Goljan 2 - Sheet1 Flashcards
(498 cards)
1
Q
CLL
A
B cell neoplasm; ? ?-globulins; MCC generalized lymphadenopathy patients> 60-yrs-old
2
Q
Adult T cell leukemia
A
HTLV-1; CD4 T cells; skin infiltration; lytic bone lesions with hypercalcemia
3
Q
Hairy cell leukemia
A
positive TRAP stain; splenomegaly; Rx with purine nucleosides
4
Q
Nodal sites
A
germinal follicles, B cells; paracortex, T cells; sinuses, histiocytes
5
Q
Testicular cancer
A
metastasizes to para-aortic nodes
6
Q
Stomach cancer
A
metastasizes to left supraclavicular nodes (Virchow node)
7
Q
Phenytoin
A
atypical lymphocytosis
8
Q
Cat scratch disease
A
Bartonella henselae; granulomatous microabscesses
9
Q
Follicular B-cell lymphoma
A
t(14;18); overexpression of BCL-2 anti-apoptosis gene
10
Q
Burkitt lymphoma
A
t(8;14); EBV association; common childhood NHL; Òstarry skyÓ appearance
11
Q
Extra nodal lymphomas
A
risk factors H. pylori (stomach); SjogrenÕs syndrome
12
Q
Mycosis fungoides
A
CD4 T cell neoplasm; skin lesions with PautrierÕs microabscesses
13
Q
Sezary syndrome
A
leukemic phase of mycosis fungoides
14
Q
Polyclonal gammopathy
A
sign of chronic inflammation
15
Q
Monoclonal gammopathy
A
M component (spike); sign of plasma cell disorder
16
Q
Confirmatory tests
A
serum and urine immunoelectrophoresis; bone marrow aspirate
17
Q
Bence Jones protein
A
light chains in urine; predictive of a malignant plasma cell disorder
18
Q
Multiple myeloma
A
M spike; lytic bone lesions; pathologic fractures; hypercalcemia; renal failure
19
Q
MGUS
A
MC monoclonal gammopathy; may progress to myeloma
20
Q
Findings in MGUS
A
elderly patient; no BJ protein; no malignant plasma cells
21
Q
WaldenstromÕs macroglobulinemia
A
lymphoplasmacytic lymphoma; IgM M spike; hyperviscosity
22
Q
HodgkinÕs lymphoma
A
neoplastic component, Reed Stemberg (RS) cell; CD15 CD30 positive
23
Q
Lymphocyte predominant HodgkinÕs
A
infrequent classic RS cells
24
Q
Nodular sclerosing HodgkinÕs
A
female dominant; supraclavicular nodes + anterior mediastinal nodes
25
Mixed cellularity HodgkinÕs
male dominant; numerous RS cells; EBV association
26
HodgkinÕs prognosis
stage of disease and type of HodgkinÕs most important factors
27
Alkylating agents in Rx of Hodgkins
? risk for second malignancies (leukemia; NHL)
28
LangerhanÕs histiocytes
CD1 positive; Birbeck granules
29
Letterer-Siwe disease
malignant histiocytosis <2 yrs old; diffuse eczematous rash; organ involvement
30
Hand-Christian-Christian disease
malignant; lytic skull lesions, diabetes insipidus, exophthalmos
31
Eosinophilic granuloma
benign histiocytosis; lytic bone lesions with pathologic fractures
32
Mast cells
release histamine (pruritus; swelling); metachromatic granules positive with toluidine blue
33
Urticaria pigmentosum
localized mastocytosis; skin lesions swell and itch with scratching
34
Amyloid
twisted ?-sheet; apple green birefringence with Congo red
35
Primary amyloidosis
AL amyloid derived from light chains; plasma cell disorders
36
Secondary amyloidosis
AA amyloid derived from serum-associated amyloid; chronic infections
37
AlzheimerÕs disease
amyloid precursor protein gene product chromosome 21; amyloid-?
38
GaucherÕs disease
macrophages have fibrillary appearance; deficiency glucocerebrosidase
39
Niemann PickÕs disease
macrophages have soap bubble appearance; deficiency sphingomyelinase
40
Hypersplenism
splenomegaly; peripheral blood cytopenias; portal hypertension MCC
41
Splenic dysfunction
Howell Jolly bodies; susceptible to Streptococcus pneumoniae sepsis
42
Anticoagulants
tissue plasminogen activator, heparin, PGI2 ATIII, protein C/S
43
Heparin
enhances ATIII activity (neutralizes all factors except V, VIII, fibrinogen)
44
Protein C/S
neutralize V and VIII
45
Procoagulants
coagulation factors, thromboxane A2 (platelet aggregation, vasoconstrictor)
46
Protein C and S
inactivate factors V and VIII; enhance fibrinolysis
47
von Willebrand factor
complexes with factor VIII to enhance VIII:C activity; platelet adhesion
48
Platelets
receptors for von Willebrand factor and fibrinogen; synthesize thromboxane A2
49
GpIb
platelet receptor for von Willebrand factor
50
GpIIb:IIIa
platelet receptor for fibrinogen
51
Extrinsic system factor
VII
52
Intrinsic system factors
XII, XI, IX, VIII
53
Final common pathway factors
X, V, prothrombin (II), fibrinogen (I)
54
Factor XIII
cross-links insoluble fibrin; strengthens fibrin clots
55
Vitamin K-dependent factors
prothrombin, VII, IX, X, protein C and S
56
Factors consumed in a clot
fibrinogen, prothrombin, V, VIII; fluid is called serum
57
Plasmin
cleaves fibrinogen and insoluble fibrin into degradation products
58
Bleeding time
evaluates platelet function (adhesion, release reaction, aggregation)
59
Aspirin
MCC of a prolonged bleeding time
60
Tests for vWF
ristocetin cofactor assay; vWF antigen assay; agar electrophoresis
61
PT
evaluates extrinsic pathway to fibrin clot
62
PTT
evaluates intrinsic pathway to stable fibrin clot
63
Fibrinolysis tests
fibrin(ogen) degradation products; D-dimers (cross-linked insoluble fibrin)
64
S/S platelet dysfunction
cannot form temporary plug; epistaxis; petechiae; bleeding from scratches
65
Idiopathic thrombocytopenic purpura (ITP)
children; antibodies against GpIIb:IIIa; no splenomegaly
66
Chronic autoimmune thrombocytopenic purpura
SLE; antibodies against GpIIb:IIIa receptors
67
Heparin
thrombocytopenia due to IgG antibody against heparin attached to PF4 on platelets
68
PF4
heparin neutralizing factor
69
HIV
thrombocytopenia MC hematologic abnormality; similar to ITP
70
TTP
platelet thrombi develop in areas of endothelial damage in small vessels; consumption of platelets
71
S/S
fever, thrombocytopenia, renal failure, hemolytic anemia with schistocytes, CNS deficits
72
Lab findings TTP
thrombocytopenia, prolonged bleeding time, normal PT and PTT
73
HUS
similar to TTP; endothelial injury from Shiga-like toxin of 0157:H7 E. coli in undercooked beef
74
S/S factor deficiency
no stable fibrin clot-late rebleeding; menorrhagia; GI bleeding; hemarthroses
75
Hemophilia A
XR; hemarthroses; prolonged PTT, ? factor VIII activity, normal VIII antigen
76
von WillebrandÕs disease
AD; platelet adhesion defect + factor VIII deficiency
77
Lab findings in VWD
? vWF, VIII antigen, and VIII:C; prolonged bleeding time
78
Desmopressin acetate
Rx of choice for mild von WillebrandÕs disease and hemophilia A
79
Circulating anticoagulants
antibodies destroy coagulation factors
80
Lab finding in circulating anticoagulant
prolonged PT and/or PTT corrected with mixing studies
81
Vitamin K deficiency
? epoxide reductase activity (? function vitamin K); hemorrhagic diathesis; ? PT
82
Causes vitamin K deficiency
antibiotics MC, newborn, malabsorption, warfarin
83
DIC
activation coagulation system from release of tissue thromboplastin and/or endothelial cell damage
84
DIC
consumption coagulation factors by fibrin clots; patient also anticoagulated
85
Causes
septic shock MCC, rattlesnake bite, massive trauma, amniotic fluid
86
S/S
bleeding from all scratches, holes, needle sites
87
Lab findings DIC
thrombocytopenia, ? PT and PTT, D-dimers (best test), anemia
88
Antiphospholipid antibodies
lupus anticoagulant and anticardiolipin antibodies; vessel thrombosis
89
Warfarin
inhibits epoxide reductase; PT best test but PTT also prolonged
90
Warfarin
full anticoagulation in 3 days when -carboxylated prothrombin disappears
91
Warfarin
ingredient in rat poison; danger to children in households with grandparents on warfarin
92
Rx warfarin over anticoagulation
intramuscular vitamin K (6-8 hrs), fresh frozen plasma (immediate)
93
Heparin
enhances ATIII; PTT best test but PT also prolonged
94
OC
estrogen ? coagulation factor synthesis and ATIII; predisposes to thrombosis
95
Factor V Leiden
MC hereditary thrombosis; resistant to degradation by protein C/S
96
ATIII deficiency
no prolongation of PTT with administration of heparin
97
Hemorrhagic skin necrosis
post-warfarin therapy in patient with heterozygote protein C deficiency
98
M cells
specialized cells that transfer foreign antigens to lymphocytes in PeyerÕs patches
99
Blood group O
some patients have anti-AB-IgG antibodies; increased incidence duodenal ulcers
100
Blood group A
increased incidence of gastric carcinoma
101
Newborns
do not have natural blood group antibodies at birth (e.g., anti-A-lgM)
102
Elderly
may lose natural blood group antibodies; no hemolytic reaction to mismatched blood
103
Rh antigens
inherited in autosomal codominant fashion; Rh antigens include D, C, c, E, e
104
Atypical antibodies
antibodies against Rh or non-Rh blood group antigens (e.g., anti-D)
105
Duffy antigen
receptor for Plasmodium vivax; blacks often lack Duffy antigen
106
Antibody screen
indirect CoombÕs test; detects atypical antibodies in serum
107
Cytomegalovirus
MC infection transmitted by blood transfusion; MC antibody
108
Hepatitis C
MCC of post-transfusion hepatitis
109
Major crossmatch
patient serum reacted against donor RBCs; does not guarantee RBC survival
110
Universal donor
blood group O; no antigens on the surface of RBCs
111
Universal recipient
blood group AB; no natural blood group antibodies in serum
112
Packed RBC transfusion
raises Hb by 1 gm/dL and Hct by 3%
113
Cryoprecipitate
fibrinogen and factor VIII
114
Fresh frozen plasma
replacement for multiple factor deficiencies (e.g., cirrhosis, DIC)
115
Allergic transfusion reaction
type I IgE-mediated hypersensitivity reaction
116
Febrile transfusion reaction
recipient anti-HLA antibodies react against donor leukocytes
117
Intravascular HTR
transfusion of ABO incompatible blood (e.g., A person receives B blood)
118
Extravascular HTR
antibody attaches to donor RBCs; macrophage phagocytosis and hemolysis
119
Positive direct CoombÕs test
present in both types of hemolytic transfusion reactions
120
S/S
jaundice, no increase in Hb, hemoglobinuria
121
ABO HDN
mother O and baby A or B; transplacental passage of maternal anti-AB-IgG
122
ABO HDN
positive direct CoombÕs test; spherocytes; MCC unconjugated hyperbilirubinemia first 24 hrs
123
Rh HDN
mother Rh (D antigen) negative and fetus Rh (O antigen) positive
124
Rh HDN
no hemolysis in first Rh incompatible pregnancy
125
Rh HDN
maternal anti-D crosses placenta; potential for hydrops fetalis; high risk for kernicterus
126
Rh immune globulin
anti-D; coats D antigen site on fetal RBCs in maternal circulation
127
Rh HDN lab
positive direct CoombÕs; severe anemia and hyperbilirubinemia
128
ABO HDN
protects mother from Rh sensitization (development of anti-D antibodies)
129
O Rh negative mother with A Rh positive baby
A+ cells destroyed by mothers anti A-lgM
130
Blue fluorescent light
converts unconjugated bilirubin in skin into harmless water soluble dipyrrole
131
MV auscultation
apex
132
TV auscultation
left parasternal border
133
AV auscultation
right 2nd intercostal space
134
PV auscultation
left 2nd intercostal space
135
S1
closure MV and TV
136
S2
closure AV and PV
137
Inspiration
split in A2 and P2; due to increased blood in right side of heart
138
S3
abnormal; due to blood entering volume overloaded ventricle in early diastole
139
Causes S3
valve regurgitation; congestive heart failure
140
S4
abnormal; due to blood entering non-compliant ventricle with atrial contraction in late diastole
141
Causes S4
volume overloaded ventricle, hypertrophy
142
Murmurs
stretching valve ring or damage to valve
143
Inspiration
increases right sided abnormal heart sounds and murmurs
144
Expiration
increases left sided abnormal heart sounds and murmurs
145
Stenosis murmurs
problem in opening valve
146
Regurgitation murmurs
problem in closing valve
147
Valves opening in systole
AV and PV
148
Valves opening in diastole
MV and TV
149
Valves closing in systole
MV and TV
150
Valves closing in diastole
AV and PV
151
LDL
primary vehicle for carrying cholesterol
152
VLDL
primary vehicle for carrying liver-synthesized triglyceride
153
Familial hypercholesterolemia (type II)
AD; deficiency of LDL receptors; ? LDL
154
Type III hyperlipoproteinemia
deficiency apo E; ? remnants (chylomicron, intermediate density)
155
Type IV hyperlipoproteinemia
? VLDL; alcoholics
156
Apo B deficiency
deficiency apo B48 (chylomicrons) and B100 (VLDL); ? CH and TG
157
Clinical findings in apo B deficiency
malabsorption; hemolytic anemia
158
Atherosclerosis
reaction to injury of endothelial cells
159
Risk factors
smoking, ? LDL, ? homocysteine, Chlamydia pneumoniae infection
160
Cells involved
platelets, macrophages, smooth muscle cells, T cells with cytokine release
161
Fibrous plaque
pathognomonic lesion of atherosclerosis
162
C-reactive protein
marker of an inflammatory atheromatous plaque
163
Inflammatory atheromatous plaque
predisposes to platelet thrombosis
164
Increased plasma homocysteine
? vessel thrombosis; folate (MC)/vitamin B12 deficiency
165
Hyaline arteriolosclerosis
small vessel disease of DM and hypertension; excess protein in vessel wall
166
Mechanisms hyaline arteriolosclerosis in DM
non-enzymatic glycosylation
167
Non-enzymatic glycosylation
glucose attaches to amino acids in BM; causes ? permeability to protein
168
Mechanisms hyaline arteriolosclerosis in hypertension
pressure pushes proteins into vessel wall
169
Abdominal aortic aneurysm rupture
due to atherosclerosis; flank pain, hypotension, pulsatile mass
170
Syphilitic aneurysm
vasculitis of vasa vasorum of aortic arch; aortic regurgitation
171
Aortic dissection
due to hypertension and collagen tissue disorders (e.g., Marfan)
172
Cystic medial degeneration
elastic tissue degeneration creates spaces filled with mucopolysaccharides
173
Intimal tear in aorta
due to wall stress from hypertension and structural weakness
174
Types of dissection
proximal (MC); distal or combination of both
175
S/S proximal aortic dissection
chest pain radiating to back, lack of pulse; cardiac tamponade MC COD
176
MarfanÕs
AD; fibrillin defect; aortic regurgitation/dissection; lens dislocation; MVP with sudden death
177
MC COD MarfanÕs and Ehlers Danlos
aortic dissection
178
Phlebothrombosis
stasis of blood flow; deep veins below knee MC site
179
Pulmonary thromboembolism
emboli originate from femoral veins
180
Superficial migratory thrombophlebitis
sign of carcinoma of head of pancreas
181
Thoracic outlet syndrome
absent radial pulse with positional change
182
TurnerÕs syndrome
lymphedema hands/feet in newborn; preductal coarctation
183
Spider telangiectasia
arteriovenous fistula; due to hyperestrinism (cirrhosis, pregnancy)
184
Capillary hemangioma in newborn
regress with age; do not surgically remove
185
KaposiÕs sarcoma
HHV-8; vascular malignancy; MC cancer in AIDS
186
Bacillary angiomatosis
Bartonella henselae; vascular infection in AIDS
187
Small vessel vasculitis
palpable purpura; e.g., Henoch Schonlein purpura
188
Muscular artery vasculitis
vessel thrombosis with infarction; e.g., classical polyarteritis nodosa
189
Elastic artery vasculitis
absent pulse, stroke
190
TakayasuÕs arteritis
pulseless disease; young Asian woman
191
Giant cell arteritis
temporal artery granulomatous vasculitis; ipsilateral blindness (ophthalmic artery)
192
Classical polyarteritis nodosa
muscular artery vasculitis with vessel thrombosis infarction
193
Path findings
vessel inflammation at different stages; aneurysms from vessel weakness
194
S/S
infarctions in kidneys, skin, GI tract, heart; HBsAg in 30%
195
Diagnosis
angiography identifies aneurysms and thrombosis
196
KawasakiÕs disease
coronary artery vasculitis/thrombosis/aneurysms in children
197
S/S
chest pain; desquamating rash; swelling hands/feet; cervical lymphadenopathy
198
Rx
IV ?-globulin
199
BuergerÕs disease (thromboangiitis obliterans)
smokerÕs digital vasculitis; digital infarction
200
RaynaudÕs syndrome
digital vasculitis in PSS and CREST syndrome
201
S/S
digital pain; white-blue-red color changes
202
Cryoglobulinemia
protein gels in cold temperature; RaynaudÕs syndrome; HCV association
203
S/S
acral cyanosis relieved by coming indoors
204
WegenerÕs granulomatosis
association with c-ANCA; sinusitis, lung infarction, crescentic GN
205
Microscopic polyangiitis
palpable purpura; crescentic GN; association with p-ANCA
206
Henoch-Schnlein purpura
IgA-anti-IgA ICs; palpable purpura buttocks/legs; arthritis; IgA GN
207
Serum sickness vasculitis
e.g., horse antivenin in Rx of rattlesnake envenomation
208
Rocky Mountain spotted fever
tick borne
209
Meningococcemia
sepsis causes petechia/ecchymoses; potential for Waterhouse Friderichsen syndrome
210
Essential HTN blacks
defect in renal excretion of sodium; ? plasma volume, ? PRA
211
Renovascular HTN
atherosclerosis renal artery in men; fibromuscular hyperplasia renal artery women
212
S/S
epigastric bruit; ? PRA affected kidney, ? PRA unaffected kidney
213
Endocrine HTN
1¼ HPTH, Graves/hypothyroidism, CushingÕs, 1¼ aldosteronism, phaeochromocytoma
214
Hypertension
LVH MC complication; AMI MC COD followed by stroke and renal failure
215
Afterload
resistance ventricles contract against
216
Preload
volume ventricles must eject
217
Concentric LVH
increased afterload; e.g., essential HTN, aortic stenosis
218
LVH with dilation/hypertrophy
increased preload; e.g., valve regurgitation; left to right shunts
219
LHF
forward failure; pulmonary edema, pillow orthopnea, paroxysmal nocturnal dyspnea
220
Systolic dysfunction
LHF due to decreased ventricular contractility (ischemia)
221
Diastolic dysfunction
LHF due to decreased ventricular compliance (hypertrophy)
222
RHF
backward failure; ? venous hydrostatic pressure; neck vein distention, hepatomegaly, edema
223
ACE inhibitors
decrease afterload and preload in heart failure
224
Diuretics in CHF
reduce preload
225
Non-pharmacologic Rx in CHF
restrict salt and water
226
AMI
MC COD in United States; left anterior descending coronary artery thrombosis MCC
227
Exertional angina
coronary artery atherosclerosis; subendocardial ischemia; ST depression
228
PrinzmetalÕs angina
coronary artery vasospasm; transmural ischemia; ST elevation
229
Sudden cardiac death
death within 1 hr of symptoms
230
Path findings
severe coronary artery atherosclerosis; absence of occlusive thrombosis
231
LAD coronary artery
anterior portion left ventricle, anterior 2/3rds IVS
232
RCA
posterior portion left ventricle and papillary muscle, inferior 1/3rd IVS, right ventricle
233
AMI
rupture of inflammatory plaque produces platelet thrombus
234
Ventricular fibrillation
MC COD in AMI
235
AMI
no gross changes until 24 hrs
236
S/S AMI
retrosternal pain radiating down arms, diaphoresis
237
AMI ruptures
3rd-7th day
238
Anterior wall rupture
MC type; LAD thrombosis; cardiac tamponade
239
Posteromedial papillary muscle rupture
RCA thrombosis; mitral regurgitation with LHF
240
IVS rupture
LAD thrombosis; left to right shunt; RHF
241
Mural thrombus
anterior AMI; danger embolization
242
Pericarditis
first week in transmural AMI; 6 wks later autoimmune
243
S/S
friction rub; leaning forward relieves pain
244
Ventricular aneurysms
late manifestation of AMI; precordial systolic bulge; CHF MC COD
245
Right ventricular infarction
RCA thrombosis; hypotension, RHF, preserved left ventricular function
246
Diagnosis of AMI
CK-MB and troponins; CK-MB absent by 3 days; troponins last 7-10 days
247
LDH isoenzymes
no longer used; LDH 1/2 flip indicates AMI
248
Reinfarction
reappearance CK-MB after 3 days
249
ECG findings in AMI
inverted T waves; ST elevation; Q waves
250
Ejection fraction
EF = stroke volume/left ventricular end-diastolic volume; 80/120 = 0.66
251
By-pass surgery
use internal mammary artery and saphenous veins (ÒarterializeÓ after 10 yrs)
252
Angioplasty complication
localized dissection with thrombosis
253
Umbilical vein
highest O2 saturation
254
Ductus arteriosis in fetus
shunts blood from pulmonary artery to aorta; PGE keeps it open
255
Ductus arteriosus in newborn
closes and becomes ligamentum arteriosum
256
EisenmengerÕs syndrome
cyanosis due to reversal of left to right shunt
257
VSD
MC congenital heart disease; ? SaO2 right ventricle (RV), pulmonary artery (PA)
258
ASD
patent foramen ovale; ? SaO2 right atrium (RA), RV, PA; MC adult congenital heart disease
259
Down syndrome
endocardial cushion defect (combined ASD and VSD)
260
PDA
machinery murmur; close with indomethacin; ? SaO2 PA
261
Tetralogy of Fallot
degree of pulmonic stenosis determines if cyanosis is present
262
Tetralogy of Fallot
? left ventricle, aorta
263
Tetralogy of Fallot
ASD and PDA are cardioprotective
264
Complete transposition
cyanosis; aorta empties RV; PA empties left ventricle
265
Complications cyanotic heart disease
2¡ polycythemia; infective endocarditis; metastatic abscesses
266
Pre-ductal coarctation
TurnerÕs syndrome
267
Post-ductal coarctation
constriction distal to ligamentum arteriosum
268
S/S
upper extremity HTN; claudication; rib-notching; activation RAA also causes HTN
269
Acute rheumatic fever
type II hypersensitivity; group A streptococcus pharyngeal infection
270
Acute rheumatic fever
sterile vegetations mitral valve (regurgitation); myocarditis with Aschoff nodule
271
S/S
polyarthritis (MC), carditis, erythema marginatum, rheumatoid nodules, chorea
272
Mitral stenosis
chronic rheumatic fever; opening snap followed by mid-diastolic rumble
273
Mitral stenosis
left atrial dilation hypertrophy - atrial fibrillation, thrombus, pulmonary edema, RHF
274
MVP
myxomatous degeneration of mitral valve; common in Marfan syndrome, Ehlers Danlos
275
S/S
mid-systolic click followed by a murmur; palpitations, chest pain, rupture of chordae
276
MVP click/murmur close to S1
decrease preload (stand, Valsalva, anxiety)
277
MVP click/murmur close to S2
increase preload (supine, squat, clench fist)
278
Mitral regurgitation
pansystolic murmur; S3 and S4 common
279
Causes
LHF, infective endocarditis, acute rheumatic fever
280
Aortic stenosis
systolic ejection murmur; syncope and angina with exercise; hemolytic anemia
281
Aortic stenosis murmur increased preload
worsens obstruction and increases murmur intensity
282
Aortic stenosis murmur decreased preload
decreases obstruction and decreases murmur intensity
283
Causes
bicuspid aortic valve; age-related sclerosis
284
Aortic regurgitation
bounding pulses; early diastolic blowing murmur
285
Austin Flint murmur
diastolic murmur; regurgitant flow on anterior leaflet mitral valve
286
Significance Austin Flint murmur
sign for AV replacement
287
Causes aortic regurgitation
essential HTN, infective endocarditis, acute rheumatic fever, dissection
288
Tricuspid regurgitation
pansystolic murmur ? intensity with inspiration
289
Causes
endocarditis IV drug abuse; RHF; carcinoid heart disease
290
Carcinoid heart disease
tricuspid regurgitation, pulmonic stenosis
291
Infective endocarditis (IE)
Streptococcus viridans MCC; Staphylococcus aureus MCC IVDA
292
IE prosthetic heart valve
Staphylococcus epidermidis (coagulase negative)
293
IE ulcerative bowel disease
Streptococcus bovis
294
S/S
IC vasculitis-Roth spot, splinter hemorrhages; regurgitant murmurs; metas1atic abscesses
295
Lab findings
positive blood culture Libman Sacks endocarditis
296
Coxsackievirus
MCC of myocarditis (lymphocyte infiltrate in myocardium) and pericarditis
297
Parasitic cause myocarditis
leishmania in Chagas disease
298
Pericardial effusion
all chamber pressures are uniformally increased
299
S/S
muffled heart sounds, pulsus paradoxus, inspiratory neck vein distention
300
Dx and Rx
echocardiogram, pericardiocentesis, respectively
301
Pulsus paradoxus
drop in blood pressure >10 mmHg with inspiration
302
Constrictive pericarditis
TB MCC worldwide; pericardial knock
303
Congestive cardiomyopathy
generalized chamber enlargement; low ejection fraction
304
Causes
postpartum, cardiotoxic drugs, hypothyroidism, alcohol
305
Hypertrophic cardiomyopathy
MCC of sudden death in young person (due to conduction defects)
306
Site of obstruction
anterior leaflet mitral valve drawn against asymmetric thickened IVS
307
Effect decreased preload on systolic murmur
worsens obstruction and increases murmur intensity
308
Effect increased preload on systolic murmur
reduces obstruction and decreases murmur intensity
309
Restrictive cardiomyopathy
decreased compliance
310
Causes
iron, amyloid, glycogen; sarcoidosis; tropical endocardial fibrosis
311
Cardiac myxoma
benign tumor left atrium; embolization; syncope
312
Cardiac rhabdomyoma
childhood tumor; association with tuberous sclerosis
313
U wave
hypokalemia; MCC diuretic therapy (e.g., thiazides; loop diuretics)
314
Peaked T wave
hyperkalemia; MCC renal failure
315
ST depression
subendocardial ischemia (e.g., classical angina pectoris)
316
ST elevation
transmural ischemia (e.g., AMI), pericarditis, ventricular aneurysm
317
Atrial fibrillation
MC chronic arrhythmia; absent P waves; danger for embolization
318
Ventricular premature beats
wide QRS complexes; MC arrhythmia in coronary care unit
319
Ventricular fibrillation
MCC of death in an AMI
320
Anterior AMI
Q waves in I and V1-V4
321
Inferior AMI
Q waves in II, III, and aVF; right coronary artery thrombosis.
322
Wolff-Parkinson-White
short PR interval with normal P wave; delta wave on upstroke of R wave
323
Alveolar O2 calculation
% O2 breathing (713) - PCO2/0.8
324
Increased A-a gradient
primary lung disease; left to right shunts in heart
325
Forced vital capacity
total amount of air expelled after a maximal inspiration
326
Forced expiratory volume/1 second (FEV1)
amount of air expelled in I second after maximal inspiration
327
Choanal atresia
cyanotic when breast feeding; turns pink when crying
328
Nasal polyps
allergic (MC; adults only), aspirin, cystic fibrosis
329
Nasal polyp in a child
requires sweat test to exclude cystic fibrosis
330
Triad asthma
patient on aspirin (pain syndrome) with nasal polyps, asthma
331
Obstructive sleep apnea (OSA)
snoring with intervals of apnea (respiratory acidosis with hypoxemia)
332
S/S
danger cor pulmonale; requires sleep test; Rx. O2 with continuous positive airway pressure
333
Sinusitis
maxillary sinusitis MC in adults; ethmoiditis MC in children; S. pneumoniae MC
334
Nasopharyngeal carcinoma
association with EBV; metastasize to cervical nodes
335
Laryngeal carcinoma
smoking MCC; hoarseness; squamous cell carcinoma
336
Resorption atelectasis
MCC of fever 24-36 hours after surgery
337
S/S
? percussion; absent fremitus, breath sounds; inspiratory lag; elevated diaphragm
338
RDS
decreased production surfactant; airway collapse; hyaline membranes
339
Type II pneumocytes
synthesize surfactant (lecithin, phosphatidylcholine); stored in lamellar bodies
340
Surfactant
reduces surface tension in airways; ? synthesis cortisol, thyroxine; ? synthesis insulin
341
Causes RDS
prematurity, maternal diabetes, C-section
342
Maternal diabetes
maternal hyperglycemia ? fetal hyperglycemia ? fetal insulin which ? surfactant
343
Complications RDS
O2 FR injury (blindness, bronchopulmonary dysplasia); necrotizing enterocolitis
344
Typical community acquired pneumonia
Streptococcus pneumoniae MCC
345
Typical pneumonia
bronchopneumonia, lobar pneumonia
346
S/S
productive cough; consolidation - ? percussion, ? tactile fremitus
347
Atypical community acquired pneumonia
interstitial pneumonia; Mycoplasma pneumoniae MCC
348
S/S
low grade fever, non-productive cough, no signs consolidation
349
Nosocomial pneumonia
Pseudomonas, aeruginosa MCC (respirators); others - S. aureus, E. coli
350
Rhinovirus
MCC common cold; hand to mouth transmission
351
Respiratory syncytial virus
MCC pneumonia and bronchiolitis in child
352
Parainfluenza virus
MCC croup in child; trachea area of obstruction
353
Cytomegalovirus
basophilic intranuclear inclusion surrounded by halo
354
Influenza
superimposed pneumonia with S. aureus increases mortality
355
Rubeola
Warthin-Finkeldey multinucleated giant cells
356
Chlamydia pneumoniae
atypical pneumonia; association with coronary artery disease
357
Chlamydia trachomatis
pneumonia in newborns; staccato cough; wheezing
358
Coxiella burnetii
only rickettsia without a vector
359
Mycoplasma pneumoniae pneumonia
crowded condition; cold agglutinins; azithromycin
360
Streptococcus pneumoniae pneumonia
gram positive diplococcus; azithromycin
361
Staphylococcus aureus pneumonia
tension pneumatocysts in children with cystic fibrosis
362
Corynebacterium diphtheriae
toxin produces ADP ribosylation of elongation factor 2
363
Haemophilus influenzae
exacerbation chronic bronchitis; acute epiglottis in children
364
Inspiratory stridor child
croup, epiglottitis
365
Pseudomonas aeruginosa
MCC of pneumonia and death in cystic fibrosis; green sputum
366
Klebsiella pneumoniae
mucoid sputum in alcoholic
367
Legionella pneumophila
silver stain; water coolers/mist (grocery produce, restaurants, zoo rain forest)
368
Mycobacterium tuberculosis
strict aerobe; MC COD due to infectious disease worldwide
369
Candida albicans
vessel invader; yeasts and pseudohyphae
370
Cryptococcus immitis
pigeon excreta; narrow-based bud
371
Aspergillus fumigatus
septate hyphae with fruiting body; fungus ball, extrinsic asthma, vessel invader
372
Mucor species
non-septate; vessel invader; frontal lobe abscess in diabetic ketoacidosis
373
Coccidioides immitis
Southwest deserts; inhale arthrospores in dust; spherule with endospores
374
S/S
erythema nodosum (painful nodules lower legs)
375
Histoplasma capsulatum
Ohio/central Mississippi river valley; excreta bats (spelunker), chickens
376
H. capsulatum
simulates TB; yeasts phagocytosed by macrophages
377
Blastomyces dermatitidis
overlaps histoplasmosis; broad-based buds; skin lesion simulates cancer
378
Pneumocystis carinii
cysts and trophozoites; pneumonia in HIV; Rx. trimethoprim/sulfamethoxazole
379
Primary TB
upper portion lower lobe, lower portion upper lobe
380
Primary TB
Ghon focus (subpleural caseation); Ghon complex (spread to hilar nodes)
381
Reactivation TB
cavitating lesion in upper lobe; kidney MC extrapulmonary site
382
Mycobacterium avium intracellulare (MAI)
atypical TB; MC TB in AIDS
383
CF
AR; 3 nucleotide deletion chromosome 7; defective CFTR (degraded in Golgi apparatus)
384
S/S
pneumonia, malabsorption, males sterile; + sweat test; P. aeruginosa pneumonia MC COD
385
Lung abscess
MCC aspiration oropharyngeal material (mixed aerobe/anaerobe); x-ray - air/fluid level
386
Aspiration sitting
posterobasal segment right lower lobe
387
Aspiration supine
superior segment right lower lobe
388
Aspiration right side
right middle lobe, posterior segment right upper lobe
389
Pulmonary thromboembolism
most derive from femoral vein
390
Bronchial artery
branch of aorta/intercostal artery; protects against developing pulmonary infarction
391
Saddle embolus
sudden death due to acute right heart strain
392
S/S pulmonary infarction
dyspnea and tachypnea; pleuritic chest pain; pleural effusion
393
Dx
ventilation/perfusion scan; respiratory alkalosis; hypoxemia
394
Pain on inspiration
pleuritic inflammation; pulmonary embolus, pneumonia, pneumothorax
395
Pathogenesis pulmonary hypertension (PH)
hypoxemia and respiratory acidosis
396
Hypoxemia + respiratory acidosis
vasoconstriction pulmonary vessels; vasodilation cerebral vessels
397
Causes PH
1¡ lung disease (COPD, restrictive), recurrent emboli, mitral stenosis, OSA, left-right shunts
398
Cor pulmonale
PH + RVH
399
S/S
dyspnea; accentuated P2 (PH); parasternal heave (RVH)
400
Restrictive lung disease
? compliance, ? elasticity; interstitial fibrosis/edema
401
Restrictive lung disease (RLD)
? all volumes and capacities; ? FEV1sec/FVC ratio
402
ARDS
RLD; non-cardiogenic pulmonary edema due to alveolar injury
403
ARDS
neutrophil destruction of type I and II pneumocytes; hyaline membranes
404
Causes
septic shock (MC), aspiration gastric contents, severe trauma
405
Pneumoconiosis
inhalation mineral dust causing interstitial fibrosis; particles <0.5 ?m to reach alveoli
406
Caplan syndrome
pneumoconiosis + rheumatoid nodules in lungs
407
Coal workerÕs
Òblack lungÓ disease; progressive massive fibrosis; no increased incidence cancer or TB
408
Silicosis
quartz; nodular opacities; foundry workers; ? incidence cancer and TB
409
Sources asbestos
roofing material, old buildings (9/11), pipe-fitter shipyard
410
Ferruginous bodies
asbestos fiber coated by iron
411
Asbestosis
benign pleural plaques (MC); bronchogenic carcinoma (MC cancer); mesothelioma
412
Mesothelioma
malignancy of serosa; no smoking association
413
Sarcoidosis
RLD; MC non-infectious lung and liver granulomatous disease
414
S/S
dyspnea, hilar adenopathy (non-caseating granulomas), uveitis, nodular skin lesions
415
Lab findings
? ACE, hypercalcemia (macrophages synthesize 1-?-hydroxylase)
416
Kveim test
intradermal injection sarcoid antigens causes skin reaction
417
FarmerÕs lung
RLD; lung reaction against thermophilic bacteria in moldy hay
418
Silo fillerÕs disease
RLD; reaction against nitrogen dioxide in fermenting corn
419
Byssinosis
RLD; reaction against cotton, linen, hemp products in textile industry
420
GoodpastureÕs syndrome
RLD; anti-BM antibodies; begins in lungs and ends in renal failure
421
Collagen vascular RLD
SLE, rheumatoid arthritis, systemic sclerosis
422
Drugs RLD
amiodarone, bleomycin, busulfan, cyclophosphamide, methotrexate, nitrofurantoin
423
Obstructive lung disease
? compliance, ? elasticity
424
Obstructive lung disease
? RV, TLC; ? TV, VC; ? FEV1sec and FVC; ? FEV1sec/FVC ratio
425
Obstructive lung disease
asthma, emphysema, chronic bronchitis, bronchiectasis
426
Asthma
extrinsic (type I hypersensitivity) and intrinsic types
427
S/S
expiratory wheezing (inflamed terminal bronchioles); LTC4,-D4,-E4 bronchoconstrictors
428
Charcot-Leyden crystals
derive from crystalline material in eosinophil granules
429
Lab findings
initial respiratory alkalosis; respiratory acidosis requires intubation
430
Emphysema
destruction elastic tissue respiratory unit; lung hyperinflation; smoking MCC; pink puffer
431
Respiratory unit
respiratory bronchiole, alveolar duct, alveoli
432
Radiograph emphysema
? AP diameter; depressed diaphragms; vertical heart
433
Pathogenesis
? AAT, ? neutrophil destruction of elastic tissue
434
Centriacinar emphysema
destruction/distention respiratory bronchioles upper lobe in smokers; THINK
435
Panacinar emphysema
destruction/distention entire respiratory unit lower lobes; AAT deficiency
436
Paraseptal emphysema
upper lobe destruction/distention alveolar ducts, alveoli; pneumothorax
437
Lab findings
normal to decreased PCO2 (respiratory alkalosis)
438
Chronic bronchitis
productive cough 3 months/2 consecutive years; blue bloater (cyanosis)
439
Site of obstruction
terminal bronchioles (proximal to respiratory unit)
440
Lab findings
respiratory acidosis/hypoxemia
441
Bronchiectasis
obstruction/infection key causes; dilated bronchioles extend to periphery
442
Causes
CF MCC, TB, immotile cilia syndrome
443
Immotile cilia syndrome
absent dynein arm in cilia; sinusitis, infertility, bronchiectasis, situs inversus
444
Central lung cancers
squamous cancer and small cell cancer; men > women
445
Peripheral lung cancers
adenocarcinoma; women > men
446
Squamous lung cancer
cavitate; secrete PTH-related protein
447
Small cell carcinoma
neuroendocrine tumor; secrete ACTH and ADH
448
Bronchioloalveolar carcinoma
no smoking relationship; lung consolidation resembling pneumonia
449
Scar carcinoma
usually adenocarcinoma developing in old TB scar
450
Bronchial carcinoid
low grade malignant; hemoptysis; rare cause carcinoid syndrome
451
Metastatic lung cancer
more common than primary cancer; breast cancer MCC
452
Pancoast tumor
squamous carcinoma posterior mediastinum; destruction superior cervical ganglion
453
S/S
HornerÕs syndrome - lid lag, miosis, anhydrosis; lower brachial plexus injury
454
Solitary coin lesion
granuloma MCC
455
Superior vena caval syndrome
primary lung cancer obstructs vessel; venous congestion
456
Anterior mediastinal masses
thymoma; nodular sclerosing HodgkinÕs; teratomas
457
Posterior mediastinal masses
usually neurogenic tumors of ganglia
458
Myasthenia gravis
B cell hyperplasia of thymus MC abnormality; association with thymoma
459
Thymoma
association with hypogammaglobulinemia, autoimmune disease, pure RBC aplasia
460
Pleural effusions
transudates or exudates; CHF MCC
461
Spontaneous pneumothorax
rupture subpleural or intrapleural bleb; air/pleural cavity pressure same
462
S/S
pleuritic chest pain, dyspnea, tracheal shift ipsilateral side, absent breath sounds
463
Tension pneumothorax
flap-like pleural tear; increased pleural cavity pressure; compression atelectasis
464
S/S
as above except tracheal shift to opposite side
465
Cleft lip/palate
failure of fusion of facial processes
466
Herpes labialis
multinucleated giant cell with acidophilic intranuclear inclusions on Tzanck prep
467
Hairy leukoplakia
EBV glossitis; pre-AIDS defining lesion; not precursor to cancer
468
Mumps
bilateral parotitis; unilateral orchitis; ? amylase
469
Diphtheria
pseudomembrane pharynx and trachea with cervical lymphadenopathy
470
Congenital syphilis
notched central incisors
471
Actinomycosis
anaerobic gram + filamentous bacteria; complication extracted dental abscess
472
S/S
draining sinuses with sulfur granules
473
Exudative tonsillitis
majority are viral; 20% group A streptococcus
474
Oral thrush
common in newborn; pre-AIDS defining lesion; yeasts and pseudohyphae
475
Dental caries
Streptococcus mutans
476
Peutz-JegherÕs syndrome
mucosal pigmentation; hamartomatous polyps
477
Leukoplakia/erythroleukoplakia
biopsy to rule out squamous dysplasia or cancer
478
Squamous cell carcinoma
smoking and alcohol association; lower lip MC site
479
Smokeless tobacco
verrucoid squamous cell carcinoma
480
Gum hyperplasia
phenytoin, pregnancy, scurvy
481
Pleomorphic adenoma
MC benign tumor of salivary glands; parotid MC site
482
Mucoepidermoid carcinoma
MC malignant tumor major and minor salivary glands
483
Dysphagia for solids only
lesion obstructing esophagus; e.g., cancer, web
484
Plummer-Vinson syndrome
iron deficiency anemia causes esophageal web, glossitis, achlorhydria (? HCl in gastric acid)
485
Dysphagia for solids and liquids
motor abnormality; e.g., achalasia MCC, PSS or CREST syndrome
486
TE fistula
polyhydramnios; proximal esophagus ends blindly; distal esophagus derives from trachea
487
VATER syndrome
vertebral abnormalities, anal atresia, TE fistula, renal disease/radius abnormality
488
ZenkerÕs diverticulum
MC pulsion diverticulum of esophagus; halitosis (stinky breath, food gets stuck); near UES
489
GERD
relaxation of lower esophageal sphincter (LES) with acid reflux
490
GERD
MCC nocturnal cough and asthma
491
AIDS esophagitis
Candida MC, CMV, HSV
492
BarrettÕs esophagus
glandular metaplasia distal esophagus in GERD
493
Complications of BarrettÕs
precursor for adenocarcinoma, stricture
494
Esophageal varices
dilated left gastric vein; sign of portal hypertension due to cirrhosis
495
Mallory Weiss syndrome
tear of distal esophagus from retching in alcoholic or bulimic
496
BoerhaaveÕs syndrome
rupture of distal esophagus from retching; pneumomediastinum
497
HammanÕs mediastinal crunch
pneumomediastinum (air in subcutaneous tissue)
498
LES ganglion cells
contain VIP - relaxes LES
