Pathophysiology 1 Flashcards
STUDY SMART : )
• What is ASHD?
○ Atherosclerotic heart disease
○ A narrowing of the coronary artery by atheroma
○ Can lead to acute myocardial infarction
• Prevention of ASHD/ Risk factors? (5)
○ Family history ○ Smoking- no ○ Hypertension- BP @ 120/80 ○ Hyperlipidemia- LDL @ 100 ○ Diabetes Mellitus- B.S. @ 100
• What is heart failure in general?
○ A pump failure
○ Can result from any disease of the heart
• What are the three most common fatal cancers?
○ LUNG
§ Preventable- no smoking
○ PROSTATE & BREAST
§ Exams catch early
§ Mammograms- 40 y.o or early if greater risk
§ Prostate rectal/physical exams- age 40
& repeat once a year
○ COLON
§ Start as polyp- takes 10 years become cancerous
§ Colonoscopy @ 50, then repeat once a year
Leg pain of the intermittent claudication variety is suggestive of what?
○ Arterial insufficiency
○ arterial=pain
• What is the manifestation of venous problems?
○ Edema
What are the causes of secondary hypertension?
○ “R.E.N,D,S”
§ Renal failure
§ Endocrine disease (Cushing's, Pheochromocytoma) § Drugs § Neurogenic § Sleep apnea
• What is the meaning of incompetence of a valve?
○ Does not close adequately
○ Ex: w/ bacterial endocarditis or rheumatic heart disease
• What are causes of congenital heart disease?
○ Artrial septal defect (ASD)
○ Ventricular septal defect (VSD)
○ Fallot’s tetralogy
○ Coarctation of the aorta
• A 32 year old female, who had a rheumatic fever as a child, is brought in with complains of malaise, a temperature of about 100 °F for approx. 3 weeks, and a new cardiac murmur. She also recently saw her dentist. What is your diagnosis? What tests?
○ Subacute bacterial endocarditis (strep infection= original cause rheumatic fever)
○ Test: culture blood, echocardiogram
• Describe fetal circulation
○ Right atrium to Left atrium to Left ventricle to aorta to body
○ Interatrial septum allows blood to bypass right ventricle and lungs
What are the signs and symptoms of heart failure?
○ Fatigue ○ SOB ○ Edema (bilateral) ○ Rales ○ Cardiomegaly ○ Hepatomegaly
Treatment of heart failure?
○ Diuretic- drain fluid ○ Oxygen- SOB ○ Sitting up- pressure on chest ○ Beta blockers ○ Surgery (by-pass, valve, left ventricular assist device)
• What are causes of heart failure?
○ ANY PROBLEM W/ HT--> HT FAILURE ○ Hypertension ○ Acute myocardial infarction ○ Arrhythmia ○ Rheumatic fever ○ Subacute bacterial endocarditis ○ ASHD ○ Valvular heart disease ○ Cardiomyopathy ○ Congenital heart disease
What percent of heart disease is ASHD?
○ 80%
○ s/s begin after 50% buildup
• What are some areas of the body where atherosclerosis leads to major disease?
○ Heart– ASHD– HT Failure
○ Brain– Stroke (CVA- cerebrovascular accident)
○ Aorta– Aortic Aneurism
○ Legs– peripheral vascular insufficiency
s/s intermittent claudication – gangrene
• In dealing with congenital heart disease, what is meant by “reversal of shunt”?
Reversal of shunt causes BLOOD FLOW RIGHT ATRIUM TO LEFT ATRIUM. High pressure on left atrium causes shunt. As pressure builds on right atrium over time, causes a reversal of shunt resulting in deoxygenated blood into circulation.
• What is pain in the chest w/ exertion?
○ Angina
• What are complications of uncontrolled hypertension?
“St.A.KD.Blind.Legs”
○ Stroke (CVA- cerebrovascular accident) ○ ASHD ○ KD disease/failure ○ Eyes- Blindness ○Periperal arterial insufficiency (legs)
• Symptoms of peripheral vascular(arterial) insufficiency?
○ Intermittent claudication
○ Loss of hair on toes/ affected limb
○ Cooler temperature
○ Weak/faint dorsalis pedis pulse
• What is the PMI and where is it located?
○ PMI- point of maximum intensity or heart apex beat
○ On the left side, medial to midclavicular line, in the fifth intercostal space
What are causes of PMI displacement?
○ Cardiomegaly
○ RT lung filled (biothorax, pneumothorax, pleural ephusion, hemothorax)
• Name examples of hemorrhages in different parts of the body:
○ Hemoptysis- coughing blood
○ Hematemesis- vomiting blood
○ Melena- tarry black stools (bleeding duodenum and above)
○ Hematochezia- fresh red blood in stools (bleeding after the duodenum)
• Classify shock
○ Hypovalemic- low fluid volume
§ Ex: severe dehydration
§ Test: orthostatic hypertension
○ Cardiogenic- inadequate circulation of blood d/t primary failure of HT function
§ ex: acute MI
○ Hypotonic- ex: anaphylactic
Classify EDEMA
○ BILATERAL all pitting
§ HT Failure- (d/t no venous return- HT not pumping) § Rel. Low oncotic pressure: □ KD Failure (d/t hypoprotenemia-Proteinuria) □ LR Disease (d/t not making proteins- albumin) □ Malnutrition (Cachexia)
○ UNILATERAL
§ Pitting:
□ Trauma
□ Venous blockage (ex:thrombophlebitis/clot)
§ Non-pitting:
□ Lymph Edema (ex: breast cancer or filaria)
• What are acute complications of acute myocardial infarction?
○ “HTBRA”
○ HT Failure (acute pulmonary edema)
○ Blood clot (thrombus/embolus)
○ Rupture
○ Arrhythmia
• What are chronic complications of acute myocardial infarction?
○ “AHA”
○ Aneurism
○ HT failure (acute pulmonary edema)
○ Arrhythmia
• What type of gland is the pancreas?
○ Endocrine & exocrine
○ Endocrine- ISLETS OF LANGERHAND
○ Exocrine duct- SPHINCTER OF ODDI
• What are the endocrine and exocrine productions of the pancreas?
○ Endocrine:
§ Insulin
§ Glucagon
○ Exocrine:
§ Protease
§ Amylase
§ Lipase
• Where are the exocrine productions of the pancreas released via the sphincter of oddi?
○ Into the 2nd part of the duodenum
• What stimulates the exocrine function of the pancreas?
○ The secretion of secretin in the duodenum (CCK- bile)
• What are four causes of acute pancreatitis?
○ GB disease
○ Alcohol
○ Trauma
○ Viral infection (ex: Mumps)
○ -GB + Alcohol= 90%
• What are s/s of acute pancreatitis?
○ Pain with eating
○ Pain around umbilicus that radiates to back
○ Test: amylase ↑, lipase↑
○ Tx: Pain meds, IV fluids, No solids
○ Q: w/ women- concern RUPTURED TUBAL PREGNANCY
• Where is amylase present?
○ Salivary glands- to begin digestion of carbohydrates
○ Duodenum- released from pancreas
○ Fallopian tubes- unknown reason
What are s/s of chronic pancreatitis?
○ Chronic diarrhea (10-12 xday) ○ Malnutrition ○ Emaciation (d/t malnutrition) ○ Vitamin xu s/s (d/t "") ○ Dehydration (d/t persistent diarrhea)
○ Test: stools for muscle fibers
○ Tx: pancreatic enzymes
• Classify Diabetes Mellitus
○ TYPE 1- (Juvenile) NO INSULIN- 10%
§ Skinny, not storing nutrients b/c no storage
hormone (insulin)
○ TYPE 2- (Adult onset) Dysfunctional insulin- 90%
§ Generally overweight
○ GESTATIONAL- w/ pregnancy
What are the general symptoms of diabetes mellitus?
○ Polyuria
○ Polydypsia
○ Blurring vision
○ Chronic yeast infections (women)
What is the diagnostic test for diabetes mellitus?
○ Fasting blood sugar (>126)
• What are chronic complications of diabetes mellitus?
○ “HKBL^2”
○ HT disease/attack
○ KD disease/failure
○ Blindness
○ Peripheral limb loss
• What are ways to prevent chronic complications of diabetes mellitus?
○ B.S. @ 100
○ A1C <7
○ B.P. @ 120/80
○ No smoking
○ Yearly eye exam
○ KD tests-
§ Creatinine clearance (urine)
§ microalbumin (earliest sign)
○ Yearly stress test (HT)
○ Dorsalis pedis pulse
• What are acute complications of diabetes mellitus?
○ Diabetic ketoacidosis (DKA) (B.S. generally 500+)
○ Hypoglycemia
○ Infection
• Make a list of heart diseases
○ Hypertensive ○ ASHD ○ Rheumatic ○ Infectious ○ Congenital ○ HT failure ○ Cardiomyopathy ○ Valvular ○ Arrhythmic
• When a person dies of a “heart attack” what 3 general causes?
○ Acute myocardial infarction
○ Arrhythmia (worst= ventricular fibrulation)
○ HT failure (pump fails d/t any disease of ht)
• What is the commonest cause of death in women?
○ Acute myocardial infarction/ ht attack
• Under what layer does an atheroma collect?
○ Endothelium
• What is diabetes insipidus?
○ No ADH (anti-diuretic hormone) from posterior pituitary
○ s/s polyuria, polydypsia
• What three organs are affected by mumps?
○ Pancreas
○ Gonads (testicles & ovaries)
§ Men become sterile
§ Women have full recovery
○ Parotid glands
• What are four pathological conditions of the esophagus?
○ Cancer of esophagus
○ Esophageal ulcer (peptic/gastric ulcer)
○ Stenosis of esophagus (from healed ulcer)
○ Reflux esophagitis
○ Hiatus hernia (A hiatus hernia or hiatal hernia is the protrusion of the upper part of the stomach into the thorax through the esophageal hiatus because of a tear or weakness in the diaphragm)
• What are the five secretions of the stomach?
○ Gastrin ○ Pepsin ○ Intrinsic factor ○ Hydrochloric acid ○ Mucin
Name three locations where peptic ulcers may occur
○ Esophagus
○ Stomach
○ Duodenum
• Name four complications of gastric ulcers?
○ Bleeding (hematemesis, melena)
○ Perforation
○ Acute peritonitis
○ Pyloric stenosis (pyloris= area ST connect to SI)
• Describe the differences between Crohn’s Disease & ulcerative colitis?
○ Crohn’s
§ Ulcerates through all layers of small intestine/gut
○ Ulcerative colitis
§ Only ulcerate mucosal layer
○ Both have s/s:
§ Abdominal pain
§ Bloody diarrhea
• What happens to an ulcer in the colon? (i.e. w/ ulcerative colitis)
○ After 10 years the without treatment the ulcer becomes cancerous
○ Therefore ↑risk cancer*
• What are complications of ulcerative colitis?
○ Bleeding (hematechezia) ○ Perforation ○ Acute peritonitis ○ Toxic megacolon ○ Cancer
• What is a fatal complication of ulcerative colitis?
○ Toxic megacolon
§ Norm size: wrist
§ T.M colon size: thigh!
• What type of anemia do Crohn’s disease patients often have?
○ Combined B12 & Iron Xu anemia
§ b/c ileum affected (where B12 absorbed) & they
are bleeding all the time (lose iron)
• What are possible complications for an ulceration, such as in Crohn’s disease, where the ulcer penetrates through all layers?
○ Perforation–>acute peritonitis
○ Fistula–Sticking together of organ, mainly the small gut, where ulcer penetrates through
• What is the MacBurney point?
○ Indicates acute appendicitis
○ Located 1/3 distance from ASIS, 2/3 distance from umbilicus, in RLQ
• What is the main cause of LLQ pain?
○ Diverticulitis
• Describe clinical features of acute peritonitis
○ Acute abdominal pain
○ Board-like rigidity
○ Rebound tenderness
○ Absence of bowel sounds
• What three conditions will lead to acute peritonitis?
○ Perforation of peptic ulcer
○ Ruptured appendix
○ Ruptured/perforated colon
• What are the complications of cirrhosis?
○ Hepatocellular jaundice
○ Coagulopathy
§ bruising (low/not producing coagulating proteins)
§ Bleeding (esophageal varices)
○ Hypoalbuminemia (–low oncotic pressure–low/not producing albumin)
§ Ascites (fluid filled abdomen)
§ Edema (pedal, bilateral)
○ Poor inactivation of hormones
§ Estrogen
□ Gynecomastia
□ Testicular atrophy
○ Hepatic encephalopathy (d/t NH₃ build up)
○ Portal hypertension
○ Esophageal varices
○ Splenomegaly (backing up in spleen b/c LR not functioning)
• What are the factors that lead to peptic ulcer disease?
○ ↑HCL
○ H pylori infection
○ NSAIDS (i.e. ibuprofein)
• What are the factors that lead to cirrhosis?
○ Chronic alcoholism
○ Hepatitis B/C/D (not A)
○ Hemachromotosis (iron storage disease)
○ Wilson’s Disease (disease with copper excess)
• What are the different terms for different sites of bleeding?
○ Above duodenum:
§ Hematemesis (vomiting blood)
§ Hemoptysis (coughing blood)
§ Melena (black tarry stools from digested blood)
○ Below duodenum:
§ Hematochezia (stools w/ fresh red blood)
• List Liver function tests (at least 6):
○ Bilirubin ○ Alkaline phosphatase ○ ALT/AST ○ NH₃ ○ Albumin ○ Prothrombin time ○ BUN (produced by liver sent to kidney for excretion)
• Classify Jaundice. Give an example of each.
○ Hepatocellular
§ Cirrhosis, Hepatitis B/C/D
○ Obstructive
§ GB stones
○ Hemolytic
§ Sickle cell anemia
• Chronic complications of Diabetes mellitus include: ○ A: Blindness ○ B: Renal Failure ○ C: Heart attack ○ D: all of the above
○ All of the above
“HKBL^2”
• In Type 1 Diabetes mellitus there is: ○ A: incapability of using insulin ○ B: No insulin present ○ C: No pancreas present ○ D: No islets of Langerhans present
○ No insulin present
• Leg pain of the intermittent claudication variety is suggestive of: ○ A: arterial insufficiency ○ B: venous insufficiency ○ C: Neuropathy ○ D: Deep thrombophlebitis
○ A: arterial insufficiency
• High hemoglobin A1C suggests: ○ A: good control of D.M. ○ B: Poor D.M. control ○ C: Diabetic complication ○ Presence of other disease in addition to D.M.
○ B: poor D.M. control
• Which one of the following is a cause of secondary hypertension: ○ A: portal hypertension ○ B: Carotid artery stenosis ○ C: Anemia ○ D: Renal artery stenosis
○ D: Renal artery stenosis
• Lab tests for acute pancreatitis include: ○ A: Creatinine ○ B: Amylase ○ C: LDL ○ D: Troponin
○ B: Amylase
• Acute complications following acute myocardial infarction include: ○ A: Rupture of the ventricle ○ B: Hemopericardium ○ C: Ventricular arrhythmia ○ D: All of the above
○ All of the above
• The complications of uncontrolled hypertension include: ○ A: Peptic ulceration ○ B: Stroke ○ C: Pulmonary embolism ○ D: COPD
○ B: Stroke
• The PMI of the heart (apex beat) is normally located in the:
○ A: Right 5th intercostal space
○ B: Left 6th intercostal space
○ C: Left 5th intercostal space
○ D: Lateral to the left midclavicular line
○ C: left 5th intercostal space
• Non pitting edema is suggestive of: ○ A; heart failure ○ B: kidney failure ○ C: lymphedema ○ D: Liver impairment
○ C: lymphedema
• What is the pathogenesis (basic cause) of rheumatic fever: ○ A: ASHD ○ B: past bacterial infection ○ C: congenital heart disease ○ D: alcohol
○ B: past bacterial infection
• The risk factors of ASHD include: ○ A: sexual promiscuity ○ B: diabetes insipidus ○ C: Lack of exercise ○ D: Family history
○ D: family history
• Causes of acute pancreatitis include: ○ A: trauma ○ B: Biliary tract disease ○ C: alcohol excess ○ D: all of the above
○ All of the above
• In arterial insufficiency of the inferior extremity, which of the following may be present? ○ A: loss of toe hair ○ B: dilatation of the veins ○ C: increased temperature of the foot ○ D: positive Babinski sign
○ A: loss of toe hair
• In dealing with congenital heart disease, “reversal of shunt” means?
○ A: flow of blood from right to left
○ B: flow of blood from left to right
○ C: flow of blood is from above to below
○ D: flow of blood from below to above
○ A: flow of blood is from right to left
• The chronic or late complications of an acute M.I. include: ○ A: coarctation of the aorta ○ B: Heart failure ○ C: COPD ○ D: cirrhosis
○ B: heart failure
• Congenital heart diseases include: ○ A: atrial septal defect ○ B: Fallot's tetralogy ○ C: Coarctation of the aorta ○ D: all of the above
○ All of the above
• The commonest cancer in USA that is fatal is: ○ A: Lung cancer ○ B: colon cancer ○ C: breast cancer ○ D: prostate cancer
○ A: lung cancer
• When a person presents to an ER with acute chest pain, the standard tests done to rule out acute myocardial infarction include: ○ A: CCK ○ B: troponin ○ C: Chest xray ○ D: CBC
○ B: troponin
• Melena is: ○ A: passage of dark tarry stool ○ B: passage of fresh red blood ○ C: Coughing up blood ○ D: none of the above
○ A: passage of dark tarry stool
• Complications of a gastric ulcer include: ○ A: Pyloric obstruction ○ B: perforation ○ C: peritonitis ○ D: all of the above
○ D: all of the above
• Advanced pancreatic cancer may not present with jaundice:
○ A: If the tumor is in the head of the pancreas
○ B: if the tumor is in the tail of the pancreas
○ C: if tumor has invaded & blocked the bile duct
○ D: none of the above
○ B: if the tumor is in the tail of the pancreas
• Gynecomastia may be present in:
○ A: Klinefelter's Syndrome
○ B: in advanced cirrhosis d/t poor hormone
inactivation
○ C: both of the above
○ D: none of the above○ C: both of the above
• Prolonged antibiotic use may lead to: ○ A: jaundice ○ B: hematuria ○ C: black hairy tongue ○ D: caries (decay of teeth)
○ C: black hairy tongue
• In portal hypertension there is ○ A: hepatomegaly ○ B: cardiomegaly ○ C: splenomegaly ○ D: none of the above
○ C: splenomegaly
• Etiology of Cirrhosis include: ○ A: asbestos exposure ○ B: viral hepatitis ○ C: vitamin deficiency ○ D: trauma
○ B: viral hepatitis
• High potassium is seen in: ○ A: hypovolemia ○ B: Addison's disease ○ C: Cushing's syndrome ○ D: prolactinoma
○ B: Addison’s disease (& KD failure)
§ Sodium is high in hypovolemia
• Ascites is: ○ A: Seen in heart failure ○ B: seen with portal hypertension ○ C: seen in obstructive jaundice ○ D: seen in COPD
○ B: seen with portal hypertension
§ Ascites is the filling of the peritoneal cavity w/ fluid
• The pain of gallbladder disease can be felt at all these locations except: ○ A: left shoulder ○ B: right shoulder ○ C: between the scapula ○ D: in the right upper quadrant
○ A: left shoulder- associated with HT attack
• Weight loss and dysphagia in a 72 year old male is probably caused by:
○ A: Depression
○ B: loneliness from the recent death of his wife
○ C: cancer of the esophagus
○ D: Cancer of the prostate
○ C: cancer of the esophagus
• Lab tests for acute pancreatitis include: ○ A: Creatinine ○ B: Amylase ○ C: LDL ○ D: troponin
○ B: Amylase
• The cause of confusion in liver failure (hepatic encephalopathy) is ○ A: Increase in BUN ○ B: Increase in Alcohol ○ C: Increase in Bilirubin ○ D: Increase in ammonia
○ D: increase in ammonia
• Vomiting of blood in a person with cirrhosis is likely to be from: ○ A: esophageal varices ○ B: esophageal cancer ○ C: reflux esophagitis ○ D: pneumonia
○ A: esophageal varices
• The precursor cell of the platelet is: ○ A: Pro-erythroblast ○ B: reticulocyte ○ C: Megakaryocyte ○ D: none of the above
○ C: megakaryocyte
• Intrinsic factor secreted by the stomach is necessary for the absorption of : ○ A: acid ○ B: alcohol ○ C: fat ○ D; vitamin B12
○ D: vitamin B12
• The duodenum secretes which one of the following: ○ A: cholecystokinin ○ B: amylase ○ C: lipase ○ D: intrinsic factor
○ A: cholecystokinin- CCK- stimulates bile by contracting GB
§ Secretic (from duodenum) stimulates pancreas
• Vitamin B12 is absorbed in the:
○ A: Stomach
○ B: Duodenum
○ C: Descending colon
○ D: Ileum○ D: ileum (both B12 & IF absorbed)
• The main function of the lacteal is to absorb: ○ A: alcohol ○ B: fat ○ C: protein ○ D: carbohydrate
○ B: fat
• The stomach is protected from its own acid by the: ○ A: bile ○ B: thick layer of mucin ○ C: Aspirin ○ D: alkali
○ B: thick layer of mucin
• BUN is made from ammonia by: ○ A: the pancreas ○ B: the liver ○ C: the spleen ○ D: the small intestine
○ B: the liver
§ Protein- N- NH₃- BUN- KD- Excretion
• Right upper quadrant pain w/ a positive Murphy sign is suggestive of: ○ A: acute gall bladder disease ○ B: duodenal ulcer ○ C: kidney stone ○ D: acute pancreatitis
○ A: acute gall bladder disease
• Which one of the following may lead to cancer? ○ A: Ulcerative colitis ○ B: duodenal ulcer ○ C: regional enteritis ○ D: gall stones
○ A: ulcerative colitis
§ Complications: bleeding, perforation, toxic
megacolon
§ From dx takes 10 years to develop into cancer
• Cancer of the pancreatic head may lead to: ○ A: obstructive jaundice ○ B: hemolytic jaundice ○ C: hepatocellular jaundice ○ D: all of the above
○ A: obstructive jaundice
§ S/S: dark urine, cotton colored stools, yellow skin § Test: Alkaline phosphatase↑, Bilirubin↑
• Initial pain of appendicitis may be: ○ A: in the back ○ B: in the right shoulder ○ C: in the chest ○ D: around the umbilicus
○ D: around the umbilicus
§ Then to RLQ- MacBurney point
• In liver failure there is an increase in: ○ A: RBC ○ B: BUN ○ C: Vit 125 D ○ D: Ammonia
D: ammonia
• In kidney failure there is an increase in: ○ A: RBC ○ B: BUN ○ C: Vit 125 D ○ D: Ammonia
○ B: BUN
• Salivary digestive juice initiates digestion of: ○ A: protein ○ B: carbohydrate ○ C: vitamins ○ D: minerals
○ B: carbohydrates
§ Salivary digestive juice= amylase
• Peptic ulceration may occur in: ○ A: esophagus ○ B: stomach ○ C: duodenum ○ D: All of the above
○ D: all of the above
• Candida infection may occur in: ○ A: esophagus ○ B: stomach ○ C: duodenum ○ D: all of the above
○ A: esophagus
§ Others have too high of acid § If thick coating of candida, concern HIV
• C.Difficile infection may lead to pseudo-membranous infection of: ○ A: esophagus ○ B: stomach ○ C: duodenum ○ D: colon
○ D: colon
• In hemolytic jaundice there is: ○ A: light colored stool ○ B: increase in reticulocyte count ○ C: increase in serum ammonia ○ D: confusion
○ B: increase in reticulocyte count
• In obstructive jaundice there is: ○ A: light colored stool ○ B: increase reticulocyte count ○ C: increase in serum ammonia ○ D: confusion
○ A: light colored stool
• A cause of hemolytic jaundice is: ○ A: iron deficiency ○ B: sickle cell disease ○ C: hemophilia ○ D: edema of both feet
○ B: sickle cell disease
• Liver failure may result in: ○ A: iron deficiency ○ B: sickle cell disease ○ C: hemophilia ○ D: edema of both feet
○ D: edema of both feet (bilateral)
- d/t low oncotic pressure b/c ↓albumin
• Persistent bleeding from the GI tract will lead to: ○ A: iron deficiency ○ B: sickle cell anemia ○ C: hemophilia ○ D: edema of both feet
○ A: iron deficiency
• Causes of edema of both feet include: ○ A: heart failure ○ B: liver failure ○ C: kidney failure ○ D: all of the above
○ D: all of the above
§ HT- not pumping ' § LR- no protein production-- low oncotic pressure § KD- proteinuria-- low oncotic pressure
• Factors that may have a role in the formation of peptic ulcers include: ○ A: high cholesterol ○ B: family history ○ C: H. Pylori ○ D: gall stones
○ C: H. Pylori
• Complications of diverticulitis include: ○ A: cancer ○ B: jaundice ○ C: perforation ○ D: kidney failure
○ C: perforation– will lead to acute peritonitis
• Heart failure may be caused by: ○ A: myocardial infarction ○ B: hypertension ○ C: valvular disease ○ D: all of the above
D: all of the above
• The main area for the breakdown of old RBC's is: ○ A: liver ○ B: kidney ○ C: bone marrow ○ D: none of the above
○ D: none of the above- is SPLEEN
Make a list of KIDNEY function tests:
○ BUN↑ ○ Creatinine (clearance) ○ Potassium↑ ○ Uric acid↑ ○ Calcium↓ (no 1,25 D) ○ RBC/Anemia↓ (no erythropoietin)
Make a list of LIVER function tests:
○ Bilirubin (↑in jaundice)
○ Alkaline phosphatase (↑ w/ blockage i.e. GB Stone, cancer pancreatic head)
○ AST/ALT (↑↑ viral hepatitis, or any time LR cell breaking down)
○ NH₃ (↑ w/ LR failure)
○ Albumin (↓ w/ LR failure- lead to low oncotic pressure & bilateral pedal edema)
○ Prothrombin time (↑ w/ LR failure b/c not enough coagulation proteins)
Name the acute complications of diabetes mellitis:
○ Ketoacidosis
○ Hypoglycemia
○ Infection
Name the chronic complications of diabetes mellitus:
“HKBL^2”
○ HT attack/disease
○ KD disease
○ Blindness
○ Peripheral limb loss
List possible causes of a positive hemocult:
○ Hemorrhoids ○ Peptic ulcer ○ Cirrhosis ○ Regional enteritis ○ Ulcerative colitis ○ Crohn's disease
What are the primary symptoms of:
A) Cancer of the esophagus
B) Duodenal ulcer
C) Diverticulitis
D) Celiac disease
E) Cancer of the cecum
A) Cancer of Esophagus- DYSPHAGEA
B) Duodenal ulcer- PAIN- epigastric & RUQ
C) Diverticulitis- PAIN- LLQ
D) Celiac disease- DIARRHEA d/t malabsorption
E) Cancer of the cecum- ANEMIA
-cecum= 1st part of colon where stool is still liquid,
so no obstruction but bleeding
• What are the secretions of the duodenum and pancreas (both exocrine and endocrine)?
○ Duodenum
§ CCK
□ Stimulate bile
§ Secretin □ Stimulate pancreas exocrine secretions ○ Pancreas § Endocrine (no duct- Islets of Langerhand): □ Insulin □ Glucagon § Exocrine (duct- Sphincter of Oddi) □ Protease □ Lipase □ Amylase
Classify anemia. Give second line tests.
○ Macrocytic
§ B12 xu
§ Folic acid xu
§ Second line tests: □ B12 (↓ in B12 xu, norm in F.A. xu) □ Folic acid (↓ in F.A. xu, norm in B12 xu) ○ Normocytic § Hemolysis § Bone marrow disease § Second line tests: □ Reticulocyte count (↓-BMD, ↑-hemolysis) ○ Microcytic § Iron xu § Anemia of chronic illness § Second line tests: □ Iron (↓-Fe xu, ↓-ACI) □ TIBC (norm- Fe xu, ↓ACI)
What is DVT?
Deep venous thrombophlebitis
Thrombus–> embolus–> lung–>Pulmonary embolus
What is G6PD?
A hormone found in the blood that is not present in many Italians. If eat fava beans will lead to complete hemolysis.
• Give four causes of hemolytic anemia.
○ Sickle cell anemia
○ Wrong blood transfusion ○ Defective heart valve (shredding blood cells) ○ Penicillin/Certain antibiotics
• Describe the different stages of Hodgkin’s disease. What is the diagnostic cell for hodgkin’s?
○ Stage 1: One area/ lymph group affected
○ Stage 2: Two areas/lymph group - on same side of diaphragm
○ Stage 3: Both sides of diaphragm affected- within lymph system
○ Stage 4: spread outside lymph system, multiple areas
○ Reed Sternberg cells
○ Hodgkin’s= Malignant lymphoma
What are possible initial S/S of Hodgkins?
○ Cough or hoarseness of voice that persists
○ Lump that persists
○ Blood in stools
○ Abnormal vaginal bleeding
○ Bleeding from nipple
○ Skin lesion
○ Dysuria
• Multiple myeloma is a disease of what cell? What substances does this cell normally produce? What tests would you do?
○ Cancer of plasma cells
○ Plasma cells normally produce antibodies
○ Multiple myeloma affects the bone marrow–>
• RBC↓ & Platelet↓
□ –>Anemia & poor clotting
• Antibodies from plasma cells are dysfunctional--> □ Poor immunofunction--> risk disease
○ Test: ↑Serum calcium, X-Ray (moth eaten bones)
• b/c bone becoming eroded from inside out
• Leads to KD failure b/c filtering shi calcium
○ S/S:
• Achey all bones
• Bruising/bleeding
• Anemia- tired/weak
• What is a megakaryocyte?
○ Precursor cell to platelet
• What are the functions of blood?
○ Transports
• O2, CO2, nutrients, wastes, hormones, etc.
○ Maintains body temperature
○ Controls pH
○ Removes toxins from the body
○ Regulation of body fluid electrolytes
• Describe the absorption of B12 starting with the intake by mouth.
○ B12- mostly found in animal sources
○ In ST combo w/ I.F.
○ Absorbed in ileum
• If ileum diseased–> B12 xu anemia
□ Ex: Crohn’s Disease (iron xu- bleeding +
B12xu- ileum diseased)
○ Need Fe + B12 to produce blood
• S/S & tests for obstructive jaundice?
○ S/S:
• Pain- URQ, referring to RT shoulder
• White cotton stools
• Itching skin
○ Test:
• ↑Bilirubin
• ↑ Alk Phos
What are tests for hemolytic jaundice?
○ ↑Bilirubin
○ ↑Reticulocyte count
• Give examples of causes and tests for hepatocelluar jaundice.
○ Examples: LR disease/failure (cirrhosis, hepatitis B/C/D)
○ Tests:
• ↑ AST/ALT
• ↑ Bilirubin
• ↑ Prothrombin time
• ↑ NH₃
Leukemia
○ Normal WBC count: 8-12,000
○ WBC count w/ infection: 15,000+ (above 30k=concern)
○ Extremely high WBC: cancer/leukemia
• Before a person is started on immunosuppressive medications, it is important that we find out if he has any past history of:
○ A: Schizophrenia ○ B: Peptic ulcer disease ○ C: TB ○ D: Asthma
○ C: TB
• Mesothelioma is seen in:
○ A: Silicosis ○ B: Anthracosis ○ C: Asbestosis ○ D: HIV
○ C: Asbestosis
• A cause of hemolytic jaundice is:
○ A: Iron xu ○ B: mismatched blood transfusion ○ C: Hemophilia ○ D: Edema of both feet
○ B: mismatched blood transfusion
• Pain on inspiration (pleuritic pain) is suggestive of:
○ A: Coronary vascular disease ○ B: gallbladder disease ○ C: lung disease ○ D: all of the above
○ C: lung disease
○ w/ GB- press on deep inhale- murphy sign
• Unilateral leg swelling, is suggestive of:
○ A: heart failure ○ B: liver disease ○ C: kidney problems ○ D: none of the above
○ D: none of the above
• Unilateral pitting:
□ Trauma
□ Venous blockage
* Unilateral nonpitting:
* Lymphedema
• Upper GI bleed may be due to:
○ A: cirrhosis of the liver ○ B: cancer of the colon ○ C: ulcerative colitis ○ D: none of the above
○ A: cirrhosis of the liver
• Esophageal varices- can cause death cirrhosis
• Cancer of colon + ulcerative colitis= hematochezia
• Soon after the TB bacteria enters the lung of a healthy person:
○ A: it spreads quickly ○ B: is confined in a system called Ghon's complex ○ C: It causes hemoptysis ○ D: it is killed by the septal cells
○ B: it is confined in a system called Ghon’s complex
• Found in tuberculosis, is a calcification and
enclosure of infection
• When a cancer cell starts producing ectopic hormones it is called:
○ A: Metastasis
○ B: paraneoplastic transformation
○ C: Mitosis
○ D: none of the above
○ B: paraneoplastic transformation
○ Metastasis= when cancer spreads– via blood, lymphatics, or locally
• The complications of uncontrolled hypertension include:
○ A: Peptic ulceration ○ B: Stroke ○ C: Pulmonary embolism ○ D: COPD
○ B: Stroke
○ St.A.KD.Blind.Legs • Stroke • ASHD/Ht attack • Kidney disease • Blindness • Arterial insufficiency of legs
• Candida infection may occur in the:
○ A: esophagus
○ B: stomach
○ C: duodenum
○ D: all of the above
○ A: esophagus
○ Stomach and duodenum have too much acid for growth
• Non-pitting edema is suggestive of:
○ A: heart failure ○ B: Kidney failure ○ C: lymphedema ○ D: liver impairment
○ C: lymphedema
○ HT, LR, KD- all bilateral pitting edema
• What is the pathogenesis (basic cause) of rheumatic fever?
○ A: ASHD ○ B: Past bacterial infection ○ C: Congenital heart disease ○ D: Alcohol
○ B: past bacterial infection
• Streptococcus
• C.Difficile infection, often seen after prolonged antibiotic use, may lead to pseudo membranous infection of the:
○ A: Esophagus ○ B: stomach ○ C: duodenum ○ D: colon
○ D: colon
• Reticulocyte count is helpful in the diagnosis of:
○ A: iron xu ○ B: hemolytic anemia ○ C: hodgkin's disease ○ D: none of the above
○ B: hemolytic anemia
○ Iron xu= Fe, TIBC
○ Hodgkin’s= reed sternberg cell
• Cancer of the colon is seen more commonly in:
○ A: Crohn's disease ○ B: ulcerative colitis ○ C: diverticulitis ○ D: C. Difficile colitis
○ B: ulcerative colitis
• Ulcer becomes cancerous after 10 years w/o tx
• Common pneumonia seen in a person with HIV infection is:
○ A: mycoplasma ○ B: staphylococcus ○ C: E. Coli ○ D: pneumocystis
○ D: pneumocystis
• The sex chromosomal pattern of a hemophilia carrier is:
○ A: XO ○ B: XXY ○ C: XX ○ D: XY
○ C: XX
• Women are always the carrier for hemophilia
○ XO= Turner’s syndrome
○ XXY= Kleindfelter’s syndrome
○ XY= male sex chromosomal pattern
• Peptic ulceration may occur in the:
○ A: esophagus ○ B: stomach ○ C: duodenum ○ D: all of the above
○ D: all of the above
○ Causes: ↑HCL, H. Pylori infection, NSAIDS or Aspirin
• The risks of thrombophlebitis of the legs include:
○ A: Acute myocardial infarction ○ B: Acute pulmonary edema ○ C: Pulmonary embolus ○ D: heart failure
○ C: pulmonary embolus
○ Acute pulmonary edema= acute complication-acute mi.
○ Any disease of heart can lead to ht failure (pump fails)
• When a person presents to any ER with acute chest pain, the standard tests done to rule out acute myocardial infarction include:
○ A: CPK ○ B: EKG ○ C: Troponin ○ D: all of the above
○ D: all of the above
○ CPK + Troponin= enzymes from inside HT cells
• Gynecomastia may be present in:
○ A: Klinefelter's Syndrome
○ B: in advanced Cirrhosis d/t poor hormone
inactivation
○ C: Both of the above
○ D: None of the above
○ C: both of the above
○ Also testicular atrophy d/t elevated levels estrogen
• Black tarry stool may be seen with:
○ A: hemorrhoids ○ B: colon cancer ○ C: bleeding duodenal ulcer ○ D: none of the above
○ C: bleeding duodenal ulcer
○ Hemorrhoids + colon cancer= hematochezia
• Below duodenum=red blood- undigested
• Which of the following often causes secondary hypertension
○ A: portal hypertension ○ B: carotid artery stenosis ○ C: anemia ○ D: renal artery stenosis
○ D: renal artery stenosis ○ "RENDS" • Renal • Endocrine (Cushings, Pheochromocytoma) • Neurogenic • Drug • Sleep apnea
• CD4 cells are:
○ A: B cells ○ B: A cells ○ C: Helper T cells
D: none of the above
○ C: helper T cells
• The PMI of the heart (apex beat) is normally located in the:
○ A: Right 5th intercostal space ○ B: left 6th intercostal space ○ C: left 5th intercostal space ○ D: lateral to the left midclavicular line
○ C: Left 5th intercostal space
• Medial to the midclavicular line
• Leg pain of the intermittent claudication variety is suggestive of:
○ A: arterial insufficiency ○ B: venous insufficiency ○ C: neuropathy ○ D: deep thrombophlebitis
○ A: arterial insufficiency
○ Venous insufficiency + deep thrombophlebitis (DVT)
=rel vein.
• Vein= edema
• Artery=pain
• Macrocytic anemia is seen in:
○ A: iron deficiency ○ B: hemolytic anemia ○ C: bone marrow failure ○ D: none of the above
○ D: none of the above
• Macrocytic= folic acid or B12 xu
○ Iron xu= microcytic
○ Hemolytic & bone marrow= normocytic
• Acute complications following acute myocardial infarction include:
○ A: rupture of the ventricle ○ B: hemopericardium ○ C: Ventricular arrythmia ○ D: all of the above
○ D: all of the above
• HTBRAA
□ HT failure (acute pulmonary edema)
□ Blood clot (thrombus or embolus)
□ Rupture
□ Arrhythmia
(acute/fatal type= ventricular fibrillation)
□ Aneurism (bulging where infarction was)
• In portal hypertension there is:
○ A: hepatomegaly ○ B: cardiomegaly ○ C: splenomegaly ○ D: none of the above
○ C: splenomegaly
• Spleen always enlarged w/ portal hypertension
• Etiology of cirrhosis include:
○ A: asbestos exposure ○ B: viral hepatitis ○ C: vitamin xu ○ D: trauma
○ B: viral hepatitis
○ Asbestos exposure= etiology mesothelioma
• High levels of serum potassium is seen in:
○ A: Addison's disease ○ B: Increased ingestion of potassium rich food ○ C: liver failure ○ D: heart failure
○ A: Addison’s disease
• b/c no aldosterone- not kicking out potassium
Also seen in KD failure b/c not filtering out potassium
• High hemoglobin A1C suggests:
○ A: good control of D.M. ○ B: poor control of DM ○ C: Diabetic complication ○ D: presence of other disease in addition to DM
○ B: poor control of DM
• Goal= A1C <7
• Ascites is seen:
○ A: in heart failure ○ B: with portal hypertension ○ C: in obstructive jaundice ○ D: in COPD
○ B: with portal hypertension
• BUN is made from ammonia by:
○ A: the pancreas ○ B: the liver ○ C: the spleen ○ D: the small intestine
○ B: the liver
• Protein>N>NH₃>LR>BUN>KD>Excretion
• The number of chromosomes present in a sex cell (sperm cell or ova) is:
○ A: 46 ○ B: 44 ○ C: 23 ○ D: 22
○ C: 23
• 22 autosomes + 1 sex chromosome
• In the bone marrow, the precursor cell that form the RBC is:
○ A: B-cell ○ B: Erythropoietin ○ C: Pro-erythroblast ○ D: All of the above
○ C: Pro-erythroblast
○ B-cell= precursor to plasma cell (which makes antibodies)
○ Erythropoietin= hormone KD stimulates bone marrow make RBC
• In dealing with congenital heart disease, “reversal of shunt” means:
○ A: flow of blood is from right to left ○ B: flow of blood is from left to right ○ C: flow of blood is from above to below ○ D: flow of blood is from below to above
○ A: flow of blood is from right to left
• Increase in hemoglobin may be seen in:
○ A: COPD ○ B: Bleeding ○ C: Renal failure ○ D: Cirrhosis
○ A: COPD
- Body produces more RBC’s when not receiving enough oxygen
- Erythropoietin↑
• The cause of confusion in liver failure (hepatic encephalopathy) is:
○ A: increase in BUN ○ B: increase in alcohol ○ C: increase in bilirubin ○ D: increase in ammonia
○ D: increase in ammonia
○ BUN↓ b/c LR not converting NH₃ to BUN
• Vomiting of blood in a person w/ cirrhosis is likely to be from:
○ A: esophageal varices ○ B: esophageal cancer ○ C: reflux esophagitis ○ D: duodenal ulcer
○ A: esophageal varices
• Also common cause of death in cirrhosis
• The endocrine secretions of the pancreas include:
○ A: Glycogen ○ B: secretin ○ C: pepsin ○ D: none of the above
○ D: none of the above
• Endocrine secretions of pancreas from Islets of langerhand
□ Glucagon
□ Insulin
- Glycogen= stored form of glucose
- Secretin= duodenal secretion
- Pepsin= stomach secretion
• Intrinsic factor combined with vitamin B12 is absorbed in the:
○ A: jejunum ○ B: ileum ○ C: cecum ○ D: none of the above
○ B: ileum
• What is the blood test for HIV infection:
○ A: western blot ○ B: ANA ○ C: microalbumin ○ D: Sedimentation rate
○ A: western blot
○ ANA= lupus
○ Microalbumin= earliest sign D.M rel KD disease
○ Sedimentation rate= PMR
• Initial pain of appendicitis may be:
○ A: in the back ○ B: in the right shoulder ○ C: in the chest ○ D: around the umbilicus
○ D: around the umbilicus
• A 32 year old IV drug using male is seen in the ER with a week of high fever, malaise, wt loss & SOB. He has a HT murmur that he never had before. His WBC count is 20,000. He probably has:
○ A: hyperthyroidism
○ B: Chronic pancreatitis
○ C: bacterial endocarditis involving left side of his HT
○ D: bacterial endocarditis involving right side of his HT
○ D: bacterial endocarditis involving the right side of his HT
- LT side= rel damaged valve from bacterial infection d/t rheumatic fever (etiology of streptococcus)
- RT side= drug users
• Pain in the left lower quadrant in a 60 year old man is suggestive of:
○ A: appendicitis ○ B: acute diverticulitis ○ C: acute pancreatitis ○ D: acute prostatitis
○ B: acute diverticulitis
• The causes of microcytic anemia include:
○ A: pernicious anemia ○ B: anemia of bone marrow failure ○ C: hemolytic anemia ○ D: anemia of chronic illness
○ D: anemia of chronic illness
• Microcytic also=iron xu
• Pernicious anemia=macrocytic d/t B12 xu
□ Autoimmune destruction of gastric parietal cells>
lack of IF> no B12 absorption in illeum
• Anemia of Bone Marrow failure + Hemolytic=Normocytic
• Antibodies are made by:
○ A: T-cells ○ B: Plasma cells ○ C: Macrocytes ○ D: megakaryocytes
○ B: plasma cells
• From B-cells
○ Megakaryocytes= precursor to platelet cells
• Prolonged antibiotic use may lead to:
○ A: jaundice ○ B: hematuria ○ C: a black hairy tongue ○ D: caries
○ C: a black hairy tongue
• Certain antibiotics (ex:penicillin) also cause hemolysis
○ Caries= cavities/tooth decay
• In addition to parotid inflammation, the mumps virus may also affect which of the following organs:
○ A: pancreas ○ B: ovary ○ C: testes ○ D: all of the above
○ D: all of the above
* Mumps affecting tests> infertility * Women= full recovery/fertility
• Complications of a gastric ulcer include all except:
○ A: pyloric obstruction ○ B: perforation ○ C: peritonitis ○ D: ascites
○ D: ascites
• d/t cirrhosis
• What is the blood test for systemic LUPUS erythemetosus?
○ A: western blot ○ B: ANA ○ C: microalbumin ○ D: sedimentation rate
○ B: ANA
* Western blot= HIV * Microalbumin= D.M urine test * Sed rate= PMR
