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Clinical Physiology Flashcards

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1
Q

Types of JVP waveforms

A

A wave: atrial contraction
C wave: Pushing of tricuspid valve towards right atrium, carotid pulsation of neck
V wave: Venous return, filling of right atrium
X wave: Relaxation of right atrium
Y wave: Emptying of right atrium

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2
Q

Pathologic JVP waveforms:
Absent A wave

A

Atrial fibrillation

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3
Q

Pathologic JVP waveforms:
Large A wave

A

Reduced RV compliance —> require more contraction from RA
Pulmonic stenosis
Pulmonary HTN

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4
Q

Pathologic JVP waveforms:
Large v wave

A

Backflow of blood to RA —> more blood pumped from RA to RV
Tricuspid regurgitation

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5
Q

Pathologic JVP waveforms:
Absent Y wave

A

Cardiac tamponade (obstructive shock)

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6
Q

Pathologic JVP waveforms:
Cannon a wave

A

RA contraction against a closed tricuspid valve
Complete heart block (3rd degree AV block pumped from RA to fill RV)

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7
Q

Aortic stenosis carotid pulse configuration

A

Pulsus parvus et tardus
(Pulse that is small and slow)
AORTIC STENOSIS

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8
Q

Pulsus Bisferiens (2 peaks in systole or triple cadence beat if with S4) is seen in?

A

HOCM
severe aortic regurg

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9
Q

Early part of diastole:
S3 or S4?

A

S3 (increasing filling pressure, systolic HF)
S4 is in late diastole (ventricular noncompliance, diastolic HF)

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10
Q

Most common type of ASD

A

Secundum

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11
Q

Wide splitting of S2

A

Delay in closure of PV - right side of heart)
• RBBB
• Pulmonic stenosis

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12
Q

Paradoxical or reversed splitting of S2

A

Delay closure in AV - left side of heart
LBBB
Aortic stenosis
HOCM
MI

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13
Q

mL for acute tamponade

A

200 ml

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14
Q

mL for chronic tamponade

A

2000 mL

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15
Q

Cardiac tamponade Triad

A

Beck’s Triad
• Muffled heart sounds
• Distended neck veins
• Hypotension

*Absent Y wave
*Prominent X wave

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16
Q

Acute MI of inferior wall of LV activated reflex

A

Bezold-Jarisch reflex
1. Bradycardia
2. Hypotension
3. Hypopnea/apnea

Due to activation of parasympathetic pathways in inferior wall of LV

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17
Q

Acute MI of anterior wall of LV activated reflex

A

James reflex
1. Tachycardia
2. Hypertension
3. Hyperapnea

Due to activation of sympathetic pathways in anterior wall of LV

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18
Q

Cerebral perfusion pressure (CPP) formula

A

CPP = MAP - ICP

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19
Q

Cushing reflex

A
  1. Hypertension
  2. Bradycardia
  3. Hypopnea/Apnea
  • due to increased MAP (to make it greater than ICP) and subsequent activation of baroreceptor reflex leading to bradycardia and hypopnea/apnea
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20
Q

Levels of Hyperkalemia in ECG:
Tall-peaked T-waves

A

5.5 - 6.5 mM

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21
Q

Levels of Hyperkalemia in ECG:
Loss of P waves

A

6.5 - 7.5 mM

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22
Q

Levels of Hyperkalemia in ECG:
Widened QRS complex

A

7.0-8.0 mM

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23
Q

hypokalemia in ECG:

A

Prominent U waves

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24
Q

Hypocalcemia in ECG

A

Prolonged QT interval

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25
Hypercalcemia in ECG
Shortened QT interval AV blocks Bradycardia
26
Abnormal fast accessory conduction pathway from atria to ventricles (bypass AV node)
Bundle of Kent
27
Most common type of ventricular preexcitatiin syndrome
Wolff-Parkinson White Syndrome 3 components 1. Delta wave 2. Shortened PR interval 3. Widened QRS complex
28
Renal tubular defect in PCT
Fanconi syndrome *Generalized absorption defect in PCT —> excretion of AAs, glucose, HCO3 And PO4, and all other substances
29
Renal tubular defect in TAL of LH
Bartter syndrome *Na-K-Cl cotransporter defect
30
Renal tubular defect in DCT
Gitelman syndrome *NaCl reabsorption defect
31
Renal tubular defect in Late CD
Liddle syndrome *Gain of function mutation —> dec. Na channel degradation —> inc Na reabsorption —> HTN Syndrome of apparent mineralocorticoid excess (SAME) *deficienct if 11-beta hydroxysteroid dehydrogenatse type 2 (11-B-HSD) —> inc cortisol —> inc mineralocorticoid activity —> aldosterone inc Na and dec K
32
What is order of renal tubular defect
Fanconi’s BaGeLS
33
Role of 11-Beta hydroxysteroid dehydrogenase Type 2
Convert cortisol to cortisone (inactive form)
34
Effects of Fanconi syndrome
Metabolic acidosis Hyposphatemia Osteopenia
35
Bartter syndrome versus Gitelman syndrome
Similarities: Autosomal recessive Metabolic alkalosis and Hypokalemia Differences *Mg and Ca Bartter: Normal Mg, Hypercalciuria Gitelman: HypoMg, Hypocalciuria Neprolith Bartter: High risk Gitelman: Low risk Mimics Bartter: Chronic loop diuretic use Gitelman: Chronic thiazide diuretic use
36
Intake of _____________ can cause SAME because it contains ____________ that blocks ______________
Licorice; Glycyrrhetinic acid; 11-B-Hydroxysteroid Dehydrogenase Type 2 (11-B-HSD)
37
Liddle is _______________disorder while SAME is ___________disorder
Autosomal dominant; Autosomal recessive
38
Liddle and SAME cause the ff effects
Metabolic Alkalosis Hypokalemia HTN Hypoaldosteronism
39
Decorticate and Decrebrate motor GCS
M3; M2
40
Cerebellar lesions affect the ____________ side
Ipsilateral
41
Presentation of cerebellar lesions in: Flocculonodular lobe
Cerebellar nystagmus
42
Presentation of cerebellar lesions in: Deep cerebellar nuclei (Dentate, Emboliform, Globose, Fastigial nuclei)
Hypotonia
43
Presentation of cerebellar lesions in: Cerebellar vermis
Truncal ataxia (middle, midline)
44
Presentation of cerebellar lesions in: Cerebellar hemisphere
Ipsilateral intention tremor Dysdiadochokinesia Falls toward side of lesion
45
Lesions of Basal Ganglia: Globus Pallidus
Athetosis (Writhing movements of hand, arm, and neck)
46
Presentation of cerebellar lesions in: Subthalamus
Hemiballismus (Sudden flailing movements of an entire limb)
47
Presentation of cerebellar lesions in: Putamen
Chorea (Flicking movements of hands, face, body)
48
Presentation of cerebellar lesions in: Substansia nigra
Parkinsons Dse Resting tremor Rigidity Akinesia Postural instability
49
Presentation of cerebellar lesions in: Striatum (Caudate nucleus + Putamen)
Huntington dse (Chorea, neurodegeneration)
50
Brain lesion in dominant parietal cortex will cause?
Gerstmann syndrome 1. Agraphia 2. Acalculia 3. Finger agnosia 4. Left-right disorientation
51
Brain lesion in nondominant parietal cortex will cause?
Hemispatial neglect syndrome Agnosia of contralateral side
52
Syndrome caused by Mamillary bodies damage
Wernicke-Korsakoff syndrome (Vitamin B1 deficiency through chronic alcoholism) Wernicke (reversible) CANO Confusion Ataxia Nystagmus Ophthalmoplegia Korsakoff (irreversible) Confabulation Personality changes
53
Syndrome caused by damage to Amygdala
Kluver Blucy Syndrome (HSV-1, temporal lobe encephalitis) Disinhibited behavior Hyperphagia Hypersexual Hyperoral
54
Caused by damage to Reticular activating system
Coma Reduced arousal and wakefulness
55
Syndrome associated with dorsal midbrain pathology
Parinaud syndrome (pinealoma - close to superior colliculus) 1. Vertical gaze palsy 2. Lid retraction 3. Pupillary light near dissociation 4. Convergence retraction nystagmus
56
FEV/FVC ratio to dx Obstructive lung dse
<70%
57
Chronic bronchitis clinical dx is: daily productive cough of ____________ months or more, in at least _________ consecutive years
3; 2
58
Characteristic of dse in 17-alpha hydroxylase deficiency
HTN Hypernatrenia Hypokalemia No virilization Low cortisol, low sex hormones, inc mineralocorticoids Bilateral adrenal hyperplasia due to negative feedback from low cortisol —> high ACTH Hyperpigmentation due to negative feedback from low cortisol —> high POMC —> high ACTH —> high MSH
59
Characteristic of dse in 21-alpha hydroxylase deficiency
Normal BP Normal NA Normal K Virilization in females, ambiguous genitalia in males Low cortisol, elevated sex hormones, low mineralocorticoids Bilateral adrenal hyperplasia due to negative feedback from low cortisol —> high ACTH Hyperpigmentation due to negative feedback from low cortisol —> high POMC —> high ACTH —> high MSH
60
Characteristic of dse in 11-beta hydroxylase deficiency
HTN Hypernatrenia Hypokalemia Virilization in females, ambiguous genitalia in males Low cortisol, elevated sex hormones, low mineralocorticoids (but elevated 11-deoxycortisone) Bilateral adrenal hyperplasia due to negative feedback from low cortisol —> high ACTH Hyperpigmentation due to negative feedback from low cortisol —> high POMC —> high ACTH —> high MSH
61
Common presentations of hyper and hypo thyroid
AUB Dec libido Infertility Proximal myopathy Pretibial myxedema
63

PHYSIOLOGY (9 decks)

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