5/7 Flashcards
congenital long QT syndrome
disorder of myocardial repolarization (ion channel defects)
risk of sudden cardiac death from torsades
two types
two types of long QT syndromes
Romano-Ward: aut dom- cardiac problems only- mutation of Ca or Na channels
Jervell and Lange-Nielsen syndrome- aut rec- cardiac and sensorineural deafness- mutation of K channels
Brugada syndrome
aut dom- asian males
pseudo RBBB and ST elevation in V1-V3
risk of ventricular tachyarrythmias and SCD
Wolff-Parkinson-White syndrome
ventricular pre-excitation syndrome that can lead to supraventricular tachycardia
cause: abnormally fast bundle of Kent bypasses AV node and prematurely depolarizes ventricles
EKG: delta wave, wide QRS, short PR
things that cause wide splitting
delay RV emptying!
pulmonic stenosis, RBBB
things that cause fixed splitting
ASD (left to right shunt)
regardless of breath!
things that cause paradoxical splitting
delay aortic valve closure so get rid of split on inspiration!
aortic stenosis
LBBB
continuous machine-like murmur
PDA
pathway of fetal blood flow
umbilical vein –> liver (ductus venosus bypass) –> IVC –> heart
then either enters pulmonary circuit or crosses from RA to LA via foramen ovale
some blood from pulmonary enters aorta via ductus arteriosus and then supplies all tissues
transfers deoxygenated blood back to placenta via umbilical arteries
amyloid angiopathy
spontaneous lobar hemorrhage- particularly parietal (contra hemisensory loss) and occipital (vision changes), sometimes frontal (contra hemiparesis)
beta amyloid deposits in small and medium sized arteries
telomerases
reverse transcriptase (RNA-dep DNA pol) that lengthens telomeres by adding TTAGGG to 3’ end.
composed of TERT (rev transcriptase) and TERC (RNA template)
which type of cells have long telomeres and high telomerase activity?
stem cells (eg. skin)
thiazides effect on Ca
increase Ca absorption in distal tubule
loop diuretics effect on Ca
hypocalemia- Ca excretion
Cori disease feature
unbranched glycogen with short outer chains (limit dextrins)
where are actin filaments bound to in the sarcomere?
structural proteins at the z line (the non-myosin part)
Babesiosis symptoms and signs
flu-like
anemia, thrombocytopenia, elevated LFTs
intraerythrocytic pleomorphic rings (maltese crosses sometimes)
how does squatting help relieve tet spells
increase SVR, preventing right to left shunts
factor Xa inhibitors effect
prolong PT and PTT (at the junction of extrinsic and intrinsic pathways)
no effect on Thrombin time
types of drug reactions
predictable- what’s expected
exaggerated- what’s expected but occurs at low unexpected dose
idiosyncratic- unpredictable reaction in certain patients
immunologic- unpredictable immunologic reaction
uncal herniation symptoms
oculomotor nerve palsy with fixed dilated pupil
SGLT2 inhibitor Tx and contra
urinary tract and genital mycotic infections (from glucosuria)
symptomatic hypotension
avoid in patients with mod-severe renal impairment (check BUN and Cr)
deep inguinal ring vs superficial inguinal ring
deep- transversalis fascia
superficial- external oblique muscle aponeurosis - then from there testis enters scrotum
adenosine tx
RAPID (half life of ten seconds)
flushing
bronchospasm (chest burn)
hypotension
AV block
which is based on prevalence? sens/specficity or pos/neg predictive value?
Positive and negative predictive value
Hartnup disease
impaired transport of neutral amino acids in small intestine and PT of kidney
particularly tryptophan affected, which is a precursor for niacin, serotonin, and melatonin
pellagra and ataxia
myocardial hibernation
chronic myocardial iscemia
LV systolic dysfunction due to redued coronary blood flow
reversed by coronary revascularization
filtration fraction
portion of renal plasma flow that is filtered through Bowmans space
GFR: RPF
what composes of most of the right side of cardiac silhouette?
right atrium
carotid sinus massage
reflex parasympathetic stimulation of SA, AV and atrial myocytes–> decrease HR and CO
murmur in VSD
holosystolic murmur
low pitched
heard best at left sternal border
accentuates with handgrip maneuver (increase afterload)
what is needed to make nitrous oxide
nitrous oxide synthetase
arginine
NADPH
O2
fixed splitting heard in…
ASD –> pulm hypertension
where is the placement of cannulation of femoral vein
medial to femoral artery (midinguinal)
1 cm below inguinal ligament
when does RF make mitral regurgitation and when mitral stenosis
regurg- first few decades- holosystolic murmur
stenosis-mid-age
after MI, when does pericarditis begin and when would dressler begin?
pericarditis- 2-4 days
dressler- one week to few months
when and where is aortic regurgitation best heard?
after second heart sound (aorta valve closes)
left sternal border, in 3-4th intercostal space
when is mitral regurgitation best heard
after first heart sound (mitral valve closes)
when is aortic stenosis best heard
mid systole (crescendo-decrescendo)
when is mitral stenosis best heard
mid diastole
polyarteritis nodosa histo and association
hep B association
transmural inflamm of mid-sized arteries
fibrinoid necrosis- amorphous, eosin staining
varicella zoster histo
multinucleated giant cells with intranuclear inclusions
cells that have raquet shaped granules
langherans cells
Kozak consensus sequence
sequence on euk mRNA that helps initiate translation before AUG start codon
gccrcc
r is either a or g
NADPH functions
- antioxidant- regnerate glutathione
- phagosomes resp burst
- biosynthesis in liver and adrenal- fatty acids, steroids, cholesterol
- cyt p450 metabolism
how many calories of protein, carb, and fat per 1 gram?
protein and carb- 4 cal/g
fat- 9 cal/g
where do internal hemorrhoids drain to?
middle and superior rectal veins–> internal iliac and inferior mesenteric veins
how can you reduce recurrence of genital herpes
daily treatment of oral valcyclovir, acyclovir, or famcyclovir
pathology of Reyes syndrome
hepatic dysfunction- microvesicular steatosis
encephalopathy- hyperammonemia –> cerebral edema
when do you screen for group b strep in pregnant women?
35-37 weeks gestation
hCG has similar structure to
FSH, LH, TSH
bacteria most common of secondary pneumonia
strep pneumo, staph aureus, hemophilus
incomplete fusion of the urethral folds results in
hypospadias
primary cause of death in acute rheumatic fever
pancarditis
how many days after MI does free wall rupture happen?
5-14 days
