OMFS Flashcards
What is the difference between physiologic and organic heart murmur?
heart murmur usually due to disruption of normal laminar flow of blood. ORGANIC cause but some cardiac disease defect such as deformed, stenotic valve, PDA. PHYSIOLOGIC due to alteration of metabolic state: pregnancy, early childhood.
How can you accentuate abnormalities of heart sounds? ie. regurgitation or mitral murmurs
regurgitation: sit up, lean forward, exhale completely and hold breath in expiration.
murmur: ask pt to roll onto his left side and then listen for apical area.
where on abdomen is appendix located?
LR quad
where on abdomen is liver percussed?
UR quad, live span of 6-12cm in midclavicular line is considered normal.
what is rebound? significance of it?
if you depress abdomen gently and release and the pt winces, it is an indication that the peritoneum is inflamed (rebound tenderness).
describe Hering-Breuer reflex
when lungs become overly inflated, stretch receptors activate an appropriate feedback response to limit further inspiration via vagus nerve.
define anisocoria
inequality of the pupils. common normal variation of pupil size but can be indication for pathology.
describe glascow scale. when is it used?
pts level of consciousness.: 1. eye opening 2. verbal response 3. best motor response. min is 3 max is 15.
describe homans sign
pain in calf when toe is dorsiflexed. sign of DVT
describe consensual light reflex
shine light in one eye and pupil of opposite eye constricts.
What does HYPOcalcemia and HYPERcalcemia look like on QT waves?
hypocalcemia causes prolonged QT intervals. hypercalcemia cause shortened QT waves.
what does HYPOkalemia and HYPERkalmeia look like on ECG?
hypokalmeia you see ST depression and flat T waves. Hyperkalemia causes tall, narrow, peaked T waves, QRS widening, and Pwave flattening and can progress to ventricular fibrillation.
describe sinus rhythm
normal 60-100beats/min. PR interval .12-.2 sec. QRS is .04-.12sec
describe supraventricular tachycardia
rate 150-250 beats/min. P waves differ from normal and may coincide with previous T wave wit lack of PR interval. QRS is normal.
describe atrial fibrillation
rate 300-500 beats/min P waves are not discrete and PR interval is impossible to distinguish. QRS complex normal.
What is called the “saw tooth” rhythm?
atrial flutter. rate 220-350 beats/min. PR and QRS are normal.
Describe first degree AV block
Prolonged PR conduction they AV node. prolonged PR interval. No tx necessary
describe second degree AV block Mobitz type I
atrial rate is normal with slower ventricular rate. P waves are normal but PR intervals lengthen until a QRS complex is “dropped” aka “dropped beat”
describe second degree AV block Mobitz ype II
normal atrial rate with slower ventricular by factor of 2:1 or 3:1. P waves are normal with normal PR interval. missed QRS complex for P waves.
describe third degree AV block
Total dissociation of atrium and ventricles. P waves and QRS complexes are regular but don’t coincide. rate of 20-60 beats/min
describe ventricullar fibrillation
no actual QRS, P or PR intervals to speak of. pt is usually without a pulse.
what are typical ECG for ischemia?
inverted T waves and ST depression
what are typical ECG for injury?
ST elevation and tall, positive T waves
What are typical ECG for infarction?
Q waves that are longer or > one third the size of the entire QRS complex.
signs of hypothermia in ECG?
bradycardia, J point (heigh corresponds to severity), prolonged QT interval, “shivering” artifact.
steps in calling dysrhythmias by name?
bradycardia- 100-250
flutter - 250-400
fibrillation- >400
components included in CBC report?
WBC, RBC, hematocrit, platelet, Mean corpuscular volume, Mean corpuscular Hb, Mean corpuscular [Hb]
what is the breakdown of a WBC?
Neutrophils (50-70%) lymphocytes (20-40%) monocytes (0-7%) basophils (0-1%) eosinophils (0-5%)
define: MCV and formula
mean corpuscular volume= (hematocrit x unit constant)/RBC
Kinda of macrocytic anemia?
> 100fL: Megaloblastic anemia, B12 or folate deficiency, chronic liver disease, alcoholism, reticulocytosis, newborn
Kinds of microcytic anemia?
What is the “corrected” count of Reticulocytes?
multiplying reticulocyte count by the measured Hct divided by 45. Answer SHOULD be
Two formulas to count Hct:
1: Hbg x 3= Hct
2: RBC x 9= Hct
Formula to calculate Hgb
RBC(in million) x 3= Hgb
Increased Hgb and Hct seen in?
Polycythemia, dehydration, heart disease, increased altitude, smoking, birth physiology.
Decreased Hgb and Hct seen in?
anemia, hemorrhage, dilution, alcohol, drugs, pregnancy
Poikilocytes
Irregular shaped RBC
Anisocytosis
irregular RBC
Sicke cell
crescent or sickle shaped RBC seen with decreased O2
howell jolly bodies
large RBC basophilic inclusions (megaloblasti anemia, spenectomy, hemolysis)
basophilic stippling
small RBC with blue inclusions.
BASIcally, ACiD alcohol is LeThal
Anemia of chronic dz, alcohol anuse, lead poisioning, thalassemias
spherocytes
spherical RBC
burr cells
spiny RBC
schistocyte
helmet RBC
dohle’s inclusion bodies
PMNs
auer bodies
AML acute myeloblastic leukemia
Hypersegmentation:
PMNs with 6-7 lobes
Define Thrombocutopenia
Low platelet count
indications for thrombocytopenia?
Idiopathic thrombocytopenic purapura (ITP), disseminated intravascular coagulation (DIC) etc.
Which clotting factors are synthesized in the liver?
II, VII, IX, X
Which vitamin deficiency affect coagulation and extrinsic pathway?
Vit K
acceptable preop platelet count?
normal 150,000-440,000. acceptable 75,000.
Describe PTT, partial thromboplastin time
Measures clotting ability of all factors in intrinsic and common pathways except Factor XIII. Normal PTT 40-100 sec.
describe DIC, disseminated intravascular coagulopathy.
extrinsic and intrinsic coagulation pathway activated causing widespread clotting cascade and small clots int he blood vessels. coagulation process consumes a lot of clotting factors and platelets and can lead to widespread bleeding. lead to end organ failure.
How does wide spectrum Abx elevate PT?
kill normal bowel flora and decrease Vit K–> increasing PT time.
Describe how heparin works
Primary affect is to activate antithrombin III, blocks coagulation inhibiting mostly IX, X factors.
S. Aureus colonized the
Nose
Inflammatory dz in s. Aureus
Toxin mediated dz
Organ abscess, pneumonia, endocarditis, osteomyelitis
TSST, scalded skin syndrome
MRSA
Describe mechanism of TSST? Which bacteria commonly assoc. with
Super antigen binds to MHC II resulting in polyclonal T cell activation. Presents fever, vomiting, rash, shock, end organ failure.
Which bacteria is catalase + and describe
S. Aureus. Binds fibrin to surface of bacteria to “camoflauge” large amounts of fibrin around local infection walling off leads to abscess.
Staph. Elidermidis
NOT SKIN. Assoc with prosthetic devices, catheters by producing biofilm. Component of Norma, skin flora. Novobicin sensitive
Staph. Saprophyticus. Descibe
Second most common cause of UTI. Novobiocin resistant.
Strep pneumoniae
Most common cause of MOPS: meningitis, otitis media, pneumonia, sinusitis
Optochin sensitive
Strep viridans describe
Alpha hemolytic. Found in normal flora of orophayrnx and cause dental caries. Optochin resistant. Differs from pneumoniae bc alpha hemolytic and o resistant.
Strep. Pyogenes causes…
Group A.
Pyogenic: pharyngitis, cellulitis, impetigo
Toxigenic: scarlet fever, toxic shock like syndrome, necrotizing fasciitis
Immunologic: rheumatic fever, acute glomerular nephritis
Bacitracin sensitivity assoc with which bacteria describe
“B-BRAS” Group B resistent, Group A sensitive.
Bacitracin interferes with cell wall and peptidoglycan synthesis. Skin/eye infection tx.
Group B? “Galactic Pye”
JONES criteria for rheumatic fever. Assoc with which bacteria
Joint (poly arthritis), heart(carditis), nodules (subcutaneous), erythema marginatum, Sydenham chorea
Strep pyogenes
Describe scarlet fever. Assoc with which bacteria
Rash with sand paper like texture, strawberry tongue, circumstances pallor. Strep pyogenes.
Strep agalactiae
Group B. Beta hemolytic. “ group B for BABIES”
Corynebacterium dipitheriae ABCDEFG
ADP ribosylation Beta prophage Corynebacterium Dipitheriae Elongation factor 2 Granules
What kind of bacteria is clostridium family?
Gram positive, spore forming, obligate anaerobic bacilli.
4 clostridium families
C. Tetani
C. Botulinum
C. Perfringens
C. Difficile
Describe c. Tetani
GABA inhibitory NTs ( from renshaw cells in spinal cord)
Describe c. Botulinum
Inhibits ach release at nmj. Bad for babies and cause flaccid paralysis i.e. Floppy baby syndrome
Describe c. Perfringens
Alpha toxin. Perfringens perforated green gangrenous leg.
Describe c. Difficile
Produces two toxins. Toxin A binds to brush border of gut. Toxin B causes cytoskeleton disruption–> pseumembranous colitis –> diarrhea
Describe anthrax. What bacteria group
Gram positive spore forming rid. Only bacterium with a polypeptide capsule
Describe two kinds of anthrax
Cutaneous: boil like lesion-> black eschar ulcer
Pulmonary: inhalation. Leads to flu like symptoms. I.e. Wool sorters dz
Bacillus cereus describe
Food poisoning. Reheated rice syndrome.
Listeria monocytogenes describe
Unpasteurized dairy, and deli meats.
What similarities does actinomyces and nocardia have?
Both long, branching filaments resembling fungi.
Actinomyces, acting mice
Gram positive ant in a robe (anaerobes)
Not acid fast (no my mycolic acid)
Normal oral flora
Cause oral facial abscess with yellow sulfur granules
Tx with penicilin.
Nocardia, notecard
Gram positive aerobe
Acid fast (has mycolic acid)
Found in soil
Causes pulmonary infections
Tx with sulfonamides
Name opportunistic fungal infection
Candida albicans
Aspergillosis fumigatus
Crytotococcus neoformans
Mucor/rhizor
Describe Candida albicans
Oral, gut, genital i.e. Yeast infection and pruruitic Nguyen yeast at 20celsius and germ tubes at 37 Celsius
Can change to pseudo hyphae growth at 37 Celsius. Vaginitis have cottage cheese discharge with firefly red appearance. Diabetics increased risk. Diaper rash. Risk of endocarditis in iv users
Describe aspergillus fumigans aka asparagus
Hyphae branching at 45 degrees. Found in lung cavities alter TB infection. Think “A” acute angles for aspergillus
Describe crytotococcus neoformans aka crippled cock
Opportunistic fungal infection. Monomorphic, only in yeast form. Bird droppings.
Name common rickettsial and vector borne dz (6)
Rash:
Rocky mountain spotted fever
Typhus
Rash rare:
Erklichiosis
Anaplasmosis
Q fever
Describe Rocky Mountain spotted fever
Is a rickettsial and vector borne dz. vector is tick. Classic triad-headache, fever, rash
Rash on palms and soles seen in CARS Coxsackie A infection (hand foot mouth dz) Rock you mountain spotted fever Syphillis
Descibe typhus
Rickettsial and vector borne dz. unlike Rocky Mountain spotted fever, doesn’t harm palms or soles.
Name the 6 rickettsial and vector borne dz and their tx
Rocky Mountain spotted fever Typhus Erlichiosos Anaplasmosis Q fever Chlyamidia
Tx: DOXYCYCLINE
Describe chlamydia
Rickettsial dz. tx azithromycin or doxycycline. Etc etc
Describe all HSV
Hsv1- gingivostomatosis, keratoconjunctivitis, herpes labialis. Latent trigeminal ganglia
HSV2- genital herpes
HSV3-VZV chicken pox shingles
EBV- mononucleosis aka kissing dz. assoc with HL, Burkett L and nasopharyngeal carcinoma
CMV. HSV5- congenital dz, retinitis. Owl eye inclusions
HHV6- roseola
HHV8- kaposis sarcoma
Name large medium and small vessel vasculitis
Temporal arteritis
Takayasu
Polyarteritis nodosa
Kawasaki
Buerger
Wegeners
Microscopic polyarteritis
Churg Strauss syndrome
Henoch scholein pura pura
Describe wegeners vasculitis
NLK
Nose- sinusitis, otitis media, perforation of septum
Lungs- cough, hemoptsis
Kidney- glomerulonephritis, hematuria
Describe polycythemia Vera
“Poly cyclist” Over production of RBC. Due to JAK2 kinase mutation a TK. Erythromelalgia (neurovascular where hands and extremities are inflamed and hyperemic. Described as burning pain). Pruritis ( itching esp after hot shower due to abnormal histamine release or prostaglandins production). After hot shower, headache, no cure but TX with phlebotomy “flea bottom” and aspirin.
Describe CML
CAMeL: 30-60-90 age, BCR ABL (Abe Lincoln) tyrosine kinase gene derived from a 9:22 translocation aka Philadelphia chromosome. Activation of TK induces pro growth and pro survival pathways of granulocytic and megakaryocytic progenitors. Low alkaline phosphatase due to increased granulocytes, (this differs from leukemoid rxn bc alkaline phosphatase would be normal or elevated) , tx imatnib
Describe CLL
Proliferation of naive b cells that co express CD5 (normally in T cells) and CD20. “Call me maybe” most common adult leukemia >60 years. Infiltrate of small lymphocytes with minimal cytoplasm k
Cells often get disrupted bc of this and have characteristic SMUDGE CELLS. Pts often asymptommatic. Associated with igM
Describe hairy cell leukemia
A kind of chronic leukemia. Others? CLL, ATLL,mycosis fungoides.
Neoplastic proliferation of Mature B cells, “hairy cytoplasmic processes”
Clinically: splenomegly RED PULP vs white pulp which is expected to be large bc where WBC grow. Responsive to TRAP enzyme: trapped in red pulp, trapped in bone marrow, trapped and can’t go to lymph node where did expect them to be. Excellent response to CDA-2 drug! Increase adenosine that’s toxic and kill neoplastic B cells which is good!
Difference between CML and leukemoid rxn?
CML has fusion of BCR ABL that increases TK activity promoting production of granulocytes and lead to ALKALINE PHOSPHATASE DECREASE vs leukemoid the alkaline phosphatase is Norma, or elevated
Which two leukemias due to JAK2 kinase mutation?
CML and ET essential thrombocytopenia
Describe platelet fxn in ET essential thrombocytopenia
Platelets not working= risk for bleeding
Platelets over fxning= risk for thrombosis
Describe diff of acute and chronic leukemia
Acute : MB and LB cannot mature and begin to pile up
Chronic: neoplastic proliferation of mature circulating lymphocytes, leaders to increase in WBc count, splenomegly, LAD
Fanconi anemia
Resoprtion defect in proximal tubule of kidney. Pts develop HYPOPHOSPHATEMIA leading to ricketts in kids and osteomalacia in adults. HYPOKALEMIA and Xs loss of bicarbonate lead to METABOLIC ACIDOSIS
Draw out the vasculature of the heart
circumflex a, coronary sinus, left anterior descending a, posterior descending a, right coronary a, right marginal a. etc.
What lab result could determine leukemoid rxn vs. CML?
alkaline phosphatase should be normal or elevated vs. CML is decreased
