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DIT Stars Flashcards

1
Q

Aortic Arch Derivation - 3rd arch from pharyngeal apparatus

A

common carotid artery

proximal part of internal carotid artery

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2
Q

Aortic Arch Derivation - 4th arch for pharyngeal apparatus

A

Left - arch of adult aorta

Right - proximal part of right subclavian artery

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3
Q

Tetralogy of Fallot - mnuemonic

A 
PROVe
Pulmonmonic stenosis/RV outflow tract obstruction
Right ventricular hypertrophy
Overriding aorta
VSD
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4
Q

CO = ?

A

CO = SV x HR

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5
Q

SV = ?

A

SV = EDV - ESV

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6
Q

Fick Principle

A

CO = Rate O2 consumption / (Arterial O2 content - Venous O2 content)

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7
Q

MAP = ? (2)

A 
MAP = CO x TPR
MAP = 2/3Diastolic Pressure + 1/3Systolic Pressure
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8
Q

Pulse Pressure = ?

A

Systolic pressure - diastolic pressure

PP correlates with SP (inc 1 = inc other)

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9
Q

Preload = ?

A

ventricular diastolic P
Atrial P
Central venous P
(venodilators decrease)

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10
Q

Afterload = ?

A

“how much P is pressing back against the heart”
MAP
TPR
(vasodilators decrease -ex: hydralazine)

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11
Q

How does exercise/exertion impact CO ? primary and secondary

A

Primary - CO will increase because SV increases
Secondary - with sustained exertion, CO will be maintained by increase HR, it will not increase bc will get incomplete diastolic filling. Will also happen if HR gets too high (ex: AFid, VTach)

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12
Q

Ejection Fraction = ?

A

EF = SV / EDV

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13
Q

Starling curve

A

SV or CO
vs
Ventricular EDV (preload)

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14
Q

Starling forces affecting capillaries (4)

A

inc Pc -CHF, venous thrombosis, vein compression
inc Kf - septic shock, toxins, burns
inc interstitial oncotic P - lymphatic obstruction
dec interstitial onctotic P - liver dz, pr malnutrition, nephrotic syndrome
**focus only on 1 main factor with condition

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15
Q

Shock (4 types)

A

feel cold and clamy:
Hypovolemic (trauma/blood loss) tx-IV fluids/blood
Cardiogenic (MI/PE/arrhythmias/tampenod,tension pneumothorax, cardiac contusion) - poor pump) tx-dobutamine (inotr)
both inc CO, inc SVR (comp)
feel warm and flushed:
Sepsis/anaphylaxis (high output failure - dilated)
inc CO (comp), dec SVR
tx - Abx, IV fluids, vasopressor (NE)
Neurogenic (SC/brain inj) dec SVR, dec CO
tx-IV fluids, (SC inj - steroids)

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16
Q

Cardiac cycle ( P vs V loop) 8 points

factors that change it: 3

A

Aortic valve closes, isovolumetric relaxation, mitral valve opens, passive filling, mitral valve closes, isovolumetric contraction, aortic valve opens
1 - increase Afterload (skinny A) - short and up
2 - increase Preload (top of P) - out
3 - increase Contractility (c) - up and out

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17
Q

heart sounds

A

1 - M/T valves closing
2 - Aortic valve / PV closing
3 - dilated ventricles (CM, CHF, MR, L-R shunt) - diastole
4 - atrial kick/stiff LV (HCM, AS, Chronic HTN, MI) - diast
-nrm inspiration split S2 (inc preload into RV)
-wide split S2 - pulmonic stenosis, RBBB
-fixed split - ASD overload RV (inc preload)
-paradoxical split -delayed ejection/AV closure (LBBB, AS), now pulmonic valve before AV

18
Q

Jugular venous a, c, and v waves

A

a - atrial contraction
c - RV contraction (closed TV bulging into antrum)
v - Filling against closed TV

19
Q

Normal heart sounds

A

Split S1
Split S2 on inspiration
S3 heart sound in pt less that 40 yo (>40 - check HF)
early, quiet systolic murmur

20
Q

Abn heart sounds - my process with noted exceptions (left sternal border, TR, MVP, PDA, VSD)

A 
Use APT M
1 - localize which valve (best place heard)
2 - systole or diastole 
(nrm S1 = T/M, nrm S2 = P/A)
(abn systole - AS/PS/MR/TR)
(abn diastole - TS/MS/AR/TR)
*stenosises have an opening sound:
MS - opening snap (cres/decresc)
AS - ejection click (cresc/decresc)
TR - holosystolic murmur (IVDU, Rheumatic HD)
MVP - midsystolic click
PDA - continues machine murmur (S+D)
VSD - holosytolic murmur
Left sternal border:
diastolic: aortic regurgitation, pulmonic regurg
systolic: HCM
21
Q

Casues of aortic stenosis

A 
#1 - congenital bicuspid valve ( >40)
senile (degenerative) calcification (>60)
chronic rheumatic heart Dz
unicuspid aortic valve (congenital)
syphilis (tertiary)
22
Q

Features of a systolic murmur

A 
radiates to carotids (like bruit)
weak, delayed peripheral pulses
syncope
angina
SOB
23
Q

Techniques to change murmur sounds

A

1 - breathing (inc RA filling) - Tricuspid
2 - expiration (inc LA filling) - Mitral murmurs
3 - hand grip/squat (inc TPR = inc afterload) - MR
4 - Valsalva (inc intrathoracic P = dec preload/afterload) HCM gets louder (other murmurs softer)
5 - left lateral decubitus position -MS/MR/Left S3/S4

24
Q

Cardiac myocyte AP (5 phases)

A

0 - depol inc Na permeability
1 - start repol, dec Na, opening (slow) K channel
2 - plateau open Ca channel, K channels still open
3 - rapid repolarization, close Ca, K channels open
4 - baseline, K+ membrane permeability
target for drugs = increase Effective Refractory Period

25
Q

Pacemaker AP (3 phases)

A

4 - slow depol, slow conductance Na channels
0 - fast depol, Ca channels open, Na channels close
3 - Fast repol, K channels open, Ca channels close
target is ERP

26
Q

Bone met mnemonic + lytic/blastic/both

A

“Permanently Relocated Tumors Like Bones”

prostate (blastic), renal cell CA, testes/thyroids, lung (lytic), breast (both)

27
Q

Bone Disorder labs - condition, what drives it

A 
Serum Ca2+, Serum Phos, Alk Phos, PTH
Osteoporsis - X         (osteoclasts)
Osteopetrosis - X     (osteoblasts)
Paget disease - alk phos (osteoclast burn out - hat tight)
Rickets/Osteomalacia - dec Ca2+ (vit D deficiency)
Renal insufficiency - dec Ca2+
Vit D intoxication - inc Ca2+
Primary hyperparathyroidism - inc PTH
Osteitis fibrosa cystica - inc PTH
28
Q

Osteoporosis

A

Osteoclast driven
DEXA scan, Cullies Fx - wrist, hand goes dorsal, vertebral Fx (kyphosis)
Tx - bisphosphonates “dronate” - inhib osteoclasts
SFx - erosive esophagitis, osteonecrosis of jaw (Sxx)
(other Tx - teriparatide, denosumab vs RANKL)

29
Q

Wrist bones mnemonic

A

“So Long To Pinky”
scaphoid, lunate, triquetrum, pisiform
“Here Comes The Thumb”
hamate, capitate, trapezoid, trapezium

30
Q

anatomic snuff box tenderness

A

scaffoid Fx - cut BF -> avascular necrosis and arthritis

31
Q

Gout: cause, birefringence, Px, tophi, trigger, tx

pseudogout

A

hyperuricemia -> monosodium urate crystals
(-) birefringence, yellow in parallel, needle shaped
cell turnover, inc purines
*asymmetric, 1 JT at a time, podagra
tophi - not inflamed or tender
Triggers: alcohol consumption (competes with kidney excretion site of UAcid
Tx: acute - NSAIDs (indomethacin), colchicine
chronic - allopurinol ( vs xanthine oxidase), probenicid (inc renal UA excretion)

pseudogout - calcium pyrophosphate crystals
(+) birefringence, rhomboid crystals, yellow at perpendicular
large joints
chondrocalcinosis - “knee with thin lines at meniscus”

32
Q

Seronegative Spondyloarthropathies
HLA-B27 mnemonic

Tx

A

PAIR
Psoriatic arthritis (silver scale, pencil-cup bone deform)
Ankylosing spondylitis (bamboo spine, risk AR)
IBD spondylitis
Reactive arthritis (Reiter syndrome)

Tx:
DMARDs:
MTX, hydrochloroquinine, sulfasalzine
TNF-alpha inhibitors (enterecept, “-mab”)

33
Q

Skin CA order of occurrence and met potential

A

occurrence: BCC > SCC > melanoma
met: BCC < SCC < melanoma

34
Q

Squamous cell CA

A

sun exposed areas
local invasion
Px - ulcerative, red lesion
Histo - keratin pearl

35
Q

Basil cell CA

A

sun exposed areas
Px: “rolled edge” appearance, center ulceration, pearly popular appearance with telangiectasias
Histo: palisading nuclei

36
Q

Melanoma

A 
sun exposed areas
\+s-100 tumor marker
met = measure tumor depth
Bx - excisional or deep punch
A - asymmetry 
B - border irregularity
C - color
D - diameter (>6mm)
Histo: nests of melanocytes fill the dermis, obscure dermal-epithelial border
37
Q

Lichen planus “P’s”

A

Puritic, Polygonal, Purple, Papule, Plaqies
Histo - saw-tooth, De-Epi jcn
assoc w/ Hep C

38
Q 
Genital homologs M:F
Male:
glans penis
corpus spongiosum/corpus cavernosum
bulbourethral gland
prostate gland
ventral shaft penis
scrotum
A

M:F
glans penis: glans clitorum
corpus spongiosum/corpus cavernosum: vestibular bulbs
bulbourethral gland: greater vestibular gland
prostate gland: urethral and paraurethral glands (skene)
ventral shaft penis: labias minora
scrotum: labias majora

39
Q 
Wallenberg Syndrome - Lateral medullar:
spinothalamic tract damage
spinal trigeminal nucleus damage
nucleus ambiguous: CN IX and X damage
descending sympathetic tract
vestibular nuclei damage
inferior cerebellar peduncle damage
A

lesion - posterior inferior cerebellar artery, branch from vertebral artery
spinothalamic tract damage: loss pain/temp contralat body

spinal trigeminal nucleus damage: loss of pain/temp over ipsilateral face

nucleus ambiguous (CN IX and X damage): hoarseness, difficulty swallowing, loss of gag reflex

descending sympathetic tract: Ipsilateral Horner syndrome

vestibular nuclei damage: vertigo, nystagmus, N/V

Inf cerebellar peduncle damage: ipsilateral cerebellar deficits (ataxia, past pointing)

40
Q

Weber Syndrome

A

Anterior midbrain infarction = occlusion of paramedian branches of the posterior cerebral artery

cerebral peduncle lesion:

  • dysphagia, dysphonia, dysarthria (corticobulbar tract damage)
  • contralateral spastic hemiparesis (corticospinal tract damage)
Oculomtor nerve (CN III) palsy:
-ipsilateral ptosis, pupillary dilation, lateral strabismus (eye looks down and out)

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