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From Flashcardlet > 5/15 > Flashcards

5/15 Flashcards

1
Q

Which nerve supplies the anterior side of the thigh and knee cap?

A

Femoral nerve

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2
Q

What are the blood smear findings of Mono?

A

mono is an infection of B-lyphocytes, but the blood smear would show atypical T-lymphocytes that are attempting to destroy the virally infected cells

They will be much larger than normal lymphos, w/ an eccentrically placed nucleus. The cell membranes will be conforming to the borders of surrounding cells

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3
Q

What are gene markers associated with early and late onset Alzheimers?

A

Early: APP, presenilin 1 and 2

Late: Apolipoprotein E4

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4
Q

Which vessels supply the most blood to the femoral head, and are most in danger of being damaged during a fracture of the femoral head?

A

Medial Femoral Circumflex artery (connects to lateral femoral circumflex) supplies the most blood

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5
Q

Chronic Lung transplant rejection vs Chronic kidney transplant rejection

A

Lung = small airway process, inflammation and fibrosis of the bronchiolar walls –> obstruction of bronchioli

Kidney = Vascular Obliteration

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6
Q

What is Amiodarone, what are its side effects? What tests should be preformed before starting a pt on amiodarone?

A

It is a class III (K channel) anti-arrhythmic.

Sdx: Hypothyroid/thyroid dysfunction (it is made of iodine), photodermatitis, corneal microdeposits, blue-grey skin, drug induced hepatitis, pulmonary fibrosis

Get TSH lvls before starting to monitor thyroid fxn

“Check TFTs, LFTs, and PFTs”

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7
Q

What is the MOA of adenosine?

MOA and Side effects of lidocaine?

MOA and Side effects of procainamide?

A

anti-arrythmic (anti-PSVT) drug that works quickly by slowing conduction in the AV node. This works by hyperpolarizing the pacemaker and conducting cells. Thy also use adenosine for chemical stress testing

sdx: flushing, chest burning (bronchospasms), hypotension

Lidocaine = 1B antiA, can cause neuroligic symptoms

Procainamide = 1A antiA, can cause SLE

Verapamil = Class IV antiA, can cause constipation and gingival hyperplasia

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8
Q

What is the cause of TCA overdose? How do you treat it?

A

Quinidine-like effect causing QRS and QT elongation and dysrythmias.

Treat this with NaHCO3

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9
Q

What is dysthymic disorder?

A

long term (more than 2 years), mild depression

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10
Q

What lab test will differentiate B12 def anemia from B9 anemia?

A

B12: will have elevated MMA in the serum

B9: wont

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11
Q

What anticancer drug alkylates DNA agents and is used in brain cancer?

A

Nitrosoureas (mustines)

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12
Q

What 3 structures pierce the diaphragm at T12?

A

“Red, White, and Blue”

Aorta
Thoracic Duct
Azygos Vein

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13
Q

What muscles are used during quiet and excercise breathing?

A

Quiet: inspo = diaphragm, expo = passive

Excercise/Sick: Inspo = external intercostals, scalenes, SCM. Expo = RA, internal intercostals, obliques

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14
Q

Which nerves do chemoRs in the carotid body and aortic body use to send low O2 signals to brain

A

Carotid = 9th CN

Aortic = CN 10

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15
Q

Young person with infertility, recurrent URIs and dextrocardia

A

Kartageners Syndrome

Defect in the Dynein arms (cant make cilia or microtubules move)

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16
Q

Where do you cut for emergency airway?

A

Right below the thyroid cartilage (Cricothyroid membrane)

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17
Q

What is the job of the conducting zone?

What substances are found at the end of the bronchi? to the end of the terminal bronchioles?

A

To warm, humidify and filter the air

End of Bronchi - cartilage, goblet cells

End of terminal bronchioles - cilia, SM cells

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18
Q

What structures are absent in respiratory zone? What types of cells are down there?

A

No cilia in resp zone

Cuboidal cells line respiratory bronchioles

Simple Squamous cells line up to alveoli

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19
Q

Type 1 vs 2 pneumocytes vs Clara cells vs alv macs

A

All are pneumocytes and are found around alveoli

Type 1 = squamous lining of alveoli (majority)

Type 2 = secrete surfactant (Cuboidal). Also are precursors to Type 1 and 2s and will proliferate during lung damage

Clara cells = Nonciliated, columnar w/ secretory granules. Degrade toxins and secrete a component of surfactant

Alv macs = clear debris and participate in immune response

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20
Q

Alveoli have a bette rchance of collapsing on expiration

A

This is b/c the radius decreases

Collapsing pressure = 2tension/r

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21
Q

What side of the lung will an aspirated peanut be found on?

A

Right side (wider and straighter)

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22
Q

What is occurring in the lungs at FRC

A

airway and alveolar pressures are 0 and intrapleural pressure is negative–> inward pull of lung is balanced by outward pull of the chest wall

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23
Q

What happens to compliance and FRC if the lungs are fibrosed, full of pneumonia, or have pulmonary edema?

Emphysema/aging?

A

Compliance will decrease and so will FRC

emphy/aging = lung compliance will increase and so will FRC

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24
Q

What elements favor the taut (T) form of Hb?

A

T form = low affinity for O2 and can more easily drop O2 off in tissues

This can be induced by increased Cl, H, CO2, temp, or 2,3 BPG –> All will shift dissociation curve to the right

Fetal Hb will shift the curve to the left

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25
Q

What is methemoglobin, and how is it induced?

A

It is oxidized Hb made of Fe+3 (does not bind O2 as easily as the Fe+2 form.)

THis can be caused by nitrites, malaria drugs (chloroquine and primaquine), Sulfas, Metaclopramide

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26
Q

How can cyanide poisoning be treated using Methemoglobin?

A

Give the pt Nitrates to oxidize Hb which will bind a ton of cyanide (releasing it from the cytochrome system)

You then get rid of the cyanide by giving thiosulfate which will form thiocyanate and get renally excreted

27
Q

What is positive cooperativity and what does it determine?

A

It is the phenomena of an increased affinity for O2 with each additional O2 that is added to Hb

This makes the shape of the Hb curve (PO2 drop from 100 - 80 doesnt result in much of an Hb saturation drop)

28
Q

What does the CO Hb curve look like?

A

CO curve will be lower than the normal O2 curve b/c O2 has to compete with CO2 for a spot on Hb. It will also be shifted to the left (doesnt let O2 drop off in tissues very easily)

*CO poisoning will report a normal pulse ox (which measures Hb sat) b/c Hb is fully saturated, just not withO2!

29
Q

What is the treatment for methemoglobinemia?

A

Methyline Blue (IV)

Can also add Vit C

Can also treat with Cimitidine

30
Q

What type of system is the pulmonary circulation?

A

Low resistance, high compliance

31
Q

What does COPD or hypoxia do to blood vessels in the lungs?

A

When the lungs sens an area of poor ventilation, the blood vessels constrict and shunt blood elsewhere. If this occurs too much, or on a massive scale, this can cause Pulmonary HTN

32
Q

Perfusion limited vs Diffusion limited circulation

A

Perf = O2 (normal health), CO2 and N20 are all perfusion limited substances. They are completely equilibrated early along the length of the capillary (O2 takes longer, but can be increased by exercise)

Diffusion: O2 (emphysema or fibrosis) and CO. These never equilibriate along the capillary

33
Q

Primary vs Secondary Pulm HTN

A

Primary - hereditary defect in BMPR2 gene (common in young women or AIDS pts.) and acts to let vascular SM proliferate out of control

Secondary - due to COPD, mitral stenosis, sleep apnea, high altitudes

34
Q

What are the 4 tx of Pulmonary HTN?

A

Bosanten (endothelin 1 R antagonist) = derease vascular resistance

Sildenafil (cGMPase blocker)

Nifedipine (CCB)

PGE analogs

35
Q

Histological Characteristics of Pulmonary HTN?

A

Medial hypertrophy, Arteriosclerosis, and Intimal Fibrosis of pulmonary arteries

36
Q

What is the equation for O2 content in blood?

A

= (O2 binding capacity * % saturation) + dissolved O2

O2 binding capacity = amount of O2 a Hb can hold * total Hb

As Hb falls, O2 content in blood decreases too. O2 sat and arterial PO2 will NOT change though (measured by dissolved O2)

37
Q

What is the alveolar gas equation?

A

PAO2 = 150 - PaCO2/0.8

Use this PAO2 value and subtract PaO2 from it to get the A-a gradient

The A-a gradient should be about 10-15, if it is higher, this means hypoxemia, shunting, V/Q mismatch, or fibrosis has occured

38
Q

What are examples of hypoxemic, hypoxic, and ischemic oxygen deprevation?

A

Hypoxemic:
High altititude, hypoventilation

V/Q mismatch, diffusion limitation, R->L shunt (high A-a)

Hypoxic:
Decreased Cardiac Output, Hypoxemia

Anemia, CO poisoning (high A-a)

Ischemic:
Impeded arterial flow, reduced venous drainage

39
Q

What is the V/Q ratio at the apex and base of the lungs?

A

apex (z1) = high V/Q ratio (3) as lots of air but not alot of blood (this can be lowered by exercise which dilates some capillaries up to the apex, thus equalling out the V/Q a bit)

Base (z3) = Low V/Q ratio (0.6) as a ton of blood flows here in proportion to O2. Both ventilation and perfusion are greater at the base of the lung vs apex

Apex: PAO2>PaO2>PvO2
Middle: PaO2>PAO2>PvO2
Base: PaO2>PvO2>PAO2

40
Q

What occurs as V/Q reaches 0?

What occurs as V/Q reaches infinity?

A

zero = airway obstruction, 100% o2 wont help

infinity = blood flow obstruction, 100% o2 will help

41
Q

What form does CO2 travel in the blood?

A

Bicarbonate (90%), Some is bound to N-terminus of globin (not heme)

42
Q

What are the changes to PAO2, PaO2, venous O2 and venous CO2 during exercise

A

Pressures - no change!

Venous - less oxygen, more CO2

43
Q

What are the changes taking place during acute mountain sickness?

A

Acute cerebral edema due to hypoxia-induced vasodilation

Acute pulmonary edema

44
Q

What are the 3 components of Virchows triad?

A

Stasis
Hypercoagulability
Injury/Endothelial Damage

45
Q

What are the classic signs of a DVT, how is it diagnosed?

A

Pain in calf, pain when foot is dorsiflexed, ridged feeling veins

Dx: Ultrasound

46
Q

What are the classic symptoms of a fat emboli and an amniotic fluid emboli>?

A

Fat: post long bone surgery –> hypoxia, neurologic pblms, and petechial rash

Amniotic fluid: DIC post partum

CT scan is the best way to dx a PE

47
Q

What will PFTs reveal for obstructive vs restrictive dz?

A

Obstructive = increased TLC, decreased FEV1 and FVC and a low FEV1/FVC ratio

Restrictive = decreased TLC, decreased FVC, but an ELEVATED What FEV1/FVC ratio

48
Q

What is found histologically in the lungs of an asthma pt?

A

Smooth Muscle Hypertrophy

Charcot-Leyden crystals = (breakdown products of eosinophils

49
Q

What type of emphysema do you see in smokers and a1-antitrypsin def?

A

Central acinar enlargement = smoking

Pan acinar = a1 def

50
Q

What is found on lung histology in bronchiectasis?

A

Permanently dilated airways w/ purulent sputum, and hemoptysis

51
Q

Name the other uses for these anti-histamines: Cyproheptadine, Promethazine, Chlorpheniramine, Hydroxyzine, Meclizine

A 
Cyproheptadine = Appetite Stimulant
Promethazine = N/V
Chlorpheniramine = OTC allergy/cold
Hydroxyzine = sedation/itching
Meclizine = vertigo
52
Q

What are the risk factors for NRDS?

What can occur if therapeutic O2 supplementation is continued for too long?

A

Prematurity, mom DM (hi fetal insulin), C-section delivery (decreased fetal glucocorticoids)

Too much o2 can make baby blind or have bronchopulmonary dysplasia

53
Q

What is seen histologically in ARDS?

A

Diffuse Alveolar Damage –> increased alveolar capillary permeability and protein rich leakage into alveoli.

This will form an intra-alveolar hyaline membrane

The cause of this damage is brought to you by your own body (PMNs and coag cascade)

54
Q

What are the features of sarcoidosis?

A

young black female with noncaseating granulomas in the lungs, bilateral hylar lymphadenopathy

High ACE, vit D, Ca

Histo: Schaumann and asteroid bodies

Tx: Steroids

55
Q

Compare Anthracosis, Silicosis, and Asbestosis

A

Anthracosis = coal miners lungs, a scale of defects, mostly in the upper lung

Silicosis = sandblasting/mines. Macs attack silica fibers and leads to fibrosis. Can increase risk of TB and Bronchogenic Carcinoma. upper lung, EGGSHELL CA OF HILAR NODES

Asbestosis = Plumbing/roofing. Ivory white Ca pleural plaques in the lower lobes of the lung. Increased risk of mesothelioma and bronchogenic Ca. DUMBBELL RODS

56
Q

What direction will trachea be deviated in: Atelectasis, Spontaneous Pneumo, Tension Pneumo

Will fremitus be increased or decreased in consolidation?

A

Atelectasis = towards lesion

Spontaneous Pneumo = towards lesion

Tension Pneumo = away from lesion

**Increased fremitus w/ consolidation

57
Q

What is Myocardium Hybernation?

A

When repetitive ischemia of cardiac myocytes or persistent hypoperfusion of myocytes results in reversible loss of contractile function

58
Q

What is a pure red cell aplasia (PRCA) and what are some causes?

A

Anemia due to central decrease in erythroid precursors but nothing else is elevated.

This can be due to a thymoma, or parvovirus

59
Q

What do golden/yellowish granules that stains w/ prussian blue inside alveolar cells represent? What is the cause?

A

These are hemosiderin laden macrophages (heart failure cells)

They represent left ventricular dysfunction/heart failure

60
Q

What are the K sparing diuretics?

A

Amiloride, Triamterene, and Spironolactone

61
Q

Where do direct hernias occur and what is the cause?

A

medial to the inferior epigastric vessels, they are caused by weakness in the transversalis fascia

62
Q

What drugs are used to block a migraine right when it is happening?

What drugs are used for migraine prophylaxis?

A

Triptans

Prophylaxis = B blockers, antidepressants (amitriptyline, venlafaxine), and anticonvulsants (valproate and topiramate)

63
Q

What type of murmur is best heard by having the pt sit up and lean forward?

A

Aortic Regurg

64
Q

What are the causes of rubella in pregnant mom and fetus?

A

Mom = rash and polyarthralgias

Fetus = sensorineural deafness, cataracts, and cardiac malformations (PDA)

From Flashcardlet (32 decks)

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