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Top 100 Secrets > 100 Secrets > Flashcards

100 Secrets Flashcards

1
Q

What determines Stroke Volume?

A

1) Preload
2) Contractility
3) Afterload

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2
Q

Define Preload

A

intraventricular volume or pressure at the end of diastole

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3
Q

Contractility

A

how forcefully the heart contracts at any end-diastolic volume

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4
Q

With greater contractility comes greater ___

A

stroke volume

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5
Q

Afterload

A

load against which the heart mus pump blood and includes the systemic arterial pressure and any other impediments to flow, such as stenotic (narrowed) aortic valve

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6
Q

Asthma

A

characterized by reversible airway obstruction and hyperreactivity of the airways to a variety of agents and can be diagnosed by a methacholine challenge

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7
Q

How do you diagnose Asthma?

A

Methacholine challenge

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8
Q

Dx Acute respiratory distress syndrome

A

presence of sudden-onset respiratory failure, bilateral diffuse pulmonary infiltrates, severe hypoxemia and coexistence of a disease known to cause it .

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9
Q

How do you manage acute respiratory distress syndrome?

A

Supportive therapy with a ventilator to maintain oxygenation and treatment of the underlying disease

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10
Q

How can you classify Lung Cancer?

A

Small cell lung cancer - susceptible to radiation therapy

Non-small cell lung cancer - more resistant to radiation therapy. All are generally treated with surgery

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11
Q

Causes of acute renal failure

A 
Renal hypoperfusion (pre renal)
Intrinsic renal damage (renal) 
Obstruction (postrenal)
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12
Q

Two most common causes of end-stage renal disease

A

Diabetes

Hypertension

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13
Q

Acute tubular necrosis (ATN) characterized by

A

The presence of “muddy brown” casts in the urinary sediment.

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14
Q

Nephrotic Syndrome

A

Characterized by massive proteinuria (>3g per 24hours), hypoalbuminemia, edema, hyperlipidemia, and minimal hematuria.

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15
Q

Nephritic Syndrome

A

Characterized by hypertension, renal dysfunction, hematuria with dysmorphic red blood cells and RBC cast in the urinary sediment, and less prominent proteinuria (<3g per 24 hours)

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16
Q

Creatinine clearance and glomerular filtration rate are inversely proportional to ________

A

serum creatinine .

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17
Q

Effective circulating volume (ECV) is regulated by

A

adjusting the rate of sodium excretion

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18
Q

Osmolality is regulated by

A

adjusting the rate of free water excretion

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19
Q

All diuretics lower extracellular fluid volume by

A

inhibiting tubular reabsorption of sodium and thereby enhancing urinary excretion of sodium

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20
Q

Hyperventilation causes

A

respiratory alkalosis by blowing off excess CO2. Maximal compensation by the kidneys requires several days.

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21
Q

Most common causes of metabolic alkalosis are:

A

1) loss of gastric secretions (as w/ vomiting or nasogastic suctioning)
2) diuretics (loop and thiazides)
3) volume depletion
4) mineralcorticoid excess

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22
Q

Metabolic acidosis can de divided into:

A

anion gap and non anion gap

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23
Q

Mnemonic for causes of high anion gap metabolic acidosis:

A

MUDPILES

Methanol
Uremia (renal failure)
Diabetic and other ketoacidoses
Paraldehyde (now rarely seen)
Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
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24
Q

Achalasia

A

Characterized by progressive dysphagia due to destruction of the myenteric plexus. “birds beak”

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25
Q

NSAIDS and H. Pylori are the most common causes of_____

A

gastric and duodenal ulcers, respectively

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26
Q

Ulcerative colitis

A

Characterized by continuous inflammation of the colonic mucosa , which begins in the rectum and progresses proximally.

Major complications are colon cancer and toxic megacolon

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27
Q

Crohns disease

A

Characterized by transmural inflammation of different patches of colon and small intestine. Sclerosing cholangitisis more common in Crohns disease than ulcerative colitis

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28
Q

Alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) are laboratory tests that suggest…

A

organ damage

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29
Q

Elevation in AST and ALT suggest…

A

hepatitis

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30
Q

Elevation in ALP and GGT are suggestive of…

A

cholestatic disease

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31
Q

Hepatitis A and E viruses are transmitted through

A

fecal-oral route.

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32
Q

Hepatitis B and C viruses are transmitted through

A

sexual contact or parenterally and can cause chronic infections

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33
Q

Tylenol (acetaminophen) is metabolized by

A

Cytochrome P-450 system producing N-acetyl-p-benzoquinoneimine (NAPQI) which is hepatotoxic.

NAPQI detoxified by a phase II reaction with glutathione

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34
Q

Most common hypersecreting pituitary tumor

A

Prolactinoma

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35
Q

Cortisol causes:

A

Hyperglycemia by directly promoting gluconeogenesis, stimulating protein catabolism in muscle with the release of amino acids to be used as precursors in gluconeogenesis and stimulating lipolysis, from which the free fatty acids that are liberated are used as an energy source of gluconeogenesis.

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36
Q

Grave’s disease

A

Most common cause of hypothyroidism
Characterized by diffuse goiter, bulging eyes (exophthalmos) and pretibial myxedema.
It is caused by antibodies to the thyroid-stimulating hormone receptor that have a stimulatory effect on the thyroid.

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37
Q

Estrogen-containing oral contraceptives

A

Work by providing a constant level of negative feedback to the anterior pituitary, thereby stabilizing follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion and preventing surges that could cause ovulation

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38
Q

Oral contraceptives increases the risk of:

A

various thromboembolic phenomena, including stroke, myocardial infarction, pulmonary embolism, and deep venous thrombosis.
Smoking further increases these risks

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39
Q

If ovulation never occurs..

A

the corpus luteum, which is the site of normal progesterone synthesis does not form, so there is no progesterone spike and decline, resulting in absence of menses

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40
Q

Pulsatile secretion of GnRH

A

stimulates pituitary FSH and LH secretion

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41
Q

Continued GnRH secretion

A

inhibits their secretion

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42
Q

Leuprolide

A

obliterate menstrual cycles and place a woman in artificial state of menopause, which is therapeutically useful for diseases that are exacerbated by the menstrual cycle, especially endometriosis

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43
Q

Sickle cell anemia

A

a change in one amino acid in the B chain of hemoglobin makes the deoxyhemoglobin form substantially less soluble.
Conditions that increase the concentration of the less soluble deoxyhemoglobin, such as dehydration, acidosis and hypoxia, can cause precipitation of hemoglobin

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44
Q

In microcytic anemia..

A

cell proliferation outpaces hemoglobin synthesis, causing formation of smaller cells

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45
Q

Hereditary Spherocytosis

A

a defect in the erythrocyte cytoskeleton causes the cells to take on a spherical rather than a biconcave shape. These abnormal cells are destroyed in the spleen, causing hemolytic anemia.

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46
Q

Primary hemostasis

A

formation of platelet plug

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47
Q

Secondary hemostasis

A

activation of the coagulation cascade and formation of the fibrin plug

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48
Q

Hemophilia A

A

X-linked recessive disorder that is due to a defect or deficiency of factor VIII.

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49
Q

Hemophilia B

A

Much less common.

Due to a defect in gactor IX

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50
Q

Voon Willebrand’s disease

A

Most common hereditary bleeding disorder, results from a defect or deficiency of von Willerbrands factor, a protein that anchors platelets to the subendothelial collagen that is exposed during vascular injury

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51
Q

NSAIDs inhibit …

A 
platelet cyclooxygenase (COX), enzyme that synthesizes thromboxane, a potent procoagulant.
Acetylsalicylc acid (aspirin) irreversibly inhibits this enzyme, whereas all other agents reversibly inhibit it.
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52
Q

Older patient presents with focal back pain without a history of trauma and constitutional symptoms of malaise, unintentional weight loss and recurrent infections.. think of..

A

Multiple Myeloma

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53
Q

Acute Lymphoblastic Leukemia/lymphoma

A

Most common cause of childhood cancer.

Presents with: fatigue, night sweats, weight loss, and bone pain.

Suspect ALL in any child with a hematologic malignancy

54
Q

Chronic Myelogenous Leukemia

A

occurs in young to middle -aged adults.

Presents with fatigue, night sweats, and unintentional weight loss. Associated with the Philadelphia chromosome, created by a translocation between chromosome 9 and 22.

55
Q

Hodgkin’s lymphoma

A

presents in young adults with a mass and nontender lymphadenopathy. Biopsy reveals the presence of large binucleated cells among other lymphocytes, histiocytes and granulocytes.

56
Q

Stage of most solid cancers is related to:

A

Size of the neoplasm, the number of lymph nodes involved and the presence or absence of metastases (TNM system)

57
Q

Paraneoplastic syndromes are caused by:

A

secretion of peptides or antibodies by a neoplasm

58
Q

IgM

A

primary immune response

59
Q

IgG

A

secondary immune response

60
Q

IgA

A

secretory immunity

61
Q

IgE

A

type I Hypersensitivity

62
Q

IgD

A

imature B cells

63
Q

Th1

A

activate cytotoxic T lymphocytes and macrophages

64
Q

Th2

A

activates B cells to plasma cells

65
Q

Most common antigen-presenting cells

A

macrophages
memory B cells
dendritic cells

Class II MHC molecules interact with the T-cell receptor and CD4 molecules in the surface of TH cells

66
Q

In type I hypersensitivity, IgE mediates …

A

mast cell degranulation

67
Q

in type II hypersensitivity cell bound antigens allow..

A

antibody-mediated cytotoxicity

68
Q

in type III hypersensitivity, immune complexes lead to..

A

complement -mediated damage

69
Q

in type IV hypersensitivity…

A

Th1 cell mediated damage occurs

70
Q

Atypical antipsychotics are more effective against

A

the negative symptoms of schizophrenia and are much less likely to cause extrapyramidal side effects.

71
Q

Low-potence typical agents have a high incidence of…

A

anticholinergics side effects, sedation and orthostatic hypotension

72
Q

High-potency typical agents have a high incidence of..

A

extrapyramidal side effects

73
Q

Valproic acid

A

mood stabilizer of choice in bipolar disorder due to its side effect profile and lower toxicity

74
Q

Lithium

A

narrow therapeutic index, and side effects include nephrogenic diabetes insipidus and hypothyroidism

75
Q

Tricyclic antidepressants cause

A

anticholinergic, orthostatic hypotensive and sedative side effects.

In overdose they can cause cardiac arrhythmias, convulsions and even coma or death

76
Q

Alcohol, benzodiazepines and barbiturates all act at

A

the gamma-aminobutyric acid receptor.

77
Q

Barbiturates are much more likely to cause

A

a fatal respiratory depression than the benzodiazepines.

78
Q

Enzymopathies (enzyme deficiencies) are usually

A

autosommal recessive or x-linked recessive

79
Q

defects in structural proteins exhibit

A

autosomal dominant inheritance

80
Q

Most common genetic cause of mental retardation

A

Trisomy 21 or Down Syndrome

81
Q

The most common form of inherited mental retardation

A

Fragile X

82
Q

Trinucleotide repeat disorders that present anticipation

A

Fragile X syndrome

Huntingtons disease

83
Q

Information from the temporal retina travels

A

without crossing over to the ipsilateral brain

84
Q

Information from the nasal retina

A

crosses over to the contralateral brain.

85
Q

closed angle glaucoma

A

acute, painful vision threatening condition associated with severe elevation of intraocular pressure, halos around lights, and blurry vision.

86
Q

Open angle glaucoma

A

chronic painless condition associated with slowly progressing loss of peripheral vision due to elevated intraocular pressure and normal appering trabecular angle structures

87
Q

Down and out position of the eye

A

seen with third nerve palsy

If the pupil is involved and dilated, emergent evaluation for an aneurysm in cerebral vasculature is required

88
Q

Amyotropic lateral sclerosis (ASL) (Lou Gehrig disease)

A

Both upper and lower motor neurons are destroyed

Both upper and lower motor neuron signs

89
Q

Upper motor neuron signs

A

spasticity, hyperreflexia and clonus.

90
Q

Lower motor neuron signs

A

hypotonia, flaccid paralysis, hyporeflexia and fasciculations

91
Q

Parkinsons disease

A

results from destruction of dopaminergic neurons in the substantia nigra, which influences movement via their projections to the basal ganglia.

Clinical manifestations: pill-rolling tremor at rest, cogwheel rigidity, masked facies and a widened gait with slow, shuffling steps

92
Q

Myasthenia Gravis

A

autoimmune disease , autoantibodies destroy the nicotinic acetylcholine receptor on skeletal muscle, reducing the effectiveness of neuromuscular transmission and causing weakness

93
Q

Syringomyelia

A

fluid filled cavity within the central spinal cord can compress the fibers of the anterolateral (spinothalamic) tract, which convey sensory information about pain and temperature to both sides of the body

94
Q

The three most important portosystemic anastomoses

A
  1. esophageal veins with the azygous system (esophageal varices)
  2. superior rectal veins with inferior and middle rectal veins (hemorrhoids)
  3. paraumbilical veins with superficial epigastric veins (caput medusae)
95
Q

Indirect inguinal hernia

A

begins lateral to the epigastric vessels, runs through the inguinal canal and is congenital

96
Q

Direct inguinal hernia

A

begins medial to the epigastric vessels and most commonly is acquired

97
Q

The right recurrent laryngeal nerve originates…

A

from the vagus nerve just inferior to the right subclavian artery.

Run posterior to the thyroid gland and are prone to injury during surgery in this area

98
Q

The left recurrent laryngeal nerve originates…

A

just inferior to the aorta.

Run posterior to the thyroid gland and are prone to injury during surgery in this area

99
Q

The preaortic and lumbar (paraaortic) nodes provide lymphatic drainage for

A

the testes and ovaries

100
Q

The gonadal arteries branch ..

A

directly from the aorta, also at the level of gonadal development (near the kidneys)

101
Q

Systemic sclerosis (scleroderma) is categorized

A

as either:

  1. the limited cutaneous form, which involves primarily only limited amounts of the skin and has limited internal organ involvement
  2. diffuse cutaneous scleroderma, which involves a greater area of the skin and has more extensive internal organ involvement (lungs, intestines)
102
Q

Systemic Lupus Erythematosus

A

autoimmune disease that, like most autoimmune diseases, affects primarily women. Can involve multiple organs, including the skin (malar rash) , joints (arthritis), kidneys (glomerulonephritis) and heart (pericarditis and Libman-Sacks endocarditis)

103
Q

Antinuclear antibodies

A

diverse group of autoantibodies that bind to various antigens within the cell nucleus,

They are present in multiple autoimmune diseases, including lupus, scleroderma, Sjogren syndrome, polymyositis and dermatomyositis

104
Q

Where are antinuclear antibodies present?

A

multiple autoimmune diseases, including lupus, scleroderma, Sjogren syndrome, polymyositis and dermatomyositis

105
Q

Osteopetrosis

A

defective osteoclasts do not effectively resorb bone.

The bone are much thicker and may crowd out the bone marrow, resulting in anemia

106
Q

Vasculitides

A

inflammatory diseases defined by the presence of leukocytes in the vessel walls.

Typically present with vague constitutional symptoms, such as fever, fatigue, malaise, myalgias or arthralgias

107
Q

Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP)

A

the most widely used indicators of the acute-phase protein response.
This response reflects the presence and intensity of an inflammatory process; therefore, ESR and CRP are two laboratory values that can be useful in following vasculitic syndromes.

108
Q

Bacterial endocarditis that occurs soon after prosthetic valvular surgery is commonly due to…

A

Staph epidermidis

result of intraoperative contamination

109
Q

Think of Lyme disease

A

in any patient who recently traveled to New England, complains of flu-like symptoms, and has an enlarging erythematous rash with central clearing

110
Q

The classic presentation of tuberculosis …

A

is a patient who complains of fever, night sweats, weight loss, and a productive cough tinged with blood. Chest x-ray film may reveal a pulmonary infiltrate, and a purified protein derivative skin test should be positive.

*Gold standard: sputum culture that grows acid-fast bacilli *

111
Q

All DNA viruses except_____ contain ______

A

Parvoviridae family; double stranded DNA

112
Q

All DNA viruses are enveloped except:

A

Parvoviridae, Adenoviridae, and Papovaviridae

113
Q

the responsible for the majority of infections in both childrens and adults:

A

Pneumococcus
Neisseria meningitides
enteroviruses

114
Q

Parasites can be divided into:

A

1) Protozoa

2) Metazoa

115
Q

Protozoa

A

Single celled eukaryotic organisms (plasmodium, giardia and entamoeba)

116
Q

Metazoa

A

the worms (cestodes, nematodes, and flukes)

117
Q

Azoles

A

inhibit ergosterol synthesis.

118
Q

Polyenes (amphotericin B and nystatin)

A

bind ergosterol in the fungal cell membrane and create pores

119
Q

NSAIDs

A

achieve their anti-inflammatory, antipyretic and analgesics effects by inhibiting the COX pathway, thus reducing prostaglandin production

120
Q

Opioids (morphine, codeine, heroin, methadone, meperidine, and fentanyl)

A

blunt the sensation of painful stimuli by binding u receptors and hyperpolarizing the cell

121
Q

Overdoses with acetaminophen, benzodiazepines and opioids can be reversed using…

A

acetylcysteine, flumazenil, and naloxone, respectively

122
Q

Cardiac glycosides

A

a group of ionotropes that increase cardiac contractility by increasing intracellular calcium levels.

123
Q

Calcium channel blockers

A

decrease intracellular calcium, thus decreasing contractility

124
Q

Sensitivity

A

is a measure of how to effectively it can detect a disease in a patient who has the disease

125
Q

Specificity

A

is a measure of how effectively it can detect “health” or the absence of disease in a patient

126
Q

Positive predictive value

A

probability that, given a positive test result, the disease in question is actually present

127
Q

Negative Predictive value

A

probability that disease is absent if a test result is negative

128
Q

The P value

A

reflects the probability that the difference observed between groups could occur by chance alone

129
Q

In a cohort study

A

a group of individuals is classified according to exposure an then followed to determine the effect of exposure on disease outcome.

130
Q

In case-control study

A

Individuals are classified according to the presence or absence of disease, and correlations are made between past exposures and the presence of disease.

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