Review Questions Flashcards
1
Q
What adult structures are derived from the 3rd aortic arch?
A
Common carotid and proximal part of internal carotid
2
Q
What adult structures are derived from the 2nd aortic arch?
A
Stapedial artery, hyoid artery
3
Q
What adult structures are derived from the 4th aortic arch?
A
L: aortic arch
R: proximal part of subclavian artery
4
Q
What adult structures are derived from the 6th aortic arch?
A
Proximal part of pulmonary arteries (L and R) Ductus arteriosus (L)
5
Q
How does a branchial cleft cyst arise?
A
Failure of cervical sinus to obliterate; branchial cleft origin (ectoderm); located in lateral neck and does NOT move when PT swallows
6
Q
Outline the heart tube formation
A
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
7
Q
3 causes of ASD
A
- Ostium secundum overlaps foramen ovale
- Absence of septum secundum
- Neither septum primum or septum secundum forms
8
Q
What does the truncus arteriosus give rise to?
A
Ascending aorta and pulmonary trunk
9
Q
What does the L. horn of the sinus venosus give rise to?
A
Coronary sinus
10
Q
What do the R. common cardinal vein and R. anterior cardinal vein give rise to?
A
SVC
11
Q
What does the bulbus cordis give rise to?
A
Smooth parts of the L & R ventricles
12
Q
What does the R. horn of the sinus venosus give rise to?
A
Smooth part of the R. atrium
13
Q
What gives rise to the trabeculated L & R atria?
A
Primitive atria
14
Q
What gives rise to the trabeculated L & R ventricles?
A
Primitive ventricles
15
Q
Which fetal vessel has the highest oxygen content?
A
Umbilical vein > Ductus venosus > IVC > R. atrium
16
Q
What is Eisenmenger syndrome?
A
L –> R shunt leads to incr. pressure in the pulmonary circuit which leads to Pulmonary HTN –> reversal of shunt R–>L
17
Q
What is the most common congenital cardiac anomaly?
A
VSD: failure of endocardial cushions to fuse
18
Q
What is the most common congenital cause of early cyanosis?
A
Tetralogy of Fallot
19
Q
How can MVO2 be decreased in ischemic situations?
A
Decr. afterload, Decr. contractility, Decr. HR
20
Q
What changes will increase SV at a given preload?
A
Sympathetic stimulation, ionotropic drugs, incr. intracellular Ca, decr. extracellular Na
21
Q
What factors affect stroke volume?
A
Contractility, Preload, Afterload
22
Q
What effect does squatting have on SV?
A
Decr. SV by incr. afterload
23
Q
What infection does C. trachomatosis (A-C) cause?
A
Eye infection; occurs in Africa
24
Q
What infection does C. trachomatosis (D-K) cause?
A
STD, PID, Urethritis, Neonatal conjuctivitis
25
What infection does C. trachomatosis (L1-L3) cause?
Lymphogranuloma venerum
26
What is Cor Pulmonale?
RHF d/t pulmonary disease
27
What are the signs of RHF?
- Peripheral edema
- JVD
- Hepatosplenomegaly
28
What are the signs of LHF?
- Cardiac dilation
- Dyspnea on exertion
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Pulmonary congestion sx i.e. Rales
29
What medications are used to tx Acute HF?
LMNOP
| -Loop diuretics, Morphine, Nitrates, Oxygen, Positioning/Pressors
30
How is Coxiella burnetti different from the other Rickettsial spp?
(-) Weil-Felix rxn, No vector, aerosol transmission of spore, No rash, interstitial pneumonia
31
What serum lab marker helps assess oxygenation of tissues?
Lactic acid
32
Where does the QRS complex fall in relation to valvular dynamics?
MV closure
33
What is the most common protozoal infection in the U.S.?
Toxoplasma gondii
34
What is teh most common helminthic infection in the U.S.?
Enterobius vermicularis
35
What murmurs are heard best in the L. Lateral decubitus position?
MV Stenosis, MV Regurgitation, L. sided S3, Late S4
36
Rumbling late diastolic murmur with an opening snap
Mitral stenosis
37
Pansystolic murmur that is best heard at L. Lower sternal border and radiates to the R. Lower sternal borner
Tricuspid regurg or VSD
38
Crescendo-decrescendo systolic murmur that is best heard in the 2nd-3rd Left ICS
Pulmonic stenosis
39
Late systolic murmur preceded by a mid-systoic click
MV Prolapse
40
Crescendo-decrescendo systolic murmur that is best heard in the 2nd-3rd Right ICS
Aortic stenosis
41
Early diastolic decrescendo murmur heard best along L. side of sternum
Pulmonic Regurg
42
Late diastolic decrescendo murmur heard best along L. side of sternum
Tricuspid stenosis
43
What drugs cause a disulfiram-like rxn?
Metronidazole, Cephalosporins, 1st gen. Sulfonylureas
44
What are the 5 Hereditary Thrombosis syndromes
- Factor V Leiden
- Prothrombin 20210
- Protein C deficiency
- Protein S deficiency
- Antithrombin deficiency
45
Preferred pharmacologic treatment of Aortic dissection
B-blockers
46
What are the Non-Dihydropyridine CCBs?
Verapamil, Diltiazem
| -block Ca-channels at pacemaker cells to decr. contractility
47
What are the Dihydropyridine CCBs?
Nifedipine, Amlodipine, Felodipine, Nicardipine, Nisoldipine
| -cause vasodilation by acting on VSM
48
What antihypertensives are safe to use in pregnancy?
- Hydralazine
- Methyldopa
- Labetalol
- Nifedipine
49
What drug causes First dose orthostatic hypotension
a1-blockers (-zosin)
50
What drug is Ototoxic esp. with aminoglycosides
Loop diuretics
51
What drug causes Hypertrichosis
Minoxidil
52
What drug causes Cyanide toxicity
Nitroprusside
53
What drug causes Dry mouth, sedation, severe rebound HTN
Clonidine (a2 agonist)
54
What drug causes Bradycardia, impotence, asthma exacerbation
B-blockers
55
What drug causes Reflex tachycardia
Nitrates, Hydralazine, Diphenhydramine
56
Avoid this drug in PTs with sulfa allergy
Loop and Thiazide diuretics
57
What are the risk factors for Coronary Artery Dz
Smoking, HTN, low HDL, age >45, family hx Congestive Heart Dz
58
How do free radicals damage cells?
Lipid peroxidation, Protein modification, DNA breakage
59
Which vitamins have anti-oxidant properties?
A, C, E
60
Which enzymes participate in elimination of free radicals?
- Catalase
- Superoxide dismutase
- Glutathione peroxidase
61
What is the role of TGF-B
Angiogenesis, Fibrosis, Cell Cycle arrest
62
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
63
What is the role of TNF-a
- Inflammatory cytokine
| - Induces and maintains granuloma formation
64
What cytokine activates macrophages
IFN-y; produced by Th1 cells
65
Disease states with incr. ESR
- Most anemias
- Infections; esp. Osteomyelitis
- Inflammation; i.e. Temporal Arteritis
- Cancer
- Pregnancy
- Autoimmune DO
- Polymyalgia Rheumatica
66
Disease states with decr. ESR
- Sickle Cell anemia
- Polycythemia
- CHF
67
How does Iron cause toxicity?
Peroxidation of membrane lipids --> cell death
| -Chronic poisoning can lead to metabolic acidosis (within 6-72hrs)
68
What are the acute phase reactive proteins?
Fibrinogen, CRP, Ferritin, ESR
69
What organs does Primary Amyloidosis affect?
- Renal --> Nephrotic syndrome
- Cardiac --> Restrictive cardiomyopathy, arrhythmias
- Hematologic --> Easy bruising
- GI --> Hepatomegaly
- Neurologic --> Neuropathy
*IgLight chains
70
What conditions are associated with Secondary Amyloidosis?
- Rheumatoid arthritis
- IBD
- Spondyloarthropathy
- Protracted infection
*serum amyloid A
71
Dialysis-related Amyloidosis
B2-microglobulin
| -may present as carpal tunnel syndrome
72
What type of amyloid is present in Heritable Amyloidosis?
```
Mutated Transthyretin (TTR)
-ATTR neurologic/ cardiac amyloidosis
```
73
What type of amyloid is present in Senile Amyloidosis?
Normal TTR
74
Amyloid deposition in Alzheimer's disease
Amyloid-B protein from APP
75
Amyloid deposition in DM II
Amylin deposition in pancreatic islets
76
Amyloid deposition in Medyllary thyroid carcinoma
Calcitonin --> A-Cal
77
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
78
What cellular change is characterized by proliferation, loss of cellular orientation, shape and size?
Dysplasia
| -often pre-neoplastic but is reversible
79
What is desmoplasia?
Fibrous tissue formation in response to neoplasm i.e. Linitis plastica (diffuse stomach cancer)
80
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
81
Carcinoma
- Epithelial origin
| - Lymphatic spread
82
Sarcoma
- Mesenchymal origin; mesenchymal tumors rarely TRANSFORM into malignant
- Hematogenous spread
83
Which carcinomas spread hematogenously?
- Renal cell carcinoma
- Hepatocellular carcinoma
- Follicular carcinoma of thyroid
- Choriocarcinoma
84
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
85
How do oncogene mutations increase cancer risk?
Gain of function mutation in 1 allele
86
How do tumor suppressor mutations increase cancer risk?
Loss of function mutation in both alleles
87
What area of lymph nodes increases in extreme cellular immune responses
Paracortex (T-cell region)
88
What are the components of lymph?
- Interstitial fluid with high protein content
- Chylomicrons with high TG content
- Antibodies
89
Where does T-cell selection occur?
Corticomedullary junction in the Thymus
90
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.)
91
Components of the adaptive immune system
Humoral; variation via VDJ recombination; primary defense against extracellular pathogens
- T-cells
- B-cells
- Circulating antibodies
92
MHC I
HLA-A, B, C
- Bind TCR and CD8; present endogenously synthesized antigens to CD8+ cytotoxic T-cells
- Expressed on all nucleated cells
93
MHC II
HLA-DR, DP, DQ
- Bind TCR and CD4; present exogenously synthesized proteins to CD4+ T-helper cells
- Only expressed on APCs
94
What cytokines enhance NK cell activity?
-IL-2, IL-12, IFN-B, IFN-a
95
B-cell functions
- Recognize antigen --> somatic hypermutation
- Produce antibody
- Maintain immunologic memory
96
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
97
IL-12
Stimulates Helper T-cell --> Th1 cell
| Th1 cell secretes IFN-y, IL-2
98
IL-4
Stimulates Helper T-cell --> Th2 cell
| Th2 cells secretes IL-4,5,6,10,13
99
Antigen presenting cells
Macrophages, B-cells, Dendritic cells in skin
100
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
101
What part of Ab recognizes Ag?
Variable part of L and H chains
102
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
103
Which Ig crosses the placenta to provide passive immunity?
IgG
104
Which cytokines induce production of Acute Phase reactants?
-IL-1, IL-6, IFN-y, TNF-a
105
Primary opsonins in bacterial defense?
C3b, IgG
106
Fxn of DAF and C1 esterase inhibitor
Prevent complement activation on self-cells
| -DAF deficiency --> complement mediated RBC lysis and PNH
107
Which vaccines are live attenuated?
-MMR, Polio (oral- Sabin), Influenza (intranasal), Varicella, Yellow Fever, Smallpox
108
Which vaccines are inactivated?
-Cholera, Hepatitis A, Polio (Salk), Influenza, Rabies
109
Which vaccines are egg-based?
-Yellow Fever, Influenza, MMR (to a small extent)
