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Hem/Onc > Mixed review 0502Q > Flashcards

Mixed review 0502Q Flashcards

1
Q

anterior surface of heart is mostly which chamber?

A

RIGHT VENTRICLE

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2
Q

injury at left sternal border in 4th intercostal space would affect….?

A

[nipple level]

  1. skin, subcutis
  2. pec major
  3. external intercostal memb
  4. internal intercostal memb
  5. internal thoracic artery and veins
  6. transversus thoracis m.
  7. parietal pleura
  8. pericardium
  9. RV myocardium
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3
Q

posterior surface of heart is mostly which chamber?

A

LEFT ATRIUM

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4
Q

lateral surface of heart is mostly which chamber?

A

LEFT VENTRICLE

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5
Q

NE effect in heart

A

stimulate beta 1 receptors to increase cAMP conc within myocytes

*little effect at beta 2 receptors

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6
Q

dilated CM physiology

A
  1. ventricular dilation
  2. LV systolic dysfunction - decreased vent contractility

*may have sx of CHF

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7
Q

common cause of LV diastolic dysfunction

A

[impaired filling due to reduced LV compliance]

chronic HTN (hypertensive heart disease).
concentric LVH with decrease in chamber size.

also seen with restrictive CM

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8
Q

hypertrophic CM physiology

A

asymm. septal hypertrophy and dynamic ventricular outflow tract obstruction

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9
Q

what does integrin bind in order for cell adhesion?

A

fibronectin, collagen, laminin - allow binding to BM and ECM

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10
Q

lipoprotein lipase action

A

hydrolyze dietary lipids in chylomicrons to release triglycerides

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11
Q

hyperlipidemia type 1

A

lipoprotein lipase deficiency - increased conc of serum chylomicrons.

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12
Q

hyperlipidemia type 1 SX

A

(lipoprotein lipase deficiency)

  1. childhood hyperlipidemia
  2. pancreatitis, abd pain
  3. lipemia retinalis
  4. skin xanthomas
  5. hepatosplenomegaly
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13
Q

what serum TG conc significantly increases risk of pancreatitis

A

> 1000 mg/dL

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14
Q

what role does heparin play in lipoprotein lipase activity?

A

heparin releases endo-bound lipases to encourage clearance of TG from circ

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15
Q

LDL clearance from circ occurs by…?

A

receptor-mediated uptake by liver

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16
Q

defect in LDL receptor

A

hypercholesterolemia (high LDL)

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17
Q

hypercholesterolemia SX

A

(defect in LDL receptor)

  1. accelerated CAD, chest pain
  2. tubular (tendon) xanthomas
  3. maybe xanthelasmas and arcus cornea
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18
Q

what is the hallmark of familial hypercholesterolemia?

A

tubular (tendon) xanthomas

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19
Q

tubular (tendon) xanthomas

A

nodular lipid deposits in tendons - Achilles, elbow

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20
Q

enterococcal endocarditis

A

in elderly men who have undergone GI or GU manipulation (cystoscopy, colonoscopy)

enterococci: Gm pos, gamma hemolytic, cultured in hypertonic saline and bile

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21
Q

adverse effects of direct arteriolar vasodilators

A

[hydralazine, minoxidil]

reflex symp activation leading to tachycardia and edema (via renin)

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22
Q

how to counteract adverse effects of direct arteriolar vasodilators

A

coadmin with sympatholytics and diuretics

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23
Q

what layer of heart does SLE affect?

A

PERICARDITIS - pleuritic chest pain that radiates to neck and shoulders, relieved by sitting up. FRICTION RUB

serosal inflammation

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24
Q

what increases pleuritic chest pain with SLE pericarditis?

A

inspiration

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25
Libman Sacks endocarditis presentation
heart murmur but otherwise asymptomatic
26
anticoagulant for pregnant women
heparin (warfarin is teratogenic)
27
DVT presentation
unilateral leg pain, swelling, warmth. HOMAN'S SIGN: tenderness of calf muscle on dorsiflexion of foot
28
DIC is a common complication of....?
1. Gm neg bacterial sepsis 2. acute pancreatitis 3. burn injury
29
mech of DIC in Gm neg sepsis
activation of coag cascade by bact endotoxins - microthrombi cause microangiopathic hemolytic anemia and thrombocytopenia
30
DIC labs
increase PT increase PTT decrease fibrinogen, V, VIII
31
what does bleeding from venous puncture sites suggest?
DIC
32
what is transmural inflamm with fibrinoid necrosis most characteristic of?
PAN (polyarteritis nodosa)
33
sx of PAN
``` fever malaise weight loss abd pain melena peripheral neuropathy diffuse aches ```
34
what infx is PAN assoc with in 10-30% of cases?
HEP B
35
what age group does PAN most affect?
young adults
36
which vasculitis is linked to asthma?
churg strauss syndrome
37
which vasculitis is linked to antibiotic use?
microscopic polyangiitis (leukocytoclastic angiitis, hypersensitivity angiitis)
38
which anemia commonly occurs in the setting of chronic alcoholism?
FOLIC ACID deficiency megaloblastic anemia - due to decreased synth of purines, thymidines. smear: macrocytes, ovalocytes, hypersegmented neutrophils
39
which nutrient deficiency is more common in alcoholics- B12 or folic acid?
FOLIC ACID!!!
40
which form of anemia has INCREASED MCHC?
hereditary spherocytosis - mild dehydration of RBC with membrane loss *spherocytes are smaller in size. cytoplasm stains more intensely
41
general markers of hemolysis
elevated LDH reticulocytosis decreased haptoglobin
42
most commonly affected protein in hereditary spherocytosis
spectrin
43
immature T lymphocytes | [thymocytes]
express BOTH CD4 and CD8 cell surf Ags AND complete TCR or pro-TCR. exist in thymic CORTEX where they undergo pos selection and in thymic MEDULLA where they undergo neg selection
44
most common cause of fatigue + new onset murmur in young adult
bacterial endocarditis
45
which bugs produce endotoxin?
GRAM NEGS
46
common tumors in Li-Fraumeni syndrome
sarcomas tumor of breast, brain, adrenal cortex leukemia *AUTO DOM p53 mutation- inherit one mutated allele. somatic mutation of second allele needed for tumor development
47
what does mitochondrial vacuolization indicate?
irreversible cell injury. | mito are permanently unable to generate ATP.
48
HUS triad
1. microangiopathic hemolytic anemia 2. acute renal failure 3. thrombocytopenia
49
migratory thrombophlebitis --- think ____
CANCER
50
paraneoplastic hypercoagulability
seen with adenocarcinomas of pancrease, colon, lung -- produce thromboplastin-like substance that causes intravasc. coagulation
51
vit K and celiac sprue
vit K deficiency due to malabsorption - can lead to hemorrhagic diathesis
52
atrophic gastritis
profound hypochlorhydria. intrinsic factor deficiency (pernicious anemia). B12 deficiency. elevated methylmalonic acid levels.
53
fomepizole
antidote for suspected methanol (rubbing alcohol) or ethylene glycol (antifreeze) poisoning. competitive antagonist of alcohol dehydrogenase - prevents conversion of methanol and ethylene glycol into toxic metabolites
54
prednisone in chemotherapy
induces lymphocyte apoptosis. | contributes to tumor lysis syndrome.
55
probenicid
increases uric acid excretion in urine. treat gout, hyperuricemia. only effective in pts with good renal fx (not for nephrolithiasis or uric acid nephropathy)
56
increased ferritin seen in....?
1. iron overload | 2. infx/inflamm (acute phase reactant)
57
infection in sickle cell pts
at high risk, esp for encapsulated orgs - Strep pneumoniae, H.influenzae
58
osteomyelitis in sickle cell child
1. salmonella** 2. S.aureus 3. E.coli
59
prophylaxis for asplenic pts
1. penicillin prophylaxis | 2. pneumococcal vaccine
60
fenoldapam
selective dopamine 1 receptor agonist (activates adenylyl cyclase to increase cAMP). causes art. dilation and natriuresis, leading to decreased systemic vasc resistance and BP
61
special feature of fenoldapam
ONLY intravenous/parenteral agent that improves renal perfusion. also increases sodium and water excretion. beneficial in HTN pts with concomitant renal insufficiency. good for emergency.
62
main use of esmolol
post operative HTN. | effects rapidly reversed after drug is withdrawn.
63
what cell directly mediates intimal hyperplasia and fibrosis in response to endo injury?
reactive smooth muscle cells that migrate from media to intima - proliferate, synthesize collagen/elastin/proteoglycans
64
what is the ONE significant non-enveloped ssDNA virus family?
Parvovirus - parvovirus B19 causing erythema infectiosum, aplastic crises, and hydrops fetalis
65
what viruses cause bronchitis/bronchiolitis?
all are enveloped, RNA viruses: | influenza A, RSV, coronavirus
66
underdeveloped area of lymph node in DiGeorge
paracortex - due to mature T cell deficiency
67
underdeveloped area of lymph node in agammaglobulinemia
primary lymphoid follicles and germinal centers (secondary follicles) - due to absence of B cells
68
left atrial enlargement can affect which nearby structure?
left recurrent laryngeal nerve - impingement leads to NEURAPRAXIA (failure of nerve conduction due to blunt injury, leading to left vocal cord paresis and hoarseness)
69
Ortner syndrome
left atrial dilatation sufficient enough to impinge on left recurrent laryngeal nerve. due to MITRAL STENOSIS.
70
what is the only intrinsic muscle of the larynx NOT innervated by recurrent laryngeal nn?
cricothyroid m
71
what process is defective in megaloblastosis?
DNA synth * ex: folate deficiency * RNA and protein synth may continue as normal (cytoplasm grows)
72
pathogenesis of neurotoxicity (peripheral neuropathy) with vinca alkaloid tx
disruption of neuronal microtubules which are responsible for transporting organelles and other cellular products between neuronal cell body and axon terminals
73
burr cells (RBC)
short evenly spaced projections. | assoc. with uremia, pyruvate kinase deficiency, microangiopathic hemolytic anemia, mech damage
74
what does left shift of Hb-O2 dissociation curve indicate?
increased Hb O2 affinity (O2 is relatively less available to tissues)- caused by increased pH, decreased 2,3-DPG, decreased temp.
75
2,3-DPG (diphosphoglycerate)
organophosphate created in RBCs during glycolysis
76
conditions that increase 2,3-DPG production
``` (diminished peripheral tissue O2 availability) hypoxemia chronic lung disease anemia CHF ```
77
what is the main enz that degrades 6-mercaptopurine?
xanthine oxidase in liver
78
what enz activates 6-mercaptopurine and 6-thioguanine (prodrugs)?
HGPRT

Hem/Onc (9 decks)

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