DIT Stars Flashcards
Aortic Arch Derivation - 3rd arch from pharyngeal apparatus
common carotid artery
proximal part of internal carotid artery
Aortic Arch Derivation - 4th arch for pharyngeal apparatus
Left - arch of adult aorta
Right - proximal part of right subclavian artery
Tetralogy of Fallot - mnuemonic
PROVe Pulmonmonic stenosis/RV outflow tract obstruction Right ventricular hypertrophy Overriding aorta VSD
CO = ?
CO = SV x HR
SV = ?
SV = EDV - ESV
Fick Principle
CO = Rate O2 consumption / (Arterial O2 content - Venous O2 content)
MAP = ? (2)
MAP = CO x TPR MAP = 2/3Diastolic Pressure + 1/3Systolic Pressure
Pulse Pressure = ?
Systolic pressure - diastolic pressure
PP correlates with SP (inc 1 = inc other)
Preload = ?
ventricular diastolic P
Atrial P
Central venous P
(venodilators decrease)
Afterload = ?
“how much P is pressing back against the heart”
MAP
TPR
(vasodilators decrease -ex: hydralazine)
How does exercise/exertion impact CO ? primary and secondary
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)
Ejection Fraction = ?
EF = SV / EDV
Starling curve
SV or CO
vs
Ventricular EDV (preload)
Starling forces affecting capillaries (4)
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
Shock (4 types)
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)
Cardiac cycle ( P vs V loop) 8 points
factors that change it: 3
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
heart sounds
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
Jugular venous a, c, and v waves
a - atrial contraction
c - RV contraction (closed TV bulging into antrum)
v - Filling against closed TV
Normal heart sounds
Split S1
Split S2 on inspiration
S3 heart sound in pt less that 40 yo (>40 - check HF)
early, quiet systolic murmur
Abn heart sounds - my process with noted exceptions (left sternal border, TR, MVP, PDA, VSD)
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
Casues of aortic stenosis
#1 - congenital bicuspid valve ( >40) senile (degenerative) calcification (>60) chronic rheumatic heart Dz unicuspid aortic valve (congenital) syphilis (tertiary)
Features of a systolic murmur
radiates to carotids (like bruit) weak, delayed peripheral pulses syncope angina SOB
Techniques to change murmur sounds
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
Cardiac myocyte AP (5 phases)
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
Pacemaker AP (3 phases)
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
Bone met mnemonic + lytic/blastic/both
“Permanently Relocated Tumors Like Bones”
prostate (blastic), renal cell CA, testes/thyroids, lung (lytic), breast (both)
Bone Disorder labs - condition, what drives it
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
Osteoporosis
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)
Wrist bones mnemonic
“So Long To Pinky”
scaphoid, lunate, triquetrum, pisiform
“Here Comes The Thumb”
hamate, capitate, trapezoid, trapezium
anatomic snuff box tenderness
scaffoid Fx - cut BF -> avascular necrosis and arthritis
Gout: cause, birefringence, Px, tophi, trigger, tx
pseudogout
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”
Seronegative Spondyloarthropathies
HLA-B27 mnemonic
Tx
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”)
Skin CA order of occurrence and met potential
occurrence: BCC > SCC > melanoma
met: BCC < SCC < melanoma
Squamous cell CA
sun exposed areas
local invasion
Px - ulcerative, red lesion
Histo - keratin pearl
Basil cell CA
sun exposed areas
Px: “rolled edge” appearance, center ulceration, pearly popular appearance with telangiectasias
Histo: palisading nuclei
Melanoma
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
Lichen planus “P’s”
Puritic, Polygonal, Purple, Papule, Plaqies
Histo - saw-tooth, De-Epi jcn
assoc w/ Hep C
Genital homologs M:F Male: glans penis corpus spongiosum/corpus cavernosum bulbourethral gland prostate gland ventral shaft penis scrotum
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
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
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)
Weber Syndrome
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)
