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Hem/Onc > Mixed review 0502Q > Flashcards

Mixed review 0502Q Flashcards

1
Q

anterior surface of heart is mostly which chamber?

A

RIGHT VENTRICLE

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2
Q

injury at left sternal border in 4th intercostal space would affect….?

A

[nipple level]

  1. skin, subcutis
  2. pec major
  3. external intercostal memb
  4. internal intercostal memb
  5. internal thoracic artery and veins
  6. transversus thoracis m.
  7. parietal pleura
  8. pericardium
  9. RV myocardium
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3
Q

posterior surface of heart is mostly which chamber?

A

LEFT ATRIUM

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4
Q

lateral surface of heart is mostly which chamber?

A

LEFT VENTRICLE

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5
Q

NE effect in heart

A

stimulate beta 1 receptors to increase cAMP conc within myocytes

*little effect at beta 2 receptors

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6
Q

dilated CM physiology

A
  1. ventricular dilation
  2. LV systolic dysfunction - decreased vent contractility

*may have sx of CHF

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7
Q

common cause of LV diastolic dysfunction

A

[impaired filling due to reduced LV compliance]

chronic HTN (hypertensive heart disease).
concentric LVH with decrease in chamber size.

also seen with restrictive CM

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8
Q

hypertrophic CM physiology

A

asymm. septal hypertrophy and dynamic ventricular outflow tract obstruction

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9
Q

what does integrin bind in order for cell adhesion?

A

fibronectin, collagen, laminin - allow binding to BM and ECM

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10
Q

lipoprotein lipase action

A

hydrolyze dietary lipids in chylomicrons to release triglycerides

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11
Q

hyperlipidemia type 1

A

lipoprotein lipase deficiency - increased conc of serum chylomicrons.

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12
Q

hyperlipidemia type 1 SX

A

(lipoprotein lipase deficiency)

  1. childhood hyperlipidemia
  2. pancreatitis, abd pain
  3. lipemia retinalis
  4. skin xanthomas
  5. hepatosplenomegaly
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13
Q

what serum TG conc significantly increases risk of pancreatitis

A

> 1000 mg/dL

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14
Q

what role does heparin play in lipoprotein lipase activity?

A

heparin releases endo-bound lipases to encourage clearance of TG from circ

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15
Q

LDL clearance from circ occurs by…?

A

receptor-mediated uptake by liver

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16
Q

defect in LDL receptor

A

hypercholesterolemia (high LDL)

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17
Q

hypercholesterolemia SX

A

(defect in LDL receptor)

  1. accelerated CAD, chest pain
  2. tubular (tendon) xanthomas
  3. maybe xanthelasmas and arcus cornea
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18
Q

what is the hallmark of familial hypercholesterolemia?

A

tubular (tendon) xanthomas

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19
Q

tubular (tendon) xanthomas

A

nodular lipid deposits in tendons - Achilles, elbow

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20
Q

enterococcal endocarditis

A

in elderly men who have undergone GI or GU manipulation (cystoscopy, colonoscopy)

enterococci: Gm pos, gamma hemolytic, cultured in hypertonic saline and bile

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21
Q

adverse effects of direct arteriolar vasodilators

A

[hydralazine, minoxidil]

reflex symp activation leading to tachycardia and edema (via renin)

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22
Q

how to counteract adverse effects of direct arteriolar vasodilators

A

coadmin with sympatholytics and diuretics

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23
Q

what layer of heart does SLE affect?

A

PERICARDITIS - pleuritic chest pain that radiates to neck and shoulders, relieved by sitting up. FRICTION RUB

serosal inflammation

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24
Q

what increases pleuritic chest pain with SLE pericarditis?

A

inspiration

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25
Q

Libman Sacks endocarditis presentation

A

heart murmur but otherwise asymptomatic

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26
Q

anticoagulant for pregnant women

A

heparin (warfarin is teratogenic)

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27
Q

DVT presentation

A

unilateral leg pain, swelling, warmth.

HOMAN’S SIGN: tenderness of calf muscle on dorsiflexion of foot

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28
Q

DIC is a common complication of….?

A
  1. Gm neg bacterial sepsis
  2. acute pancreatitis
  3. burn injury
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29
Q

mech of DIC in Gm neg sepsis

A

activation of coag cascade by bact endotoxins - microthrombi cause microangiopathic hemolytic anemia and thrombocytopenia

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30
Q

DIC labs

A

increase PT
increase PTT
decrease fibrinogen, V, VIII

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31
Q

what does bleeding from venous puncture sites suggest?

A

DIC

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32
Q

what is transmural inflamm with fibrinoid necrosis most characteristic of?

A

PAN (polyarteritis nodosa)

33
Q

sx of PAN

A 
fever 
malaise
weight loss
abd pain
melena
peripheral neuropathy
diffuse aches
34
Q

what infx is PAN assoc with in 10-30% of cases?

A

HEP B

35
Q

what age group does PAN most affect?

A

young adults

36
Q

which vasculitis is linked to asthma?

A

churg strauss syndrome

37
Q

which vasculitis is linked to antibiotic use?

A

microscopic polyangiitis (leukocytoclastic angiitis, hypersensitivity angiitis)

38
Q

which anemia commonly occurs in the setting of chronic alcoholism?

A

FOLIC ACID deficiency megaloblastic anemia - due to decreased synth of purines, thymidines.

smear: macrocytes, ovalocytes, hypersegmented neutrophils

39
Q

which nutrient deficiency is more common in alcoholics- B12 or folic acid?

A

FOLIC ACID!!!

40
Q

which form of anemia has INCREASED MCHC?

A

hereditary spherocytosis - mild dehydration of RBC with membrane loss

*spherocytes are smaller in size. cytoplasm stains more intensely

41
Q

general markers of hemolysis

A

elevated LDH
reticulocytosis
decreased haptoglobin

42
Q

most commonly affected protein in hereditary spherocytosis

A

spectrin

43
Q

immature T lymphocytes

[thymocytes]

A

express BOTH CD4 and CD8 cell surf Ags
AND complete TCR or pro-TCR.

exist in thymic CORTEX where they undergo pos selection and in thymic MEDULLA where they undergo neg selection

44
Q

most common cause of fatigue + new onset murmur in young adult

A

bacterial endocarditis

45
Q

which bugs produce endotoxin?

A

GRAM NEGS

46
Q

common tumors in Li-Fraumeni syndrome

A

sarcomas
tumor of breast, brain, adrenal cortex
leukemia

*AUTO DOM p53 mutation- inherit one mutated allele. somatic mutation of second allele needed for tumor development

47
Q

what does mitochondrial vacuolization indicate?

A

irreversible cell injury.

mito are permanently unable to generate ATP.

48
Q

HUS triad

A
  1. microangiopathic hemolytic anemia
  2. acute renal failure
  3. thrombocytopenia
49
Q

migratory thrombophlebitis — think ____

A

CANCER

50
Q

paraneoplastic hypercoagulability

A

seen with adenocarcinomas of pancrease, colon, lung – produce thromboplastin-like substance that causes intravasc. coagulation

51
Q

vit K and celiac sprue

A

vit K deficiency due to malabsorption - can lead to hemorrhagic diathesis

52
Q

atrophic gastritis

A

profound hypochlorhydria.
intrinsic factor deficiency (pernicious anemia).
B12 deficiency.
elevated methylmalonic acid levels.

53
Q

fomepizole

A

antidote for suspected methanol (rubbing alcohol) or ethylene glycol (antifreeze) poisoning.

competitive antagonist of alcohol dehydrogenase - prevents conversion of methanol and ethylene glycol into toxic metabolites

54
Q

prednisone in chemotherapy

A

induces lymphocyte apoptosis.

contributes to tumor lysis syndrome.

55
Q

probenicid

A

increases uric acid excretion in urine.
treat gout, hyperuricemia.
only effective in pts with good renal fx (not for nephrolithiasis or uric acid nephropathy)

56
Q

increased ferritin seen in….?

A
  1. iron overload

2. infx/inflamm (acute phase reactant)

57
Q

infection in sickle cell pts

A

at high risk, esp for encapsulated orgs - Strep pneumoniae, H.influenzae

58
Q

osteomyelitis in sickle cell child

A
  1. salmonella**
  2. S.aureus
  3. E.coli
59
Q

prophylaxis for asplenic pts

A
  1. penicillin prophylaxis

2. pneumococcal vaccine

60
Q

fenoldapam

A

selective dopamine 1 receptor agonist (activates adenylyl cyclase to increase cAMP).
causes art. dilation and natriuresis, leading to decreased systemic vasc resistance and BP

61
Q

special feature of fenoldapam

A

ONLY intravenous/parenteral agent that improves renal perfusion.

also increases sodium and water excretion.

beneficial in HTN pts with concomitant renal insufficiency. good for emergency.

62
Q

main use of esmolol

A

post operative HTN.

effects rapidly reversed after drug is withdrawn.

63
Q

what cell directly mediates intimal hyperplasia and fibrosis in response to endo injury?

A

reactive smooth muscle cells that migrate from media to intima - proliferate, synthesize collagen/elastin/proteoglycans

64
Q

what is the ONE significant non-enveloped ssDNA virus family?

A

Parvovirus - parvovirus B19 causing erythema infectiosum, aplastic crises, and hydrops fetalis

65
Q

what viruses cause bronchitis/bronchiolitis?

A

all are enveloped, RNA viruses:

influenza A, RSV, coronavirus

66
Q

underdeveloped area of lymph node in DiGeorge

A

paracortex - due to mature T cell deficiency

67
Q

underdeveloped area of lymph node in agammaglobulinemia

A

primary lymphoid follicles and germinal centers (secondary follicles) - due to absence of B cells

68
Q

left atrial enlargement can affect which nearby structure?

A

left recurrent laryngeal nerve - impingement leads to NEURAPRAXIA (failure of nerve conduction due to blunt injury, leading to left vocal cord paresis and hoarseness)

69
Q

Ortner syndrome

A

left atrial dilatation sufficient enough to impinge on left recurrent laryngeal nerve.
due to MITRAL STENOSIS.

70
Q

what is the only intrinsic muscle of the larynx NOT innervated by recurrent laryngeal nn?

A

cricothyroid m

71
Q

what process is defective in megaloblastosis?

A

DNA synth

  • ex: folate deficiency
  • RNA and protein synth may continue as normal (cytoplasm grows)
72
Q

pathogenesis of neurotoxicity (peripheral neuropathy) with vinca alkaloid tx

A

disruption of neuronal microtubules which are responsible for transporting organelles and other cellular products between neuronal cell body and axon terminals

73
Q

burr cells (RBC)

A

short evenly spaced projections.

assoc. with uremia, pyruvate kinase deficiency, microangiopathic hemolytic anemia, mech damage

74
Q

what does left shift of Hb-O2 dissociation curve indicate?

A

increased Hb O2 affinity (O2 is relatively less available to tissues)-
caused by increased pH, decreased 2,3-DPG, decreased temp.

75
Q

2,3-DPG (diphosphoglycerate)

A

organophosphate created in RBCs during glycolysis

76
Q

conditions that increase 2,3-DPG production

A 
(diminished peripheral tissue O2 availability)
hypoxemia
chronic lung disease
anemia
CHF
77
Q

what is the main enz that degrades 6-mercaptopurine?

A

xanthine oxidase in liver

78
Q

what enz activates 6-mercaptopurine and 6-thioguanine (prodrugs)?

A

HGPRT

Hem/Onc (9 decks)

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