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TEST 3 - ADVANCED PATHOPHYSIOLOGY SUMMER 2024 UTA 5315 QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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TEST 3 - ADVANCED PATHOPHYSIOLOGY SUMMER 2024 UTA 5315 QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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TEST 3 - ADVANCEDPATHOPHYSIOLOGY SUMMER 2024 UTA
5315 QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
MitralLValveLStenosisL-LANSWERL-LCharacterizedLbyLNARROWINGLofLmitralLvalve
-LNormalLisL4-6Lcm
-NarrowedLisLlessLthanL2.5Lcm
-LCausedLbyLRHEUMATICLFEVER
-MoreLcommonLinLWOMEN
-
OxygenatedLbloodLcomesLbackLintoLheartLintoLtheLleftLatriumLandLdownLthroughLtheLmitralLvalveLtoLtheLleftL
ventricle
-
LComplex:LStenosisLleadsLtoLvolume/pressureLinLleftLatrium,LwhichLresultsLinLatrialLhypertrophy/dilation,Lw
hichLincreasesLpressure/volumeLinLtheLpulmonaryLcirculationL&LcausesLPULMONARYLEDEMA
-
LSimplified:LSkinnyLmitralLvalveLdoesn'tLletLbloodLpassLthroughLeasily,LsoLbloodLbacksLupLintoLtheLleftLatriumL
andLcausesLitLtoLswell,LthenLbacksLupLintoLtheLlungLandLcausesLresp.Lsymptoms
-S/sx:Ldyspnea,Lhemoptysis,La-fib,Ldysphagia,LpulmonaryLhypertension
MitralLValveLRegurgitationL-LANSWERL-CharacterizedLbyLINCOMPLETELCLOSURELofLmitralLvalve
-
CausedLbyLMITRALLVALVELPROLAPSEL(flapsLdon'tLcloseLtogetherLproperly,LleavingLvalveLajar);LmoreLcommo
nLinLWOMEN;LSTICKINGLCHESTLPAIN
-
BloodLinLleftLventricleLbacksLupLtoLleftLventricleLduringLsystoleL(mitralLvalveLshouldLbeLclosedLduringLsystole
/contractionLofLheart)
-
LeadsLtoLatrialLdilation/hypertrophy,LincreasedLpulmonaryLvascularLpressure/volume,LPULMONARYLEDEM
A
-S/sx:LDyspnea,Lrales,LpansystolicLmurmur,LS3L&LS4LheartLsounds
,AorticLValveLStenosisL-LANSWERL-MostLcommonLvalvularLdisease
-
MostLcommonLcausesLareLaorticLvalveLCALCIFICATIONL(stiffening)LinLpeopleLoverL60;LcongenitalLaorticLvalve
LstenosisLinLpeopleLlessLthanL30
-NormalLvalveL3Lcm;LsymptomsLseenLwhenLvalveLlessLthanL1Lcm;LsevereLwhenLvalveLisLlessLthanL0.5Lcm
-
NarrowedLvalveLpreventsLoutflowLfromLleftLventricleLtoLaorta.LThisLbacksLupLbloodLtoLtheLleftLatriumLandLult
imatelyLfloodsLtheLlungLcausingLPULMONARYLEDEMA
S/Sx:LPulmonaryLhypertension/edema,LpoorLoutflowLofLaortaLtoLbodyL(aortaLsendsLoutLoxygenatedLbloodLt
oLbody),LcausingLfaintingLorLchestLpain
Simplified:LAortaLisLstiffLandLcan'tLsendLoutLoxygenatedLbloodLproperlyLtoLtheLbody,LdeprivingLtissuesLofLoxy
gen.LBloodLgetsLbackedLupLintoLlungs,LcausingLpulmonaryLedema.
AorticLValveLRegurgitationL-LANSWERL-
ValveLisLTOOLWIDELorLTOOLNARROW,LbloodLdoesn'tLpassLthroughLeffectively,LcausingLbackLflowLofLbloodLint
oLtheLleftLventricle
-
MarkedLbyLEARLYLDIASTOLICLMURMURL(onLsystole,LheartLcontractsLandLpushesLbloodLupLtheLaorta,LbutLonL
diastole,LheartLrelaxesLandLineffectiveLaorticLvalveLisLnotLableLtoLholdLbloodLupLinLaorta,LsoLbloodLfallsLandL
makesLaLswishLsound,LwhichLisLtheLmurmur)
-MostLcommonlyLcausedLbyLAORTICLROOTLDILATION(startingLpointLofLaortaLisLtooLwide)
-
OtherLcauses:LinfectiveLendocarditis,LrheumaticLfever,LaortitisLfromLsyphilis,LcoarctationL(congenitalLnarro
wingLofLaorta),LaorticLdissectionL(tear),LankylosingLspondylitisL(inflammatoryLarthritis)
-Acute:LincreasesLleftLventricularLend-
diastolicLpressureL(LVEDP)L(increasedLbloodLbackLdownLinLtheLleftLventricleLincreasesLpressure),LdecreasedL
strokeLvolumeL(notLmuchLbloodLisLbeingLpushedLfromLleftLventricleLbecauseLblood'sLbackedLupLandLoverwh
elmingLleftLventricle),LnormalLorLdecreasedLpulseLpressure,LdecreasedLcardiacLoutputL(aortaLisLnotLeffective
lyLpumpingLbloodLfromLheart)
Chronic:LBodyLadjusts;LLVEDPLnormalizes,LsystolicLbpLincreasesL(compensation:LharderLcontractionLtoLpushL
bloodLoutLofLaortaLbeforeLitLfallsLbackLdownLtoLleftLventricle),LdiastolicLbpLdecreasesL(compensation:Ldecre
asedLrelaxationLofLheartLtoLstopLbloodLfromLseepingLbackLoutLofLaorta),LcardiacLoutputLisLnormal,LpulseLpre
ssureLisLincrease.LBloodLultimatelyLisLbackedLupLintoLtheLleftLatriumLandLpulmonaryLcirculation.
,AtherosclerosisLCausesL-LANSWERL-BeginsLwithLtissueLinjuryL
SourcesLofLinjury:
CIGARETTESL(toxins)
HypertensionL(increasedLforceLofLtheLbloodLhittingLtheLbloodLvesselLcanLweakenLit)
DiabetesL
HyperlipidemiaL(lipidsLtakeLplaceLofLendothelialLcellsLliningLtheLbloodLvessel,LinitiatingLanLinflammatoryLres
ponse)
PathoLofLAtherosclerosisLr/tLHyperlipidemiaL-LInflammatoryLResponseL-
LANSWERL1.LTissueLinjuryLtoLendothelialLcellsLliningLtheLbloodLvessel.
2.LEndothelialLcellsLbecomeLinflammedLandLunableLtoLproduceLsufficientLantithromboticLandLvasodilatingLc
ytokines,LincreasingLriskLforLclotLformationLandLcreatingLaLtighterLspaceLforLplaquesLandLclotsLtoLgrow.
3.LMacrophagesLandLplateletsLareLcalledLtoLtheLareaLofLinjury,LfurtherLcongestingLtheLgrowingLplaqueLarea.
4.LLDLLreplacesLendothelialLcellsLinLtheLliningLofLtheLbloodLvessel.
5.LMacrophagesLengulfLtheLLDLLparticles.
6.LMacrophagesLeatLtooLmuchLLDL,LcausingLthemLtoLburstLandLbecomeLfoamLcellsL(underLaLmicroscopeLthe
yLlookLlikeLseaLfoam)
7.LAccumulationLofLfoamLcellsLcausesLaLfattyLstreak.LFattingLstreakLfurtherLtriggersLinflammatoryLresponses,
LrepeatingLtheLwholeLcycle,LandLgrowingLtheLfattyLstreak.
8.LSmoothLmuscleLhyperplasiaLfromLallLtheLinflammationLgrows,LproducesLcollagen,LandLcoversLtheLfattyLstr
eakLtoLcreateLaLfibrousLplaque.L
9.LTheLplaqueLmayLcalcify,LprotrudeLintoLtheLvessel,LandLoccludeLbloodLflow,LresultingLinLischemiaLorLinfarcti
on.
HyperlipidemiaL-LANSWERLLeadingLcauseLofLcoronaryLarteryLdisease
MostLcommonlyLaffectsLpromximalLportionsLofLcoronaryLarteries,LlargerLbranchesLofLcarotidLarteries,LcircleL
ofLWillisL(baseLofLbrain),LlargeLvesselsLofLlowerLextremities,LrenalLarteries,LmesentericL(intestinal)Larteries
ConsequencesLofLAtherosclerosisL-LANSWERLReducedLbloodLflow
, CoronaryLarteryLdisease,LmyocardialLinfarction,LcarotidLarteryLdisease,LcerebralLvascularLdisease,Lstroke,Lm
esentericLischemia,LperipheralLvascularLdisease,LrenalLarteryLstenosis
CongenitalLHeartLDiseaseL-LANSWERL-MostLcommonLheartLdiseaseLaffectingLchildren
-EtiologyLisLunknownLinL90%LofLcases
Causes:
Genetic/environmentalLfactorsL(multifactorialLfactors)
PrimaryLgeneticLfactorsL(singleLgeneLdisorders,LchromosomeLdisorders)
SoleLenvironmentalLfactorsL(Accutane/isotretinoinLforLacne,Lalcohol,LmaternalLrubellaLinfection)
MaternalLRiskLFactors:
AgeLoverL45,LpriorLchildLwithLheartLdefect,LpoorlyLcontrolledLdiabetesLduringLpregnancy,Lalcohol,Lcongenita
lLinfectionLduringLpregnancyL(rubella),Laspirin,Llupus,LDilantin/phenytoin/diphenylhydantoinLforLseizures
LEFTLtoLRIGHTLshuntL(CongenitalLheartLdefect)L-LANSWERL-
OxygenatedLbloodLfromLtheLleftLsideLofLtheLheartLmixesLwithLunoxygenatedLbloodLinLtheLrightLsideLofLtheLhe
art.L
-OxygenLsaturationLonLleftLsideLisLusuallyL95%,LwhereasLrightLsideLisL75%
-LAsLbloodLmixes,LrightLside'sLoxygenLsaturationLincreasesLtoL80%LorLmore
-
VOLUMELOVERLOADLoccursLonLRIGHTLsideLofLheartLoccurs,LleadingLtoLPULMONARYLHYPERTENSION,Lwhich
LcausesLRIGHTLVENTRICULARLHYPERTROPHY,L(secondaryLtoLpulm.Lhptn.),LandLLEFTLVENTRICULARLHYPERTR
OPHY(secondaryLtoLbloodLbeingLreturnedLtoLleftLventricle)
EisenmengerLSyndrome:LReversalLofLleftLtoLrightLshuntLtoLaLrightLtoLleftLshunt.
EisenmengerLSyndromeL-
LANSWERL1.LIncreasedLbloodLflowLreturnsLtoLlungsLratherLthanLtoLtheLrestLofLtheLbody.
2.LBloodLvesselsLbecomeLstiffLandLnarrowL-LpermanentLdamage.
3.LIncreasedLpressureLofLtheLbloodLflowLinLtheLlungLbecomesLsoLgreatLthatLtheLdirectionLofLbloodLflowLthrou
ghLtheLshuntLreverses.
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