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UWORLD Q REVIEWS > Cardio Block Wk 2 > Flashcards

Cardio Block Wk 2 Flashcards

1
Q

What is migratory thrombophlebitis?

aka?

Migratory thrombophlebitis should raise suspicion for?

A

Superficial venous thrombosis.

Trousseau syndrome

Underlying (viscera) cancer
Esp: adenocarcinomas of the pancreas, colon, lung.

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2
Q

What are 2 risk factors for pulmonary embolism?

A

Immobilization and recent surgery

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3
Q

What is the most significant risk factor for UTI?

A

Duration of catheterization.

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4
Q

Where do macrophages in the lungs first appear?

Mucus secreting cells are px at what level?

A

Respiratory bronchioles

**at the distal ends

Larger bronchioles
** After which club cells become the prominent secretory cell type.

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5
Q

MOA for Montelukast/Zafirlukast?

A

Leukotriene receptor antagonist. Used for asthma tx. Bind to receptor on bronchial smooth muscles cells and block effect of cysteinyl containing leukotrienes.

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6
Q

What are the effects of leukotrienes?

A

Inflammatory mediators, released from Mast cells and eosinophils. Cause bronchoconstriction (bronchial smooth m. contraction), bronchial mucus secretion and edema.

**mostly caused by Cysteinyl containing leukotrienes (C4, D4, E4).

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7
Q

MOA of Albuterol?

A

short acting bronchodilator via selective stimulation of B2 receptors

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8
Q

Dextromethorpan MOA?

A

Cold medication: Suppresses cough via stimulation of sigma opiod receptors in the CNS

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9
Q

Inhaled corticosteroid MOA?

A

Inhibits nuclear transcription of inflammatory genes. Especially reduced activity of the enzyme phospholipase A2 to decrease production of leukotrienes.

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10
Q

MOA of Zileuton?

A

5 lipoxygenase enzyme inhibitor that reduces production of leukotrienes . Used in tx of asthma

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11
Q

Legionella pneumophila has the tendency tp affect?

A

Older adults with chronic lung diseases who smoke.

**will not stain with gram staining.

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12
Q

What happens to the bladder of a patient with MS?

A

Develop a spastic bladder few weeks after developing an acute lesion. Presents with increased frequency and urge incontinence.

**urodynamic studies show the presence of bladder hypertonia.

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13
Q

What is small cell lung cancer associated with?

A

SIADH (px as hyponatremia)
ACTh
Lambert Eaton Myasthenic syndrome
Cerebellar ataxia

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14
Q

How is TB controlled in the lungs?

A

Via activated macrophages. APC -> display mycobacterial antigens -> differentiation into T-helper type 1 cells -> secretes IFN -> Activates macrophages -> differentiates into histiocytes + giant cells -> release NO, proteases and ROS contain infection but also destroy surrounding tissues.

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15
Q

How do NSAIDS cause acute kidney injury?

A

Inhibit COX -> block prostacyclin synthesis -> inhibits prostacyclin effect (inhibit afferent dilation) -> reduced GFR -> prerenal azotemia.

**this process is especially important in patients with chronic kidney disease that depend on this process. Urinalysis will be bland.

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16
Q

When do you see RBC vs RBC casts in kidney disease?

A

RBC - direct bleeding of the ureteral epithelium.

RBC cast - glomerular bleeding (trapping by precipitating Tamm Horsefall proteins). These RBCs are usually dysmorphic

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17
Q

What are some of the causes of ARDS?

A

ARDS is caused by injury of the pulmonary epithelium usually due to sepsis or pneumonia.
Other causes: pancreatitis, burns.

**may lead to irreversible pulmonary fibrosis.

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18
Q

Why does BPH (benign prostatic hyperplasia) present with bleeding?

A

BPH is due to glandular growth in the periurethral and transitional zone of the prostate. This new growth is supported by new blood vessels that are fragile and prone to bleeding.

** Cystoscopy will often show detrusor m. hypertrophy (trabaculations).

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19
Q

Digital clubbing is often associated with?

In which patients can it be found?

A

Prolonged hypoxia.

Large cell lung cancer, TB, CF, and suppurative lung diseases such as empyema, bronchiectasis and chronic lung abscesses.

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20
Q

Administration of excessively high oxygen concentration during COPD exacerbation can lead to ?

A

Increased CO2 retention (oxygen induced hypercapnia) -> confusion and depressed level of consciousness (e.g lethargy).

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21
Q

How does oxygen induced hypercapnia occur?

A

Majorly due to increased ventilation - perfusion mismatch.

This is caused by reversal of hypoxic pulmonary vasoconstriction which increases physiologic deadspace.

**In hypoxia blood is shunted (pulmonary vasoconstriction) to alveoli with better perfusion. When O2 is given, this reverses the vasoconstriction.

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22
Q

Where should thoracentesis be performed?

A

Below the 6th rib in the midclavicular line
8th rib along midaxillary line
10th rib along paravertebral line.

**below 9th - abdominal structure injury

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23
Q

Malignant mesothelioma
arises from the?

Is typically associated with?

A

Pleura.

Asbestosis.

Shows unilateral pleural thickening/plaque formation. May see pleural effusions and may be hemorragic.

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24
Q

What is the histological px of mesothelioma?

A

Tumors cells with numerous long, slender microvilli and abundant tonofilament.

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25
Q

How does papillary necrosis typically present?

A

Gross hematuria, acute flank pain, sickle cell dz or trait and DM.

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26
Q

Common histologic findings in aortic dissections?

A

Fragmentation and loss of elastic lamellae with fibrosis and cystic medial degeneration (with basket weave” pattern.

**cystic medial degeneration occurs with aging but is accelerated with Marfan.

27
Q

What is Pancoast syndrome and how does it present?

A

Tumor in the apex of the lung (superior sulcus). Often causes shoulder pain (most common px sx). Can also cause:
Horner sx: cervical sympathetic ganglia.
Spinal cord compression and paraplegia from tumor extension into the intervertebral foramina.
UE edema by compressing subclavian veins.

28
Q

Why is the MOA of developing cysteinuria?

Why does it not cause AA deficiencies in these people?

A

AR. Deficiency of COLA transporter in the intestines and GI

Absorbed as oligopeptides.

**Cysteine precipitation involves low urine pH and urine supersaturation.

29
Q

What conditions can lead to membranous nephropathy?

A

SLE, viral hepatitis and solid malignancies.

**Deposits have spike and dome appearance.

30
Q

Reinfection with the influenza A virus is due to major adaptive immune mechanisms like?

A

Antihemagglutinin antibodies.

**neutralize the virus and block its binding to host cells.

31
Q

Patiromer therapy MOA?

A

Forms resin that binds to Potassium in exchange for calcium, trapping potassium in GI tract.

**Tx for chronic hyperkalemia.
AE- GI upset, hypercalcemia, hypokalemia and hypomagnesemia.

32
Q

How does sodium zirconium cyclosilicate work?

A

Nonabsorbable cation exchange resin that binds K+ in exchange for Na & H+. More selective.

**Not good for use in people that are sensitive to exogenous sodium.

33
Q

How does varenicline work?

A

Partial agonist of nicotinic acetylcholine receptors. Assists with tobacco cessation (reduce withdrawal and attenuate reward effects).

34
Q

Are myxomas position dependent?

What type of murmur would be heard with it?

A

Yes. They typically cause position dependent obstruction. Worse with standing and better with laying down.

** also produce cytokines (IL-6 ) and can px with constitutional sx.

35
Q

What are some causes of intracellular K+ shift, a potential cause of hypokalemia?

A

B-adrenergic hyperactivity (via Na/K Atpase stimulation).
Increased insulin levels
Elevated extracellular pH
Increased cell production (AML, GM-CSF)

36
Q

What increases the chance of plaque rupture?

What can this be affected by?

A

Plaque stability (of fibrous cap)

Macrophages within plaque can secrete metalloproteases (which can degrade extracellular matrix proteins).

37
Q

Why is urea reabsoprtion increased in RAAS activation?

A

Mediated by ADH. This accentuates the medullary concentration gradient promoting free water retention.

38
Q

What is the Train of Four stimulation used for?

A

TOF is used during anesthesia to assess the degree of paralysis induced by NMJ blocking agents. A nerve is stimulated in quick succession 4 times. and resposnse is noted. The height of each bar = response.

39
Q

How does TOF vary for different muscle blocking agents?

A

When non depolarizing NMJ blockers are used (e.g vercuronium) prevent some of the fibers from activating (competitive inhibition of postsynaptic acth receptor) -> shows progressive reduction in each impulse.

When Succinyl choline is used -> rapid onset -> equal reduction of all 4 twitches (phase I). Persistent exposure/pts with abnormal plasma cholinesterase activity -> eventual transition to phase II as acetylcholine receptors become desensitized.

40
Q

Mesotheliomas stain positively for these?

A

Cytokeratin and some may also stain positive for calretinin

41
Q

What is pathognomonic for acute pyelonephritis when accompanied by symptoms of UTI?

A

White cell casts.

42
Q

Apart from pyelonephritis when accompanied by symtoms of UTI when else can white cell casts be seen?

A

Acute interstitial nephritis.

**often px with low grade fever and findings of acute kidney injury.

43
Q

What are some of the markers of Small cell lung cancer?

A

Chromagranin and synaptophysin and neural cell adhesion molecule (CD56)

44
Q

How can a patient with atheroembolic disease px?

What is a typical cause of atheroembolic disease?

A

Livedo reticularis, blue toe syndrome and acute kidney injury.

Invasive vascular procedures.

**cholesterol conatinfin debris from atherosclerotic plaques can become dislodged and shower microemboli into circulation.

45
Q

How do the granulomas in Churge-Strauss appear?

A

GRanulomas have eosinophilic infiltration and extensive necrosis.

46
Q

What are some lab findings for sarcoidosis?

A

Hypercalcemia/hypercalciuria.

& Elevated ACE level.

47
Q

Most patients with sarcoidosis also develop?

A

Liver involvement (asymptomatic hepatomegaly) with mild liver function test abnormality.

48
Q

What are some extrapulmonary symptoms of sarcoidosis?

A

SKin lesions, ant/post uveitis and lofgren syndrome (fever, erythema nodosum and bilat hilar adenopathy)

49
Q

Subpleural blebs are consistent with?

A

emphysema.

50
Q

How would a mitral valve prolapse murmur preasent?

A

Midsystolic click followed by a systolic murmur at the cardiac apex that disappears with squatting (increased LVED).

51
Q

What causes a mitral valve prolapse?

A

defects in CT

**predisposes to myxomatous degeneration of mitral leaflets and chordae tendineae.

52
Q

Histological presentation of RCC?

A

Rounded polygonal cells with clear cytoplasm and eccentric nuclei. And branching chicken wire vasculature.

** RRC will also px with signs of metastasis (lytic bone lesions).

53
Q

Airway inflammation, bronchial hyperreactivity & variable airflow triggered by workplace exposure?

A

Occupational asthma.

54
Q

In aspiration pneumonia what are the most common lung segments affected when lying supine?

A

R lung. Posterior section of upper lobes and superior segment of lower lobes.

55
Q

Clinical presentation of paroxysmal cough lasting for > 2 weeks that is associated with post-tussive emesis or inspiratory whoop after a severe cough episode?

A

Pertussis

**gran -ve coccobaccillus

56
Q

In what situation can corticosteroids (flucticasone) be used?

A

Corticosteroids reduce airway inflammation. Chronic asthma management (inhaled) and acute exacerbations (systemic).

57
Q

Patients with recurrent upper urinary tract infection caused by urease-producing organism are more prone to forming this type of calculi?

A

Staghorn calculi.

**overtime kidney can atrophy due to recurrent infection and chronic obstructive nephropathy.

58
Q

What will urinalysis of a patient with staghorn calculi show?

A

Hematuria and elevated urine pH.

59
Q

What is the most significant adverse effect of cyclosporine?

A

Calcineurin inhibitor nephrotoxicity with resultant impairment of renal function.

**calcineurin inhibitors prevent activation of transcription for IL-2.

60
Q

How do you differentiate between absolute and relative erythrocytosis?

A

RBC mass.

In absolute erythrocytosis, the RBC mass will be larger.

In relative - RBC will be nromal size.

61
Q

What are some causes of relative erythrocytosis?

A

Volume contraction: dehydration and excessive diuresis.

62
Q

What is the cause of the high ventilation rate in hypovolemic shock?

A

Lactic acidosis.

HYpoxia -> anaerobic metabolism -> lactic acidosis -> decrease ph-> compensatory hyperventilation -> respiratory alkalosis.

63
Q

Chronic lung transplant rejection is marked by this?

A

Lymphocytic inflammation in the walls of the small airways -> granulation -> obstruction (bronchiolotis obliterans).

**Months or years after transplant

64
Q

Pathophysiology of HAP (high altitude pulmonary edema)?

A

High altitude -> hypoxia -> uneven vasoconstriction -> high perfusion in other areas -> alveolar injury and edema.

UWORLD Q REVIEWS (13 decks)

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