UW9 Flashcards
(165 cards)
1
Q
JVD, hypotension, tachycardia
A
cardiac tamponade vs. tension pneumothorax
2
Q
Signs of tamponade
A
hypotension, distended neck veins, distant heart sound (Beck triad), tachycardia. Pulses paradoxes
3
Q
signs of acute fibrinous pericarditis
A
Pleuritic chest pain and pericardial friction rub
4
Q
what will you hear on auscultation in cardiogenic shock
A
rales ( pulmonary edema)
5
Q
initial stage of septic shock
A
lower vascular resistance and increased cardiac output
6
Q
quadriplegia, pseudobulbar palsy ( head neck muscle weakness, dysphagia, dysarthria)
A
central pontine myelinolysis
7
Q
Rapid correction of hypernatremia
A
Cerebral edema/ herniation
8
Q
aromatase
A
converts androstenedione to estrone. Testosterol to estradiol
9
Q
high androgen and low estrogen levels in a female fetus. Maternal virulization
A
Aromatase deficiency
10
Q
Maternal Hirsutism, clitoromegaly, femal pseudohermaphrodism, primary amonorrhea, osteoporosis, tall stature
A
Aromatase deficiency
11
Q
ambiguous genitalia, hypotension
A
21 hydroxylase deficiency
12
Q
ambiguous genitalia, hypertension
A
17 hydroxylase deficiency
13
Q
what is accomodation
A
Focusing on near objections (reading)
14
Q
what happens in accomodation
A
ciliary muscle contraction relaxes zonular fibers causes thickening of lens ( more convex)
15
Q
presbyopia
A
inability to focus on near objects. Impaired lens elasticity from protein denaturation, diminished ciliary muscle strength (image focuses behind retina)
16
Q
Myopia
A
image focuses in front of retina. Presbyopia can compensate for myopia
17
Q
Risks for femoral head osteonecrosis
A
vasculitis (lupus), corticoisteroids, sickle cell, alcoholism
18
Q
dermal and epithermal thinning, fattening of dermoepidermal junction, decreased number of fibroblasts and reduced synthesis and increased breakdown of collagen and elastin
A
Skin rhytides (wrinkles) due to aging
19
Q
Ciliary mucles and zonular fibers in relaxed pupil
A
Ciliary muscle relaxed and zolular fibers contracted (lens flattened)
20
Q
Ciliary mucles and zonular fibers in accomodated pupil
A
Ciliary muscle contracted and zolular fibers relaxed (thickening of lens)
21
Q
Lens changes in prebyopia
A
Hardened lens is unable to thicken leading to loss of accomodation (cant focus on near objections)
22
Q
findings in isolated diastolic heart failure. LVEDP, LVEDV, LV ejection fraction
A
increased end diastolic pressure, normal end diastolic volume, normal ejection fraction
23
Q
diastolic heart failure can be due to
A
impaired myocardial relaxation or increased intrinsic ventricular wall stiffness (amyloid). Filling problem = ejection fraction is normal
24
Q
what is the problem in diastolic heart failure
A
filling problem (decreased ventricular compliance) which means end diastolic volume is decreased.
25
what can cause systolic heart failure
acute massive MI
26
What is the problem in systolic heart failure
decreased contractility. Decrease ejection fraction, decreases stroke volume and cardiac output. EDP and EFV must both increase to maintain normal cardiac ouput
27
excessive daytime sleepiness, morning headaches, impotence, poor judgement, depression, snoring
obstructive sleep apnea
28
Abnormal ventilation during sleep
1. Apnea ( cessation of breathing \>10 s) or 2. hypopnea (redued airflow) SaO2 decreases \>4%
29
poor REM sleep, excessive daytime sleepiness, cataplexy, sleep attacks, sleep paralysis
Narcolepsy
30
increased PaCO2, reduced PaO2 in obesity
Obesity hypoventilation syndrome. Obesity impedes expansion of chest wall leading to decreased respiratory drive.
31
How many calories are in a gram of protein or carb?
4
32
how many calories are in a gram of fat?
9
33
how does inspiration affect alveolar vessels
Increased lung v. cause alveolar expansion which reduces the diameter of alveolar blood vessels. Increases vessel resistance
34
How does expiration affect extraalveolar vessels
Decreased lung volumes cause extraalveolar arteries to become narrow leading to increase in vessel resistance
35
When is pulmonary vascular resistance the lowest?
At functional residual capacity (inspiration and expiration both increase resistance in vessels)
36
Side effect of Amphotericin B
Nephrotoxic. Causes a decrease in GFR and has direct toxic effects on tubular epithelium. Hypokalemia and hypomagnesemia (increased permeability of distal tubule)
37
ECG findings in hypokalemia
T wave flattening, ST depression, prominent U waves, PVC
38
Side effect of doxorubicin
Dose dependent cardiotoxicity
39
Chloramphenicol, zidovudine, phenybutazone, gold containing medications are examples of drugs that can cause what side effect
Bone marrow suppression
40
Acetaminophen and halothane are examples of medications that can cause what side effect
liver necrosis
41
what are some drugs that can cause pulmonary fibrosis
Busulfan and bleomycin
42
sudden onset abdominal pain, gross hematuria, new varicocele
renal vein thrombosis
43
maltese cross under polarized light
oval fat bodies in urine. Lipiduria due to increased synthesis of lipoproteins by liver in nephrotic syndrome
44
what are some proteins that can be loss in nephrotic syndrome
Albumin (edema), ATIII (hypercoagulable), Immunoglobulins (infections)
45
Mechanism of Nesiritide
recombinant BNP used for decompensated LV dysfunction leading to congestive heart failure
46
Where are ANP and BNP secreted from
ANP from atria and BNP from ventricle. Vasodilation, diuresis, natriuresis and decrease in BP
47
Endothelin
vasoconstriction
48
transmural inflammation of arterial wall with fibrinoid necrosis
Polyarteritis nodosa
49
vasculitis linked to smoking
atherosclerosis, thromboangiitis obliterans
50
Vasculitis linked to asthma
Churg strauss
51
vasculitis: granulomas with eosinophilic necrosis in smaller vessels
Churg strauss
52
most common vasculitis from antibiotic use
Microscopic polyangiitis ( type III HSR) often due to Penicillin
53
pes cavus
high plantar arch
54
Pes cavus, hyphoscoliosis, hypertrophic cardiomyopathy, DM
Friedreich ataxia (chr 9 frataxin gene) AR
55
degeneration of spinocerebellar tracts causing gait ataxia, loss of position and vibration sensation, muscle weakness
Friederich ataxia
56
why is there an increased risk of TB in silicosis
impairs macrophage kiling of phagocytosed mycobacteria due to disruption of phagolysosome
57
negative skin TB test after M. TB exposure suggests
weak cell mediated immune response seenin HIV, Sarcoidosis
58
what transporter does the liver use to pick up unconjugated bilirubin
Organic anion transporting polypeptide
59
How does conjugated bilirubin exist the liver?
active transport by ATP Binding Cassette protein (MRP2)- organic anion transporter into biliary system
60
isolated conjugated hyperbilirubinemia
inhibition of canalicular active organic anion transporter that secretes conjugated bili into biliary system
61
unconjugated hyper-bili
excessive production of bili, decreased uptake, impaired conjugation
62
conjugated hyper-bili
decreased hepatocellular excretion, impaired bile flow
63
Acute attacks of hepatic porphyria can be precipitated by what drugs
Cyp p450 inducers (phenobarbitol, griseofulvin, phenytoin)
64
enzyme defect in acute intermittent porphyria
Prophobilinogen deaminase. Tx with heme and glucose (inhibits ALA synthase)
65
from which embryonic layer is the spleen derived from?
Mesoderm (arises in mesentary of stomach)
66
Forgut organs
Esophagus to secondar part of duodenum, liver, gall bladder, part of pancreas ( develop as outpouching of primitive gut tube)
67
From what embryonic layer is the liver derived from
Endoderm from diverticulum of primitive gut tube in ventral mesentary
68
From what embryonic layer are the kidneys formed from
Mesoderm
69
From what embryonic layer is the pancreas formed from
Endoderm
70
What does the arteriovenous concentration gradient in an anesthetic reflect?
Tissue solubility
71
What compartments does an anesthetic move through
Inhaled air--\> lungs--\> blood--\> brain
72
What determines anesthetic concentration in inhaled air
partial pressure of anesthetic in inspired gas
73
What determines anesthetic concentration in lungs
pulmonary ventilation rate (rate of rise of gas tention is alveoli is directly proportional to both rate and depth of respiration)
74
What determines anesthetic concentration in blood
Solubility of anesthetic in blood (blood/gas partition). Higher blood gas solubility means more anesthetic must be absorbed by blood before it can be transferred to other tissues
75
What determines anesthetic concentration in brain
solubility of anesthetic in peripheral tissues. Higher peripheral tissue solubility means more anesthetic must be absorbed to saturate the blood and then the brain.
76
Hows does a high arteriovenous concentration gradient affect the activity of an anesthetic
high gradient= higher amount taken up in tissues= low venous concentration= more anesthetic required= slower onset of action
77
how would low tissue solubility and uptake affect actions of an anesthetic
smaller arteriovenous gradient (less peripheral uptake) less absorbed by tissue = higher concentration in brain ( equilibrates faster)
78
how is the potency of an anesthetic determined
MAC. Minimal alveolar concentration that prevents movement in 50% of people exposed to noxious stimuli. Potent= Low MAC
79
Does the arteriovenous gradient of an anesthetic affect potency or rate of induction?
Rate of induction
80
DOC for Hairy cell leukemia
Cladribine ( adenosine analog) that is resistant to adenosine deaminase (allows drugs to reach high concentrations to cause dsDNA breaks)
81
Mechanism of action of Cladribine
adenosine analog that is resistant to adenosine deaminase
82
how will a competitive antagonist change ED50 and Emax on a dose response curve
increase ED50 (right shift) no change in Emax
83
how will a noncompetitive antagonist change ED50 and Emax on a dose response curve
ED50 is unchanged and decreased Emax
84
pH in pulmonary embolism
V/Q mismatch causes hyperventilation leading to respiratory alkalosis (pH \>7.45). pCO2
85
high pH, low PaCO2, low pO2
PE
86
increased A-a gradient
V/Q mismatch, diffusion limited, right to left shunt
87
why is HTN a risk for aortic dissection
medial hypertrophy of aortic vasa vasorum causes decreased blood flow to aortic media leading to loss of smooth muscle cells (aortic enlargement and increased wall stiffness) ultimately leads to intimal tearing
88
hyperglycemia and anion gap metabolic acidosis
DKA
89
appropriate compensation in metabolic acidosis
PaCO2= [1.5x HCO3] +8
90
Appropriate compensation in metabolic alkalosis
increase in PaCO2 by 0.7 mmHg for every 1 mEq/LHCO3
91
Appropriate compensation in acute respiratory acidosis
Increase serum HCO3 by 1 mEq/L for every 10 mmHg in PaCO2
92
Appropriate compensation in acute respiratory alkalosis
decrease in serum HCO3 by 2 for every 10 mmHg decrease in PaCo2
93
Normal anion gap
8 to 12
94
delayed separation of umbilical cord, lack pus formation
Leukocyte adhesion deficiency (LAD I) due to absence of CD 18
95
abdominal pain, bloody vagina discharge, orthostatic hypotension, positive pregnancy test
Ectopic pregnancy
96
MVA with sudden deceleration, hypotensive
blunt aortic injury (traumatic aortic rupture) occurs most commonly at aortic isthmus (ligamentum arterosum is fixed and immobile compared to descending aorta)
97
Facial nerve CN VII functions
Motor to facial muscles, parasympathetic to lacrimal, submandibular, sublingual glands, anterior 2/3 for tast, afferent from pinna and external auditory canal
98
Major basic protein is found in
Eosinophils
99
TdT positive cells are found in
ALL (immature lymphocytes)
100
TRAP +
Hairy cell leukemia
101
Peroxidase + cytoplasmic inclusions
Auer rods (AMP)
102
HTN + BPH
Alpha 1 blockers ( Prazosin, Doxazosin, Terazosin)
103
HTN + CHF
Beta-blocker ( metoprolol, atenolo)
104
First choice for essential HTN
Hydrochlorothiazide
105
HTN + osteoporosis
HCTZ
106
Tx for stable angina
Isosorbide dinitrate (venodilation decreases preload)
107
Acute transplant rejection
host T cells against graft MHC. Tx: corticosteroids and calcineurin inhibitors
108
Hyperacute graft infection
preformed antibodies against ABO antigens (mottling seen immediately)
109
Chronic graft rejection
Host B cell and T cell sensitization against graft MHC
110
Graft vs Host disease
Bone marrow transplant. Graft T cells against host MHC
111
How does Hepcidin regulate iron
Binds ferroportin and degrades it ( decreases intestinal absorption) and inhibits release of iron by macrophages
112
Transported responsible for iron uptake
Divalent metal transporter 1 (DMT1)
113
what causes an increase or decrease in hepcidin levels
High iron and inflammatory conditions increase hepcidin. Low hepcidin levels cause increase in intestinal absorption and stimulate iron release by macrophages
114
What is the erythrocyte sedimentation rate?
Increased acute phase protein (fibrinogen) causes erythrocytes to form stacks (aggregate)
115
Major risk factors for esophageal squamous cell cancer
alcohol, tobacco, nitrite containing foods
116
Risk factors for esophageal adenocarcinoma
Barretts, GERD, Obesity, Tobacco
117
Mechanism of OCPs
suppresses FSH and LH, causes thickening of cervical mucus (prevent sperm from accessing uterus), prevents growth of endometrium (prevent implantation)
118
Function of paneth cells in intestinal crypts
secrete lysozyme, defensins
119
PaO2 in hypoxemia
less than 80mmHg
120
normal A-a gradient
does not exceed 10-15 mmHg
121
Hypoxemia with a normal A-a gradient
high altitude or hypoventilation
122
cause of hypoventilation
Suppressed respiratory drive ( sedative OD, sleep apnea) or decreased inspiratory capacity (myasthenia gravis, obesity)
123
Increased A-a gradient is seen in
alveolar hyaline membrane disease ( decreased diffusion) Right to left shunt (venous blood bypasses lung), V/Q mismatch (poor ventilation of well perfused alveoli)
124
When is V/Q mismatch seen
poor ventilation of well perfused alveoli: pneumonia, obstructive pulmonary disease, pulmonary embolism
125
which enzyme is responsible for removing RNA primeres in prokaryotes?
DNA pol I ( has 5' to 3' exonuclease activity)
126
surgical operation outside of US
probably used halothane
127
Side effect of Halothane
Massive liver necrosis. Rapid atrophy leads to shrunken liver. Thought to be a hypersensitivity reaction
128
elevated PT is seen aute hepatic failure, why?
failure of hepatic function leads to deficiency of Factor VII which has the shortest half life.
129
labs in anemia
low erythrocyte, low reticulocytes, low hemoglobin
130
low retigulocytes, low RBC, normal wbc, normal platelet
pure red cell aplasia
131
effects of anesthesia
myocardial depression (decrease CO), respiratory depression (hypercapnia), increased cerebral blood flow, decrease GFR, decrease hepatic blood flow
132
probability of 1 event turning out differently
1- (probability of all events being the same)= 1-(product of the separate probabilities)
133
specificity
True negative rate ( proportion of all people without disease who test negative)= (negative in health= if healthy tests negative)
134
Sensitivity
True positive. Proportion of people with disease that test positive
135
RPR (rapid plasma reagin)
cardiolipin, cholesterol and lecithin is mixed with patient's serum. Nontreponeal serologic test because it detects antibodies against human lipids after destruction by T. pallidum
136
What can dissolve viral envelopes
Ether and other organic solvents
137
Class IA antiarrhythmic
Disopyramide, Quinidine, Procainamide (double quarter pounder). Prolonges AP, slows phase 0 depolarization
138
Class IB antiarrhythmic
Lidocaine, Tocainide, Mexiletine (lettuce, tomato, Mayo). Weakly slows Phase ) depolarization. Shortens AP
139
Class IC antiarrythmic
Moricizine, Flecainide, Propafenone (More Fries Please). Strong inhibitor of phase 0 depolarization. No change in AP
140
Adenosine
acts at AV node to slow conduction and decrease automaticity by hyperpolarizing cell
141
Digoxin
increases vagal output to AV node and slows conduction. Increases Ca to increase contractility
142
Buproprion
inhibits presynaptic reuptake of dopamine and NE. Contraindicated in pts with seizure disorder or with bulimia or anorexia due to risk of seizures
143
SE of clozapine
agranulocytosis
144
Stevens johnson syndrome
seen as a side effect of lamotrigine
145
Olanzapine side effect
weight gain
146
anti-inflammatory cytokines
IL10, TGFB
147
TNF alpha induces what factor to produce more inflammatory mediators
NFkB
148
Why is DKA only seen in Type I DM
they have no insulin!! Not seen in DMII (insulin resistance)
149
What is Hageman factor
Factor 12
150
What is Kallikrein
converts kininogen into bradykinin
151
Normal core body temp
37-38 (fever \>38.3)
152
Hyperpyrexia
\> 40. treat with cold blankets and oral acetaminophen
153
Phenyalanine delection
Common cause of CF
154
Lesser omentum
Hepatogastric and hepatoduodenal portions
155
Falciform ligament
Liver to anterior body wall
156
Greater omentum
encompases the transverse colon and is divided in surgery to access anterior pancreas and posterior wall of stomach
157
Splenorenal ligament
left kidney and spleen and contains splenic vessels and tail of pancreas
158
What is selective protinuria
albumin loss with minimal loss of more bulky proteins (IgG and macroglobulin) (seen in Minimal change disease)
159
Tubular proteinuria
low molecular weight proteins (b2 microglobulin, IgG light chain, amino acid) usually filtered and reabsorbed in PT
160
Overload proteinuria
reabsorptive capacity of proximal tubules is exceeded (ie. Multiple myeloma)
161
Functional proteinuria
change in blood flow through glomerulus
162
Orthostatic proteinuria
Increased protein excretion in upright position but normal in supine. Seen in older tall, thin adolescents
163
Isolated proteinuria
incidental finding with normal renal function
164
holosystolic crescendo decrescendo murmur
aortic stenosis
165
Developmental milestone at age 3
play in parallel, speak simple sentences, copy a circle, use utensils, ride a tricycle
