BOARDVITALS #3 Flashcards
(161 cards)
1
Q
thromboembolism vs thrombocytopenia
A
Thromboembolism is when a blood clot forms and then travels to block another blood vessel, causing problems like a stroke or pulmonary embolism.
Thrombocytopenia is when you have too few platelets in your blood, making it harder for your body to stop bleeding.
2
Q
HIV antibody test positive, EKG shows ST elevation, chest pain
what is most likely cause
A
acute pericarditis
3
Q
tachycardia, hypotension, elevated JVP
what is the concern?
A
cardiac tamponade
Becks triad=hypotension, JVD, muffled heart sounds
Fluid accumulates in pericardial sac. Can’t fill during diastole leading to decreased cardiac output
4
Q
cardiac tamponade
A
Cardiac tamponade is a life-threatening condition caused by accumulation of fluid in the pericardial sac, which compresses the heart and impairs its ability to fill and pump effectively.
becks triad
- hypotension
-jugular venous distention
- muffled heart sounds
5
Q
becks triad in what condition
A
cardiac tamponade
becks triad
- hypotension
-jugular venous distention
- muffled heart sounds
6
Q
at what intercostal space do you drain excess pericardial fluid at the area where pericardial and cardiac notch of left lung
A
5th
7
Q
troponin T role in muscle contraction
A
attaches tropomyosin and actin to the troponin complex
8
Q
troponin C
A
calcium ions bind troponin C in the sarcomere, signaling tropomyosin to move from myosin head binding site on actin
9
Q
troponin I
A
inhibits activity of actomyosin ATPase
10
Q
which type of collagen fibers accumulate in tissues in cases of scleroderma
A
type III
11
Q
different types of collagen
A
type I: skin, tendons, ligaments, blood vessels, organs, bones
type II: cartilage
type III: reticular connective tissue (found in lymphoid organs)
type IV: basement membrane
type V: interstitial tissue, hair, placenta
12
Q
what antibodies found in scleroderma
A
anti-nuclear
ANA is for autoimmune
13
Q
antineutrophil cytoplasmic antibodies (ANCA) elevated in
A
autoimmune vascultitis
14
Q
anti-DNase B antibodies are elevated in
A
strep infection by group A strep
15
Q
anti-dsDNA antibodies are elevated in
A
systemic lupus erythematosus
16
Q
protein lysine-6- oxidase is the enzyme responsible for cross linking collagen and elastin fibers at hydroxylysine residues. what cofactor is important in the function of it?
A
copper and vitramin C
17
Q
scleroderma is often accompanies by Sjogren’s syndrome. what is sjogrens syndrome?
A
autoimmune destruction of salivary and lacrimal glands
18
Q
Sjögren’s syndrome
A
Sjögren’s syndrome is a chronic autoimmune disease primarily affecting the exocrine glands, especially the salivary and lacrimal glands, leading to dry mouth and dry eyes.
19
Q
langer’s lines of tension in what layer of skin
A
reticular layer of dermis
20
Q
reticular vs papillary layer of dermis
A
reticular: langer’s lines, elastic fibers, collagen
papillary: capillaries, nerves, lymphatics
21
Q
what is found in G6PD deficiency
A
Heinz bodies
heinz bodies are inclusions within red blood cells that are composed of denatured hemoglobin
22
Q
target cells
A
red blood cells with central staining due to precipitated hemoglobin and are seen in cases of sickle cell disease and iron deficiency anemia
23
Q
multiple myeloma
A
Multiple Myeloma is a malignant proliferation of plasma cells (a type of B cell) in the bone marrow, producing excessive amounts of monoclonal immunoglobulin or light chains.
hypercalcemia, bence jones proteins (renal failure), anemia and fatigue, “punched out” bone lesions
24
Q
G6PD is more common in males since its
A
x linked recessive
25
glucose 6 phosphate dehydrogenase is the rate limiting enzyme for the HMP shunt. it produces ribose-5 phosphate which is needed for ____
DNA synthesis (nucleotide and nucleic acids --> i.e RNA and DNA)
it also makes NADPH which is used for fatty acid synthesis and steroid hormone synthesis
26
the HMP shunt makes ___ ATP molecules
0
it makes 2 NADPH for fatty acid and steroid hormone synthesis
27
clostridium difficile is a ______ spore forming bacillus that is responsible for development of antibiotic associated diarrhea and colitis
gram positive, anaerobic
28
test with high sensitivity for C. difficile infection
stool culture
29
pseudomembranous colitis
raised yellowish white plaques
30
primary risk for c difficile colitis is exposure to which type of antibitoics
cephalosporins
31
most c. difficile infections occur shortly after antibiotic use, but many (up to 40%) can occur as late as
10 weeks following antibiotic use
32
amyotrophic lateral sclerosis (ALS) findings
ALS is a progressive neurodegenerative disease that affects both upper and lower motor neurons, leading to muscle weakness, atrophy, and eventually paralysis, while sparing sensory and cognitive functions (in most cases).
upper neurons: spasticity, hyperreflexia, babinski sign
lower neurons: muscle atrophy, fasciculation, weakness
33
amyotrophic lateral sclerosis (ALS) involves degeneration of
upper and lower motor neurons
34
a patient has noticed muscle atrophy in his upper arms particularly. which nerve innervates the biceps brachii muscle
musculocutaneous
35
which nerve innervates triceps and anconeus and some forearm and hand muscles
radial nerve
36
what nerve innervated deltoid and teres minor
axillary nerve
37
90% of the corticospinal fibers cross over in which area to form the lateral corticospinal tract
caudal medullary pyramids
38
an action potential stimulates release of Ca2+ from which area during muscle contraction
terminal cisternae of the sarcoplasmic reticulum
39
patellar deep tendon reflex tests which spinal nerve root
L4
40
deep tendon reflex of bicep
C5, C6
41
deep tendon reflex of brachioradialis
C6
42
triceps deep tendon reflex
C7
43
achilles deep tendon reflex
S1
44
melanosomes are organelles specific to melanocytes, within the epidermis these organelles are transferred to what cell to deposit melanin
basal cell
45
2 yr old male with loud barking cough and dyspnea. diagnosed with laryngotracheobronchitis. main cause?
parainfluenza virus
46
main cause of epiglottitis
haemophilus influenza B
47
leading cause of bacterial phayrngitis/ strep throat
strep pyogenes
48
skin infections like impetigo via
staph aureus
49
the larynx has how many cartilages
9
50
amount of air entering lungs during a single inspiration under resting conditions
tidal volume
51
anatomical volume vs physiological volume
anatomical: volume of the conducting respiratory pathways that never contribute to gas exhange in the alveoli
physiological: sum of anatomic and alveolar dead space
52
residual volume
volume of air remaining in lungs after maximal active expiration and prevents lung collapse
53
what causes oxygen to easily dissociate from hemoglobin
high temp, low pH, high 2,3BPH
54
what monosaccharide is the most importantly and abundant in the body and is used to regulate insulin and generate energy in the body
d-glucose
55
monosaccharides vs disaccharide
mono: d-glucose, d-fructose, d-galactose, d-mannose
di:
sucrose (glucose + fructose)
lactose (galactose + glucose)
maltose (glucose + glucose)
isomaltose
56
disaccharides
sucrose (glucose + fructose)
lactose (galactose + glucose)
maltose (glucose + glucose)
isomaltose
57
polysaccharide
glycogen (storage form of glucose in liver and skeletal muscle), starch, cellulose
58
primary rate limiting enzymatic step in glycolysis
phosphofructokinase
59
where do VLDL and LDL come from
liver
chylomicrons get bound to Apo-E in liver so they can be packaged into usable forms and distributed into body
60
in the liver, which of the following is used to make fat soluble compounds more water soluble during phase 1 detoxification by adding -OH groups
CYP450
heme cofactor
and O2 and NADPH
61
phase 2 detocification in liver needs what enzyme
conjugation phase
Glucuronidation
Acetylation
Sulfation
Methylation
Amino acid conjugation
Mercapturic acid (final form of glutathione conjugates)
for example;; glutathione S transferase conjugates toxins with the antioxidant glutathione
62
what enzyme in the pentose phosphate shunt is implicated in a genetically linked deficiency preventing the reduction of glutathione and thus leading to buildup of free radicals
G6PD
63
complication of GERD
esophagitis
64
dysfunctional lower esophageal sphincter, hiatal hernia and delayed gastric emptying can all contribute to pathophysiology of
GERD
65
which IL for B cells to form
IL7
66
spleen is largest lymphatic organ and derived from
mesoderm
67
which immunoglobulin is first expressed on B cell surface during an infection
IgM
--> early in the primary immune response
68
IgA
in body secretions in order to prevent attachment of microorganisms to mucous membranes
69
IgG
most abundant immunoglobulin and is part of secondary immune response against viruses and bacteria
70
IgE
mediates histamine response by binding to mast cells (parasitic and allergy)
71
which pathogen is associated with Hodgkins lymphoma
epstein barr virus
72
to estimate GFR
creatinine
73
which spinal levels are the kidneys at`
T11-L3
74
in an effort to reduce the edema a loop diuretic pharmaceutical drug is administered in the ER that night. on which part of the nephron does this drug act?
thick ascending loop of henle
75
what is the functional unit of the kidney
nephron
76
renal excretion is mediated by which processes
filtration, secretion, reabsorption
77
foamy urine is indicative of which sign that is diagnostic for diabetic nephropathy
proteinuria
78
besides its function in filtering the blood and concentrating the urine, the kidney is also the site of
conversion of 25(OH) hydroxyvitamin D to 1,25 (OH)2 hydroxyvitamin D
79
hyperglycemia is thought to exert its damage through either advanced glycation end products or activation of cytokines. what concurrent condition is also implicated in the pathogenesis of nephropathy?
hypertension
80
melanoma is distinct from other common skin cancers due to its
aggressive behaviour and tendency for metastasis
81
melanocytes in which layer of epidermis
stratum basale
82
strongest risk factor for melanoma is sun exposure that is
intense and intermittent
83
ABCDE of skin cancer
asymmetry, border (irregular), color (variable), diameter (>6mm), evolving
84
one type of melanoma that accounts for majority (70%) of cases
superficial spreading melanomas
85
electrical conduction in the heart begins in ____ and progresses to ____
sinoatrial node (SA node); atrioventricular node (AV node)
86
which receptors modulate the discharging of the sinoatrial node in the heart
beta adrenergic and muscarinic receptors
87
ECG for atrial fibrillation
absence of discrete P waves, replaced by irregular, chaotic F waves
f waves= fibrilatory
irregularly irregular rhythm (no predictable R-R intervals) without distinct P waves.
88
what is the risk of stroke in patients with atrial fibrillation
its dependent on risk factors
calculate using CHADS2 score
89
the primary treatment focus is that atrial fibrillation increases risk of
thromboembolism
--> due to incomplete/ineffective contractions of the atria, blood pooling and stasis can cause formation of intracardaic thrombus --> thromboembolism and stroke
90
elevated GGT, ALP and AST, jaundice, fatigue, nausea. has chronic hepatic failure. what is the cause
alcoholic cirrhosis
--> bc of elevated GGT
91
which lactate dehydrogenase enzyme is elevated in liver failure
LDH-5
92
lactate dehydrogenase: LDH-1 and LDH2 are associated with
heart muscle damage
93
lactate dehydrongenase LDH-3 is associated with
lungs and pancreas
94
LDH-5 for
liver failure
95
toxins can build up in tissues if phase II enzymes run out of donors they require in order to create water soluble end products/ this is commonly seen in ___ deficiency
sulfur
--> glutathione S transferase (GST) is an enzyme that catalyzes the conjugation of glutathione, a sulphur containing compound to various toxins for purpose of detoxification. this conjugation process renders the xenobiotics more water soluble. the rate limiting substrate for glutathione synthesis is cysteine, which is a sulphur containing amino acid
96
the liver is one of the main sites of amino acid synthesis via transaminases. what is a cofactor for transamination reactions?
pyridoxine
97
which category of amino acids does the liver not take up
branched chain
these are spared for insulin dependent absorption by skeletal muscle.
98
branched chain amino acids (3)
leucine, isoleucine, valine
99
acute pancreatitis and has hypocalcemia. what is the cause of hypocalcemia?
calcium deposition in fatty acid calcium soaps
acute pacreastitis is associated with fat necrosis in which the enzyme lipase releases fatty acids from triglycerides. these fatty acids then complex with calcium to form soaps thereby lowering calcium levels
100
pancreas gets PNS and SNS signals from which nerves
vagus nerve via celiac plexus
and SNS from thoracic splanchnic nerves via celiac plexus
101
lower mesenteric plexus for
colon and rectum
102
pancreatic cells that secrete enzymes?
acinar cells (in head of pancreas; exocrine gland)
103
goblet cells
secrete gel forming mucins and are found in intestinal and respiratory tracts
104
parietal cells
secrete Hcl and Intrsinic factor. located in gastric glands of stomach
105
islet cells
throughout pancreas and are responsible for endocrine function
106
exocrine vs endocrine pancreas
The exocrine pancreas produces digestive enzymes (like amylase, lipase, and proteases) that are secreted into the duodenum to aid in digestion. These enzymes are made by acinar cells and travel through ducts.
In contrast, the endocrine pancreas consists of the islets of Langerhans, which secrete hormones such as insulin, glucagon, and somatostatin directly into the bloodstream to regulate blood sugar and metabolism. The exocrine portion is about 98% of the pancreas, while the endocrine part is only about 2%.
107
which hormone is released in response to consumption of proteins and fats and stimulates the release of enzymes
cholecystokinin
stimulated by Hcl, amino acids or fatty acids into stomach or duodenum
108
how do dipeptides or tripeptides enter a cell from the intestinal lumen
via hydrogen ion dependent cotransporters
most ingest protein is broken down to di and tripeptides forms before absorption. these are transported from intestinal lumen into cell via hydgeon ion dependent cotransporters on apical membrane. inside the cell they are hydrolyzed to amino acids by cytosolic peptidases.
109
what happens to di and tripeptides once they get into the cell via hydrogen ion dependent cotransporters
broken down into amino acids by cytosolic peptidases
110
cystic fibrosis is a disease of _____ glands, which results in viscous secretions due to dysfunction of ___ channels
exocrine; chloride
111
cystic fibrosis
Cystic fibrosis is an autosomal recessive genetic disorder caused by mutations in the CFTR gene (Cystic Fibrosis Transmembrane Conductance Regulator), most commonly the ΔF508 mutation. This defect leads to abnormal chloride and sodium transport across epithelial cells, resulting in thick, sticky secretions in various organs.
112
common findings in cystic fibrosis
malabsorption, weifght loss, failure to thrive, nasal polyps, meconium ileus, steatorrhea
113
pulmonary ____ carry _____ blood to alveoli
arteries; deoxygenated
114
which test to diagnose cystic fibrosis
sweat test--> because of dysfunctional chloride channels lead to elevated sweat chloride levels
115
common complication of giant cell arteritis
blindness
116
giant cell arteritis
Giant Cell Arteritis is a vasculitis of large and medium-sized arteries, primarily affecting the temporal arteries and other branches of the external carotid artery. It usually occurs in adults over 50 years old.
Cause: Granulomatous inflammation with multinucleated giant cells in the arterial wall.
Symptoms:
New, localized headache (often temporal)
Scalp tenderness
Jaw claudication (pain when chewing)
Vision changes (can lead to blindness)
Fever, fatigue, weight loss
Associated condition: Often linked with Polymyalgia Rheumatica.
117
giant cell arteritis is considered a _____ vessel disease
medium and large
118
temporal artery is supplied by
external carotid artery
119
internal carotid artery terminates
as anterior and middle cerebral arteries which provide blood to the brain
internal carotid artery has no branches in the neck
120
which condition increases the risk of developing giant cell arteritis
polymyalgia rheumatica
121
polymyalgia rheumatica
Polymyalgia Rheumatica is an inflammatory disorder seen mostly in adults over 50 years old, characterized by pain and stiffness in the shoulders, neck, and hips—especially in the morning or after inactivity.
associated with giant cell arteritis
122
______ is a force exerted by a fluid on a wall whereas _____ is created by the presence of large, non diffusible molecules which draw water towards themselves
hydrostatic pressure; oncotic pressure
123
diabetes insipidus
Diabetes insipidus is a disorder where the kidneys cannot concentrate urine, leading to excessive urination and thirst. It occurs either because the body doesn’t produce enough antidiuretic hormone (central DI) or the kidneys don’t respond to it (nephrogenic DI). Treatment depends on the type—central DI is treated with synthetic ADH (desmopressin), while nephrogenic DI requires addressing the kidney’s resistance
124
diabetes insipid involved which hormone
ADH
1. decreased pituitary secretion of ADH, or
2. decreased renal sensitivity to ADH
125
triphasic diabetes insidious (DI); what order are the phases seen
polyuric, anti-diuretic, permanent DI
126
central or neurogenic diabetes insipidus is characterized by
decreased secretion of ADH
which causes increased urine output and very dilute urine of low specific gravity
central DI may be from tumor, brain injury, trauma, surgery, or mutation in ADH gene on chromosome 20
127
which of the following neuropeptides function as a potent diuretic, inhibiting ADH release
apelin
apelin is a ligand for a G coupled receptor and functions to control blood pressure, thirst and hunger. it suppresses the secretion of vasopressin, thereby acting as a diuretic and an antagonist to the functions of ADH
128
what hormone has the opposite effect of ADH
apelin
129
what is the normal response to a decrease in extracellular fluid volume?
increased aldosterone secretion
130
the arteries that supply the stomach originate from which artery coming of the abdominal aorta
celiac artery
131
what does the celiac artery supply
The celiac artery (also called the celiac trunk) supplies blood to the foregut structures, including the stomach, liver, spleen, gallbladder, pancreas, and the upper part of the duodenum. It branches into three main arteries: the left gastric artery, common hepatic artery, and splenic artery, each supplying specific organs within this region.
132
what is the layer of muscularis externa in the stomach from inner to outer?
oblique, circular, longitudinal
133
what embryological processes are responsible for the shape and positioning of the stomach in the abdomen
the dorsal border of the stomach grows more rapidly than the ventral border forming the greater and lesser curvatures of the stomach, then the stomach rotates 90 degrees clockwise on a longitudinal axis
134
what do D cells, found in the pyloric glands of the stomach produce
somatostatin
they make somatostatin in repose to increase acid levels. somatostatin inhibits gastric release from nearby G cells.
135
what are the virulence factors of helicobacter pylori
CagA toxin, urease activity, adhesins
----------
urease: generates ammonia from endogenous urea and elevates local pH
adhesins: tissue adherence in stomach
flagella: motility through mucus lining of stomach
CagA: stimulate NF-kB in gastric epithelial cells leading to expression of pro-inflammatory cytokines
136
epithelium of esophagus
stratified squamous --> mucus secreting columnar cells of stomach at Z line
137
striated muscles of upper third of esophagus is innervated by what nerve
recurrent laryngeal nerve
138
esophagus muscle type
upper 1/3 is striated muscle
lower 2/3 is smooth muscle
139
what describes the cellular changes seen in Barrett's esophagus, a compensatory and healing response to erosive esophagitis?
metaplasia
chronic inflmmation from exposure to acidic stomach contents causes a replacement of stratified squamous cells with columnar epithelium
could lead to dysplasia and adenocarcinoma
140
esophageal stage of swallowing is a continuation of peristaltic wave that begins in the pharynx. what nucleus within the medulla oblongata controls reflexes involving the heart, lungs, and GI tracts?
solitary nucleus
141
a woman is found to have thickened and hardened skin on her hands accompanied by local erythema and edema of the fingers. which condition does she have that predisposes her to GERD?
scleroderma
142
scleroderma
Scleroderma, also known as systemic sclerosis, is a chronic autoimmune connective tissue disease characterized by excess collagen deposition, leading to skin thickening and fibrosis of internal organs.
143
bronchioles of lungs differ from bronchi because
they do not contain cartilage
144
nitric oxide, an intrinsic bronchodilator within the respiratory system, requires what cofactor in its synthesis
biopterin
NO is formed from the amino acid arginine by the enzyme nitric acid synthase. this formation requires the addition of H4 biopterin as a cofactor for the rxn
145
nitric oxide formation. from what amino acid?
NO is formed from the amino acid arginine by the enzyme nitric acid synthase. this formation requires the addition of H4 biopterin as a cofactor for the rxn
146
what is a finding in an asthmatic patient
elevated leukotriene C,D, E
also histamine, nitric oxide, cytokines
147
asthma
bronchosapms, mucus secretion, airway remodelling
many inflammatory cells like mast cells, eosinophils, platelets and TH2 cells. they produce mediators like histamine, nitric oxide, leukotrienes, and cytokines to cause brocnhopasm
leukotrienes C, D and E made bronchoconstriction, mucus secretion and edema
148
the average oxygen partial pressure (PO2) of alveoli is 104 mmHg. which PO2 of the pulmonary capillaries would allow the diffusion of oxygen from alveoli into blood?
40mmHg
need to go from high to low down gradient
149
what directly stimulates respiratory center in medulla oblongata to induce ventilation
increased carbon dioxide or hydrogen ions (decreased pH)
150
pH of skin
4-6
acidic to act as barrier
151
two main types of contact dermatitis
irritant and allergic
152
allergic contact dermatitis is what type of reaction
delayed hypersensitivity reaction
153
pathogenesis of irritant contact dermatitis is a non-immunologic process that often requires
disruption of skin barrier
it does not require previous sensitiziation. its results from contact with agents that abrade, irritate or traumatize the skin. leads to increase in transepidermal water loss
154
irritant contact dermatitis occurs with what substance
a mild irritant, but frequent exposure
i.e. frequent handwashing with soap
155
what is false regarding nightmare disorder?
a. there are frightening dreams that awaken a person from sleep
b. the person remains confused and disoriented upon awakening
c. the content of the dreams is threatening and/or anxiety provoking
d. the person has detailed recall of the nightmare
e. awakenings usually happen during the second half of the sleep period
b. the person remains confused and disoriented upon awakening
156
nightmare disorder DSM-5 criteria
recurrent nightmares or disturbing dreams that are prolonged and viid. these are usually related to risk of life or limb, safety or similar and often in the latter half of the night. the patient is quick to re-orient themselves once awake. the nightmares lead to dysfunction (academic, social, professional) and/or anguish. the nightmares are not more appropriately related to a substance or medication, medical condition or mental health concern
157
in a normal functioning beta cell, insulin secretion is stimulated by membrane depolarization and resultant influx of what ion?
Ca2+
158
blood supply to the tail of pancreas comes from ____ artery
splenic
159
what is the type of transport used to reabsorb glucose in the proximal convoluted tubules of the kidneys?
secondary active
glucsose/ sodium cotrasnporte
160
eosinophilic esophagitis vs achalasia
eosinophilic esophagitis is inflammation of the esophagus with dysmotility, while achalasia is loss of peristalsis and insufficient sphincter relaxation such that both liquids and solids are regurgitated. esophagitis is ameliorated by proton pump inhibitors but achalasia is mostly unresponsive to PPis
161
achalasia
primary esophageal motor disorder with loss of peristalsis, insufficient lower esophageal sphincter relaxation, dysphagia to solids and liquids
-------
Achalasia is a motility disorder of the esophagus caused by the loss of inhibitory ganglion cells in the myenteric (Auerbach's) plexus, leading to failure of the lower esophageal sphincter (LES) to relax and absent peristalsis in the body of the esophagus.
