MENDIX CERTIFICATION EXAM REVIEW
SHEET VERIFIED QUESTIONS AND
ACCURATE ANSWERS GRADED A+
⩥ Pulmonary Atrial Hypertension.
Answer: -Hypertension in pulmonary artery
-Mean pulmonary arterial pressure greater than 25 at rest (normal is 15-
18)
-May be secondary to genetic defect in the gene that codes bone
morphogenetic protein receptor type 2 (BMPR2)
-Risk factors: diet meds (caffeine), amphetamines, cocaine, COPD, left
heart failure/valvular disease
-Patho: Overabundance of vasoconstrictors and ineffecicent vasodilators
(think caffeine, cocaine, ), leading to CONSTRICTION OF
PULMONARY ARTERY. Precapillary pulmonary arteries become
resistant to vasoconstriction. Increased calcium causes vasoconstriction.
-The higher the pressure in the pulmonary artery, the harder the right
ventricle has to work as it has to push against the increased pressure.
Right ventricle will compensate for the increased workload by enlarging
and will eventually fail, causing cor pulmonale (abnormal enlargement
of right side of heart)
,Signs:
Chest x-ray - enlarged right ventricle and pulmonary artery
Symptoms: fatigue, chest pain, tachypnea, dyspnea on exertion,
palpitations, cough. Signs of right-sided heart failure (JVD,
hepatosplenomegaly, peripheral edema)
⩥ Cor Pulmonale.
Answer: -Secondary to pulmonary artery hypertension
-Right ventricle has to push against higher pulmonary artery pressure
and eventually fails
-Patient will have symptoms of right-sided heart failure (JVD,
hepatosplenomegaly, peripheral edema)
⩥ What are the signs of right-sided heart failure?.
Answer: JVD, hepatosplenomegaly, peripheral edema
⩥ Shock.
Answer: -Decreased cardiac output
-Decreased circulating volume
-Widespread vasodilation
Leads to:
-Hypotension
,-Decreased organ perfusion
-Hypoxia
-Anaerobic metabolism (making energy with carbs in absence of
oxygen)
-Production of lactic acid
BASIC RULE: MINIMUM SYSTOLIC BP OF 90 (top number) IS
REQUIRED TO MAINTAIN PERFUSION TO BODY
⩥ 3 stages of shock.
Answer: 1. Nonprogressive. Early shock. In an attempt to maintain
perfusion, heart rate increases & vasoconstriction occurs to maintain
perfusion and increase blood pressure.
2. Progressive. Body is no longer able to compensate. Hypoxia,
anaerobic cellular metabolism (creation of energy with carbs in the
absence of oxygen), & production of lactic acid. MULTI-ORGAN
FAILURE OCCURS.
3. Irreversible shock. Organs are permanently and severely damaged.
Patient will not survive.
⩥ Hypovolemic Shock.
, Answer: Results from a DECREASE IN CIRCULATING VOLUME
secondary to loss, such as from hemorrhage, burns, vomiting, diarrhea,
dehydration
⩥ Cardiogenic Shock.
Answer: Results in COLLAPSE OF CIRCULATORY SYSTEM
secondary to pump failure. TYPICALLY CAUSED BY MYOCARDIAL
INFARCTION. Left ventricular systole fails and is not able to maintain
cardiac output, blood pressure, or perfusion. In any shock state,
vasoconstriction occurs. This increases the workload of the heart,
making it more difficult for the left ventricle to pump blood, worsening
the shock state.
⩥ Sepsis.
Answer: Most commonly caused by gram positive bacteria (easier to
treat with antibiotics), followed by gram negative bacteria (harder to
treat with antibiotics). Infective agent triggers vasodilation. Again, the
MAJOR PROBLEM IS THAT THE VASCULAR SYSTEM EXPANDS,
therefore the available blood volume is insufficient to completely fill the
vascular system.
Gram negative bacteria have endotoxins which are released when they
are killed and makes this septic shock worse.
Antibiotics don't have any effect on endotoxins and they trigger a
massive inflammatory and immune reaction.
⩥ Neurogenic Shock.
SHEET VERIFIED QUESTIONS AND
ACCURATE ANSWERS GRADED A+
⩥ Pulmonary Atrial Hypertension.
Answer: -Hypertension in pulmonary artery
-Mean pulmonary arterial pressure greater than 25 at rest (normal is 15-
18)
-May be secondary to genetic defect in the gene that codes bone
morphogenetic protein receptor type 2 (BMPR2)
-Risk factors: diet meds (caffeine), amphetamines, cocaine, COPD, left
heart failure/valvular disease
-Patho: Overabundance of vasoconstrictors and ineffecicent vasodilators
(think caffeine, cocaine, ), leading to CONSTRICTION OF
PULMONARY ARTERY. Precapillary pulmonary arteries become
resistant to vasoconstriction. Increased calcium causes vasoconstriction.
-The higher the pressure in the pulmonary artery, the harder the right
ventricle has to work as it has to push against the increased pressure.
Right ventricle will compensate for the increased workload by enlarging
and will eventually fail, causing cor pulmonale (abnormal enlargement
of right side of heart)
,Signs:
Chest x-ray - enlarged right ventricle and pulmonary artery
Symptoms: fatigue, chest pain, tachypnea, dyspnea on exertion,
palpitations, cough. Signs of right-sided heart failure (JVD,
hepatosplenomegaly, peripheral edema)
⩥ Cor Pulmonale.
Answer: -Secondary to pulmonary artery hypertension
-Right ventricle has to push against higher pulmonary artery pressure
and eventually fails
-Patient will have symptoms of right-sided heart failure (JVD,
hepatosplenomegaly, peripheral edema)
⩥ What are the signs of right-sided heart failure?.
Answer: JVD, hepatosplenomegaly, peripheral edema
⩥ Shock.
Answer: -Decreased cardiac output
-Decreased circulating volume
-Widespread vasodilation
Leads to:
-Hypotension
,-Decreased organ perfusion
-Hypoxia
-Anaerobic metabolism (making energy with carbs in absence of
oxygen)
-Production of lactic acid
BASIC RULE: MINIMUM SYSTOLIC BP OF 90 (top number) IS
REQUIRED TO MAINTAIN PERFUSION TO BODY
⩥ 3 stages of shock.
Answer: 1. Nonprogressive. Early shock. In an attempt to maintain
perfusion, heart rate increases & vasoconstriction occurs to maintain
perfusion and increase blood pressure.
2. Progressive. Body is no longer able to compensate. Hypoxia,
anaerobic cellular metabolism (creation of energy with carbs in the
absence of oxygen), & production of lactic acid. MULTI-ORGAN
FAILURE OCCURS.
3. Irreversible shock. Organs are permanently and severely damaged.
Patient will not survive.
⩥ Hypovolemic Shock.
, Answer: Results from a DECREASE IN CIRCULATING VOLUME
secondary to loss, such as from hemorrhage, burns, vomiting, diarrhea,
dehydration
⩥ Cardiogenic Shock.
Answer: Results in COLLAPSE OF CIRCULATORY SYSTEM
secondary to pump failure. TYPICALLY CAUSED BY MYOCARDIAL
INFARCTION. Left ventricular systole fails and is not able to maintain
cardiac output, blood pressure, or perfusion. In any shock state,
vasoconstriction occurs. This increases the workload of the heart,
making it more difficult for the left ventricle to pump blood, worsening
the shock state.
⩥ Sepsis.
Answer: Most commonly caused by gram positive bacteria (easier to
treat with antibiotics), followed by gram negative bacteria (harder to
treat with antibiotics). Infective agent triggers vasodilation. Again, the
MAJOR PROBLEM IS THAT THE VASCULAR SYSTEM EXPANDS,
therefore the available blood volume is insufficient to completely fill the
vascular system.
Gram negative bacteria have endotoxins which are released when they
are killed and makes this septic shock worse.
Antibiotics don't have any effect on endotoxins and they trigger a
massive inflammatory and immune reaction.
⩥ Neurogenic Shock.
