Pathophysiology 1 Flashcards
STUDY SMART : ) (200 cards)
1
Q
• What is ASHD?
A
○ Atherosclerotic heart disease
○ A narrowing of the coronary artery by atheroma
○ Can lead to acute myocardial infarction
2
Q
• Prevention of ASHD/ Risk factors? (5)
A
○ Family history ○ Smoking- no ○ Hypertension- BP @ 120/80 ○ Hyperlipidemia- LDL @ 100 ○ Diabetes Mellitus- B.S. @ 100
3
Q
• What is heart failure in general?
A
○ A pump failure
○ Can result from any disease of the heart
4
Q
• What are the three most common fatal cancers?
A
○ LUNG
§ Preventable- no smoking
○ PROSTATE & BREAST
§ Exams catch early
§ Mammograms- 40 y.o or early if greater risk
§ Prostate rectal/physical exams- age 40
& repeat once a year
○ COLON
§ Start as polyp- takes 10 years become cancerous
§ Colonoscopy @ 50, then repeat once a year
5
Q
Leg pain of the intermittent claudication variety is suggestive of what?
A
○ Arterial insufficiency
○ arterial=pain
6
Q
• What is the manifestation of venous problems?
A
○ Edema
7
Q
What are the causes of secondary hypertension?
A
○ “R.E.N,D,S”
§ Renal failure
§ Endocrine disease (Cushing's, Pheochromocytoma) § Drugs § Neurogenic § Sleep apnea
8
Q
• What is the meaning of incompetence of a valve?
A
○ Does not close adequately
○ Ex: w/ bacterial endocarditis or rheumatic heart disease
9
Q
• What are causes of congenital heart disease?
A
○ Artrial septal defect (ASD)
○ Ventricular septal defect (VSD)
○ Fallot’s tetralogy
○ Coarctation of the aorta
10
Q
• A 32 year old female, who had a rheumatic fever as a child, is brought in with complains of malaise, a temperature of about 100 °F for approx. 3 weeks, and a new cardiac murmur. She also recently saw her dentist. What is your diagnosis? What tests?
A
○ Subacute bacterial endocarditis (strep infection= original cause rheumatic fever)
○ Test: culture blood, echocardiogram
11
Q
• Describe fetal circulation
A
○ Right atrium to Left atrium to Left ventricle to aorta to body
○ Interatrial septum allows blood to bypass right ventricle and lungs
12
Q
What are the signs and symptoms of heart failure?
A
○ Fatigue ○ SOB ○ Edema (bilateral) ○ Rales ○ Cardiomegaly ○ Hepatomegaly
13
Q
Treatment of heart failure?
A
○ Diuretic- drain fluid ○ Oxygen- SOB ○ Sitting up- pressure on chest ○ Beta blockers ○ Surgery (by-pass, valve, left ventricular assist device)
14
Q
• What are causes of heart failure?
A
○ ANY PROBLEM W/ HT--> HT FAILURE ○ Hypertension ○ Acute myocardial infarction ○ Arrhythmia ○ Rheumatic fever ○ Subacute bacterial endocarditis ○ ASHD ○ Valvular heart disease ○ Cardiomyopathy ○ Congenital heart disease
15
Q
What percent of heart disease is ASHD?
A
○ 80%
○ s/s begin after 50% buildup
16
Q
• What are some areas of the body where atherosclerosis leads to major disease?
A
○ Heart– ASHD– HT Failure
○ Brain– Stroke (CVA- cerebrovascular accident)
○ Aorta– Aortic Aneurism
○ Legs– peripheral vascular insufficiency
s/s intermittent claudication – gangrene
17
Q
• In dealing with congenital heart disease, what is meant by “reversal of shunt”?
A
Reversal of shunt causes BLOOD FLOW RIGHT ATRIUM TO LEFT ATRIUM. High pressure on left atrium causes shunt. As pressure builds on right atrium over time, causes a reversal of shunt resulting in deoxygenated blood into circulation.
18
Q
• What is pain in the chest w/ exertion?
A
○ Angina
19
Q
• What are complications of uncontrolled hypertension?
A
“St.A.KD.Blind.Legs”
○ Stroke (CVA- cerebrovascular accident) ○ ASHD ○ KD disease/failure ○ Eyes- Blindness ○Periperal arterial insufficiency (legs)
20
Q
• Symptoms of peripheral vascular(arterial) insufficiency?
A
○ Intermittent claudication
○ Loss of hair on toes/ affected limb
○ Cooler temperature
○ Weak/faint dorsalis pedis pulse
21
Q
• What is the PMI and where is it located?
A
○ PMI- point of maximum intensity or heart apex beat
○ On the left side, medial to midclavicular line, in the fifth intercostal space
22
Q
What are causes of PMI displacement?
A
○ Cardiomegaly
○ RT lung filled (biothorax, pneumothorax, pleural ephusion, hemothorax)
23
Q
• Name examples of hemorrhages in different parts of the body:
A
○ Hemoptysis- coughing blood
○ Hematemesis- vomiting blood
○ Melena- tarry black stools (bleeding duodenum and above)
○ Hematochezia- fresh red blood in stools (bleeding after the duodenum)
24
Q
• Classify shock
A
○ Hypovalemic- low fluid volume
§ Ex: severe dehydration
§ Test: orthostatic hypertension
○ Cardiogenic- inadequate circulation of blood d/t primary failure of HT function
§ ex: acute MI
○ Hypotonic- ex: anaphylactic
25
Classify EDEMA
○ BILATERAL *all pitting*
§ HT Failure- (d/t no venous return- HT not pumping)
§ Rel. Low oncotic pressure:
□ KD Failure (d/t hypoprotenemia-Proteinuria)
□ LR Disease (d/t not making proteins- albumin)
□ Malnutrition (Cachexia)
○ UNILATERAL
§ Pitting:
□ Trauma
□ Venous blockage (ex:thrombophlebitis/clot)
§ Non-pitting:
□ Lymph Edema (ex: breast cancer or filaria)
26
• What are acute complications of acute myocardial infarction?
○ "HTBRA"
○ HT Failure (acute pulmonary edema)
○ Blood clot (thrombus/embolus)
○ Rupture
○ Arrhythmia
27
• What are chronic complications of acute myocardial infarction?
○ "AHA"
○ Aneurism
○ HT failure (acute pulmonary edema)
○ Arrhythmia
28
• What type of gland is the pancreas?
○ Endocrine & exocrine
○ Endocrine- ISLETS OF LANGERHAND
○ Exocrine duct- SPHINCTER OF ODDI
29
• What are the endocrine and exocrine productions of the pancreas?
○ Endocrine:
§ Insulin
§ Glucagon
○ Exocrine:
§ Protease
§ Amylase
§ Lipase
30
• Where are the exocrine productions of the pancreas released via the sphincter of oddi?
○ Into the 2nd part of the duodenum
31
• What stimulates the exocrine function of the pancreas?
○ The secretion of secretin in the duodenum (CCK- bile)
32
• What are four causes of acute pancreatitis?
○ GB disease
○ Alcohol
○ Trauma
○ Viral infection (ex: Mumps)
○ -GB + Alcohol= 90%
33
• What are s/s of acute pancreatitis?
○ Pain with eating
○ Pain around umbilicus that radiates to back
○ Test: amylase ↑, lipase↑
○ Tx: Pain meds, IV fluids, No solids
○ Q: w/ women- concern RUPTURED TUBAL PREGNANCY
34
• Where is amylase present?
○ Salivary glands- to begin digestion of carbohydrates
○ Duodenum- released from pancreas
○ Fallopian tubes- unknown reason
35
What are s/s of chronic pancreatitis?
```
○ Chronic diarrhea (10-12 xday)
○ Malnutrition
○ Emaciation (d/t malnutrition)
○ Vitamin xu s/s (d/t "")
○ Dehydration (d/t persistent diarrhea)
```
○ Test: stools for muscle fibers
○ Tx: pancreatic enzymes
36
• Classify Diabetes Mellitus
○ TYPE 1- (Juvenile) NO INSULIN- 10%
§ Skinny, not storing nutrients b/c no storage
hormone (insulin)
○ TYPE 2- (Adult onset) Dysfunctional insulin- 90%
§ Generally overweight
○ GESTATIONAL- w/ pregnancy
37
What are the general symptoms of diabetes mellitus?
○ Polyuria
○ Polydypsia
○ Blurring vision
○ Chronic yeast infections (women)
38
What is the diagnostic test for diabetes mellitus?
○ Fasting blood sugar (>126)
39
• What are chronic complications of diabetes mellitus?
○ "HKBL^2"
○ HT disease/attack
○ KD disease/failure
○ Blindness
○ Peripheral limb loss
40
• What are ways to prevent chronic complications of diabetes mellitus?
○ B.S. @ 100
○ A1C <7
○ B.P. @ 120/80
○ No smoking
○ Yearly eye exam
○ KD tests-
§ Creatinine clearance (urine)
§ microalbumin (earliest sign)
○ Yearly stress test (HT)
○ Dorsalis pedis pulse
41
• What are acute complications of diabetes mellitus?
○ Diabetic ketoacidosis (DKA) (B.S. generally 500+)
○ Hypoglycemia
○ Infection
42
• Make a list of heart diseases
```
○ Hypertensive
○ ASHD
○ Rheumatic
○ Infectious
○ Congenital
○ HT failure
○ Cardiomyopathy
○ Valvular
○ Arrhythmic
```
43
• When a person dies of a "heart attack" what 3 general causes?
○ Acute myocardial infarction
○ Arrhythmia (worst= ventricular fibrulation)
○ HT failure (pump fails d/t any disease of ht)
44
• What is the commonest cause of death in women?
○ Acute myocardial infarction/ ht attack
45
• Under what layer does an atheroma collect?
○ Endothelium
46
• What is diabetes insipidus?
○ No ADH (anti-diuretic hormone) from posterior pituitary
○ s/s polyuria, polydypsia
47
• What three organs are affected by mumps?
○ Pancreas
○ Gonads (testicles & ovaries)
§ Men become sterile
§ Women have full recovery
○ Parotid glands
48
• What are four pathological conditions of the esophagus?
○ Cancer of esophagus
○ Esophageal ulcer (peptic/gastric ulcer)
○ Stenosis of esophagus (from healed ulcer)
○ Reflux esophagitis
○ Hiatus hernia (A hiatus hernia or hiatal hernia is the protrusion of the upper part of the stomach into the thorax through the esophageal hiatus because of a tear or weakness in the diaphragm)
49
• What are the five secretions of the stomach?
```
○ Gastrin
○ Pepsin
○ Intrinsic factor
○ Hydrochloric acid
○ Mucin
```
50
Name three locations where peptic ulcers may occur
○ Esophagus
○ Stomach
○ Duodenum
51
• Name four complications of gastric ulcers?
○ Bleeding (hematemesis, melena)
○ Perforation
○ Acute peritonitis
○ Pyloric stenosis (pyloris= area ST connect to SI)
52
• Describe the differences between Crohn's Disease & ulcerative colitis?
○ Crohn's
§ Ulcerates through all layers of small intestine/gut
○ Ulcerative colitis
§ Only ulcerate mucosal layer
○ Both have s/s:
§ Abdominal pain
§ Bloody diarrhea
53
• What happens to an ulcer in the colon? (i.e. w/ ulcerative colitis)
○ After 10 years the without treatment the ulcer becomes cancerous
○ Therefore ↑risk cancer*
54
• What are complications of ulcerative colitis?
```
○ Bleeding (hematechezia)
○ Perforation
○ Acute peritonitis
○ Toxic megacolon
○ Cancer
```
55
• What is a fatal complication of ulcerative colitis?
○ Toxic megacolon
§ Norm size: wrist
§ T.M colon size: thigh!
56
• What type of anemia do Crohn's disease patients often have?
○ Combined B12 & Iron Xu anemia
§ b/c ileum affected (where B12 absorbed) & they
are bleeding all the time (lose iron)
57
• What are possible complications for an ulceration, such as in Crohn's disease, where the ulcer penetrates through all layers?
○ Perforation-->acute peritonitis
| ○ Fistula--Sticking together of organ, mainly the small gut, where ulcer penetrates through
58
• What is the MacBurney point?
○ Indicates acute appendicitis
| ○ Located 1/3 distance from ASIS, 2/3 distance from umbilicus, in RLQ
59
• What is the main cause of LLQ pain?
○ Diverticulitis
60
• Describe clinical features of acute peritonitis
○ Acute abdominal pain
○ Board-like rigidity
○ Rebound tenderness
○ Absence of bowel sounds
61
• What three conditions will lead to acute peritonitis?
○ Perforation of peptic ulcer
○ Ruptured appendix
○ Ruptured/perforated colon
62
• What are the complications of cirrhosis?
○ Hepatocellular jaundice
○ Coagulopathy
§ bruising (low/not producing coagulating proteins)
§ Bleeding (esophageal varices)
○ Hypoalbuminemia (--low oncotic pressure--low/not producing albumin)
§ Ascites (fluid filled abdomen)
§ Edema (pedal, bilateral)
○ Poor inactivation of hormones
§ Estrogen
□ Gynecomastia
□ Testicular atrophy
○ Hepatic encephalopathy (d/t NH₃ build up)
○ Portal hypertension
○ Esophageal varices
○ Splenomegaly (backing up in spleen b/c LR not functioning)
63
• What are the factors that lead to peptic ulcer disease?
○ ↑HCL
○ H pylori infection
○ NSAIDS (i.e. ibuprofein)
64
• What are the factors that lead to cirrhosis?
○ Chronic alcoholism
○ Hepatitis B/C/D (not A)
○ Hemachromotosis (iron storage disease)
○ Wilson's Disease (disease with copper excess)
65
• What are the different terms for different sites of bleeding?
○ Above duodenum:
§ Hematemesis (vomiting blood)
§ Hemoptysis (coughing blood)
§ Melena (black tarry stools from digested blood)
○ Below duodenum:
§ Hematochezia (stools w/ fresh red blood)
66
• List Liver function tests (at least 6):
```
○ Bilirubin
○ Alkaline phosphatase
○ ALT/AST
○ NH₃
○ Albumin
○ Prothrombin time
○ BUN (produced by liver sent to kidney for excretion)
```
67
• Classify Jaundice. Give an example of each.
○ Hepatocellular
§ Cirrhosis, Hepatitis B/C/D
○ Obstructive
§ GB stones
○ Hemolytic
§ Sickle cell anemia
68
```
• Chronic complications of Diabetes mellitus include:
○ A: Blindness
○ B: Renal Failure
○ C: Heart attack
○ D: all of the above
```
○ All of the above
"HKBL^2"
69
```
• In Type 1 Diabetes mellitus there is:
○ A: incapability of using insulin
○ B: No insulin present
○ C: No pancreas present
○ D: No islets of Langerhans present
```
○ No insulin present
70
```
• Leg pain of the intermittent claudication variety is suggestive of:
○ A: arterial insufficiency
○ B: venous insufficiency
○ C: Neuropathy
○ D: Deep thrombophlebitis
```
○ A: arterial insufficiency
71
```
• High hemoglobin A1C suggests:
○ A: good control of D.M.
○ B: Poor D.M. control
○ C: Diabetic complication
○ Presence of other disease in addition to D.M.
```
○ B: poor D.M. control
72
```
• Which one of the following is a cause of secondary hypertension:
○ A: portal hypertension
○ B: Carotid artery stenosis
○ C: Anemia
○ D: Renal artery stenosis
```
○ D: Renal artery stenosis
73
```
• Lab tests for acute pancreatitis include:
○ A: Creatinine
○ B: Amylase
○ C: LDL
○ D: Troponin
```
○ B: Amylase
74
```
• Acute complications following acute myocardial infarction include:
○ A: Rupture of the ventricle
○ B: Hemopericardium
○ C: Ventricular arrhythmia
○ D: All of the above
```
○ All of the above
75
```
• The complications of uncontrolled hypertension include:
○ A: Peptic ulceration
○ B: Stroke
○ C: Pulmonary embolism
○ D: COPD
```
○ B: Stroke
76
• The PMI of the heart (apex beat) is normally located in the:
○ A: Right 5th intercostal space
○ B: Left 6th intercostal space
○ C: Left 5th intercostal space
○ D: Lateral to the left midclavicular line
○ C: left 5th intercostal space
77
```
• Non pitting edema is suggestive of:
○ A; heart failure
○ B: kidney failure
○ C: lymphedema
○ D: Liver impairment
```
○ C: lymphedema
78
```
• What is the pathogenesis (basic cause) of rheumatic fever:
○ A: ASHD
○ B: past bacterial infection
○ C: congenital heart disease
○ D: alcohol
```
○ B: past bacterial infection
79
```
• The risk factors of ASHD include:
○ A: sexual promiscuity
○ B: diabetes insipidus
○ C: Lack of exercise
○ D: Family history
```
○ D: family history
80
```
• Causes of acute pancreatitis include:
○ A: trauma
○ B: Biliary tract disease
○ C: alcohol excess
○ D: all of the above
```
○ All of the above
81
```
• In arterial insufficiency of the inferior extremity, which of the following may be present?
○ A: loss of toe hair
○ B: dilatation of the veins
○ C: increased temperature of the foot
○ D: positive Babinski sign
```
○ A: loss of toe hair
82
• In dealing with congenital heart disease, "reversal of shunt" means?
○ A: flow of blood from right to left
○ B: flow of blood from left to right
○ C: flow of blood is from above to below
○ D: flow of blood from below to above
○ A: flow of blood is from right to left
83
```
• The chronic or late complications of an acute M.I. include:
○ A: coarctation of the aorta
○ B: Heart failure
○ C: COPD
○ D: cirrhosis
```
○ B: heart failure
84
```
• Congenital heart diseases include:
○ A: atrial septal defect
○ B: Fallot's tetralogy
○ C: Coarctation of the aorta
○ D: all of the above
```
○ All of the above
85
```
• The commonest cancer in USA that is fatal is:
○ A: Lung cancer
○ B: colon cancer
○ C: breast cancer
○ D: prostate cancer
```
○ A: lung cancer
86
```
• When a person presents to an ER with acute chest pain, the standard tests done to rule out acute myocardial infarction include:
○ A: CCK
○ B: troponin
○ C: Chest xray
○ D: CBC
```
○ B: troponin
87
```
• Melena is:
○ A: passage of dark tarry stool
○ B: passage of fresh red blood
○ C: Coughing up blood
○ D: none of the above
```
○ A: passage of dark tarry stool
88
```
• Complications of a gastric ulcer include:
○ A: Pyloric obstruction
○ B: perforation
○ C: peritonitis
○ D: all of the above
```
○ D: all of the above
89
• Advanced pancreatic cancer may not present with jaundice:
○ A: If the tumor is in the head of the pancreas
○ B: if the tumor is in the tail of the pancreas
○ C: if tumor has invaded & blocked the bile duct
○ D: none of the above
○ B: if the tumor is in the tail of the pancreas
90
```
• Gynecomastia may be present in:
○ A: Klinefelter's Syndrome
○ B: in advanced cirrhosis d/t poor hormone
inactivation
○ C: both of the above
○ D: none of the above
```
○ C: both of the above
91
```
• Prolonged antibiotic use may lead to:
○ A: jaundice
○ B: hematuria
○ C: black hairy tongue
○ D: caries (decay of teeth)
```
○ C: black hairy tongue
92
```
• In portal hypertension there is
○ A: hepatomegaly
○ B: cardiomegaly
○ C: splenomegaly
○ D: none of the above
```
○ C: splenomegaly
93
```
• Etiology of Cirrhosis include:
○ A: asbestos exposure
○ B: viral hepatitis
○ C: vitamin deficiency
○ D: trauma
```
○ B: viral hepatitis
94
```
• High potassium is seen in:
○ A: hypovolemia
○ B: Addison's disease
○ C: Cushing's syndrome
○ D: prolactinoma
```
○ B: Addison's disease (& KD failure)
§ Sodium is high in hypovolemia
95
```
• Ascites is:
○ A: Seen in heart failure
○ B: seen with portal hypertension
○ C: seen in obstructive jaundice
○ D: seen in COPD
```
○ B: seen with portal hypertension
§ Ascites is the filling of the peritoneal cavity w/ fluid
96
```
• The pain of gallbladder disease can be felt at all these locations except:
○ A: left shoulder
○ B: right shoulder
○ C: between the scapula
○ D: in the right upper quadrant
```
○ A: left shoulder- associated with HT attack
97
• Weight loss and dysphagia in a 72 year old male is probably caused by:
○ A: Depression
○ B: loneliness from the recent death of his wife
○ C: cancer of the esophagus
○ D: Cancer of the prostate
○ C: cancer of the esophagus
98
```
• Lab tests for acute pancreatitis include:
○ A: Creatinine
○ B: Amylase
○ C: LDL
○ D: troponin
```
○ B: Amylase
99
```
• The cause of confusion in liver failure (hepatic encephalopathy) is
○ A: Increase in BUN
○ B: Increase in Alcohol
○ C: Increase in Bilirubin
○ D: Increase in ammonia
```
○ D: increase in ammonia
100
```
• Vomiting of blood in a person with cirrhosis is likely to be from:
○ A: esophageal varices
○ B: esophageal cancer
○ C: reflux esophagitis
○ D: pneumonia
```
○ A: esophageal varices
101
```
• The precursor cell of the platelet is:
○ A: Pro-erythroblast
○ B: reticulocyte
○ C: Megakaryocyte
○ D: none of the above
```
○ C: megakaryocyte
102
```
• Intrinsic factor secreted by the stomach is necessary for the absorption of :
○ A: acid
○ B: alcohol
○ C: fat
○ D; vitamin B12
```
○ D: vitamin B12
103
```
• The duodenum secretes which one of the following:
○ A: cholecystokinin
○ B: amylase
○ C: lipase
○ D: intrinsic factor
```
○ A: cholecystokinin- CCK- stimulates bile by contracting GB
§ Secretic (from duodenum) stimulates pancreas
104
```
• Vitamin B12 is absorbed in the:
○ A: Stomach
○ B: Duodenum
○ C: Descending colon
○ D: Ileum
```
○ D: ileum (both B12 & IF absorbed)
105
```
• The main function of the lacteal is to absorb:
○ A: alcohol
○ B: fat
○ C: protein
○ D: carbohydrate
```
○ B: fat
106
```
• The stomach is protected from its own acid by the:
○ A: bile
○ B: thick layer of mucin
○ C: Aspirin
○ D: alkali
```
○ B: thick layer of mucin
107
```
• BUN is made from ammonia by:
○ A: the pancreas
○ B: the liver
○ C: the spleen
○ D: the small intestine
```
○ B: the liver
| § Protein- N- NH₃- BUN- KD- Excretion
108
```
• Right upper quadrant pain w/ a positive Murphy sign is suggestive of:
○ A: acute gall bladder disease
○ B: duodenal ulcer
○ C: kidney stone
○ D: acute pancreatitis
```
○ A: acute gall bladder disease
109
```
• Which one of the following may lead to cancer?
○ A: Ulcerative colitis
○ B: duodenal ulcer
○ C: regional enteritis
○ D: gall stones
```
○ A: ulcerative colitis
§ Complications: bleeding, perforation, toxic
megacolon
§ From dx takes 10 years to develop into cancer
110
```
• Cancer of the pancreatic head may lead to:
○ A: obstructive jaundice
○ B: hemolytic jaundice
○ C: hepatocellular jaundice
○ D: all of the above
```
○ A: obstructive jaundice
§ S/S: dark urine, cotton colored stools, yellow skin
§ Test: Alkaline phosphatase↑, Bilirubin↑
111
```
• Initial pain of appendicitis may be:
○ A: in the back
○ B: in the right shoulder
○ C: in the chest
○ D: around the umbilicus
```
○ D: around the umbilicus
§ Then to RLQ- MacBurney point
112
```
• In liver failure there is an increase in:
○ A: RBC
○ B: BUN
○ C: Vit 125 D
○ D: Ammonia
```
D: ammonia
113
```
• In kidney failure there is an increase in:
○ A: RBC
○ B: BUN
○ C: Vit 125 D
○ D: Ammonia
```
○ B: BUN
114
```
• Salivary digestive juice initiates digestion of:
○ A: protein
○ B: carbohydrate
○ C: vitamins
○ D: minerals
```
○ B: carbohydrates
| § Salivary digestive juice= amylase
115
```
• Peptic ulceration may occur in:
○ A: esophagus
○ B: stomach
○ C: duodenum
○ D: All of the above
```
○ D: all of the above
116
```
• Candida infection may occur in:
○ A: esophagus
○ B: stomach
○ C: duodenum
○ D: all of the above
```
○ A: esophagus
§ Others have too high of acid
§ If thick coating of candida, concern HIV
117
```
• C.Difficile infection may lead to pseudo-membranous infection of:
○ A: esophagus
○ B: stomach
○ C: duodenum
○ D: colon
```
○ D: colon
118
```
• In hemolytic jaundice there is:
○ A: light colored stool
○ B: increase in reticulocyte count
○ C: increase in serum ammonia
○ D: confusion
```
○ B: increase in reticulocyte count
119
```
• In obstructive jaundice there is:
○ A: light colored stool
○ B: increase reticulocyte count
○ C: increase in serum ammonia
○ D: confusion
```
○ A: light colored stool
120
```
• A cause of hemolytic jaundice is:
○ A: iron deficiency
○ B: sickle cell disease
○ C: hemophilia
○ D: edema of both feet
```
○ B: sickle cell disease
121
```
• Liver failure may result in:
○ A: iron deficiency
○ B: sickle cell disease
○ C: hemophilia
○ D: edema of both feet
```
○ D: edema of both feet (bilateral)
- d/t low oncotic pressure b/c ↓albumin
122
```
• Persistent bleeding from the GI tract will lead to:
○ A: iron deficiency
○ B: sickle cell anemia
○ C: hemophilia
○ D: edema of both feet
```
○ A: iron deficiency
123
```
• Causes of edema of both feet include:
○ A: heart failure
○ B: liver failure
○ C: kidney failure
○ D: all of the above
```
○ D: all of the above
§ HT- not pumping
'
§ LR- no protein production-- low oncotic pressure
§ KD- proteinuria-- low oncotic pressure
124
```
• Factors that may have a role in the formation of peptic ulcers include:
○ A: high cholesterol
○ B: family history
○ C: H. Pylori
○ D: gall stones
```
○ C: H. Pylori
125
```
• Complications of diverticulitis include:
○ A: cancer
○ B: jaundice
○ C: perforation
○ D: kidney failure
```
○ C: perforation-- will lead to acute peritonitis
126
```
• Heart failure may be caused by:
○ A: myocardial infarction
○ B: hypertension
○ C: valvular disease
○ D: all of the above
```
D: all of the above
127
```
• The main area for the breakdown of old RBC's is:
○ A: liver
○ B: kidney
○ C: bone marrow
○ D: none of the above
```
○ D: none of the above- is SPLEEN
128
Make a list of KIDNEY function tests:
```
○ BUN↑
○ Creatinine (clearance)
○ Potassium↑
○ Uric acid↑
○ Calcium↓ (no 1,25 D)
○ RBC/Anemia↓ (no erythropoietin)
```
129
Make a list of LIVER function tests:
○ Bilirubin (↑in jaundice)
○ Alkaline phosphatase (↑ w/ blockage i.e. GB Stone, cancer pancreatic head)
○ AST/ALT (↑↑ viral hepatitis, or any time LR cell breaking down)
○ NH₃ (↑ w/ LR failure)
○ Albumin (↓ w/ LR failure- lead to low oncotic pressure & bilateral pedal edema)
○ Prothrombin time (↑ w/ LR failure b/c not enough coagulation proteins)
130
Name the acute complications of diabetes mellitis:
○ Ketoacidosis
○ Hypoglycemia
○ Infection
131
Name the chronic complications of diabetes mellitus:
"HKBL^2"
○ HT attack/disease
○ KD disease
○ Blindness
○ Peripheral limb loss
132
List possible causes of a positive hemocult:
```
○ Hemorrhoids
○ Peptic ulcer
○ Cirrhosis
○ Regional enteritis
○ Ulcerative colitis
○ Crohn's disease
```
133
What are the primary symptoms of:
A) Cancer of the esophagus
B) Duodenal ulcer
C) Diverticulitis
D) Celiac disease
E) Cancer of the cecum
A) Cancer of Esophagus- DYSPHAGEA
B) Duodenal ulcer- PAIN- epigastric & RUQ
C) Diverticulitis- PAIN- LLQ
D) Celiac disease- DIARRHEA d/t malabsorption
E) Cancer of the cecum- ANEMIA
-cecum= 1st part of colon where stool is still liquid,
so no obstruction but bleeding
134
• What are the secretions of the duodenum and pancreas (both exocrine and endocrine)?
○ Duodenum
§ CCK
□ Stimulate bile
§ Secretin
□ Stimulate pancreas exocrine secretions
○ Pancreas
§ Endocrine (no duct- Islets of Langerhand):
□ Insulin
□ Glucagon
§ Exocrine (duct- Sphincter of Oddi)
□ Protease
□ Lipase
□ Amylase
135
Classify anemia. Give second line tests.
○ Macrocytic
§ B12 xu
§ Folic acid xu
§ Second line tests:
□ B12 (↓ in B12 xu, norm in F.A. xu)
□ Folic acid (↓ in F.A. xu, norm in B12 xu)
○ Normocytic
§ Hemolysis
§ Bone marrow disease
§ Second line tests:
□ Reticulocyte count (↓-BMD, ↑-hemolysis)
○ Microcytic
§ Iron xu
§ Anemia of chronic illness
§ Second line tests:
□ Iron (↓-Fe xu, ↓-ACI)
□ TIBC (norm- Fe xu, ↓ACI)
136
What is DVT?
Deep venous thrombophlebitis
Thrombus--> embolus--> lung-->Pulmonary embolus
137
What is G6PD?
A hormone found in the blood that is not present in many Italians. If eat fava beans will lead to complete hemolysis.
138
• Give four causes of hemolytic anemia.
○ Sickle cell anemia
○ Wrong blood transfusion
○ Defective heart valve (shredding blood cells)
○ Penicillin/Certain antibiotics
139
• Describe the different stages of Hodgkin's disease. What is the diagnostic cell for hodgkin's?
○ Stage 1: One area/ lymph group affected
○ Stage 2: Two areas/lymph group - on same side of diaphragm
○ Stage 3: Both sides of diaphragm affected- within lymph system
○ Stage 4: spread outside lymph system, multiple areas
○ Reed Sternberg cells
○ Hodgkin's= Malignant lymphoma
140
What are possible initial S/S of Hodgkins?
○ Cough or hoarseness of voice that persists
○ Lump that persists
○ Blood in stools
○ Abnormal vaginal bleeding
○ Bleeding from nipple
○ Skin lesion
○ Dysuria
141
• Multiple myeloma is a disease of what cell? What substances does this cell normally produce? What tests would you do?
○ Cancer of plasma cells
○ Plasma cells normally produce antibodies
○ Multiple myeloma affects the bone marrow-->
• RBC↓ & Platelet↓
□ -->Anemia & poor clotting
• Antibodies from plasma cells are dysfunctional-->
□ Poor immunofunction--> risk disease
○ Test: ↑Serum calcium, X-Ray (moth eaten bones)
• b/c bone becoming eroded from inside out
• Leads to KD failure b/c filtering shi calcium
○ S/S:
• Achey all bones
• Bruising/bleeding
• Anemia- tired/weak
142
• What is a megakaryocyte?
○ Precursor cell to platelet
143
• What are the functions of blood?
○ Transports
• O2, CO2, nutrients, wastes, hormones, etc.
○ Maintains body temperature
○ Controls pH
○ Removes toxins from the body
○ Regulation of body fluid electrolytes
144
• Describe the absorption of B12 starting with the intake by mouth.
○ B12- mostly found in animal sources
○ In ST combo w/ I.F.
○ Absorbed in ileum
• If ileum diseased--> B12 xu anemia
□ Ex: Crohn's Disease (iron xu- bleeding +
B12xu- ileum diseased)
○ Need Fe + B12 to produce blood
145
• S/S & tests for obstructive jaundice?
○ S/S:
• Pain- URQ, referring to RT shoulder
• White cotton stools
• Itching skin
○ Test:
• ↑Bilirubin
• ↑ Alk Phos
146
What are tests for hemolytic jaundice?
○ ↑Bilirubin
| ○ ↑Reticulocyte count
147
• Give examples of causes and tests for hepatocelluar jaundice.
○ Examples: LR disease/failure (cirrhosis, hepatitis B/C/D)
```
○ Tests:
• ↑ AST/ALT
• ↑ Bilirubin
• ↑ Prothrombin time
• ↑ NH₃
```
148
Leukemia
○ Normal WBC count: 8-12,000
○ WBC count w/ infection: 15,000+ (above 30k=concern)
○ Extremely high WBC: cancer/leukemia
149
• Before a person is started on immunosuppressive medications, it is important that we find out if he has any past history of:
○ A: Schizophrenia
○ B: Peptic ulcer disease
○ C: TB
○ D: Asthma
○ C: TB
150
• Mesothelioma is seen in:
○ A: Silicosis
○ B: Anthracosis
○ C: Asbestosis
○ D: HIV
○ C: Asbestosis
151
• A cause of hemolytic jaundice is:
○ A: Iron xu
○ B: mismatched blood transfusion
○ C: Hemophilia
○ D: Edema of both feet
○ B: mismatched blood transfusion
152
• Pain on inspiration (pleuritic pain) is suggestive of:
○ A: Coronary vascular disease
○ B: gallbladder disease
○ C: lung disease
○ D: all of the above
○ C: lung disease
○ w/ GB- press on deep inhale- murphy sign
153
• Unilateral leg swelling, is suggestive of:
○ A: heart failure
○ B: liver disease
○ C: kidney problems
○ D: none of the above
○ D: none of the above
• Unilateral pitting:
□ Trauma
□ Venous blockage
* Unilateral nonpitting:
* Lymphedema
154
• Upper GI bleed may be due to:
○ A: cirrhosis of the liver
○ B: cancer of the colon
○ C: ulcerative colitis
○ D: none of the above
○ A: cirrhosis of the liver
• Esophageal varices- can cause death cirrhosis
• Cancer of colon + ulcerative colitis= hematochezia
155
• Soon after the TB bacteria enters the lung of a healthy person:
○ A: it spreads quickly
○ B: is confined in a system called Ghon's complex
○ C: It causes hemoptysis
○ D: it is killed by the septal cells
○ B: it is confined in a system called Ghon's complex
• Found in tuberculosis, is a calcification and
enclosure of infection
156
• When a cancer cell starts producing ectopic hormones it is called:
○ A: Metastasis
○ B: paraneoplastic transformation
○ C: Mitosis
○ D: none of the above
○ B: paraneoplastic transformation
○ Metastasis= when cancer spreads-- via blood, lymphatics, or locally
157
• The complications of uncontrolled hypertension include:
○ A: Peptic ulceration
○ B: Stroke
○ C: Pulmonary embolism
○ D: COPD
○ B: Stroke
```
○ St.A.KD.Blind.Legs
• Stroke
• ASHD/Ht attack
• Kidney disease
• Blindness
• Arterial insufficiency of legs
```
158
• Candida infection may occur in the:
○ A: esophagus
○ B: stomach
○ C: duodenum
○ D: all of the above
○ A: esophagus
○ Stomach and duodenum have too much acid for growth
159
• Non-pitting edema is suggestive of:
○ A: heart failure
○ B: Kidney failure
○ C: lymphedema
○ D: liver impairment
○ C: lymphedema
| ○ HT, LR, KD- all bilateral pitting edema
160
• What is the pathogenesis (basic cause) of rheumatic fever?
○ A: ASHD
○ B: Past bacterial infection
○ C: Congenital heart disease
○ D: Alcohol
○ B: past bacterial infection
| • Streptococcus
161
• C.Difficile infection, often seen after prolonged antibiotic use, may lead to pseudo membranous infection of the:
○ A: Esophagus
○ B: stomach
○ C: duodenum
○ D: colon
○ D: colon
162
• Reticulocyte count is helpful in the diagnosis of:
○ A: iron xu
○ B: hemolytic anemia
○ C: hodgkin's disease
○ D: none of the above
○ B: hemolytic anemia
○ Iron xu= Fe, TIBC
○ Hodgkin's= reed sternberg cell
163
• Cancer of the colon is seen more commonly in:
○ A: Crohn's disease
○ B: ulcerative colitis
○ C: diverticulitis
○ D: C. Difficile colitis
○ B: ulcerative colitis
| • Ulcer becomes cancerous after 10 years w/o tx
164
• Common pneumonia seen in a person with HIV infection is:
○ A: mycoplasma
○ B: staphylococcus
○ C: E. Coli
○ D: pneumocystis
○ D: pneumocystis
165
• The sex chromosomal pattern of a hemophilia carrier is:
○ A: XO
○ B: XXY
○ C: XX
○ D: XY
○ C: XX
• Women are always the carrier for hemophilia
○ XO= Turner's syndrome
○ XXY= Kleindfelter's syndrome
○ XY= male sex chromosomal pattern
166
• Peptic ulceration may occur in the:
○ A: esophagus
○ B: stomach
○ C: duodenum
○ D: all of the above
○ D: all of the above
○ Causes: ↑HCL, H. Pylori infection, NSAIDS or Aspirin
167
• The risks of thrombophlebitis of the legs include:
○ A: Acute myocardial infarction
○ B: Acute pulmonary edema
○ C: Pulmonary embolus
○ D: heart failure
○ C: pulmonary embolus
○ Acute pulmonary edema= acute complication-acute mi.
○ Any disease of heart can lead to ht failure (pump fails)
168
• When a person presents to any ER with acute chest pain, the standard tests done to rule out acute myocardial infarction include:
○ A: CPK
○ B: EKG
○ C: Troponin
○ D: all of the above
○ D: all of the above
○ CPK + Troponin= enzymes from inside HT cells
169
• Gynecomastia may be present in:
```
○ A: Klinefelter's Syndrome
○ B: in advanced Cirrhosis d/t poor hormone
inactivation
○ C: Both of the above
○ D: None of the above
```
○ C: both of the above
○ Also testicular atrophy d/t elevated levels estrogen
170
• Black tarry stool may be seen with:
○ A: hemorrhoids
○ B: colon cancer
○ C: bleeding duodenal ulcer
○ D: none of the above
○ C: bleeding duodenal ulcer
○ Hemorrhoids + colon cancer= hematochezia
• Below duodenum=red blood- undigested
171
• Which of the following often causes secondary hypertension
○ A: portal hypertension
○ B: carotid artery stenosis
○ C: anemia
○ D: renal artery stenosis
```
○ D: renal artery stenosis
○ "RENDS"
• Renal
• Endocrine (Cushings, Pheochromocytoma)
• Neurogenic
• Drug
• Sleep apnea
```
172
• CD4 cells are:
○ A: B cells
○ B: A cells
○ C: Helper T cells
D: none of the above
○ C: helper T cells
173
• The PMI of the heart (apex beat) is normally located in the:
○ A: Right 5th intercostal space
○ B: left 6th intercostal space
○ C: left 5th intercostal space
○ D: lateral to the left midclavicular line
○ C: Left 5th intercostal space
| • Medial to the midclavicular line
174
• Leg pain of the intermittent claudication variety is suggestive of:
○ A: arterial insufficiency
○ B: venous insufficiency
○ C: neuropathy
○ D: deep thrombophlebitis
○ A: arterial insufficiency
○ Venous insufficiency + deep thrombophlebitis (DVT)
=rel vein.
• Vein= edema
• Artery=pain
175
• Macrocytic anemia is seen in:
○ A: iron deficiency
○ B: hemolytic anemia
○ C: bone marrow failure
○ D: none of the above
○ D: none of the above
• Macrocytic= folic acid or B12 xu
○ Iron xu= microcytic
○ Hemolytic & bone marrow= normocytic
176
• Acute complications following acute myocardial infarction include:
○ A: rupture of the ventricle
○ B: hemopericardium
○ C: Ventricular arrythmia
○ D: all of the above
○ D: all of the above
• HTBRAA
□ HT failure (acute pulmonary edema)
□ Blood clot (thrombus or embolus)
□ Rupture
□ Arrhythmia
(acute/fatal type= ventricular fibrillation)
□ Aneurism (bulging where infarction was)
177
• In portal hypertension there is:
○ A: hepatomegaly
○ B: cardiomegaly
○ C: splenomegaly
○ D: none of the above
○ C: splenomegaly
| • Spleen always enlarged w/ portal hypertension
178
• Etiology of cirrhosis include:
○ A: asbestos exposure
○ B: viral hepatitis
○ C: vitamin xu
○ D: trauma
○ B: viral hepatitis
○ Asbestos exposure= etiology mesothelioma
179
• High levels of serum potassium is seen in:
○ A: Addison's disease
○ B: Increased ingestion of potassium rich food
○ C: liver failure
○ D: heart failure
○ A: Addison's disease
• b/c no aldosterone- not kicking out potassium
Also seen in KD failure b/c not filtering out potassium
180
• High hemoglobin A1C suggests:
○ A: good control of D.M.
○ B: poor control of DM
○ C: Diabetic complication
○ D: presence of other disease in addition to DM
○ B: poor control of DM
| • Goal= A1C <7
181
• Ascites is seen:
○ A: in heart failure
○ B: with portal hypertension
○ C: in obstructive jaundice
○ D: in COPD
○ B: with portal hypertension
182
• BUN is made from ammonia by:
○ A: the pancreas
○ B: the liver
○ C: the spleen
○ D: the small intestine
○ B: the liver
| • Protein>N>NH₃>LR>BUN>KD>Excretion
183
• The number of chromosomes present in a sex cell (sperm cell or ova) is:
○ A: 46
○ B: 44
○ C: 23
○ D: 22
○ C: 23
| • 22 autosomes + 1 sex chromosome
184
• In the bone marrow, the precursor cell that form the RBC is:
○ A: B-cell
○ B: Erythropoietin
○ C: Pro-erythroblast
○ D: All of the above
○ C: Pro-erythroblast
○ B-cell= precursor to plasma cell (which makes antibodies)
○ Erythropoietin= hormone KD stimulates bone marrow make RBC
185
• In dealing with congenital heart disease, "reversal of shunt" means:
○ A: flow of blood is from right to left
○ B: flow of blood is from left to right
○ C: flow of blood is from above to below
○ D: flow of blood is from below to above
○ A: flow of blood is from right to left
186
• Increase in hemoglobin may be seen in:
○ A: COPD
○ B: Bleeding
○ C: Renal failure
○ D: Cirrhosis
○ A: COPD
* Body produces more RBC's when not receiving enough oxygen
* Erythropoietin↑
187
• The cause of confusion in liver failure (hepatic encephalopathy) is:
○ A: increase in BUN
○ B: increase in alcohol
○ C: increase in bilirubin
○ D: increase in ammonia
○ D: increase in ammonia
○ BUN↓ b/c LR not converting NH₃ to BUN
188
• Vomiting of blood in a person w/ cirrhosis is likely to be from:
○ A: esophageal varices
○ B: esophageal cancer
○ C: reflux esophagitis
○ D: duodenal ulcer
○ A: esophageal varices
| • Also common cause of death in cirrhosis
189
• The endocrine secretions of the pancreas include:
○ A: Glycogen
○ B: secretin
○ C: pepsin
○ D: none of the above
○ D: none of the above
• Endocrine secretions of pancreas from Islets of langerhand
□ Glucagon
□ Insulin
* Glycogen= stored form of glucose
* Secretin= duodenal secretion
* Pepsin= stomach secretion
190
• Intrinsic factor combined with vitamin B12 is absorbed in the:
○ A: jejunum
○ B: ileum
○ C: cecum
○ D: none of the above
○ B: ileum
191
• What is the blood test for HIV infection:
○ A: western blot
○ B: ANA
○ C: microalbumin
○ D: Sedimentation rate
○ A: western blot
○ ANA= lupus
○ Microalbumin= earliest sign D.M rel KD disease
○ Sedimentation rate= PMR
192
• Initial pain of appendicitis may be:
○ A: in the back
○ B: in the right shoulder
○ C: in the chest
○ D: around the umbilicus
○ D: around the umbilicus
193
• A 32 year old IV drug using male is seen in the ER with a week of high fever, malaise, wt loss & SOB. He has a HT murmur that he never had before. His WBC count is 20,000. He probably has:
○ A: hyperthyroidism
○ B: Chronic pancreatitis
○ C: bacterial endocarditis involving left side of his HT
○ D: bacterial endocarditis involving right side of his HT
○ D: bacterial endocarditis involving the right side of his HT
* LT side= rel damaged valve from bacterial infection d/t rheumatic fever (etiology of streptococcus)
* RT side= drug users
194
• Pain in the left lower quadrant in a 60 year old man is suggestive of:
○ A: appendicitis
○ B: acute diverticulitis
○ C: acute pancreatitis
○ D: acute prostatitis
○ B: acute diverticulitis
195
• The causes of microcytic anemia include:
○ A: pernicious anemia
○ B: anemia of bone marrow failure
○ C: hemolytic anemia
○ D: anemia of chronic illness
○ D: anemia of chronic illness
• Microcytic also=iron xu
• Pernicious anemia=macrocytic d/t B12 xu
□ Autoimmune destruction of gastric parietal cells>
lack of IF> no B12 absorption in illeum
• Anemia of Bone Marrow failure + Hemolytic=Normocytic
196
• Antibodies are made by:
○ A: T-cells
○ B: Plasma cells
○ C: Macrocytes
○ D: megakaryocytes
○ B: plasma cells
• From B-cells
○ Megakaryocytes= precursor to platelet cells
197
• Prolonged antibiotic use may lead to:
○ A: jaundice
○ B: hematuria
○ C: a black hairy tongue
○ D: caries
○ C: a black hairy tongue
• Certain antibiotics (ex:penicillin) also cause hemolysis
○ Caries= cavities/tooth decay
198
• In addition to parotid inflammation, the mumps virus may also affect which of the following organs:
○ A: pancreas
○ B: ovary
○ C: testes
○ D: all of the above
○ D: all of the above
* Mumps affecting tests> infertility
* Women= full recovery/fertility
199
• Complications of a gastric ulcer include all except:
○ A: pyloric obstruction
○ B: perforation
○ C: peritonitis
○ D: ascites
○ D: ascites
| • d/t cirrhosis
200
• What is the blood test for systemic LUPUS erythemetosus?
○ A: western blot
○ B: ANA
○ C: microalbumin
○ D: sedimentation rate
○ B: ANA
* Western blot= HIV
* Microalbumin= D.M urine test
* Sed rate= PMR
