100 Secrets Flashcards
(130 cards)
1
Q
What determines Stroke Volume?
A
1) Preload
2) Contractility
3) Afterload
2
Q
Define Preload
A
intraventricular volume or pressure at the end of diastole
3
Q
Contractility
A
how forcefully the heart contracts at any end-diastolic volume
4
Q
With greater contractility comes greater ___
A
stroke volume
5
Q
Afterload
A
load against which the heart mus pump blood and includes the systemic arterial pressure and any other impediments to flow, such as stenotic (narrowed) aortic valve
6
Q
Asthma
A
characterized by reversible airway obstruction and hyperreactivity of the airways to a variety of agents and can be diagnosed by a methacholine challenge
7
Q
How do you diagnose Asthma?
A
Methacholine challenge
8
Q
Dx Acute respiratory distress syndrome
A
presence of sudden-onset respiratory failure, bilateral diffuse pulmonary infiltrates, severe hypoxemia and coexistence of a disease known to cause it .
9
Q
How do you manage acute respiratory distress syndrome?
A
Supportive therapy with a ventilator to maintain oxygenation and treatment of the underlying disease
10
Q
How can you classify Lung Cancer?
A
Small cell lung cancer - susceptible to radiation therapy
Non-small cell lung cancer - more resistant to radiation therapy. All are generally treated with surgery
11
Q
Causes of acute renal failure
A
Renal hypoperfusion (pre renal) Intrinsic renal damage (renal) Obstruction (postrenal)
12
Q
Two most common causes of end-stage renal disease
A
Diabetes
Hypertension
13
Q
Acute tubular necrosis (ATN) characterized by
A
The presence of “muddy brown” casts in the urinary sediment.
14
Q
Nephrotic Syndrome
A
Characterized by massive proteinuria (>3g per 24hours), hypoalbuminemia, edema, hyperlipidemia, and minimal hematuria.
15
Q
Nephritic Syndrome
A
Characterized by hypertension, renal dysfunction, hematuria with dysmorphic red blood cells and RBC cast in the urinary sediment, and less prominent proteinuria (<3g per 24 hours)
16
Q
Creatinine clearance and glomerular filtration rate are inversely proportional to ________
A
serum creatinine .
17
Q
Effective circulating volume (ECV) is regulated by
A
adjusting the rate of sodium excretion
18
Q
Osmolality is regulated by
A
adjusting the rate of free water excretion
19
Q
All diuretics lower extracellular fluid volume by
A
inhibiting tubular reabsorption of sodium and thereby enhancing urinary excretion of sodium
20
Q
Hyperventilation causes
A
respiratory alkalosis by blowing off excess CO2. Maximal compensation by the kidneys requires several days.
21
Q
Most common causes of metabolic alkalosis are:
A
1) loss of gastric secretions (as w/ vomiting or nasogastic suctioning)
2) diuretics (loop and thiazides)
3) volume depletion
4) mineralcorticoid excess
22
Q
Metabolic acidosis can de divided into:
A
anion gap and non anion gap
23
Q
Mnemonic for causes of high anion gap metabolic acidosis:
A
MUDPILES
Methanol Uremia (renal failure) Diabetic and other ketoacidoses Paraldehyde (now rarely seen) Isoniazid Lactic acidosis Ethylene glycol Salicylates
24
Q
Achalasia
A
Characterized by progressive dysphagia due to destruction of the myenteric plexus. “birds beak”
25
NSAIDS and H. Pylori are the most common causes of_____
gastric and duodenal ulcers, respectively
26
Ulcerative colitis
Characterized by continuous inflammation of the colonic mucosa , which begins in the rectum and progresses proximally.
Major complications are colon cancer and toxic megacolon
27
Crohns disease
Characterized by transmural inflammation of different patches of colon and small intestine. Sclerosing cholangitisis more common in Crohns disease than ulcerative colitis
28
Alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) are laboratory tests that suggest...
organ damage
29
Elevation in AST and ALT suggest...
hepatitis
30
Elevation in ALP and GGT are suggestive of...
cholestatic disease
31
Hepatitis A and E viruses are transmitted through
fecal-oral route.
32
Hepatitis B and C viruses are transmitted through
sexual contact or parenterally and can cause chronic infections
33
Tylenol (acetaminophen) is metabolized by
Cytochrome P-450 system producing N-acetyl-p-benzoquinoneimine (NAPQI) which is hepatotoxic.
NAPQI detoxified by a phase II reaction with glutathione
34
Most common hypersecreting pituitary tumor
Prolactinoma
35
Cortisol causes:
Hyperglycemia by directly promoting gluconeogenesis, stimulating protein catabolism in muscle with the release of amino acids to be used as precursors in gluconeogenesis and stimulating lipolysis, from which the free fatty acids that are liberated are used as an energy source of gluconeogenesis.
36
Grave's disease
Most common cause of hypothyroidism
Characterized by diffuse goiter, bulging eyes (exophthalmos) and pretibial myxedema.
It is caused by antibodies to the thyroid-stimulating hormone receptor that have a stimulatory effect on the thyroid.
37
Estrogen-containing oral contraceptives
Work by providing a constant level of negative feedback to the anterior pituitary, thereby stabilizing follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion and preventing surges that could cause ovulation
38
Oral contraceptives increases the risk of:
various thromboembolic phenomena, including stroke, myocardial infarction, pulmonary embolism, and deep venous thrombosis.
*Smoking further increases these risks*
39
If ovulation never occurs..
the corpus luteum, which is the site of normal progesterone synthesis does not form, so there is no progesterone spike and decline, resulting in absence of menses
40
Pulsatile secretion of GnRH
stimulates pituitary FSH and LH secretion
41
Continued GnRH secretion
inhibits their secretion
42
Leuprolide
obliterate menstrual cycles and place a woman in artificial state of menopause, which is therapeutically useful for diseases that are exacerbated by the menstrual cycle, especially endometriosis
43
Sickle cell anemia
a change in one amino acid in the B chain of hemoglobin makes the deoxyhemoglobin form substantially less soluble.
Conditions that increase the concentration of the less soluble deoxyhemoglobin, such as dehydration, acidosis and hypoxia, can cause precipitation of hemoglobin
44
In microcytic anemia..
cell proliferation outpaces hemoglobin synthesis, causing formation of smaller cells
45
Hereditary Spherocytosis
a defect in the erythrocyte cytoskeleton causes the cells to take on a spherical rather than a biconcave shape. These abnormal cells are destroyed in the spleen, causing hemolytic anemia.
46
Primary hemostasis
formation of platelet plug
47
Secondary hemostasis
activation of the coagulation cascade and formation of the fibrin plug
48
Hemophilia A
X-linked recessive disorder that is due to a defect or deficiency of factor VIII.
49
Hemophilia B
Much less common.
| Due to a defect in gactor IX
50
Voon Willebrand's disease
Most common hereditary bleeding disorder, results from a defect or deficiency of von Willerbrands factor, a protein that anchors platelets to the subendothelial collagen that is exposed during vascular injury
51
NSAIDs inhibit ...
```
platelet cyclooxygenase (COX), enzyme that synthesizes thromboxane, a potent procoagulant.
Acetylsalicylc acid (aspirin) irreversibly inhibits this enzyme, whereas all other agents reversibly inhibit it.
```
52
Older patient presents with focal back pain without a history of trauma and constitutional symptoms of malaise, unintentional weight loss and recurrent infections.. think of..
Multiple Myeloma
53
Acute Lymphoblastic Leukemia/lymphoma
Most common cause of childhood cancer.
Presents with: fatigue, night sweats, weight loss, and bone pain.
*Suspect ALL in any child with a hematologic malignancy*
54
Chronic Myelogenous Leukemia
occurs in young to middle -aged adults.
Presents with fatigue, night sweats, and unintentional weight loss. Associated with the Philadelphia chromosome, created by a translocation between chromosome 9 and 22.
55
Hodgkin's lymphoma
presents in young adults with a mass and nontender lymphadenopathy. Biopsy reveals the presence of large binucleated cells among other lymphocytes, histiocytes and granulocytes.
56
Stage of most solid cancers is related to:
Size of the neoplasm, the number of lymph nodes involved and the presence or absence of metastases (TNM system)
57
Paraneoplastic syndromes are caused by:
secretion of peptides or antibodies by a neoplasm
58
IgM
primary immune response
59
IgG
secondary immune response
60
IgA
secretory immunity
61
IgE
type I Hypersensitivity
62
IgD
imature B cells
63
Th1
activate cytotoxic T lymphocytes and macrophages
64
Th2
activates B cells to plasma cells
65
Most common antigen-presenting cells
macrophages
memory B cells
dendritic cells
Class II MHC molecules interact with the T-cell receptor and CD4 molecules in the surface of TH cells
66
In type I hypersensitivity, IgE mediates ...
mast cell degranulation
67
in type II hypersensitivity cell bound antigens allow..
antibody-mediated cytotoxicity
68
in type III hypersensitivity, immune complexes lead to..
complement -mediated damage
69
in type IV hypersensitivity...
Th1 cell mediated damage occurs
70
Atypical antipsychotics are more effective against
the negative symptoms of schizophrenia and are much less likely to cause extrapyramidal side effects.
71
Low-potence typical agents have a high incidence of...
anticholinergics side effects, sedation and orthostatic hypotension
72
High-potency typical agents have a high incidence of..
extrapyramidal side effects
73
Valproic acid
mood stabilizer of choice in bipolar disorder due to its side effect profile and lower toxicity
74
Lithium
narrow therapeutic index, and side effects include nephrogenic diabetes insipidus and hypothyroidism
75
Tricyclic antidepressants cause
anticholinergic, orthostatic hypotensive and sedative side effects.
In overdose they can cause cardiac arrhythmias, convulsions and even coma or death
76
Alcohol, benzodiazepines and barbiturates all act at
the gamma-aminobutyric acid receptor.
77
Barbiturates are much more likely to cause
a fatal respiratory depression than the benzodiazepines.
78
Enzymopathies (enzyme deficiencies) are usually
autosommal recessive or x-linked recessive
79
defects in structural proteins exhibit
autosomal dominant inheritance
80
Most common genetic cause of mental retardation
Trisomy 21 or Down Syndrome
81
The most common form of inherited mental retardation
Fragile X
82
Trinucleotide repeat disorders that present anticipation
Fragile X syndrome
| Huntingtons disease
83
Information from the temporal retina travels
without crossing over to the ipsilateral brain
84
Information from the nasal retina
crosses over to the contralateral brain.
85
closed angle glaucoma
acute, painful vision threatening condition associated with severe elevation of intraocular pressure, halos around lights, and blurry vision.
86
Open angle glaucoma
chronic painless condition associated with slowly progressing loss of peripheral vision due to elevated intraocular pressure and normal appering trabecular angle structures
87
Down and out position of the eye
seen with third nerve palsy
If the pupil is involved and dilated, emergent evaluation for an aneurysm in cerebral vasculature is required
88
Amyotropic lateral sclerosis (ASL) (Lou Gehrig disease)
Both upper and lower motor neurons are destroyed
| Both upper and lower motor neuron signs
89
Upper motor neuron signs
spasticity, hyperreflexia and clonus.
90
Lower motor neuron signs
hypotonia, flaccid paralysis, hyporeflexia and fasciculations
91
Parkinsons disease
results from destruction of dopaminergic neurons in the substantia nigra, which influences movement via their projections to the basal ganglia.
Clinical manifestations: pill-rolling tremor at rest, cogwheel rigidity, masked facies and a widened gait with slow, shuffling steps
92
Myasthenia Gravis
autoimmune disease , autoantibodies destroy the nicotinic acetylcholine receptor on skeletal muscle, reducing the effectiveness of neuromuscular transmission and causing weakness
93
Syringomyelia
fluid filled cavity within the central spinal cord can compress the fibers of the anterolateral (spinothalamic) tract, which convey sensory information about pain and temperature to both sides of the body
94
The three most important portosystemic anastomoses
1. esophageal veins with the azygous system (esophageal varices)
2. superior rectal veins with inferior and middle rectal veins (hemorrhoids)
3. paraumbilical veins with superficial epigastric veins (caput medusae)
95
Indirect inguinal hernia
begins lateral to the epigastric vessels, runs through the inguinal canal and is congenital
96
Direct inguinal hernia
begins medial to the epigastric vessels and most commonly is acquired
97
The right recurrent laryngeal nerve originates...
from the vagus nerve just inferior to the right subclavian artery.
Run posterior to the thyroid gland and are prone to injury during surgery in this area
98
The left recurrent laryngeal nerve originates...
just inferior to the aorta.
Run posterior to the thyroid gland and are prone to injury during surgery in this area
99
The preaortic and lumbar (paraaortic) nodes provide lymphatic drainage for
the testes and ovaries
100
The gonadal arteries branch ..
directly from the aorta, also at the level of gonadal development (near the kidneys)
101
Systemic sclerosis (scleroderma) is categorized
as either:
1. the limited cutaneous form, which involves primarily only limited amounts of the skin and has limited internal organ involvement
2. diffuse cutaneous scleroderma, which involves a greater area of the skin and has more extensive internal organ involvement (lungs, intestines)
102
Systemic Lupus Erythematosus
autoimmune disease that, like most autoimmune diseases, affects primarily women. Can involve multiple organs, including the skin (malar rash) , joints (arthritis), kidneys (glomerulonephritis) and heart (pericarditis and Libman-Sacks endocarditis)
103
Antinuclear antibodies
diverse group of autoantibodies that bind to various antigens within the cell nucleus,
They are present in multiple autoimmune diseases, including lupus, scleroderma, Sjogren syndrome, polymyositis and dermatomyositis
104
Where are antinuclear antibodies present?
multiple autoimmune diseases, including lupus, scleroderma, Sjogren syndrome, polymyositis and dermatomyositis
105
Osteopetrosis
defective osteoclasts do not effectively resorb bone.
The bone are much thicker and may crowd out the bone marrow, resulting in anemia
106
Vasculitides
inflammatory diseases defined by the presence of leukocytes in the vessel walls.
Typically present with vague constitutional symptoms, such as fever, fatigue, malaise, myalgias or arthralgias
107
Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP)
the most widely used indicators of the acute-phase protein response.
This response reflects the presence and intensity of an inflammatory process; therefore, ESR and CRP are two laboratory values that can be useful in following vasculitic syndromes.
108
Bacterial endocarditis that occurs soon after prosthetic valvular surgery is commonly due to...
Staph epidermidis
| *result of intraoperative contamination*
109
Think of Lyme disease
in any patient who recently traveled to New England, complains of flu-like symptoms, and has an enlarging erythematous rash with central clearing
110
The classic presentation of tuberculosis ...
is a patient who complains of fever, night sweats, weight loss, and a productive cough tinged with blood. Chest x-ray film may reveal a pulmonary infiltrate, and a purified protein derivative skin test should be positive.
*Gold standard: sputum culture that grows acid-fast bacilli *
111
All DNA viruses except_____ contain ______
Parvoviridae family; double stranded DNA
112
All DNA viruses are enveloped except:
Parvoviridae, Adenoviridae, and Papovaviridae
113
the responsible for the majority of infections in both childrens and adults:
Pneumococcus
Neisseria meningitides
enteroviruses
114
Parasites can be divided into:
1) Protozoa
| 2) Metazoa
115
Protozoa
Single celled eukaryotic organisms (plasmodium, giardia and entamoeba)
116
Metazoa
the worms (cestodes, nematodes, and flukes)
117
Azoles
inhibit ergosterol synthesis.
118
Polyenes (amphotericin B and nystatin)
bind ergosterol in the fungal cell membrane and create pores
119
NSAIDs
achieve their anti-inflammatory, antipyretic and analgesics effects by inhibiting the COX pathway, thus reducing prostaglandin production
120
Opioids (morphine, codeine, heroin, methadone, meperidine, and fentanyl)
blunt the sensation of painful stimuli by binding u receptors and hyperpolarizing the cell
121
Overdoses with acetaminophen, benzodiazepines and opioids can be reversed using...
acetylcysteine, flumazenil, and naloxone, respectively
122
Cardiac glycosides
a group of ionotropes that increase cardiac contractility by increasing intracellular calcium levels.
123
Calcium channel blockers
decrease intracellular calcium, thus decreasing contractility
124
Sensitivity
is a measure of how to effectively it can detect a disease in a patient who has the disease
125
Specificity
is a measure of how effectively it can detect "health" or the absence of disease in a patient
126
Positive predictive value
probability that, given a positive test result, the disease in question is actually present
127
Negative Predictive value
probability that disease is absent if a test result is negative
128
The P value
reflects the probability that the difference observed between groups could occur by chance alone
129
In a cohort study
a group of individuals is classified according to exposure an then followed to determine the effect of exposure on disease outcome.
130
In case-control study
Individuals are classified according to the presence or absence of disease, and correlations are made between past exposures and the presence of disease.
