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From Flashcardlet > 5/17 > Flashcards

5/17 Flashcards

1
Q

Where is the most common place for colon cancer?

Second most common?

A

Rectosigmoid colon

  1. Ascending Colon
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2
Q

What is functional mitral regurgitation? How is it fixed?

What is a classic presentation of MR?

What is a sign of severe MR?

A

It is MR due to increased preload (venous return) causing the LV to dilate. If you decrease the preload w/ diuretics, the MR murmur will go away

Classic presentation = holosystolic murmur heard at the apex and radiating to the axilla

Severe MR can cause an s3, which would indicate large flow regurgitating back into the ventricle mid diastole

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3
Q

What bug causes bronchiectasis/severe asthma w/ eosinophilia?

A

Aspergillis

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4
Q

In a pt with aortic regurg, what maintains the CO?

A

An increased LVEDV (aka a high preload)

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5
Q

What does arabinosyl transferase do? What drug blocks this?

A

It polymerizes the carb, arabinose, into arabinan to make a portion of the mycobacterial cell wall (fungi)

Ethambutol (anti-TB, w/ side effect of vision loss) will block this enzyme

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6
Q

What is the cause of an infant failing to eat/thrive and vomiting bile substance?

A

intestinal atresia, most likely due to “apple peel” atresia caused by artery (SMA) obstruction

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7
Q

What is the most common cause and pathology of nursemaids elbow?

A

Tugging in an axial direction on the arm of a 1-5 yo.

This causes a tear of the annular ligament that normally keeps the radial head covered and protected

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8
Q

What is the only saturable enzyme in the handling of PAH?

A

the transporter enzyme that secretes PAH into the tubule. The free filtration of PAH at the glomeruli is insatiable

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9
Q

What disorder is diagnosed by a positive osmotic RBC fragility test?

A

Hereditary Spherocytosis

Will develop gallstones!

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10
Q

What are the members of the spirochete family?

A

BLT

Borrelia (lyme dz)
Leptospira (leptospirosis)
Tripomonas (syphilis)

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11
Q

What is Leptospirosis and how do you get it?

A

flu like symptoms w/ jaundice and photophobia with conjunctivitis

Due to surfing in hawaii in urine infested water

Can develop into Weil’s disease: severe jaundice with liver and kidney dysfunction w/ HEMORRHAGE

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12
Q

What are the stages of lyme disease? How is it treated?

A

Stage 1 - bullseye rash w/ central clearing (erythema chronicum migrans) and flu-ish

Stage 2 - facial nerve palsey and AV nodal block

Stage 3 - migratory polyarthritis and encephalopathy

Tx: early stages = doxycycline
Late stages = Ceftriaxone

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13
Q

1* vs 2* vs 3* vs congenital Syphilis

A

1*: painless chancre

2* rash on palms/soles w/ condyloma lata and baldness

3* granulomas (gummas) with aortitis (tree barking due to destruction of vasa vasorum), tabes dorsalis (dorsal column destruction) and Argyll Robertson pupil

Congenital: saber shins (anterior tibial bowing) w/ saddle nose, deafness (CN8) and hutchinsons teeth

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14
Q

How do you test for syphilis?

A

Screening test = VDRL (can give false + to viruses (mono, hep), drugs, RA, and lupus)

Spinal fluid will be VRDL + in 3* Syph

Confirm test = FTA-ABS (specific Ab)

Tx: Pen G

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15
Q 
Zoonotic Bacteria:
bartonella
borerelia recurrentis
brucella
ehrlichia chaffeensis
pasteurella multocida
rickettsia prowazekii
rickettsia rickettsii
rickettsia typhi
yersinia pestis
A

bartonella = cat scratch dz (cats)
borerelia recurrentis = recurrent fever (louse)
brucella = undulant fever (goats/dairy)
ehrlichia chaffeensis = ehrlichiosis (lone star tick) - NO rash, just berry inclusions in monocytes
pasteurella multocida = cellulitis/osteomyelitis (dogs/cats)
rickettsia prowazekii = epidemic typhus (louse) –> rash spreads trunk to outward
rickettsia rickettsii = Rocky mountain spotted fever (dermacentor tick) –> rash spreads wrists to inward
rickettsia typhi = endemic typhus (fleas) –> rash spreads trunk to outward
yersinia pestis = plague (fleas, prairie dogs)

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16
Q

What causes a painless gray vaginal discharge w/ fishy smell?

A

Gardnerella Vaginalis - a gram variable bacteria that shows Clue Cells on histo

(Tricho Vaginalis will be caused by a protozoa and produce a burning/itching green fishy discharge)

Tx: Metro

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17
Q

What are the 5 main rickettsial illnesses?

A

Classic Symptom Triad: fever, HA, rash

Rocky mountain = Rick Ricky
Endemic Typhus = r. thphi
Epidemic Typhus = r. prowazekii
ehrlichiosis = Ehrlichia
Q fever = Cox burnetii (UNIQUE b/c no arthropod vector --> get spores from tick poo or cattle placenta)

Tx: Doxy

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18
Q

What is the treatment for Chlamydia pneumonia?

What is the tx for atypical pneumonia (unsure if MCL?)

A

Doxy

Azithromycin

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19
Q

What are the aortic arches?

A

1: maxillary artery
2: stapedial artery + hyoid artery
3: common carotid + internal carotid
4: aortic arch and proximal part of right subclavian artery
6: proximal pulmonary arteries and ductus arteriosus

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20
Q 
What do the following embyonic structures give rise to?
Truncus arteriosus (TA)
Bulbus Cordis
Primitive Ventricle
Primitive Atria
Left Horn of Sinus Venosus (SV)
Right Horn of SV
Right Common and RIght Anterior Cardinal Vein
A

Truncus arteriosus (TA) = AP septum w/ ascending aorta and pulmonary trunk
Bulbus Cordis: smooth outflow tracts of ventricles
Primitive Ventricle: L and R vents
Primitive Atria: L and R atriums
Left Horn of Sinus Venosus (SV): coronary sinus
Right Horn of SV: smooth part of RA
Right Common and RIght Anterior Cardinal Vein: SVC

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21
Q

What cells does the Truncus arteriosus come from?

What happens if it this development doesn’t occur?

A

Comes from Neural Crest Cells

Pathology: transposition of great vessels (failure to spiral)
tetraology of fallot (skewed AP septum), persistent TA (partial AP septum development)

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22
Q

Once the heart S-tube forms, what relation do the atrium and ventricles lie?

A 
Atrium = posterior
Ventricles = Anterior
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23
Q

What forms the foramen ovale?

How does it close?

A

The septum secundum contains a perminant opening called the foramen ovale, the valve of the foramen ovale is formed by the septum primum

Blood is shunted right to left

It is closed at birth when the baby takes their first breath and resistance in the pulmonary vessels decreases. This causes pressure to grow higher on the left side of the heart and the foramen closes.

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24
Q

Describe ventricular remodeling after they form and the TA forms the outflow tracts (180 degree turn)

A

The myocardium erodes and the ventricles are able to erode

Mesodermal tissue becomes fibrotic and form chordae tendineae

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25
Q

What genetic abnormality is commonly associated with an endocardial cushion defect?

A

Down Syndrome

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26
Q

What are the 3 important fetal shunts in blood flow?

A
  1. Ductus venosus = umbilical vein (highest o2 content) flows into the ductus venosus and into the IVC to pass the liver
  2. Foramen Ovale = blood exits the IVC and bypasses fetal respiratory circulation and instead heads for the left heart and out into the body
  3. Ductus Arteriosus = The little blood that does try to go into lungs (deoxygenated from the RA) flows from pulm artery into the descending aorta

This shunt is closed by decreased PGEs after birth. Can give Indomethacin if this doesn’t happen after 24h
Produces a machine like continous murmur if kept open

27
Q

Problems in fetus of diabetic moms:

A

Transposition of great vessels

Hypoglycemia

Large for Gestational Age

28
Q

What are the abnormalities in tetralogy of fallot?

A

VSD (pulm stenosis causes a right to left shunt)
Overriding Aorta
Pulmonary Infundibular Stenosis (most important feature)
RVH

Older pts squat to increase systemic vascular pressure and decrease the right to left shunting that causes them to be cyanotic

29
Q

What is the transposition of the great vessels?

A

The aorta will leave the RV and the Pulm artery will leave the LV

This is due to failure of the septum to spiral 180*

Only compatible with life if a shunt is present and blood is allowed to mix (VSD or PDA or Foramen Ovale)

30
Q

What can lead to Eisenmengers Syndrome?

A

an uncorrected VSD/ASD/PDA can cause compensatory pulmonary hypertrophy –> htn and can reverse the left to right shunt into a RIGHT TO LEFT shunt

31
Q

What is the cause of Ebsteins anomaly? What is the pathology?

A

Lithium use by mom

Can cause tricuspid leaflets displaced into the RV –> hypoplastic RV or a Foramen Ovale (R–> L shunt)

32
Q

What are the directions of flow in a PDA?

A

fetus: R–> L (pulm to aorta)
birthed: L –> R (aorta to pulm)

33
Q

What heart sounds are heard in an ASD?

A

loud S1 and a fixed split of S2 (this is due to higher right sided circulation causing the pulmonic valve to close after the aortic valve)

34
Q

What is a coarctation of aorta? What can it cause?

A

Infant type: aortic stenosis proximal to Ductus Arteriosus (pre-ductal). You can check this by femoral pulses
Common in Turners syndrome

Adult type: Stenosis distal to the ligamentum arteriosum (post-ductal) leading to rib notching and hypertension in upper extremities but weak lower pulses. Common in bicuspid aortic valves

Both can lead to aortic regurgitation

35
Q 
Congenital defect association:
22q11 syndrome
Down Syndrome
Congenital Rubella
Turner Syndrome
Marfans
Diabetic Moms
A

22q11 syndrome: truncus arteriosis, tetrology of fallot
Down Syndrome: endocardial cushion defect (can lead to a VSD, ASD, or AV septal defect)
Congenital Rubella: PDA, septal defects, pulm stenosis
Turner Syndrome: Coarctation, bicuspid aorta/endocarditis
Marfans: Aortic insufficiency later in life
Diabetic Moms: Hypoglycemia, transposition of great vessels

36
Q

What are the two equations for C.O.?

A

CO = SV * HR

CO = rate of O2 consumption / (arterial O2 content) - (venous O2 content)

37
Q

What are the two equations for MAP?

A

MAP = CO * TPR

MAP = 2/3Diastolic Pressure + 1/3 Systolic Pressure

38
Q

What are the two equations for Pulse Pressure?

What is the equation for Stroke Volume?

A

PP = systolic pressure - diastolic pressure

PP = SV

SV = EDV - ESV

39
Q

During exercise, how is CO maintained?

A

at first it is maintained by increased HR and SV

late stages, it is increased by increased HR (but if HR gets too high, ventricles wont have time to fill all the way and CO will drop (v.tach)

40
Q

How does digitalis increase contractility?

A

By blocking the Na/K exchanger and increasing intracellular Na (thus decreasing the Ca/Na exchange and trapping Ca inside the cell

41
Q

What effects do ACEis and ARBs have on preload and afterload?

A

They decrease both preload and afterload

42
Q

What is the equation for Ejection Fraction?

A

EF = (EDV - ESV) / EDV

or SV / EDV

43
Q

Resistance is directly proportional to viscosity and vessel length

A

And inversely proportional to radius to the 4th power

44
Q

What changes would be made to the cardiac function curve in exercise, hemmorhage, and heart failure?

A

Exercise = increased venous return, increased CO, decreased TPR, same atrial pressure

Hemorrhage = decreased venous return, decreased CO, increased TPR, same atrial pressure

Heart Failure = Same venous return, decreased CO, same TPR, increased atrial pressure

45
Q

What is Angiotension 2’s effect on blood vessels, what receptor does this stimulate?

A

It stimulates AT1 receptor on vascular smooth muscle cells to constrict causing an increase of BP

46
Q

What are the main symptoms of left sided and right sided heart failure?

A

Left = pulmonary edema (fluid backing up) and hemosiderin-laden macs (heart failure cells) w/ orthopnea due to decreased venous return while supine

Right = peripheral edema and jugular venous distention, due to increased venous pressure. Nutmeg liver can be seen if CVP gets too high

47
Q 
What are some conditions that lead to:
Increased capillary pressure (Pc)
Decreased Plasma Proteins (Pie c)
Increased capillary permeability (Kf)
Increased interstitial fluid colloid osmotic pressure (Pie i)
A

Increased capillary pressure (Pc): HF, pulmonary embolism, leg casts

Decreased Plasma Proteins (Pie c): liver failure, nephrotic syndrome, kidney failure

Increased capillary permeability (Kf): infection, burns, toxins

Increased interstitial fluid colloid osmotic pressure (Pie i): lymphatic blockage after surgery etc

48
Q

What runs inside of the femoral sheath?

A

Sheath = femoral artery, vein, and inguinal lymph nodes.
Femoral triangle = VAN
The nerve travels outside

NAVL

49
Q 
What are the CO and TPR changes in:
Hypovolemic/Cardiogenic Shock
Heart Failure
Sepsis/anaphylaxis
Neurogenic shock
A

Hypovolemic/Cardiogenic Shock: increased TPR, decreased CO –> tx w/ fluids
Heart Failure: increased TPR, decreased CO. Tx: LMNOP
Sepsis/anaphylaxis: decreased TPR, increased CO. Tx: NE
Neurogenic shock: decreased TPR and CO. Tx: fluids, Abs

50
Q

What are some causes of hypovolemic and cardiogenic shock?

A

Hypovolemic = trauma or burns

Cardiogenic = MI, PE, CHF, arrhythmias

51
Q

What are the best places to start a swan ganz catheter?

A

Right Internal Jug > Left Subclavian

52
Q

What is pleiotrophy?

What is polyploidy?

A

The occurence of multiple phenotypic manifestations of different organ systems coming from a single genetic defect

Polyploidy occurs when there are two complete sets of homologous chromosomes within an organism or cell

53
Q

What defect causes orotic acidurea and hyper ammonemia?

Just orotic acidurea?

A

OTC deficiency (Urea cycle)

CPS or NAGS deficiency or UMP synthase

54
Q

What is the cause of hyperestrogenemia with an adnexal mass?

A

Granulosa cell tumor. You will see Call Exner bodies (eosinophilic)

55
Q

What is pulsus paradoxus?

A

A decrease in systolic blood pressure of greater than 10mmHg with inspiration (due to the positioning of the heart being blocked by a pericardial dz process)

Could be pericarditis

56
Q

What is the capsule of H. Flu made out of?

A

PRP - Abs to this polymer can kill h flu via compliment dependent phagocytosis and killing via opsonization

57
Q

What are the side effects of digoxin>?

A

Hyperkalemia (although if you are hypokalemic this is even more dangerous) and arrythmias w/ v. tachs

58
Q

What are the effects ob benzos on chloride channels?

A

They increase the frequency of their openings

Barbiturates increased the duration of the opening of the chloride channels

59
Q

Where do renal cell carcinomas arise from?

A

Epithelial cells of the proximal renal tubules

60
Q

A patent foramen ovale is normal in 30% of adults, it is just kept closed by higher left sided pressures

A

If the right sided pressure were to rise however, they would have problems

61
Q

What must be monitored in Ank Spond pts?

A

Chest expansion abilities

62
Q

What is the most common cause of a spontaneous pneumothorax?

A

Rupture of a subpleural bleb

63
Q

What makes up the walls of a pseudo cyst?

A

Fibrous and granulation tissue - no real epithelial lining

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