorer prognosis compared to minimal change and membranous ds


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Flashcard 1334198013196

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#nephrology
Question
FSGS has worse response to treatment and poorer prognosis compared to [...] and [...]
Answer
FSGS has worse response to treatment and poorer prognosis compared to minimal change and membranous ds


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Flashcard 1334199848204

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#nephrology
Question
What do you see on pathology of FSGS?
Answer
Presence of mesangial collapse and sclerosis in some glomeruli (focal) segmental areas


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Flashcard 1334201683212

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#nephrology
Question
[...] is the most common cause of nephrotic syndrome in adults
Answer
Membranous ds


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Flashcard 1334203518220

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#nephrology
Question
What are the main secondary causes of membranous ds?
Answer
Malignancy – usually solid tumors Eg. breast, colon
Autoimmune – SLE
Infections – Hep B, Hep C, malaria, syphilis
Drugs – Gold, penicillamine


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Flashcard 1334205615372

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#nephrology
Question
What's observed in membranous nephropathy pathology?
Answer
Membranous nephropathy characterized by basement membrane thickening with little or no cellular proliferation on light microscopy


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Flashcard 1334207450380

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#nephrology
Question
[...] is the most common cause of secondary nephrotic syndrome in adults
Answer
DM is the most common cause of secondary nephrotic syndrome in adults


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Flashcard 1334209285388

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#nephrology
Question
DM is the most common cause of [...] in adults
Answer
DM is the most common cause of secondary nephrotic syndrome in adults


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Flashcard 1334211120396

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#exam #nephrology
Question
What are the risk factors of DM?
(which can cause nephrotic syndrome)
Answer
– Uncontrolled hyperglycemia
– Hypertension
– Proteinuria
– Smoking
– Dyslipidemia
– Genetic predisposition


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Flashcard 1334212955404

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#nephrology
Question
What is the characteristic kidney bx finding in diabetic nephropathy?
Answer
Kimmelsteil‐Wilson nodules


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Flashcard 1334214790412

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#exam #nephrology
Question
What is the rx for nephrotic syndrome?
Answer
Step 1: Treat Symptoms
• Salt restriction and diuretics for edema
• ACEi /ARBs to decrease proteinuria
Statins for increased cholesterol
• Anticoagulation, if thromboembolism

Step 2: Treat pathological disease
• If secondary process found, treat accordingly
• Otherwise, immunosuppressive medications if indicated: (in truly primary cases)
--Corticosteroids (prednisone) + Other immunotherapy (some other agent)


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Flashcard 1334216625420

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#exam #nephrology
Question
What are clues that the renal parenchymal disease is tubulointerstitial?
Answer
WBCs and WBC casts in the urine
– Variable degree of proteinuria, but usually < 1.5 g
– Evidence of renal tubular dysfunction Eg.hyperkalemia, renal tubular acidosis


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Flashcard 1334218722572

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#nephrology
Question
What are acute tubulointerstitial diseases?
Answer
• Acute allergic interstitial nephritis (Eg. to a drug)
• Acute tubular necrosis


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Flashcard 1334220557580

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#nephrology
Question
What are chronic tubulointerstitial diseases?
Answer
• Drugs: – Analgesic nephropathy, NSAIDs, Lithium, chemotherapy, antiretrovirals, Chinese herbs
• Chronic obstruction/infection/reflux/stones
• Autoimmune: – Sjogren’s syndrome, sarcoidosis
• Cystic diseases: – Most common, polycystic kidney disease


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Flashcard 1334222392588

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#nephrology
Question
What is polycystic kidney ds?
Answer
• Progressive cyst growth and enlargement
• Can lead to hypertension, chronic kidney disease
• Cysts can also bleed, rupture or become infected


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Flashcard 1334224227596

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Question
What are extrarenal manifestations of polycystic kidney ds?
Answer
• Cerebral aneurysms
• Cysts in other organs: liver, pancreas
• Valvular heart disease:
– Mitral valve prolapse and aortic regurgitation most common
• Diverticulosis of colon
• Hernia formation (d/t ↑ intra-abdo pressure)


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Flashcard 1334228946188

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#exam #nephrology
Question
What are vascular kidney diseases?
Answer
Arteries → renal artery stenosis (atherosclerosis, fibromuscular dysplasia)
Arterioles → atheroembolic ds
Capillaries → thrombotic microangiopathies (thrombotic thrombocytopenic purpura, hemolytic uremic syndrome)
Veins → thrombosis


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Flashcard 1334230781196

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Question
How do you classify causes of nephrotic syndrome in peds?
Answer
First year of life (often genetic)
– Primary
– Secondary
Older children and adolescents
– Primary
– Secondary


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Flashcard 1334232616204

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#nephrology
Question
What are causes of nephrotic syndrome in the first year of life?
Answer
• Primary
– Congenital nephrotic syndrome of the Finnish type (mutation in nephrin gene)
– Mesangial sclerosis (mutation in WT1 gene)
– Associated with other genetic syndromes (multiple gene mutations)
– Minimal change disease after 6 months
• Secondary
– Congenital infections


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Flashcard 1334234451212

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#nephrology
Question
What are causes of nephrotic syndrome after the first year of life?
Answer
Primary
– Minimal Change Disease
– Focal Segmental Glomerulosclerosis (some associated with genetic mutations)
– Membranous Nephropathy
– (membranoproliferative glomerulonephritis - nephrotic/nephritic)

Secondary
– Systemic Lupus Erythematosus
– Drugs
– Infections : HIV, malaria
– Lymphomas/leukemias
– Genetic syndrome


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Flashcard 1334236286220

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#exam #nephrology
Question
What do you do in an older child/adolescent presenting with minimal change ds nephrotic syndrome?
Answer
If presents w/ typical ft's, start w/ steroid therapy (also allows for specific dx based on response) and don't bx right away

unless has other atypical ft's: (indication for bx) - suggesting non-idiopathic MCNS
--age <1 y or >12y
--+ve fhx
--extrarenal ds (arthritis, rash, anemia)
--chr ds
--sx's d/t intravascular volume expansion (HTN, pulm edema)
--renal failure
--active urine sediment (red blood cell casts
)


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Flashcard 1334238121228

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#nephrology
Question
What is the initial rx for minimal change neprhotic syndrome (peds)?
Answer
– Prednisone therapy: 60 mg/m2/day with taper over 3-4 months
– Control of Edema
– Low salt diet

Response
– Usually in 2 weeks
– 95% will respond in 4 weeks


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Flashcard 1334239956236

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Question
What is the rx of relapses for minimal change nephrotic syndrome (peds)?
Answer
– High dose Prednisone again
– Second line drugs if multiple relapses
• Cyclophosphamide, cyclosporine, tacrolimus, mycophenolate mofetil, rituximab (all have s/e)


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Flashcard 1334241791244

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Question
What are complications of therapy for minimal change nephrotic syndrome in kids?
Answer
steroids, cytotoxic drugs, diuretics, etc

NB: what it said in the notes; not sure if means these cause complications


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Flashcard 1334243626252

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Question
Children with minimal change nephrotic syndrome often have [...] @ puberty w/ [...]
Answer
long term remission
normal renal function


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Flashcard 1334245461260

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#nephrology
Question
What are causes of glomerulonephritis in children?
Answer
Hypocomplementemic (low C3)
– Primary renal disease
  • post infectious glomerulonephritis (post strep GN most common)
  • membranoproliferative glomerulonephritis
  • C3 nephropathy
– Systemic disease
  • SLE (main)
  • shunt nephritis
  • sub acute bacterial endocarditis

Normocomplementemic (normal C3)
– Primary renal disease
  • IgA nephropathy
  • ANCA + pauci immune GN
– Systemic disease
  • ANCA + ds (GPA granulomatosis w/ polyangiitis, MPA microscopic polyangiitis)
  • Anti GBM ds (goodpasture ds)
  • Henoch Schonlein Purpura

NB: so check for C3 in labs


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Flashcard 1334247296268

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Question
What are ft's of post-infectious GN in kids?
Answer
• Evidence of previous infection
– Post Strep is most common
• Nephritic syndrome
• Low C3


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Flashcard 1334250441996

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#nephrology
Question
What can cause post strep GN in kids?
Answer
• Strep pharyngitis
– nephritogenic strain
– may be seasonal
– occurs 10-14 days following infection

• Impetigo (skin infection)
– nephritogenic strain
– more frequent in temperate climate
– occurs up to 3 weeks following infection


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Flashcard 1334252277004

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Question
Post Strep Glomerulonephritis Pathology
Answer
proliferative GN w/ PMNs

C3 deposits on immunofluorescence


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Flashcard 1334254112012

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Question
What are the presentations of post strep GN (peds)?
Answer
– Gross hematuria described as tea coloured or coke like urine
– Mild to moderate edema
– Mild to severe hypertension
– Mild to moderate renal dysfunction
– Hyperkaliemia
– Urinalysis: protein and blood and casts


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Flashcard 1334255947020

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Question
What is the rx for post strep GN (peds)?
Answer
• Conservative Treatment of renal failure
– Fluid Restriction
– Potassium restriction
– Phosphate restriction
• Antihypertensives
• Diuretics
• Not an indication for steroids (will usually start to improve w/i a week)


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Flashcard 1334257782028

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Question
Post Strep Glomerulonephritis Outcome
Answer
• C3 back to normal by 6-8 weeks
– if persistent hypocomplementemia past 8 weeks consider other diseases
• Spontaneous recovery in more than 95% of children
• No recurrence

=excellent outcome


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Flashcard 1334259617036

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Question
What are the 2 major forms of hemolytic uremic syndrome?
Answer
– Typical or Diarrhea positive HUS
• Usually caused by shiga toxin producing E Coli or shigella bacteria
• Most common is E Coli 0157:H7
• Over 90% of cases of HUS in children
– Atypical HUS
• Genetic abnormalities of Complement (treatment with Eculizumab)
• Genetic abnormality DKGE
• Other infections (pneumoccoccus)


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Flashcard 1334261452044

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Question
What is typical hemolytic uremic syndrome? What is the classic triad observed?
Answer
• HUS is a disease of younger children presenting with acute kidney injury
• Classic triad
– Microangiopathic hemolytic anemia (
anemia can be very severe & transfusions are freq needed)
– Thrombocytopenia
(severe w/ very low counts - risk of bleeding)
– Acute Kidney Injury (
variable severity from abn urinalysis alone to oligoanuria)
• One of the main causes of acute kidney injury in children <3 years of age


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Flashcard 1334263287052

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Question
What are sources of infection of e.coli in diarrhea positive HUS?
Answer
– Ground beef
– Bovine contact
– Unpasteurized milk
– Unpasteurized apple cider
– Some vegetables
– Daycare centres and person/person contacts
– Swimming water


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Flashcard 1334265122060

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Question
What is the clinical presentation of HUS (peds)?
Answer
• Prodromal episode of vomiting, followed by bloody diarrhea and abdominal pain
• Later simultaneous occurrence of microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury


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Flashcard 1334266957068

Tags
#exam #nephrology
Question
What is the prevention of HUS?
Answer
• Prevention of risk of infection
– No unpasteurized milk
– Safe water testing practices
– Well cooked hamburgers
– Public Health surveillance of meat
• Once infection has occurred, no successful treatment to prevent progression to HUS


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Flashcard 1334268792076

Tags
#exam #nephrology
Question
What is the pathogenesis of HUS?
Answer
Damage to endothelial cells by the TOXIN is the primary event in the pathogenesis of hemolytic-uremic syndrome → narrowed lumen, thrombus, expanded subendothelial zone (TMA capillary)
• Pathology: the cardinal lesion is composed of arteriolar and capillary microthrombi (thrombotic microangiopathy [TMA]) and red blood cell (RBC) fragmentation

• Kidney: affects glomerular capillaries and small arterioles
• Can occur in other organ capillaries


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Flashcard 1334271675660

Tags
#nephrology
Question
HUS rx
Answer
• Symptomatic therapy
– Acute Kidney injury : dialysis when needed
– Blood transfusions for severe anemia
– Platelet transfusions if bleeding or in need of surgical procedure
– Treatment of other organ involvement

• No Specific Therapy
– No evidence to support plasma transfusion/exchange in diarrhea positive HUS
– No definite evidence to support Eculizumab therapy


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Flashcard 1334273510668

Tags
#nephrology
Question
HUS outcome
Answer
death to complete recovery (varies)


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Flashcard 1334275345676

Tags
#exam #nephrology
Question
What are the types of diuretics?
Answer
• Loop diuretics (block NaK2Cl channels)
– Furosemide, bumetanide, torsemide, ethacrynic acid
• Thiazide diuretics (block NaCl cotransporters)
– Hydrochlorothiazide, chlorthalidone, indapamide, metolazone
• K+ sparing diuretics (Aldosterone antagonists)
– Amiloride, triamterene (ENaC channel)
– Spironolactone (Aldosterone receptor)


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Flashcard 1334280326412

Tags
#exam #nephrology
Question
Differentiate CKD from AKI
Answer
• Hx/PEx
– Any chronic diseases
– Any systemic features of acute GN
– Any new medications (recent, herbal, OTC)
– Volume status
• Labs
– Anemia
– Secondary hyperparathyroidism (Ca, PO4, PTH)
– Urinalysis (active sediment)
• Investigations
– Abdominal ultrasound


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Flashcard 1334286617868

Tags
#cardiology
Question
Cardiac myocytes form a branching network joined at [...]
Answer
intercalated disks
NB: this is where signal for contraction goes through, allowing for synchronized contraction throughout the heart


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Flashcard 1334288452876

Tags
#cardiology
Question
Action potential spreads through the conduction system to the [...] and [...] (myocardial depolarization)
Answer
sarcolemma
T-tubules


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Flashcard 1334290287884

Tags
#cardiology
Question
Troponin binds to tropomyosin which inhibits [...] from binding to the [...] filament
Answer
myosin
actin


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Flashcard 1334292122892

Tags
#cardiology
Question
[...] are primary fuel source of the heart
Answer
Fatty acids (triglycerides)


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Flashcard 1334294482188

Tags
#cardiology
Question
Left ventricular myocytes are arranged [in what fashion] (which allows for coordinated contraction)
Answer
circumferentially in a spiral orientation

NB: Right ventricular myocytes are less structured in organization


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Flashcard 1334296317196

Tags
#cardiology
Question
Cardiac valves are lined by [...] and have a [...] structure
Answer
endothelium
tri-layer


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Flashcard 1334298152204

Tags
#cardiology
Question
What is the tri-layer structure of cardiac valves?
Answer
 Dense collagenous core (fibrosa) along the outflow surface
--Connected to the valvular supporting structures (heart wall)

 Central core of loose connective tissue (spongiosa)

 A layer rich in elastin on the inflow surface (ventricularis or atrialis depending on which chamber it faces)
--Allows for rapid recoil and prompt closure of the valve


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Flashcard 1334299987212

Tags
#cardiology
Question
What are the points of interconnection between systemic and pulmonic circuits?
Answer
 Physiological connections (mostly in fetal life) - R to L shunts
-- Foramen Ovale
-- Ductus Arteriosus

 Pathological connections
-- Interatrial, interventricular septal defects
-- Intrapulmonary malformations (arteriovenous malformations)


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Flashcard 1334301822220

Tags
#cardiology
Question
[...] has control over SA node
Answer
Autonomic nervous system


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Flashcard 1334303657228

Tags
#cardiology
Question
myocardial depolarization:

[...] can cause disease or sudden death
e.g. Long QT Syndrome
Answer
Aberrant channel activity


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Flashcard 1334305492236

Tags
#cardiology
Question
S3 - [...] in diastole d/t [...]
S4 - [...] in diastole d/t [...]
Answer
early, blood hitting wall of ventricle when mitral valve opens

late, stiff ventricle


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Flashcard 1334307327244

Tags
#cardiology
Question
Heart and vasculature communicate with brain through [what system] helping to regulate cardiac output and vascular tone
Answer
adrenergic nervous system


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Flashcard 1334309162252

Tags
#cardiology
Question
the Sympathetics innervate [...] to increase [...]

the Parasympathetics innervate [...] via vagus nerve to decrease [...]
Answer
both atria & ventricles; HR, AV conduction, irritability of foci

atria; vagus nerve; HR, AV conduction, & irritability


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Flashcard 1334313880844

Tags
#cardiology #exam
Question
Most oxygen, nutrients delivered via [...] during [...]
Answer
coronary arteries
ventricular diastole


NB: Left main coronary artery (left anterior descending, circumflex) & Right coronary artery


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Flashcard 1334316502284

Tags
#cardiology #exam
Question
Three primary determinants of myocardial performance:
Answer
 Loading conditions (preload, afterload)
 Contractile state of myocardium
 Heart rate


NB: loading conditions & contractile state can affect stroke volume


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Flashcard 1334317813004

Tags
#cardiology
Question
What histological changes occur in the heart with aging
Answer
 Increased fibrous tissue in myocardium (increased myocardial stiffness)
 Decreased maximum cardiac output
 Deposition of extracellular amyloid in myocardium
 Increased stiffness, atherosclerosis, calcification of vasculature (aorta, coronary arteries)
 Thickening and calcification of valve cusps


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Flashcard 1334319648012

Tags
#cardiology
Question
What is the preload?
Answer
The mechanical load caused by blood on the left ventricular myocardium at the end of diastole, before contraction commences
 In essence, the degree to which the myocardium is stretched before it contracts
 Reflects the venous filling pressure


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Flashcard 1334321483020

Tags
#cardiology
Question
What is the afterload?
Answer
The load or resistance against which the left ventricular myocardium has to push in order to eject blood


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Flashcard 1334323318028

Tags
#cardiology
Question
What is Starling's law for the heart?
Answer
Stroke volume increases the more stretched the ventricle (up to a certain limit) because the ventricles will also contract harder to pump it all out


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Flashcard 1334325153036

Tags
#cardiology
Question
The heart produces [...] which induces loss of Na+ from kidneys, diuresis and vasodilatation
Answer
The heart produces atrial natriuretic peptides which induces loss of Na+ from kidneys, diuresis and vasodilatation


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Flashcard 1334326988044

Tags
#cardiology
Question
The heart produces atrial natriuretic peptides which induces [3 things]
Answer
loss of Na+ from kidneys, diuresis and vasodilatation


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Flashcard 1334328823052

Tags
#cardiology #exam
Question
The heart is essentially [...] differentiated
Answer
terminally


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Flashcard 1334330658060

Tags
#cardiology #exam
Question
Where possible the heart adapts to physiological or pathological stresses through [...] and remodelling of the myocardium present
Answer
hypertrophy
remodelling


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Flashcard 1334332493068

Tags
#cardiology #exam
Question
Damage to the heart (e.g. myocardial infarction) results in [2 things]
Answer
scarring and fibrosis

NB: Leading to Loss or reduction of normal cardiac function + Numerous possible pathological sequelae depending
on degree of injury


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Flashcard 1334334328076

Tags
#cardiology
Question
What are the mechanisms of cardiac ds?
Answer
 Congenital cardiac disease

 Common underlying mechanisms of acquired
cardiac disease
--Vascular/ischemia
--Infectious/inflammatory/autoimmune
--Tissue stress/trauma

 Uncommon underlying mechanisms of acquired
cardiac disease
-- Endocrine/Metabolic
-- Neoplasia


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Flashcard 1334336163084

Tags
#cardiology
Question
What is a cardiac myxoma?
Answer
It's a benign neoplasm that often forms in the left atrium and forms a ball that swings around and causes dmg like a wrecking ball


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Flashcard 1334337998092

Tags
#cardiology #exam
Question
What are the functional ds categories?
Answer
Cardiac disease may be classified as:
 Failure of the cardiac pump
 Obstruction to blood flow - Through the heart or To the heart
 Regurgitant blood flow (failure to maintain unidirectional blood flow)
 Shunted blood flow
 Disorders of cardiac conduction
 Rupture of the heart or major vessels


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Flashcard 1334339833100

Tags
#cardiology
Question
FAILURE OF THE CARDIAC PUMP (CONGESTIVE HEART FAILURE):
Most commonly due to [...] or may be due to stiffness of the ventricular wall preventing ventricular filling (impaired compliance)
Answer
FAILURE OF THE CARDIAC PUMP (CONGESTIVE HEART FAILURE):
Most commonly due to weak contractions of cardiac muscle (impaired contractility) or may be due to stiffness of the ventricular wall preventing ventricular filling (impaired compliance)


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Flashcard 1334341668108

Tags
#cardiology
Question
FAILURE OF THE CARDIAC PUMP (CONGESTIVE HEART FAILURE):
Most commonly due to weak contractions of cardiac muscle (impaired contractility) or may be due to [...]
Answer
FAILURE OF THE CARDIAC PUMP (CONGESTIVE HEART FAILURE):
Most commonly due to weak contractions of cardiac muscle (impaired contractility) or may be due to stiffness of the ventricular wall preventing ventricular filling (impaired compliance)


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Flashcard 1334343503116

Tags
#cardiology
Question
FAILURE OF THE CARDIAC PUMP (CONGESTIVE HEART FAILURE) is:
Often an [...] presentation for many forms of [...]
Answer
end-stage
chronic heart disease


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Flashcard 1334345338124

Tags
#cardiology
Question
The net result of FAILURE OF THE CARDIAC PUMP (CONGESTIVE HEART FAILURE) is:
Answer
reduced ability or inability to pump blood forwards
-Insufficient blood flow to meet metabolic needs of organs and tissues


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Flashcard 1334347173132

Tags
#cardiology
Question
How do physiological mechanisms act to maintain arterial pressure and organ perfusion in CHF (failure of the cardiac pump)?
Answer
 Frank-Starling Mechanism: increase in end-diastolic ventricular volume increases tension in wall and enhances contractility

 Activation of the sympathetic nervous system
- Increase heart rate
- Increase myocardial contractility

 Activation of the renin-angiotensin system

 Myocardial adaptations, including hypertrophy and ventricular remodeling


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Flashcard 1334349008140

Tags
#cardiology #exam
Question
The hypertrophied heart is vulnerable to [...]
Answer
decompensation

d/t:
 Increase in size of cardiac myocytes
 No proportional increase in capillary number!
 Oxygen consumption increased in hypertrophied heart but supply of oxygen and nutrients potentially more restricted


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Flashcard 1334350843148

Tags
#cardiology
Question
Differential Diagnosis of Cardiac Hypertrophy
Answer
Cardiomyopathic processes e.g. Hypertrophic cardiomyopathy
Volume overload processes e.g. Aortic insufficiency
Pressure overload processes e.g. Essential hypertension
Compensatory processes e.g. Atherosclerotic heart disease
Interstitial infiltrative processes e.g Amyloidosis
Storage disease processes e.g. Pompe Disease
Drugs e.g. Anabolic steroids


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Flashcard 1334352678156

Tags
#cardiology
Question
Physiological hypertrophy is:
Answer
increased size of cardiomyocytes without significant end organ damage (i.e. fibrosis)


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Flashcard 1334354513164

Tags
#cardiology
Question
Pathological hypertrophy is:
Answer
cardiomyocyte hypertrophy associated with both structural changes and molecular changes


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Flashcard 1334356348172

Tags
#cardiology
Question
Cardiac hypertrophy initially [...] but ultimately leads to [...]
Answer
decreases wall stress
decreased myocardial performance


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Flashcard 1334358183180

Tags
#cardiology
Question
What increases cardiac work? (4 things)
Answer
1) MI (regional dysfn w/ volume overload)
2) valvular ds (pressure and/or volume overload)
3) HTN (pressure overload)
4) cardiomyopathy (cellular contraction defect or myocarditis)


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Flashcard 1334360018188

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#cardiology
Question
[...] → ↑ wall stress → cell stretch → hypertrophy and/or dilatation → systolic/diastolic dysfn
Answer
↑ cardiac work → ↑ wall stress → cell stretch → hypertrophy and/or dilatation → systolic/diastolic dysfn


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Flashcard 1334361853196

Tags
#cardiology
Question
↑ cardiac work → [...] → cell stretch → hypertrophy and/or dilatation → systolic/diastolic dysfn
Answer
↑ cardiac work → ↑ wall stress → cell stretch → hypertrophy and/or dilatation → systolic/diastolic dysfn


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Flashcard 1334363688204

Tags
#cardiology
Question
↑ cardiac work → ↑ wall stress → [...] → hypertrophy and/or dilatation → systolic/diastolic dysfn
Answer
↑ cardiac work → ↑ wall stress → cell stretch → hypertrophy and/or dilatation → systolic/diastolic dysfn


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Flashcard 1334365523212

Tags
#cardiology
Question
↑ cardiac work → ↑ wall stress → cell stretch → [...] → systolic/diastolic dysfn
Answer
↑ cardiac work → ↑ wall stress → cell stretch → hypertrophy and/or dilatation → systolic/diastolic dysfn


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Flashcard 1334367358220

Tags
#cardiology
Question
↑ cardiac work → ↑ wall stress → cell stretch → hypertrophy and/or dilatation → [...]
Answer
systolic/diastolic dysfn


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Flashcard 1334369193228

Tags
#cardiology
Question
Cardiomyopathy is:
Answer
a term used to describe heart disease resulting from an abnormality in the myocardium


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Flashcard 1334371028236

Tags
#cardiology
Question
Cardiac myopathy has multiple different etiologies:
Answer
 Primary cardiomyopathies represent diseases of the myocardium itself

 Secondary cardiomyopathies are other systemic disorders that also cause damage to the myocardium (e.g. Alcoholism, infectious myocarditis, thiamine deficiency, etc.)


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Flashcard 1334372863244

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#cardiology
Question
What are the patterns of cardiomyopathy?
Answer
 Dilated cardiomyopathy (including arrhythmogenic right ventricular cardiomyopathy) - mix of genetic & acquired
 Hypertrophic cardiomyopathy - usually genetic (beta myosin chain)
 Restrictive cardiomyopathy - usually acquired (something causing stiffening of myocardium e.g. amyloid)


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Flashcard 1334374698252

Tags
#cardiology
Question
What are other causes of myocardial dysfunction or damage?
Answer
 Myocarditis - Infectious, Immune-mediated
 Cardiotoxic drugs - Cancer chemotherapy drugs, lithium, etc.
 Amyloidosis - Cardiac restricted (transthyretin), Systemic amyloidosis


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Flashcard 1334376533260

Tags
#cardiology
Question
fluid hemodynamics:
The capillary bed is the site of [...]
Answer
hemodynamic control

NB:
Arteriolar end – hydrostatic pressure predominates
Venular end – oncotic pressure predominates


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Flashcard 1334379154700

Tags
#cardiology
Question
fluid hemodynamics:
Exit of fluid at the [...] end is nearly balanced by influx of fluid at the venular end
Answer
arteriolar
venular


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Flashcard 1334380989708

Tags
#cardiology
Question
fluid hemodynamics:
Excess interstitial fluid is drained via [...]
Answer
lymphatics


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Flashcard 1334382824716

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#cardiology
Question
CAUSES OF EDEMA
Answer
 Increased hydrostatic pressure: - Venous obstruction, congestive heart failure, arteriolar dilatation
 Reduced plasma oncotic pressure: - Cirrhosis, malnutrition, nephrotic syndrome
 Lymphatic obstruction
 Sodium Retention
 Inflammation


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Flashcard 1334384659724

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Question
In Subcutaneous edema, Distribution is influenced by [...] and is most pronounced in the [...] parts of the body
Answer
gravity
dependant

NB: it may be the first clue to heart failure


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Flashcard 1334386494732

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#cardiology
Question
pulmonary edema is Most commonly seen with [...]
Answer
left ventricular failure


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Flashcard 1334388329740

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Question
Brain edema May be [...] or generalized (e.g. encephalitis, CSF outflow obstruction)
Answer
localized (e.g. with abscess or neoplasm)


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Flashcard 1334390164748

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#cardiology
Question
Brain edema May be localized (e.g. with abscess or neoplasm) or [...]
Answer
generalized (e.g. encephalitis, CSF outflow obstruction)


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Flashcard 1334391999756

Tags
#cardiology #exam
Question
CLINICAL CONSEQUENCES OF EDEMA
Answer
Effects range from merely annoying to fatal

 Subcutaneous edema most significant as a marker of an underlying problem with fluid hemodynamics
 Pulmonary edema can interfere with normal ventilatory function
 Severe brain edema can result in herniation and compression of critical structures


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Flashcard 1334393834764

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#cardiology
Question
Obstruction to blood flow can take two forms:
Answer
 Obstruction to flow of blood through the heart (e.g. obstruction of a valve or great vessel)
 Obstruction to flow of blood to the heart (i.e. obstruction of a coronary vessel) - reducing blood supply to the heart when it needs it the most


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Flashcard 1334395669772

Tags
#cardiology #exam
Question
Obstruction to blood flow through the heart is frequently due to problems with [...]
Answer
heart valves

E.g. Aortic valve stenosis, Congenital heart valve problems (e.g. Tricuspid atresia, bicuspid aortic valve), Endocarditis


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Flashcard 1334397504780

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#cardiology
Question
A stenotic valve cannot open completely, thus hindering [...]
Answer
forward flow of blood


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Flashcard 1334399339788

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#cardiology
Question
Valve stenosis can lead to [...] and can also lead to cardiac hypertrophy or potentially pump failure if untreated
Answer
increased work for the heart (pressure overload)


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Flashcard 1334401699084

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#cardiology
Question
Valve stenosis can lead to increased work for the heart (pressure overload) and can also lead to [...] or potentially pump failure if untreated
Answer
cardiac hypertrophy


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Flashcard 1334403534092

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#cardiology
Question
Valve stenosis can lead to increased work for the heart (pressure overload) and can also lead to cardiac hypertrophy or potentially [...] if untreated
Answer
pump failure


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Flashcard 1334405369100

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#cardiology
Question
Obstruction to blood flow through coronary aa → MI
why?
Answer
Development of atherosclerotic plaque +/- thrombus (fixed or variable obstruction)

Occlusive thrombus on plaque (complete obstruction)


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Flashcard 1334407466252

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#cardiology
Question
What is the triad of thrombosis?
Answer
hypercoagulability

abnormal blood flow

endothelial injury


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Flashcard 1334409301260

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#cardiology
Question
What is the predominant cause of thrombosis?
Answer
Endothelial injury

-Particularly important for arterial or cardiac thrombus formation
-Frequently occurs over atherosclerotic plaques, or at sites of trauma or inflammatory vascular injury (vasculitis)
-May be due to physical disruption of endothelium with exposure of underlying collagen, or endothelial dysfunction


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Flashcard 1334411136268

Tags
#cardiology #exam
Question
What types of abn blood flow can lead to thrombosis?
Answer
turbulence
-Contributes to arterial/cardiac thrombosis by promoting endothelial injury/dysfunction
-Also forms countercurrents and local pockets of static blood

stasis
-Major factor in the development of venous thrombi
-hyperviscosity

Turbulence and Stasis:
 Disrupt laminar blood flow
 Allow platelets to come into close contact with endothelium
 Prevent dilution of activated clotting factors
 Promote endothelial cell activation


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Flashcard 1334412971276

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#cardiology
Question
Hypercoagulability is
Answer
Any alteration of the coagulation pathways that predisposes to thrombosis


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Flashcard 1334414806284

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#cardiology
Question
What are causes of hypercoagulability?
Answer
Primary (genetic)
 Factor V Leiden
 Prothrombin mutation
 Homocysteinemia
 Protein C, S deficiency

Secondary (acquired)
 OCP, Pregnancy
 Smoking
 Prolonged immobilization
 Cancer


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Flashcard 1334416641292

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#cardiology
Question
What is the fate of the thrombus?
Answer
Propagation
 Extension and growth of thrombus
 May eventually lead to vessel occlusion (bad with coronary aa)

Embolization
 Arterial vs. venous

Dissolution

Organization and recanalization (so thrombus may not cause much problem)


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Flashcard 1334418476300

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#cardiology
Question
What is regurgitant blood flow?
Answer
Failure to maintain unidirectional flow of blood through the heart


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Flashcard 1334420311308

Tags
#cardiology
Question
[...] and [...] of blood flow through damaged valves may coexist
Answer
Obstruction
Regurgitation


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Flashcard 1334422146316

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#cardiology
Question
Shunted blood flow is typically a ft of:
Answer
congenital cardiac anomalies, involving the heart and/or great vessels


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Flashcard 1334423981324

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Question
Cardiac anomalies arise during gestational weeks [#] when major cardiovascular structures begin to form
Answer
3 - 8


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Flashcard 1334425816332

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Question
Defects compatible with embryological development and maturation usually only affect [...] or [...]
Answer
one chamber
discrete region of the heart


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Flashcard 1334427651340

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Question
What are different types of congenital cardiac anomalies?
Answer
 Malformations causing left-to-right shunt (more load on RV)
 Malformations causing right-to-left shunt (shunting de-O2 blood into systemic)
 Malformations causing an obstruction (e.g. coarctation of aorta w/ R to L shunt)


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Flashcard 1334431321356

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#cardiology
Question
Type of arrhythmia depends on [...] to the conduction system and/or presence of [...]
Answer
location of disruption
ectopic foci of excitation


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Flashcard 1334433156364

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Question
[...] is often a result of trauma, leading to massive loss of blood into body cavities, and shock
Answer
Rupture of the heart/great vessels


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Flashcard 1334434991372

Tags
#cardiology
Question
Rupture of the heart/great vessels is often a result of [...] , leading to massive loss of blood into body cavities, and shock
Answer
trauma


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Flashcard 1334436826380

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Question
A smaller cardiac rupture may result in [...] into the [...]
Answer
leakage of blood
pericardial space

NB: can cause cardiac tamponade = mechanical restriction


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Flashcard 1334438661388

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Question
Rupture of the great vessels may be seen with [2-3 things]
Answer
severe atherosclerotic or aneurysmal disease, diseases of collagen synthesis (i.e. Marfan syndrome, Ehlers-Danlos syndrome), etc.


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Flashcard 1334440496396

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Question
What is shock?
Answer
Systemic hypoperfusion caused by reduction in effective circulating blood volume or cardiac output, resulting in impaired tissue perfusion and cellular hypoxia


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Flashcard 1334442331404

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Question
What are causes of shock?
Answer
 Cardiogenic Shock (acute versions)
- Myocardial infarction, ventricular rupture, arrhythmia, cardiac tamponade, pulmonary embolism
 Hypovolemic Shock
- Hemorrhage, fluid loss, trauma, etc.
 (Septic Shock)
 (Neurogenic Shock)
 (Anaphylactic Shock)


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Flashcard 1334444166412

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Question
What are the stages of shock?
Answer
1) initial non-progressive phase (compensatory mechanisms)
-Neurohumoral mechanisms act to maintain cardiac output and blood pressure
-Ex. Release of catecholamines, ADH, activation of reninangiotensin-aldosterone pathway, generalized sympathetic stimulation
-Net effect: tachycardia, peripheral vasoconstriction, renal conservation of fluid

2) progressive phase
-Widespread tissue hypoxia commences:
  • ↓ pH due to lactic acid production (anaerobic glycolysis)
  • ↓ vasomotor response with arteriolar dilatation and blood pooling in the peripheral circulation
  • Vital organs begin to fail (AKI)
-clinically confused, urine output ↓

3) irreversible stage
-Widespread anoxic cellular injury occurs
 Leakage of lysosomal enzymes
 Marked electrolyte disturbances
 ↓ Myocardial contractility
 Complete renal shutdown due to acute tubular necrosis
 Multi-organ system failure ensues
 May develop disseminated intravascular coagulation


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