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USMLE > Goljan 2 - Sheet1 > Flashcards

Goljan 2 - Sheet1 Flashcards

1
Q

CLL

A

B cell neoplasm; ? ?-globulins; MCC generalized lymphadenopathy patients> 60-yrs-old

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2
Q

Adult T cell leukemia

A

HTLV-1; CD4 T cells; skin infiltration; lytic bone lesions with hypercalcemia

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3
Q

Hairy cell leukemia

A

positive TRAP stain; splenomegaly; Rx with purine nucleosides

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4
Q

Nodal sites

A

germinal follicles, B cells; paracortex, T cells; sinuses, histiocytes

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5
Q

Testicular cancer

A

metastasizes to para-aortic nodes

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6
Q

Stomach cancer

A

metastasizes to left supraclavicular nodes (Virchow node)

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7
Q

Phenytoin

A

atypical lymphocytosis

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8
Q

Cat scratch disease

A

Bartonella henselae; granulomatous microabscesses

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9
Q

Follicular B-cell lymphoma

A

t(14;18); overexpression of BCL-2 anti-apoptosis gene

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10
Q

Burkitt lymphoma

A

t(8;14); EBV association; common childhood NHL; Òstarry skyÓ appearance

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11
Q

Extra nodal lymphomas

A

risk factors H. pylori (stomach); SjogrenÕs syndrome

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12
Q

Mycosis fungoides

A

CD4 T cell neoplasm; skin lesions with PautrierÕs microabscesses

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13
Q

Sezary syndrome

A

leukemic phase of mycosis fungoides

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14
Q

Polyclonal gammopathy

A

sign of chronic inflammation

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15
Q

Monoclonal gammopathy

A

M component (spike); sign of plasma cell disorder

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16
Q

Confirmatory tests

A

serum and urine immunoelectrophoresis; bone marrow aspirate

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17
Q

Bence Jones protein

A

light chains in urine; predictive of a malignant plasma cell disorder

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18
Q

Multiple myeloma

A

M spike; lytic bone lesions; pathologic fractures; hypercalcemia; renal failure

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19
Q

MGUS

A

MC monoclonal gammopathy; may progress to myeloma

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20
Q

Findings in MGUS

A

elderly patient; no BJ protein; no malignant plasma cells

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21
Q

WaldenstromÕs macroglobulinemia

A

lymphoplasmacytic lymphoma; IgM M spike; hyperviscosity

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22
Q

HodgkinÕs lymphoma

A

neoplastic component, Reed Stemberg (RS) cell; CD15 CD30 positive

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23
Q

Lymphocyte predominant HodgkinÕs

A

infrequent classic RS cells

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24
Q

Nodular sclerosing HodgkinÕs

A

female dominant; supraclavicular nodes + anterior mediastinal nodes

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25
Q

Mixed cellularity HodgkinÕs

A

male dominant; numerous RS cells; EBV association

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26
Q

HodgkinÕs prognosis

A

stage of disease and type of HodgkinÕs most important factors

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27
Q

Alkylating agents in Rx of Hodgkins

A

? risk for second malignancies (leukemia; NHL)

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28
Q

LangerhanÕs histiocytes

A

CD1 positive; Birbeck granules

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29
Q

Letterer-Siwe disease

A

malignant histiocytosis <2 yrs old; diffuse eczematous rash; organ involvement

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30
Q

Hand-Christian-Christian disease

A

malignant; lytic skull lesions, diabetes insipidus, exophthalmos

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31
Q

Eosinophilic granuloma

A

benign histiocytosis; lytic bone lesions with pathologic fractures

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32
Q

Mast cells

A

release histamine (pruritus; swelling); metachromatic granules positive with toluidine blue

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33
Q

Urticaria pigmentosum

A

localized mastocytosis; skin lesions swell and itch with scratching

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34
Q

Amyloid

A

twisted ?-sheet; apple green birefringence with Congo red

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35
Q

Primary amyloidosis

A

AL amyloid derived from light chains; plasma cell disorders

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36
Q

Secondary amyloidosis

A

AA amyloid derived from serum-associated amyloid; chronic infections

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37
Q

AlzheimerÕs disease

A

amyloid precursor protein gene product chromosome 21; amyloid-?

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38
Q

GaucherÕs disease

A

macrophages have fibrillary appearance; deficiency glucocerebrosidase

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39
Q

Niemann PickÕs disease

A

macrophages have soap bubble appearance; deficiency sphingomyelinase

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40
Q

Hypersplenism

A

splenomegaly; peripheral blood cytopenias; portal hypertension MCC

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41
Q

Splenic dysfunction

A

Howell Jolly bodies; susceptible to Streptococcus pneumoniae sepsis

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42
Q

Anticoagulants

A

tissue plasminogen activator, heparin, PGI2 ATIII, protein C/S

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43
Q

Heparin

A

enhances ATIII activity (neutralizes all factors except V, VIII, fibrinogen)

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44
Q

Protein C/S

A

neutralize V and VIII

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45
Q

Procoagulants

A

coagulation factors, thromboxane A2 (platelet aggregation, vasoconstrictor)

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46
Q

Protein C and S

A

inactivate factors V and VIII; enhance fibrinolysis

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47
Q

von Willebrand factor

A

complexes with factor VIII to enhance VIII:C activity; platelet adhesion

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48
Q

Platelets

A

receptors for von Willebrand factor and fibrinogen; synthesize thromboxane A2

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49
Q

GpIb

A

platelet receptor for von Willebrand factor

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50
Q

GpIIb:IIIa

A

platelet receptor for fibrinogen

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51
Q

Extrinsic system factor

A

VII

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52
Q

Intrinsic system factors

A

XII, XI, IX, VIII

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53
Q

Final common pathway factors

A

X, V, prothrombin (II), fibrinogen (I)

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54
Q

Factor XIII

A

cross-links insoluble fibrin; strengthens fibrin clots

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55
Q

Vitamin K-dependent factors

A

prothrombin, VII, IX, X, protein C and S

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56
Q

Factors consumed in a clot

A

fibrinogen, prothrombin, V, VIII; fluid is called serum

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57
Q

Plasmin

A

cleaves fibrinogen and insoluble fibrin into degradation products

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58
Q

Bleeding time

A

evaluates platelet function (adhesion, release reaction, aggregation)

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59
Q

Aspirin

A

MCC of a prolonged bleeding time

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60
Q

Tests for vWF

A

ristocetin cofactor assay; vWF antigen assay; agar electrophoresis

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61
Q

PT

A

evaluates extrinsic pathway to fibrin clot

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62
Q

PTT

A

evaluates intrinsic pathway to stable fibrin clot

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63
Q

Fibrinolysis tests

A

fibrin(ogen) degradation products; D-dimers (cross-linked insoluble fibrin)

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64
Q

S/S platelet dysfunction

A

cannot form temporary plug; epistaxis; petechiae; bleeding from scratches

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65
Q

Idiopathic thrombocytopenic purpura (ITP)

A

children; antibodies against GpIIb:IIIa; no splenomegaly

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66
Q

Chronic autoimmune thrombocytopenic purpura

A

SLE; antibodies against GpIIb:IIIa receptors

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67
Q

Heparin

A

thrombocytopenia due to IgG antibody against heparin attached to PF4 on platelets

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68
Q

PF4

A

heparin neutralizing factor

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69
Q

HIV

A

thrombocytopenia MC hematologic abnormality; similar to ITP

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70
Q

TTP

A

platelet thrombi develop in areas of endothelial damage in small vessels; consumption of platelets

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71
Q

S/S

A

fever, thrombocytopenia, renal failure, hemolytic anemia with schistocytes, CNS deficits

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72
Q

Lab findings TTP

A

thrombocytopenia, prolonged bleeding time, normal PT and PTT

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73
Q

HUS

A

similar to TTP; endothelial injury from Shiga-like toxin of 0157:H7 E. coli in undercooked beef

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74
Q

S/S factor deficiency

A

no stable fibrin clot-late rebleeding; menorrhagia; GI bleeding; hemarthroses

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75
Q

Hemophilia A

A

XR; hemarthroses; prolonged PTT, ? factor VIII activity, normal VIII antigen

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76
Q

von WillebrandÕs disease

A

AD; platelet adhesion defect + factor VIII deficiency

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77
Q

Lab findings in VWD

A

? vWF, VIII antigen, and VIII:C; prolonged bleeding time

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78
Q

Desmopressin acetate

A

Rx of choice for mild von WillebrandÕs disease and hemophilia A

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79
Q

Circulating anticoagulants

A

antibodies destroy coagulation factors

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80
Q

Lab finding in circulating anticoagulant

A

prolonged PT and/or PTT corrected with mixing studies

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81
Q

Vitamin K deficiency

A

? epoxide reductase activity (? function vitamin K); hemorrhagic diathesis; ? PT

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82
Q

Causes vitamin K deficiency

A

antibiotics MC, newborn, malabsorption, warfarin

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83
Q

DIC

A

activation coagulation system from release of tissue thromboplastin and/or endothelial cell damage

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84
Q

DIC

A

consumption coagulation factors by fibrin clots; patient also anticoagulated

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85
Q

Causes

A

septic shock MCC, rattlesnake bite, massive trauma, amniotic fluid

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86
Q

S/S

A

bleeding from all scratches, holes, needle sites

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87
Q

Lab findings DIC

A

thrombocytopenia, ? PT and PTT, D-dimers (best test), anemia

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88
Q

Antiphospholipid antibodies

A

lupus anticoagulant and anticardiolipin antibodies; vessel thrombosis

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89
Q

Warfarin

A

inhibits epoxide reductase; PT best test but PTT also prolonged

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90
Q

Warfarin

A

full anticoagulation in 3 days when -carboxylated prothrombin disappears

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91
Q

Warfarin

A

ingredient in rat poison; danger to children in households with grandparents on warfarin

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92
Q

Rx warfarin over anticoagulation

A

intramuscular vitamin K (6-8 hrs), fresh frozen plasma (immediate)

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93
Q

Heparin

A

enhances ATIII; PTT best test but PT also prolonged

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94
Q

OC

A

estrogen ? coagulation factor synthesis and ATIII; predisposes to thrombosis

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95
Q

Factor V Leiden

A

MC hereditary thrombosis; resistant to degradation by protein C/S

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96
Q

ATIII deficiency

A

no prolongation of PTT with administration of heparin

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97
Q

Hemorrhagic skin necrosis

A

post-warfarin therapy in patient with heterozygote protein C deficiency

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98
Q

M cells

A

specialized cells that transfer foreign antigens to lymphocytes in PeyerÕs patches

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99
Q

Blood group O

A

some patients have anti-AB-IgG antibodies; increased incidence duodenal ulcers

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100
Q

Blood group A

A

increased incidence of gastric carcinoma

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101
Q

Newborns

A

do not have natural blood group antibodies at birth (e.g., anti-A-lgM)

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102
Q

Elderly

A

may lose natural blood group antibodies; no hemolytic reaction to mismatched blood

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103
Q

Rh antigens

A

inherited in autosomal codominant fashion; Rh antigens include D, C, c, E, e

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104
Q

Atypical antibodies

A

antibodies against Rh or non-Rh blood group antigens (e.g., anti-D)

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105
Q

Duffy antigen

A

receptor for Plasmodium vivax; blacks often lack Duffy antigen

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106
Q

Antibody screen

A

indirect CoombÕs test; detects atypical antibodies in serum

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107
Q

Cytomegalovirus

A

MC infection transmitted by blood transfusion; MC antibody

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108
Q

Hepatitis C

A

MCC of post-transfusion hepatitis

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109
Q

Major crossmatch

A

patient serum reacted against donor RBCs; does not guarantee RBC survival

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110
Q

Universal donor

A

blood group O; no antigens on the surface of RBCs

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111
Q

Universal recipient

A

blood group AB; no natural blood group antibodies in serum

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112
Q

Packed RBC transfusion

A

raises Hb by 1 gm/dL and Hct by 3%

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113
Q

Cryoprecipitate

A

fibrinogen and factor VIII

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114
Q

Fresh frozen plasma

A

replacement for multiple factor deficiencies (e.g., cirrhosis, DIC)

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115
Q

Allergic transfusion reaction

A

type I IgE-mediated hypersensitivity reaction

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116
Q

Febrile transfusion reaction

A

recipient anti-HLA antibodies react against donor leukocytes

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117
Q

Intravascular HTR

A

transfusion of ABO incompatible blood (e.g., A person receives B blood)

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118
Q

Extravascular HTR

A

antibody attaches to donor RBCs; macrophage phagocytosis and hemolysis

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119
Q

Positive direct CoombÕs test

A

present in both types of hemolytic transfusion reactions

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120
Q

S/S

A

jaundice, no increase in Hb, hemoglobinuria

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121
Q

ABO HDN

A

mother O and baby A or B; transplacental passage of maternal anti-AB-IgG

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122
Q

ABO HDN

A

positive direct CoombÕs test; spherocytes; MCC unconjugated hyperbilirubinemia first 24 hrs

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123
Q

Rh HDN

A

mother Rh (D antigen) negative and fetus Rh (O antigen) positive

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124
Q

Rh HDN

A

no hemolysis in first Rh incompatible pregnancy

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125
Q

Rh HDN

A

maternal anti-D crosses placenta; potential for hydrops fetalis; high risk for kernicterus

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126
Q

Rh immune globulin

A

anti-D; coats D antigen site on fetal RBCs in maternal circulation

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127
Q

Rh HDN lab

A

positive direct CoombÕs; severe anemia and hyperbilirubinemia

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128
Q

ABO HDN

A

protects mother from Rh sensitization (development of anti-D antibodies)

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129
Q

O Rh negative mother with A Rh positive baby

A

A+ cells destroyed by mothers anti A-lgM

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130
Q

Blue fluorescent light

A

converts unconjugated bilirubin in skin into harmless water soluble dipyrrole

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131
Q

MV auscultation

A

apex

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132
Q

TV auscultation

A

left parasternal border

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133
Q

AV auscultation

A

right 2nd intercostal space

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134
Q

PV auscultation

A

left 2nd intercostal space

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135
Q

S1

A

closure MV and TV

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136
Q

S2

A

closure AV and PV

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137
Q

Inspiration

A

split in A2 and P2; due to increased blood in right side of heart

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138
Q

S3

A

abnormal; due to blood entering volume overloaded ventricle in early diastole

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139
Q

Causes S3

A

valve regurgitation; congestive heart failure

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140
Q

S4

A

abnormal; due to blood entering non-compliant ventricle with atrial contraction in late diastole

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141
Q

Causes S4

A

volume overloaded ventricle, hypertrophy

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142
Q

Murmurs

A

stretching valve ring or damage to valve

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143
Q

Inspiration

A

increases right sided abnormal heart sounds and murmurs

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144
Q

Expiration

A

increases left sided abnormal heart sounds and murmurs

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145
Q

Stenosis murmurs

A

problem in opening valve

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146
Q

Regurgitation murmurs

A

problem in closing valve

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147
Q

Valves opening in systole

A

AV and PV

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148
Q

Valves opening in diastole

A

MV and TV

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149
Q

Valves closing in systole

A

MV and TV

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150
Q

Valves closing in diastole

A

AV and PV

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151
Q

LDL

A

primary vehicle for carrying cholesterol

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152
Q

VLDL

A

primary vehicle for carrying liver-synthesized triglyceride

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153
Q

Familial hypercholesterolemia (type II)

A

AD; deficiency of LDL receptors; ? LDL

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154
Q

Type III hyperlipoproteinemia

A

deficiency apo E; ? remnants (chylomicron, intermediate density)

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155
Q

Type IV hyperlipoproteinemia

A

? VLDL; alcoholics

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156
Q

Apo B deficiency

A

deficiency apo B48 (chylomicrons) and B100 (VLDL); ? CH and TG

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157
Q

Clinical findings in apo B deficiency

A

malabsorption; hemolytic anemia

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158
Q

Atherosclerosis

A

reaction to injury of endothelial cells

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159
Q

Risk factors

A

smoking, ? LDL, ? homocysteine, Chlamydia pneumoniae infection

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160
Q

Cells involved

A

platelets, macrophages, smooth muscle cells, T cells with cytokine release

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161
Q

Fibrous plaque

A

pathognomonic lesion of atherosclerosis

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162
Q

C-reactive protein

A

marker of an inflammatory atheromatous plaque

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163
Q

Inflammatory atheromatous plaque

A

predisposes to platelet thrombosis

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164
Q

Increased plasma homocysteine

A

? vessel thrombosis; folate (MC)/vitamin B12 deficiency

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165
Q

Hyaline arteriolosclerosis

A

small vessel disease of DM and hypertension; excess protein in vessel wall

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166
Q

Mechanisms hyaline arteriolosclerosis in DM

A

non-enzymatic glycosylation

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167
Q

Non-enzymatic glycosylation

A

glucose attaches to amino acids in BM; causes ? permeability to protein

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168
Q

Mechanisms hyaline arteriolosclerosis in hypertension

A

pressure pushes proteins into vessel wall

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169
Q

Abdominal aortic aneurysm rupture

A

due to atherosclerosis; flank pain, hypotension, pulsatile mass

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170
Q

Syphilitic aneurysm

A

vasculitis of vasa vasorum of aortic arch; aortic regurgitation

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171
Q

Aortic dissection

A

due to hypertension and collagen tissue disorders (e.g., Marfan)

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172
Q

Cystic medial degeneration

A

elastic tissue degeneration creates spaces filled with mucopolysaccharides

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173
Q

Intimal tear in aorta

A

due to wall stress from hypertension and structural weakness

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174
Q

Types of dissection

A

proximal (MC); distal or combination of both

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175
Q

S/S proximal aortic dissection

A

chest pain radiating to back, lack of pulse; cardiac tamponade MC COD

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176
Q

MarfanÕs

A

AD; fibrillin defect; aortic regurgitation/dissection; lens dislocation; MVP with sudden death

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177
Q

MC COD MarfanÕs and Ehlers Danlos

A

aortic dissection

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178
Q

Phlebothrombosis

A

stasis of blood flow; deep veins below knee MC site

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179
Q

Pulmonary thromboembolism

A

emboli originate from femoral veins

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180
Q

Superficial migratory thrombophlebitis

A

sign of carcinoma of head of pancreas

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181
Q

Thoracic outlet syndrome

A

absent radial pulse with positional change

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182
Q

TurnerÕs syndrome

A

lymphedema hands/feet in newborn; preductal coarctation

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183
Q

Spider telangiectasia

A

arteriovenous fistula; due to hyperestrinism (cirrhosis, pregnancy)

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184
Q

Capillary hemangioma in newborn

A

regress with age; do not surgically remove

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185
Q

KaposiÕs sarcoma

A

HHV-8; vascular malignancy; MC cancer in AIDS

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186
Q

Bacillary angiomatosis

A

Bartonella henselae; vascular infection in AIDS

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187
Q

Small vessel vasculitis

A

palpable purpura; e.g., Henoch Schonlein purpura

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188
Q

Muscular artery vasculitis

A

vessel thrombosis with infarction; e.g., classical polyarteritis nodosa

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189
Q

Elastic artery vasculitis

A

absent pulse, stroke

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190
Q

TakayasuÕs arteritis

A

pulseless disease; young Asian woman

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191
Q

Giant cell arteritis

A

temporal artery granulomatous vasculitis; ipsilateral blindness (ophthalmic artery)

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192
Q

Classical polyarteritis nodosa

A

muscular artery vasculitis with vessel thrombosis infarction

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193
Q

Path findings

A

vessel inflammation at different stages; aneurysms from vessel weakness

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194
Q

S/S

A

infarctions in kidneys, skin, GI tract, heart; HBsAg in 30%

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195
Q

Diagnosis

A

angiography identifies aneurysms and thrombosis

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196
Q

KawasakiÕs disease

A

coronary artery vasculitis/thrombosis/aneurysms in children

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197
Q

S/S

A

chest pain; desquamating rash; swelling hands/feet; cervical lymphadenopathy

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198
Q

Rx

A

IV ?-globulin

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199
Q

BuergerÕs disease (thromboangiitis obliterans)

A

smokerÕs digital vasculitis; digital infarction

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200
Q

RaynaudÕs syndrome

A

digital vasculitis in PSS and CREST syndrome

201
Q

S/S

A

digital pain; white-blue-red color changes

202
Q

Cryoglobulinemia

A

protein gels in cold temperature; RaynaudÕs syndrome; HCV association

203
Q

S/S

A

acral cyanosis relieved by coming indoors

204
Q

WegenerÕs granulomatosis

A

association with c-ANCA; sinusitis, lung infarction, crescentic GN

205
Q

Microscopic polyangiitis

A

palpable purpura; crescentic GN; association with p-ANCA

206
Q

Henoch-Schšnlein purpura

A

IgA-anti-IgA ICs; palpable purpura buttocks/legs; arthritis; IgA GN

207
Q

Serum sickness vasculitis

A

e.g., horse antivenin in Rx of rattlesnake envenomation

208
Q

Rocky Mountain spotted fever

A

tick borne

209
Q

Meningococcemia

A

sepsis causes petechia/ecchymoses; potential for Waterhouse Friderichsen syndrome

210
Q

Essential HTN blacks

A

defect in renal excretion of sodium; ? plasma volume, ? PRA

211
Q

Renovascular HTN

A

atherosclerosis renal artery in men; fibromuscular hyperplasia renal artery women

212
Q

S/S

A

epigastric bruit; ? PRA affected kidney, ? PRA unaffected kidney

213
Q

Endocrine HTN

A

1¼ HPTH, Graves/hypothyroidism, CushingÕs, 1¼ aldosteronism, phaeochromocytoma

214
Q

Hypertension

A

LVH MC complication; AMI MC COD followed by stroke and renal failure

215
Q

Afterload

A

resistance ventricles contract against

216
Q

Preload

A

volume ventricles must eject

217
Q

Concentric LVH

A

increased afterload; e.g., essential HTN, aortic stenosis

218
Q

LVH with dilation/hypertrophy

A

increased preload; e.g., valve regurgitation; left to right shunts

219
Q

LHF

A

forward failure; pulmonary edema, pillow orthopnea, paroxysmal nocturnal dyspnea

220
Q

Systolic dysfunction

A

LHF due to decreased ventricular contractility (ischemia)

221
Q

Diastolic dysfunction

A

LHF due to decreased ventricular compliance (hypertrophy)

222
Q

RHF

A

backward failure; ? venous hydrostatic pressure; neck vein distention, hepatomegaly, edema

223
Q

ACE inhibitors

A

decrease afterload and preload in heart failure

224
Q

Diuretics in CHF

A

reduce preload

225
Q

Non-pharmacologic Rx in CHF

A

restrict salt and water

226
Q

AMI

A

MC COD in United States; left anterior descending coronary artery thrombosis MCC

227
Q

Exertional angina

A

coronary artery atherosclerosis; subendocardial ischemia; ST depression

228
Q

PrinzmetalÕs angina

A

coronary artery vasospasm; transmural ischemia; ST elevation

229
Q

Sudden cardiac death

A

death within 1 hr of symptoms

230
Q

Path findings

A

severe coronary artery atherosclerosis; absence of occlusive thrombosis

231
Q

LAD coronary artery

A

anterior portion left ventricle, anterior 2/3rds IVS

232
Q

RCA

A

posterior portion left ventricle and papillary muscle, inferior 1/3rd IVS, right ventricle

233
Q

AMI

A

rupture of inflammatory plaque produces platelet thrombus

234
Q

Ventricular fibrillation

A

MC COD in AMI

235
Q

AMI

A

no gross changes until 24 hrs

236
Q

S/S AMI

A

retrosternal pain radiating down arms, diaphoresis

237
Q

AMI ruptures

A

3rd-7th day

238
Q

Anterior wall rupture

A

MC type; LAD thrombosis; cardiac tamponade

239
Q

Posteromedial papillary muscle rupture

A

RCA thrombosis; mitral regurgitation with LHF

240
Q

IVS rupture

A

LAD thrombosis; left to right shunt; RHF

241
Q

Mural thrombus

A

anterior AMI; danger embolization

242
Q

Pericarditis

A

first week in transmural AMI; 6 wks later autoimmune

243
Q

S/S

A

friction rub; leaning forward relieves pain

244
Q

Ventricular aneurysms

A

late manifestation of AMI; precordial systolic bulge; CHF MC COD

245
Q

Right ventricular infarction

A

RCA thrombosis; hypotension, RHF, preserved left ventricular function

246
Q

Diagnosis of AMI

A

CK-MB and troponins; CK-MB absent by 3 days; troponins last 7-10 days

247
Q

LDH isoenzymes

A

no longer used; LDH 1/2 flip indicates AMI

248
Q

Reinfarction

A

reappearance CK-MB after 3 days

249
Q

ECG findings in AMI

A

inverted T waves; ST elevation; Q waves

250
Q

Ejection fraction

A

EF = stroke volume/left ventricular end-diastolic volume; 80/120 = 0.66

251
Q

By-pass surgery

A

use internal mammary artery and saphenous veins (ÒarterializeÓ after 10 yrs)

252
Q

Angioplasty complication

A

localized dissection with thrombosis

253
Q

Umbilical vein

A

highest O2 saturation

254
Q

Ductus arteriosis in fetus

A

shunts blood from pulmonary artery to aorta; PGE keeps it open

255
Q

Ductus arteriosus in newborn

A

closes and becomes ligamentum arteriosum

256
Q

EisenmengerÕs syndrome

A

cyanosis due to reversal of left to right shunt

257
Q

VSD

A

MC congenital heart disease; ? SaO2 right ventricle (RV), pulmonary artery (PA)

258
Q

ASD

A

patent foramen ovale; ? SaO2 right atrium (RA), RV, PA; MC adult congenital heart disease

259
Q

Down syndrome

A

endocardial cushion defect (combined ASD and VSD)

260
Q

PDA

A

machinery murmur; close with indomethacin; ? SaO2 PA

261
Q

Tetralogy of Fallot

A

degree of pulmonic stenosis determines if cyanosis is present

262
Q

Tetralogy of Fallot

A

? left ventricle, aorta

263
Q

Tetralogy of Fallot

A

ASD and PDA are cardioprotective

264
Q

Complete transposition

A

cyanosis; aorta empties RV; PA empties left ventricle

265
Q

Complications cyanotic heart disease

A

2¡ polycythemia; infective endocarditis; metastatic abscesses

266
Q

Pre-ductal coarctation

A

TurnerÕs syndrome

267
Q

Post-ductal coarctation

A

constriction distal to ligamentum arteriosum

268
Q

S/S

A

upper extremity HTN; claudication; rib-notching; activation RAA also causes HTN

269
Q

Acute rheumatic fever

A

type II hypersensitivity; group A streptococcus pharyngeal infection

270
Q

Acute rheumatic fever

A

sterile vegetations mitral valve (regurgitation); myocarditis with Aschoff nodule

271
Q

S/S

A

polyarthritis (MC), carditis, erythema marginatum, rheumatoid nodules, chorea

272
Q

Mitral stenosis

A

chronic rheumatic fever; opening snap followed by mid-diastolic rumble

273
Q

Mitral stenosis

A

left atrial dilation hypertrophy - atrial fibrillation, thrombus, pulmonary edema, RHF

274
Q

MVP

A

myxomatous degeneration of mitral valve; common in Marfan syndrome, Ehlers Danlos

275
Q

S/S

A

mid-systolic click followed by a murmur; palpitations, chest pain, rupture of chordae

276
Q

MVP click/murmur close to S1

A

decrease preload (stand, Valsalva, anxiety)

277
Q

MVP click/murmur close to S2

A

increase preload (supine, squat, clench fist)

278
Q

Mitral regurgitation

A

pansystolic murmur; S3 and S4 common

279
Q

Causes

A

LHF, infective endocarditis, acute rheumatic fever

280
Q

Aortic stenosis

A

systolic ejection murmur; syncope and angina with exercise; hemolytic anemia

281
Q

Aortic stenosis murmur increased preload

A

worsens obstruction and increases murmur intensity

282
Q

Aortic stenosis murmur decreased preload

A

decreases obstruction and decreases murmur intensity

283
Q

Causes

A

bicuspid aortic valve; age-related sclerosis

284
Q

Aortic regurgitation

A

bounding pulses; early diastolic blowing murmur

285
Q

Austin Flint murmur

A

diastolic murmur; regurgitant flow on anterior leaflet mitral valve

286
Q

Significance Austin Flint murmur

A

sign for AV replacement

287
Q

Causes aortic regurgitation

A

essential HTN, infective endocarditis, acute rheumatic fever, dissection

288
Q

Tricuspid regurgitation

A

pansystolic murmur ? intensity with inspiration

289
Q

Causes

A

endocarditis IV drug abuse; RHF; carcinoid heart disease

290
Q

Carcinoid heart disease

A

tricuspid regurgitation, pulmonic stenosis

291
Q

Infective endocarditis (IE)

A

Streptococcus viridans MCC; Staphylococcus aureus MCC IVDA

292
Q

IE prosthetic heart valve

A

Staphylococcus epidermidis (coagulase negative)

293
Q

IE ulcerative bowel disease

A

Streptococcus bovis

294
Q

S/S

A

IC vasculitis-Roth spot, splinter hemorrhages; regurgitant murmurs; metas1atic abscesses

295
Q

Lab findings

A

positive blood culture Libman Sacks endocarditis

296
Q

Coxsackievirus

A

MCC of myocarditis (lymphocyte infiltrate in myocardium) and pericarditis

297
Q

Parasitic cause myocarditis

A

leishmania in Chagas disease

298
Q

Pericardial effusion

A

all chamber pressures are uniformally increased

299
Q

S/S

A

muffled heart sounds, pulsus paradoxus, inspiratory neck vein distention

300
Q

Dx and Rx

A

echocardiogram, pericardiocentesis, respectively

301
Q

Pulsus paradoxus

A

drop in blood pressure >10 mmHg with inspiration

302
Q

Constrictive pericarditis

A

TB MCC worldwide; pericardial knock

303
Q

Congestive cardiomyopathy

A

generalized chamber enlargement; low ejection fraction

304
Q

Causes

A

postpartum, cardiotoxic drugs, hypothyroidism, alcohol

305
Q

Hypertrophic cardiomyopathy

A

MCC of sudden death in young person (due to conduction defects)

306
Q

Site of obstruction

A

anterior leaflet mitral valve drawn against asymmetric thickened IVS

307
Q

Effect decreased preload on systolic murmur

A

worsens obstruction and increases murmur intensity

308
Q

Effect increased preload on systolic murmur

A

reduces obstruction and decreases murmur intensity

309
Q

Restrictive cardiomyopathy

A

decreased compliance

310
Q

Causes

A

iron, amyloid, glycogen; sarcoidosis; tropical endocardial fibrosis

311
Q

Cardiac myxoma

A

benign tumor left atrium; embolization; syncope

312
Q

Cardiac rhabdomyoma

A

childhood tumor; association with tuberous sclerosis

313
Q

U wave

A

hypokalemia; MCC diuretic therapy (e.g., thiazides; loop diuretics)

314
Q

Peaked T wave

A

hyperkalemia; MCC renal failure

315
Q

ST depression

A

subendocardial ischemia (e.g., classical angina pectoris)

316
Q

ST elevation

A

transmural ischemia (e.g., AMI), pericarditis, ventricular aneurysm

317
Q

Atrial fibrillation

A

MC chronic arrhythmia; absent P waves; danger for embolization

318
Q

Ventricular premature beats

A

wide QRS complexes; MC arrhythmia in coronary care unit

319
Q

Ventricular fibrillation

A

MCC of death in an AMI

320
Q

Anterior AMI

A

Q waves in I and V1-V4

321
Q

Inferior AMI

A

Q waves in II, III, and aVF; right coronary artery thrombosis.

322
Q

Wolff-Parkinson-White

A

short PR interval with normal P wave; delta wave on upstroke of R wave

323
Q

Alveolar O2 calculation

A

% O2 breathing (713) - PCO2/0.8

324
Q

Increased A-a gradient

A

primary lung disease; left to right shunts in heart

325
Q

Forced vital capacity

A

total amount of air expelled after a maximal inspiration

326
Q

Forced expiratory volume/1 second (FEV1)

A

amount of air expelled in I second after maximal inspiration

327
Q

Choanal atresia

A

cyanotic when breast feeding; turns pink when crying

328
Q

Nasal polyps

A

allergic (MC; adults only), aspirin, cystic fibrosis

329
Q

Nasal polyp in a child

A

requires sweat test to exclude cystic fibrosis

330
Q

Triad asthma

A

patient on aspirin (pain syndrome) with nasal polyps, asthma

331
Q

Obstructive sleep apnea (OSA)

A

snoring with intervals of apnea (respiratory acidosis with hypoxemia)

332
Q

S/S

A

danger cor pulmonale; requires sleep test; Rx. O2 with continuous positive airway pressure

333
Q

Sinusitis

A

maxillary sinusitis MC in adults; ethmoiditis MC in children; S. pneumoniae MC

334
Q

Nasopharyngeal carcinoma

A

association with EBV; metastasize to cervical nodes

335
Q

Laryngeal carcinoma

A

smoking MCC; hoarseness; squamous cell carcinoma

336
Q

Resorption atelectasis

A

MCC of fever 24-36 hours after surgery

337
Q

S/S

A

? percussion; absent fremitus, breath sounds; inspiratory lag; elevated diaphragm

338
Q

RDS

A

decreased production surfactant; airway collapse; hyaline membranes

339
Q

Type II pneumocytes

A

synthesize surfactant (lecithin, phosphatidylcholine); stored in lamellar bodies

340
Q

Surfactant

A

reduces surface tension in airways; ? synthesis cortisol, thyroxine; ? synthesis insulin

341
Q

Causes RDS

A

prematurity, maternal diabetes, C-section

342
Q

Maternal diabetes

A

maternal hyperglycemia ? fetal hyperglycemia ? fetal insulin which ? surfactant

343
Q

Complications RDS

A

O2 FR injury (blindness, bronchopulmonary dysplasia); necrotizing enterocolitis

344
Q

Typical community acquired pneumonia

A

Streptococcus pneumoniae MCC

345
Q

Typical pneumonia

A

bronchopneumonia, lobar pneumonia

346
Q

S/S

A

productive cough; consolidation - ? percussion, ? tactile fremitus

347
Q

Atypical community acquired pneumonia

A

interstitial pneumonia; Mycoplasma pneumoniae MCC

348
Q

S/S

A

low grade fever, non-productive cough, no signs consolidation

349
Q

Nosocomial pneumonia

A

Pseudomonas, aeruginosa MCC (respirators); others - S. aureus, E. coli

350
Q

Rhinovirus

A

MCC common cold; hand to mouth transmission

351
Q

Respiratory syncytial virus

A

MCC pneumonia and bronchiolitis in child

352
Q

Parainfluenza virus

A

MCC croup in child; trachea area of obstruction

353
Q

Cytomegalovirus

A

basophilic intranuclear inclusion surrounded by halo

354
Q

Influenza

A

superimposed pneumonia with S. aureus increases mortality

355
Q

Rubeola

A

Warthin-Finkeldey multinucleated giant cells

356
Q

Chlamydia pneumoniae

A

atypical pneumonia; association with coronary artery disease

357
Q

Chlamydia trachomatis

A

pneumonia in newborns; staccato cough; wheezing

358
Q

Coxiella burnetii

A

only rickettsia without a vector

359
Q

Mycoplasma pneumoniae pneumonia

A

crowded condition; cold agglutinins; azithromycin

360
Q

Streptococcus pneumoniae pneumonia

A

gram positive diplococcus; azithromycin

361
Q

Staphylococcus aureus pneumonia

A

tension pneumatocysts in children with cystic fibrosis

362
Q

Corynebacterium diphtheriae

A

toxin produces ADP ribosylation of elongation factor 2

363
Q

Haemophilus influenzae

A

exacerbation chronic bronchitis; acute epiglottis in children

364
Q

Inspiratory stridor child

A

croup, epiglottitis

365
Q

Pseudomonas aeruginosa

A

MCC of pneumonia and death in cystic fibrosis; green sputum

366
Q

Klebsiella pneumoniae

A

mucoid sputum in alcoholic

367
Q

Legionella pneumophila

A

silver stain; water coolers/mist (grocery produce, restaurants, zoo rain forest)

368
Q

Mycobacterium tuberculosis

A

strict aerobe; MC COD due to infectious disease worldwide

369
Q

Candida albicans

A

vessel invader; yeasts and pseudohyphae

370
Q

Cryptococcus immitis

A

pigeon excreta; narrow-based bud

371
Q

Aspergillus fumigatus

A

septate hyphae with fruiting body; fungus ball, extrinsic asthma, vessel invader

372
Q

Mucor species

A

non-septate; vessel invader; frontal lobe abscess in diabetic ketoacidosis

373
Q

Coccidioides immitis

A

Southwest deserts; inhale arthrospores in dust; spherule with endospores

374
Q

S/S

A

erythema nodosum (painful nodules lower legs)

375
Q

Histoplasma capsulatum

A

Ohio/central Mississippi river valley; excreta bats (spelunker), chickens

376
Q

H. capsulatum

A

simulates TB; yeasts phagocytosed by macrophages

377
Q

Blastomyces dermatitidis

A

overlaps histoplasmosis; broad-based buds; skin lesion simulates cancer

378
Q

Pneumocystis carinii

A

cysts and trophozoites; pneumonia in HIV; Rx. trimethoprim/sulfamethoxazole

379
Q

Primary TB

A

upper portion lower lobe, lower portion upper lobe

380
Q

Primary TB

A

Ghon focus (subpleural caseation); Ghon complex (spread to hilar nodes)

381
Q

Reactivation TB

A

cavitating lesion in upper lobe; kidney MC extrapulmonary site

382
Q

Mycobacterium avium intracellulare (MAI)

A

atypical TB; MC TB in AIDS

383
Q

CF

A

AR; 3 nucleotide deletion chromosome 7; defective CFTR (degraded in Golgi apparatus)

384
Q

S/S

A

pneumonia, malabsorption, males sterile; + sweat test; P. aeruginosa pneumonia MC COD

385
Q

Lung abscess

A

MCC aspiration oropharyngeal material (mixed aerobe/anaerobe); x-ray - air/fluid level

386
Q

Aspiration sitting

A

posterobasal segment right lower lobe

387
Q

Aspiration supine

A

superior segment right lower lobe

388
Q

Aspiration right side

A

right middle lobe, posterior segment right upper lobe

389
Q

Pulmonary thromboembolism

A

most derive from femoral vein

390
Q

Bronchial artery

A

branch of aorta/intercostal artery; protects against developing pulmonary infarction

391
Q

Saddle embolus

A

sudden death due to acute right heart strain

392
Q

S/S pulmonary infarction

A

dyspnea and tachypnea; pleuritic chest pain; pleural effusion

393
Q

Dx

A

ventilation/perfusion scan; respiratory alkalosis; hypoxemia

394
Q

Pain on inspiration

A

pleuritic inflammation; pulmonary embolus, pneumonia, pneumothorax

395
Q

Pathogenesis pulmonary hypertension (PH)

A

hypoxemia and respiratory acidosis

396
Q

Hypoxemia + respiratory acidosis

A

vasoconstriction pulmonary vessels; vasodilation cerebral vessels

397
Q

Causes PH

A

1¡ lung disease (COPD, restrictive), recurrent emboli, mitral stenosis, OSA, left-right shunts

398
Q

Cor pulmonale

399
Q

S/S

A

dyspnea; accentuated P2 (PH); parasternal heave (RVH)

400
Q

Restrictive lung disease

A

? compliance, ? elasticity; interstitial fibrosis/edema

401
Q

Restrictive lung disease (RLD)

A

? all volumes and capacities; ? FEV1sec/FVC ratio

402
Q

ARDS

A

RLD; non-cardiogenic pulmonary edema due to alveolar injury

403
Q

ARDS

A

neutrophil destruction of type I and II pneumocytes; hyaline membranes

404
Q

Causes

A

septic shock (MC), aspiration gastric contents, severe trauma

405
Q

Pneumoconiosis

A

inhalation mineral dust causing interstitial fibrosis; particles <0.5 ?m to reach alveoli

406
Q

Caplan syndrome

A

pneumoconiosis + rheumatoid nodules in lungs

407
Q

Coal workerÕs

A

Òblack lungÓ disease; progressive massive fibrosis; no increased incidence cancer or TB

408
Q

Silicosis

A

quartz; nodular opacities; foundry workers; ? incidence cancer and TB

409
Q

Sources asbestos

A

roofing material, old buildings (9/11), pipe-fitter shipyard

410
Q

Ferruginous bodies

A

asbestos fiber coated by iron

411
Q

Asbestosis

A

benign pleural plaques (MC); bronchogenic carcinoma (MC cancer); mesothelioma

412
Q

Mesothelioma

A

malignancy of serosa; no smoking association

413
Q

Sarcoidosis

A

RLD; MC non-infectious lung and liver granulomatous disease

414
Q

S/S

A

dyspnea, hilar adenopathy (non-caseating granulomas), uveitis, nodular skin lesions

415
Q

Lab findings

A

? ACE, hypercalcemia (macrophages synthesize 1-?-hydroxylase)

416
Q

Kveim test

A

intradermal injection sarcoid antigens causes skin reaction

417
Q

FarmerÕs lung

A

RLD; lung reaction against thermophilic bacteria in moldy hay

418
Q

Silo fillerÕs disease

A

RLD; reaction against nitrogen dioxide in fermenting corn

419
Q

Byssinosis

A

RLD; reaction against cotton, linen, hemp products in textile industry

420
Q

GoodpastureÕs syndrome

A

RLD; anti-BM antibodies; begins in lungs and ends in renal failure

421
Q

Collagen vascular RLD

A

SLE, rheumatoid arthritis, systemic sclerosis

422
Q

Drugs RLD

A

amiodarone, bleomycin, busulfan, cyclophosphamide, methotrexate, nitrofurantoin

423
Q

Obstructive lung disease

A

? compliance, ? elasticity

424
Q

Obstructive lung disease

A

? RV, TLC; ? TV, VC; ? FEV1sec and FVC; ? FEV1sec/FVC ratio

425
Q

Obstructive lung disease

A

asthma, emphysema, chronic bronchitis, bronchiectasis

426
Q

Asthma

A

extrinsic (type I hypersensitivity) and intrinsic types

427
Q

S/S

A

expiratory wheezing (inflamed terminal bronchioles); LTC4,-D4,-E4 bronchoconstrictors

428
Q

Charcot-Leyden crystals

A

derive from crystalline material in eosinophil granules

429
Q

Lab findings

A

initial respiratory alkalosis; respiratory acidosis requires intubation

430
Q

Emphysema

A

destruction elastic tissue respiratory unit; lung hyperinflation; smoking MCC; pink puffer

431
Q

Respiratory unit

A

respiratory bronchiole, alveolar duct, alveoli

432
Q

Radiograph emphysema

A

? AP diameter; depressed diaphragms; vertical heart

433
Q

Pathogenesis

A

? AAT, ? neutrophil destruction of elastic tissue

434
Q

Centriacinar emphysema

A

destruction/distention respiratory bronchioles upper lobe in smokers; THINK

435
Q

Panacinar emphysema

A

destruction/distention entire respiratory unit lower lobes; AAT deficiency

436
Q

Paraseptal emphysema

A

upper lobe destruction/distention alveolar ducts, alveoli; pneumothorax

437
Q

Lab findings

A

normal to decreased PCO2 (respiratory alkalosis)

438
Q

Chronic bronchitis

A

productive cough 3 months/2 consecutive years; blue bloater (cyanosis)

439
Q

Site of obstruction

A

terminal bronchioles (proximal to respiratory unit)

440
Q

Lab findings

A

respiratory acidosis/hypoxemia

441
Q

Bronchiectasis

A

obstruction/infection key causes; dilated bronchioles extend to periphery

442
Q

Causes

A

CF MCC, TB, immotile cilia syndrome

443
Q

Immotile cilia syndrome

A

absent dynein arm in cilia; sinusitis, infertility, bronchiectasis, situs inversus

444
Q

Central lung cancers

A

squamous cancer and small cell cancer; men > women

445
Q

Peripheral lung cancers

A

adenocarcinoma; women > men

446
Q

Squamous lung cancer

A

cavitate; secrete PTH-related protein

447
Q

Small cell carcinoma

A

neuroendocrine tumor; secrete ACTH and ADH

448
Q

Bronchioloalveolar carcinoma

A

no smoking relationship; lung consolidation resembling pneumonia

449
Q

Scar carcinoma

A

usually adenocarcinoma developing in old TB scar

450
Q

Bronchial carcinoid

A

low grade malignant; hemoptysis; rare cause carcinoid syndrome

451
Q

Metastatic lung cancer

A

more common than primary cancer; breast cancer MCC

452
Q

Pancoast tumor

A

squamous carcinoma posterior mediastinum; destruction superior cervical ganglion

453
Q

S/S

A

HornerÕs syndrome - lid lag, miosis, anhydrosis; lower brachial plexus injury

454
Q

Solitary coin lesion

A

granuloma MCC

455
Q

Superior vena caval syndrome

A

primary lung cancer obstructs vessel; venous congestion

456
Q

Anterior mediastinal masses

A

thymoma; nodular sclerosing HodgkinÕs; teratomas

457
Q

Posterior mediastinal masses

A

usually neurogenic tumors of ganglia

458
Q

Myasthenia gravis

A

B cell hyperplasia of thymus MC abnormality; association with thymoma

459
Q

Thymoma

A

association with hypogammaglobulinemia, autoimmune disease, pure RBC aplasia

460
Q

Pleural effusions

A

transudates or exudates; CHF MCC

461
Q

Spontaneous pneumothorax

A

rupture subpleural or intrapleural bleb; air/pleural cavity pressure same

462
Q

S/S

A

pleuritic chest pain, dyspnea, tracheal shift ipsilateral side, absent breath sounds

463
Q

Tension pneumothorax

A

flap-like pleural tear; increased pleural cavity pressure; compression atelectasis

464
Q

S/S

A

as above except tracheal shift to opposite side

465
Q

Cleft lip/palate

A

failure of fusion of facial processes

466
Q

Herpes labialis

A

multinucleated giant cell with acidophilic intranuclear inclusions on Tzanck prep

467
Q

Hairy leukoplakia

A

EBV glossitis; pre-AIDS defining lesion; not precursor to cancer

468
Q

Mumps

A

bilateral parotitis; unilateral orchitis; ? amylase

469
Q

Diphtheria

A

pseudomembrane pharynx and trachea with cervical lymphadenopathy

470
Q

Congenital syphilis

A

notched central incisors

471
Q

Actinomycosis

A

anaerobic gram + filamentous bacteria; complication extracted dental abscess

472
Q

S/S

A

draining sinuses with sulfur granules

473
Q

Exudative tonsillitis

A

majority are viral; 20% group A streptococcus

474
Q

Oral thrush

A

common in newborn; pre-AIDS defining lesion; yeasts and pseudohyphae

475
Q

Dental caries

A

Streptococcus mutans

476
Q

Peutz-JegherÕs syndrome

A

mucosal pigmentation; hamartomatous polyps

477
Q

Leukoplakia/erythroleukoplakia

A

biopsy to rule out squamous dysplasia or cancer

478
Q

Squamous cell carcinoma

A

smoking and alcohol association; lower lip MC site

479
Q

Smokeless tobacco

A

verrucoid squamous cell carcinoma

480
Q

Gum hyperplasia

A

phenytoin, pregnancy, scurvy

481
Q

Pleomorphic adenoma

A

MC benign tumor of salivary glands; parotid MC site

482
Q

Mucoepidermoid carcinoma

A

MC malignant tumor major and minor salivary glands

483
Q

Dysphagia for solids only

A

lesion obstructing esophagus; e.g., cancer, web

484
Q

Plummer-Vinson syndrome

A

iron deficiency anemia causes esophageal web, glossitis, achlorhydria (? HCl in gastric acid)

485
Q

Dysphagia for solids and liquids

A

motor abnormality; e.g., achalasia MCC, PSS or CREST syndrome

486
Q

TE fistula

A

polyhydramnios; proximal esophagus ends blindly; distal esophagus derives from trachea

487
Q

VATER syndrome

A

vertebral abnormalities, anal atresia, TE fistula, renal disease/radius abnormality

488
Q

ZenkerÕs diverticulum

A

MC pulsion diverticulum of esophagus; halitosis (stinky breath, food gets stuck); near UES

489
Q

GERD

A

relaxation of lower esophageal sphincter (LES) with acid reflux

490
Q

GERD

A

MCC nocturnal cough and asthma

491
Q

AIDS esophagitis

A

Candida MC, CMV, HSV

492
Q

BarrettÕs esophagus

A

glandular metaplasia distal esophagus in GERD

493
Q

Complications of BarrettÕs

A

precursor for adenocarcinoma, stricture

494
Q

Esophageal varices

A

dilated left gastric vein; sign of portal hypertension due to cirrhosis

495
Q

Mallory Weiss syndrome

A

tear of distal esophagus from retching in alcoholic or bulimic

496
Q

BoerhaaveÕs syndrome

A

rupture of distal esophagus from retching; pneumomediastinum

497
Q

HammanÕs mediastinal crunch

A

pneumomediastinum (air in subcutaneous tissue)

498
Q

LES ganglion cells

A

contain VIP - relaxes LES

USMLE (16 decks)

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