Block 4 Flashcards
inc hyperresonance vs inc tact fremitus & percussion means?
pneumothorax vs consolidation
What current contributes to atrial/ventricular rate difference? Where is highest vs lowest resistance in lungs?
slow Ca2+ current at phase 0 AV node. bronchi vs term bronchioles & max inspiration
pathogenesis of ARDS
alv insult -> cytok, neu -> endothel dmg -> vessel perm, protein leak -> hyaline mem, pulm edema
how does paradox emboli form? ANP vs BNP
PFO, ASD; from venous to arterial circ. in atrium, dil aff & constricts eff, inc blood vol & atrial pressure, dec Na reabsorption vs dx HF, nesiritide tx HF; both A/BNP inc UO & dec vasc resist, inhib by neprilysin/metalloprotease
Beck’s 3ad. sxs & tx of tamponade
JVD, HOTN, dec heart sounds (bonus: cool extremities, no palp PMI, clear lungs). this, low volt EKG, pulsus paradoxus & tx pericardiocentesis
renal complications from malig HTN. heme complication from malig HTN
fib nec, hyperplastic/onion skinning arterio. micro hemangiopathic anemia
how do athero plaques rupture? how to tx unstable angina/NSTEMI vs STEMI?
metalloproteases degrade collagen & ECM cap. anticoag, antiPLT vs reperfusion, PCI
pericarditis
friction rub, diffuse ST elev, better leaning forward; caused by staph/strep (not so much Kleb), coxsackie/echo, RA/SLE, uremia; tx w/ NSAIDs, colchicine, glucocorticoids, dialysis
CXR shows patchy vs lobar, nodular, cavitary infiltrate
myco or chlamdyia PNA => atypical/walking PNA; tx w/ macrolide or tetracycline (protein synthesis inhib) vs fungi; tx w/ azoles
conditions that predispose to mitral vs tricuspid regurg? MVP?
both RF & IE; LV dil, MVP, ischemic vs RV dil, Marfan, carcinoid. myxoma, ADPCKD, Marfan/EDS, chordae rupture
conditions that predispose to aortic regurg vs mitral sten?
BEAR -> LHF vs RF; LAP > LVP during diastole -> inc PCWP, PAH
conditions assoc w/ Ebstein? defects of ASD vs PFO
tricusp regurg, RHF, accessory conduction pathways. ostium 2o defect vs failed septum 1/2o fusion
athero pathogenesis
a copy cat named willis. endothel dysfxn -> mac/foam/LDL -> smooth mm mig, ECM, fib -> atheroma -> calc
aortic aneurysm vs trauma aortic rupture vs aortic dissect
from eccentric hypertophy, aortic regurg, chronic inflam vs @ aortic isthmus distal to L subclavian origin, CXR wide mediastinum vs A: leads to aortic regurg, tamponade; a/w HTN or Marfan; CXR wide mediastinum, tx surg. B: below L subclav; CXR wide mediastinum; tx BB -> vasodil
how does Eisen correct itself? examples of V/Q airway vs blood obstruction
L/R shunt -> PAH/RVH -> R/L shunt. shunt, foreign body vs PE
pulm hypoplasia vs bronchogenic cysts
poor developed bronchial tree -> congen diaphragm hern, bil renal agen/Potter vs abnl foregut budding + dil terminal or lg bronchi -> liquid filled or air filled densities/infxn CXR -> airway compression, recurrent resp infxns
NRDS
no surfact. RISK FACTORS: DM, premature. tx w/ mom steroids or exog surfact; if gave O2 -> retinopathy, intravent hem, bronchopulm dysplasia (dil airspace w/ bronchiole metaplasia). L/S <1.5
markers for mesothelioma
psammoma, calretinin, cytokeratin 5/6; tonofilaments, microvilli, desmosomes
how does tension PTX cause obstructive shock?
shift away mediastinum -> kink IVC -> dec venous return -> obstructive shock, JVD
cardio curve: what causes inc vs dec venous return?
inc vol, fluid infuse, venoconstrict vs dec vol, hem, venodil
PAH drugs
endothel-1 antag -> vasodil -> dec PVR; PDE5I -> inc cGMP -> NO; PG -> vasodil
milrenone vs nesiritide. hydralazine vs nitroprusside vs fenoldapam
PDEI -> inc cAMP -> inc ctx vs vasodil -> dec pre/afterload, naturesis. HTN emerg, vasodil; AE reflex tachy -> give BB vs HTN emerg, vasodil by inc cGMP; AE CN poison vs vasodil by inc cAMP, dil renal aa, D1 ag -> inc Na/H2O excretion
