16 May wk8-A Flashcards
ARDS is characterized by…?
What are some potential causes?
Characterized by: hypoxemia with bilateral symmetric pulmonary infiltrates in the absence of fluid overload or heart failure
Causes: trauma, pulmonary contusions, infection/sepsis, fat embolism
Pathophysiology: injury and inflammation to the alveoli leads to neutrophil recruitment and they release proteases and other mediators that damage the pneumocytes and perpetuate the cycle of damage leading to endothelial damage and fluid accumulation in the lungs
Where would edema be expected in a patient with R heart infarct?
Failing R heart would cause peripheral edema more than it would lung edema
Diabetic nephropathy is characterized by…?
Mesangial expansion, glomerular basement membrane thickening, glomerular sclerosis
If the sclerosis is nodular, it is called Kimmelstiel-Wilson lesion
Onset is usually 10-15 years after start of DM I or II
What makes the proximal portions of the pulmonary veins unique?
They contain myocardial tissue that functions like a sphincter during atrial contraction
Has different electrical properties than other parts of the heart and is prone to initiating premature atrial contractions and atrial fibrillation
Order the conduction velocity through the different parts of the cardiac conduction system
1-Purkinje fibers (fastest)
2-Atrial muscle
3-Ventricular muscle
4-AV node (slowest)
In general, what is Paget disease of bone?
Imbalance between osteoclast and osteoblast activity
3 stages: 1-osteoclast, 2-mixed, 3-osteoblast
Unknown cause
Over 60 y/o
What is the end result of Paget disease of bone?
Thick, sclerotic bone that fractures easily
Biopsy shows mosaic pattern of lamellar bone
Patient has increasing hat size, bone pain, hearing loss, lion-like face, and elevated AP levels. Dx? What would be seen on biopsy of the bone?
Paget disease of bone
Biopsy shows mosaic pattern
What is the treatment strategy and potential complications of Paget disease of bone?
Tx: calcitonin to inhibit osteoclasts, Bisphosphonates to cause apoptosis of osteoclasts
Complications: high output heart failure from AV shunts in bone, Osteosarcoma
Risedronate
Risedronic acid
Bisphosphonate used to treat osteoporosis and Paget disease of the bone
Features of osteosarcoma including: Proliferating cells Peak incidence Risk factors Location Presentation Imaging
Proliferation of osteoblasts
Peak in teenagers, but possible in elderly
Risk: familial retinoblastoma, Paget disease, radiation
Location: metaphysis of long bones, usually distal femur or proximal tibia
Presents: pathologic fracture, bone pain, swelling
Imaging: destructive bone mass with sunburst appearance (ossification of surrounding soft tissue) and lifting of the periosteum creating Codman triangle
What is the most common bone tumor associated with Paget disease of the bone? Where?
Osteosarcoma
Generally femur, tibia, humerus, and others
What is the pathognomonic radiographic sign for avascular necrosis of bone?
Crescent sign showing subchondral collapse
What radiograph findings are expected for osteoarthritis?
Osteophytes and joint space narrowing
Globus sensation
Abnormal sensation of something in throat
Worse when swallow saliva and may be better with food or liquid
Not associated with structural abnormality or motility disorder
Often associated with anxiety, underlying psychological distress, ongoing emotional Sx
Dysphonia vs Dysarthria
Dysphonia: more a problem with making sound
Dysarthria: more a problem with articulating speech to be comprehensible
What is a substernal goiter?
Hyperplasia of the thyroid goes down into the thoracic cavity compressing airway causing wheezing, dyspnea, or cough. Swallowing Sx less common.
What is a zenker diverticulum?
Mucosal outpouching from motor abnormalities of the esophagus. Cause dysphagia, regurgitation, aspiration, hallitosis. Dx with barium swallow
Describe what would be seen in a joint aspirate of a patient with gouty arthritis.
Monosodium Urate Crystals that are needle shaped and negative birefringent
Onset of Sx will often be acute and exposure of the crystals to IgG leads to an immune response producing neutrophils in the aspirate as well as macrophages.
What joints are preferentially affected by RA?
Peripheral Joints
What is adenomyosis?
Endometrial tissue in the myometrium of the uterus
What tumor of the female reproductive tract has a whorled pattern?
Leiomyoma: benign tumor of smooth muscle
What is endometriosis?
Presence of endometrial glands and stromal tissue outside the uterus. Ovaries is most common site. Dysmenorrhea is most common presenting Sx. Adnexal masses appearing as chocolate cysts in the ovary is common.
Why does consuming Vit A from plant sources not lead to toxicity?
Plant sources do not have preformed Vit A like that which comes from supplements and animal sources.
Conversion to the active form is a very regulated process and won’t produce enough to cause toxicity.
