Review Questions Flashcards
What adult structures are derived from the 3rd aortic arch?
Common carotid and proximal part of internal carotid
What adult structures are derived from the 2nd aortic arch?
Stapedial artery, hyoid artery
What adult structures are derived from the 4th aortic arch?
L: aortic arch
R: proximal part of subclavian artery
What adult structures are derived from the 6th aortic arch?
Proximal part of pulmonary arteries (L and R) Ductus arteriosus (L)
How does a branchial cleft cyst arise?
Failure of cervical sinus to obliterate; branchial cleft origin (ectoderm); located in lateral neck and does NOT move when PT swallows
Outline the heart tube formation
Heart tube elongates, folds into S-shape with atrial chamber posterior and ventricular anterior, anterior grows to incorporate SVC and pulmonary vein, septum primum forms, septum secundum forms
3 causes of ASD
- Ostium secundum overlaps foramen ovale
- Absence of septum secundum
- Neither septum primum or septum secundum forms
What does the truncus arteriosus give rise to?
Ascending aorta and pulmonary trunk
What does the L. horn of the sinus venosus give rise to?
Coronary sinus
What do the R. common cardinal vein and R. anterior cardinal vein give rise to?
SVC
What does the bulbus cordis give rise to?
Smooth parts of the L & R ventricles
What does the R. horn of the sinus venosus give rise to?
Smooth part of the R. atrium
What gives rise to the trabeculated L & R atria?
Primitive atria
What gives rise to the trabeculated L & R ventricles?
Primitive ventricles
Which fetal vessel has the highest oxygen content?
Umbilical vein > Ductus venosus > IVC > R. atrium
What is Eisenmenger syndrome?
L –> R shunt leads to incr. pressure in the pulmonary circuit which leads to Pulmonary HTN –> reversal of shunt R–>L
What is the most common congenital cardiac anomaly?
VSD: failure of endocardial cushions to fuse
What is the most common congenital cause of early cyanosis?
Tetralogy of Fallot
How can MVO2 be decreased in ischemic situations?
Decr. afterload, Decr. contractility, Decr. HR
What changes will increase SV at a given preload?
Sympathetic stimulation, ionotropic drugs, incr. intracellular Ca, decr. extracellular Na
What factors affect stroke volume?
Contractility, Preload, Afterload
What effect does squatting have on SV?
Decr. SV by incr. afterload
What infection does C. trachomatosis (A-C) cause?
Eye infection; occurs in Africa
What infection does C. trachomatosis (D-K) cause?
STD, PID, Urethritis, Neonatal conjuctivitis
What infection does C. trachomatosis (L1-L3) cause?
Lymphogranuloma venerum
What is Cor Pulmonale?
RHF d/t pulmonary disease
What are the signs of RHF?
- Peripheral edema
- JVD
- Hepatosplenomegaly
What are the signs of LHF?
- Cardiac dilation
- Dyspnea on exertion
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Pulmonary congestion sx i.e. Rales
What medications are used to tx Acute HF?
LMNOP
-Loop diuretics, Morphine, Nitrates, Oxygen, Positioning/Pressors
How is Coxiella burnetti different from the other Rickettsial spp?
(-) Weil-Felix rxn, No vector, aerosol transmission of spore, No rash, interstitial pneumonia
What serum lab marker helps assess oxygenation of tissues?
Lactic acid
Where does the QRS complex fall in relation to valvular dynamics?
MV closure
What is the most common protozoal infection in the U.S.?
Toxoplasma gondii
What is teh most common helminthic infection in the U.S.?
Enterobius vermicularis
What murmurs are heard best in the L. Lateral decubitus position?
MV Stenosis, MV Regurgitation, L. sided S3, Late S4
Rumbling late diastolic murmur with an opening snap
Mitral stenosis
Pansystolic murmur that is best heard at L. Lower sternal border and radiates to the R. Lower sternal borner
Tricuspid regurg or VSD
Crescendo-decrescendo systolic murmur that is best heard in the 2nd-3rd Left ICS
Pulmonic stenosis
Late systolic murmur preceded by a mid-systoic click
MV Prolapse
Crescendo-decrescendo systolic murmur that is best heard in the 2nd-3rd Right ICS
Aortic stenosis
Early diastolic decrescendo murmur heard best along L. side of sternum
Pulmonic Regurg
Late diastolic decrescendo murmur heard best along L. side of sternum
Tricuspid stenosis
What drugs cause a disulfiram-like rxn?
Metronidazole, Cephalosporins, 1st gen. Sulfonylureas
What are the 5 Hereditary Thrombosis syndromes
- Factor V Leiden
- Prothrombin 20210
- Protein C deficiency
- Protein S deficiency
- Antithrombin deficiency
Preferred pharmacologic treatment of Aortic dissection
B-blockers
What are the Non-Dihydropyridine CCBs?
Verapamil, Diltiazem
-block Ca-channels at pacemaker cells to decr. contractility
What are the Dihydropyridine CCBs?
Nifedipine, Amlodipine, Felodipine, Nicardipine, Nisoldipine
-cause vasodilation by acting on VSM
What antihypertensives are safe to use in pregnancy?
- Hydralazine
- Methyldopa
- Labetalol
- Nifedipine
What drug causes First dose orthostatic hypotension
a1-blockers (-zosin)
What drug is Ototoxic esp. with aminoglycosides
Loop diuretics
What drug causes Hypertrichosis
Minoxidil
What drug causes Cyanide toxicity
Nitroprusside
What drug causes Dry mouth, sedation, severe rebound HTN
Clonidine (a2 agonist)
What drug causes Bradycardia, impotence, asthma exacerbation
B-blockers
What drug causes Reflex tachycardia
Nitrates, Hydralazine, Diphenhydramine
Avoid this drug in PTs with sulfa allergy
Loop and Thiazide diuretics
What are the risk factors for Coronary Artery Dz
Smoking, HTN, low HDL, age >45, family hx Congestive Heart Dz
How do free radicals damage cells?
Lipid peroxidation, Protein modification, DNA breakage
Which vitamins have anti-oxidant properties?
A, C, E
Which enzymes participate in elimination of free radicals?
- Catalase
- Superoxide dismutase
- Glutathione peroxidase
What is the role of TGF-B
Angiogenesis, Fibrosis, Cell Cycle arrest
What are the Granulomatous diseases?
- B. henselae (cat scratch), F. tularensis, L. monocytogenes, M. leprae, M. tuberculosis, T. pallidum, Schistosomiasis, Fungal infections (histoplasmosis, blastomycosis)
- Berylliosis
- Churg-Strauss
- Crohn’s
- Granulomatosis with polyangiitis (Wegener’s)
- Sarcoidosis
- Chronic Granulomatous dz
- Foreign bodies
What is the role of TNF-a
- Inflammatory cytokine
- Induces and maintains granuloma formation
What cytokine activates macrophages
IFN-y; produced by Th1 cells
Disease states with incr. ESR
- Most anemias
- Infections; esp. Osteomyelitis
- Inflammation; i.e. Temporal Arteritis
- Cancer
- Pregnancy
- Autoimmune DO
- Polymyalgia Rheumatica
Disease states with decr. ESR
- Sickle Cell anemia
- Polycythemia
- CHF
How does Iron cause toxicity?
Peroxidation of membrane lipids –> cell death
-Chronic poisoning can lead to metabolic acidosis (within 6-72hrs)
What are the acute phase reactive proteins?
Fibrinogen, CRP, Ferritin, ESR
What organs does Primary Amyloidosis affect?
- Renal –> Nephrotic syndrome
- Cardiac –> Restrictive cardiomyopathy, arrhythmias
- Hematologic –> Easy bruising
- GI –> Hepatomegaly
- Neurologic –> Neuropathy
*IgLight chains
What conditions are associated with Secondary Amyloidosis?
- Rheumatoid arthritis
- IBD
- Spondyloarthropathy
- Protracted infection
*serum amyloid A
Dialysis-related Amyloidosis
B2-microglobulin
-may present as carpal tunnel syndrome
What type of amyloid is present in Heritable Amyloidosis?
Mutated Transthyretin (TTR) -ATTR neurologic/ cardiac amyloidosis
What type of amyloid is present in Senile Amyloidosis?
Normal TTR
Amyloid deposition in Alzheimer’s disease
Amyloid-B protein from APP
Amyloid deposition in DM II
Amylin deposition in pancreatic islets
Amyloid deposition in Medyllary thyroid carcinoma
Calcitonin –> A-Cal
What is multi-drug resistance protein I?
MDR1 is expressed by some cancer cells to pump out toxins- including chemotherapeutic agents; mechanism of decr. responsiveness to chemotherapy
What cellular change is characterized by proliferation, loss of cellular orientation, shape and size?
Dysplasia
-often pre-neoplastic but is reversible
What is desmoplasia?
Fibrous tissue formation in response to neoplasm i.e. Linitis plastica (diffuse stomach cancer)
What has more prognostic value- Tumor Stage or Grade?
Stage
-degree of localization/ spread based on site and size of primary lesion, spread to regional LN, presence of metastases
Carcinoma
- Epithelial origin
- Lymphatic spread
Sarcoma
- Mesenchymal origin; mesenchymal tumors rarely TRANSFORM into malignant
- Hematogenous spread
Which carcinomas spread hematogenously?
- Renal cell carcinoma
- Hepatocellular carcinoma
- Follicular carcinoma of thyroid
- Choriocarcinoma
What are the mediators of Cachexia?
TNF-a, TFN-y, IL-6
-Cachexia occurs in chronic disease states i.e. cancer, AIDS, heart failure, TB
How do oncogene mutations increase cancer risk?
Gain of function mutation in 1 allele
How do tumor suppressor mutations increase cancer risk?
Loss of function mutation in both alleles
What area of lymph nodes increases in extreme cellular immune responses
Paracortex (T-cell region)
What are the components of lymph?
- Interstitial fluid with high protein content
- Chylomicrons with high TG content
- Antibodies
Where does T-cell selection occur?
Corticomedullary junction in the Thymus
Components of the innate immune system
Cell-mediated; germline encoded; non-specific; primary defense against intracellular pathogens
- Neutrophils
- Macrophages
- Monocytes
- Dendritic cells
- NK cells (lymphocyte)
- Complement
TLRs recognized PAMPs (LPS, flagellin, ssRNA, etc.)
Components of the adaptive immune system
Humoral; variation via VDJ recombination; primary defense against extracellular pathogens
- T-cells
- B-cells
- Circulating antibodies
MHC I
HLA-A, B, C
- Bind TCR and CD8; present endogenously synthesized antigens to CD8+ cytotoxic T-cells
- Expressed on all nucleated cells
MHC II
HLA-DR, DP, DQ
- Bind TCR and CD4; present exogenously synthesized proteins to CD4+ T-helper cells
- Only expressed on APCs
What cytokines enhance NK cell activity?
-IL-2, IL-12, IFN-B, IFN-a
B-cell functions
- Recognize antigen –> somatic hypermutation
- Produce antibody
- Maintain immunologic memory
T-cell functions
- help B-cells make antibody and produce cytokines to activate cells of immune system
- kill virus-infected cells directly
- delayed (Type IV) hypersensitivity
IL-12
Stimulates Helper T-cell –> Th1 cell
Th1 cell secretes IFN-y, IL-2
IL-4
Stimulates Helper T-cell –> Th2 cell
Th2 cells secretes IL-4,5,6,10,13
Antigen presenting cells
Macrophages, B-cells, Dendritic cells in skin
Regulatory T-cell surface markers
CD3, CD4, CD25, FOXP3
- fxn is to suppress CD4 and CD8 T-cell fxns
- produce IL-10 and TGF-B
What part of Ab recognizes Ag?
Variable part of L and H chains
What part of Ab fixes complement?
Fc portion of IgM and IgG
- Heavy chain contributes to Fc portion (carboxy terminal)
- Fc portion determines Ab isotype
Which Ig crosses the placenta to provide passive immunity?
IgG
Which cytokines induce production of Acute Phase reactants?
-IL-1, IL-6, IFN-y, TNF-a
Primary opsonins in bacterial defense?
C3b, IgG
Fxn of DAF and C1 esterase inhibitor
Prevent complement activation on self-cells
-DAF deficiency –> complement mediated RBC lysis and PNH
Which vaccines are live attenuated?
-MMR, Polio (oral- Sabin), Influenza (intranasal), Varicella, Yellow Fever, Smallpox
Which vaccines are inactivated?
-Cholera, Hepatitis A, Polio (Salk), Influenza, Rabies
Which vaccines are egg-based?
-Yellow Fever, Influenza, MMR (to a small extent)
