Set 10 Flashcards
How much does the H&H change in a person that has acclimatized to a hypoxic environment for weeks?
Hct rises from 45 to 60
Hemoglobin 15 to 20
Part of acclimatizing
- A 53-year-old man has just been diagnosed with peptic ulcer disease (PUD) visualized on endoscopy. Ranitidine and lansoprazole are the medications available on your hospital formulary for treatment of PUD. Describe the different ways in which ranitidine and lansoprazole decrease parietal cell acid secretion. Why is ranitidine preferred over cimetidine? What other conditions can you treat with lansoprazole and ranitidine?
Ranitidine: reversible block of histamine H2 receptors —> sends a signal that inhibits —> luminal H+/K+ ATPase pump—> decreased H+ secretion by parietal cells. Used for peptic ulcer, gastritis and mild esophageal reflux.
Lansoprazole: Proton pump inhibitor, irreversibly inhibits H+/K+ ATPase in stomach parietal cells. Used for peptic ulcer, gastritis esophageal reflux, and Zollinger-Ellison syndrome (gastrinoma).
Cimetidine is a P450 inhibitor, has antiandrogenic effects (gynecomastia), can cross the BBB (dizziness, headaches and confusion) and placenta.
What are some extrapulmonary causes of restrictive lung disease?
Poor muscular effort - polio, myasthenia gravis
Poor structural apparatus - scoliosis, severe kyphosis, morbid obesity
Wallenberg syndrome is an injury of the lateral medulla that presents with a constellation of neurologic symptoms including difficulty with swallowing (dysphagia), hoarseness and difficulty with palate elevation. Which part of the lateral medulla is responsible for swallowing and palate elevation? What other cranial nerves can be involved with this region?
Nucleus ambiguus (blood supply - PICA) “Don’t pick a (PICA) horse (hoarseness) that can’t eat (dysphagia)”
Vagus nerve (CN X)
Glossopharyngeal (IX)
Spinal accessory nerve (CN XI)
What muscles compose the rotator cuff?
Supraspinatus: (suprascapular nerve) abducts the arm initially (before the deltoid), most common rotator cuff injury
Infraspinatus: (suprascapular nerve) laterally rotates the arm, pitching injury
Teres minor: (axillary nerve) adducts and laterally rotates the arm
Subscapularis: (subscapular nerve) medially rotates and adducts arm
SItS (small t is for teres minor)
What are the essential amino acids?
PVT. TIM HALL Phenylalanine (Phe) Valine (Val) Threonine (Thr) Tryptophan (Trp) Isoleucine (Ile) Methionine (Met) Histidine (His) Arginine (Arg) - only essential in children (high demand for growth) Leucine (Leu) Lysine (Lys)
What medications are commonly used for the treatment of insomnia?
Melatonin (OTC)
Antihistamines: Diphenhydramine (Benadryl)
Trazadone (increases REM)
Tricyclics: Amitriptyline (arrhythmia and overdose risk)
Benzodiazepines: Temazepam, Lorazepam (short-term use only, addictive)
Zolpidem (Ambien)
Zaleplon (act at Benzo (GABA) receptor, rebound insomnia with D/C use)
Eszopiclone (Lunesta) - approved for long-term use
Ramelteon (acts as melatonin receptor, no addiction)
What mature structures arise from each of the following embryologic structures?
Bulbus cordis Left horn of sinus venous Primitive atrium Truncus arteriosus Primitive ventricle Right horn of sinus venous Right common and anterior cardinal veins
Bulbus cordis: RV, outflow tracts of L and R ventricles (smooth parts)
Left horn of sinus venous: coronary sinus
Primitive atrium: trabeculated (fibrous) part of L and R atria
Truncus arteriosus: ascending aorta and pulmonary trunk
Primitive ventricle: trabeculated (fibrous) part of L and R ventricles
Right horn of sinus venous: smooth part of R atria
Right common and anterior cardinal veins: SVC
Describe the rash presentation (timing, description, location) associated with each of the following diseases.
Rubella
Rash begins at head and moves down
Fine truncal rash
Postauricular lymphadenopathy
Describe the rash presentation (timing, description, location) associated with each of the following diseases.
Herpes Zoster
Grouped vesicles on an erythematous base, in a unilateral dermatomal distribution
Describe the rash presentation (timing, description, location) associated with each of the following diseases.
HHV-6
Roseola
A macular rash over body appears after several days of high fever
Can present with febrile seizures
Usually affects infants
Describe the rash presentation (timing, description, location) associated with each of the following diseases.
Parvovirus B19
Erythema infectiosum (fifth disease) “Slapped cheek” rash on face (can cause hydrops fetalis in pregnant woman), then appears over the body in a reticular, lace-like pattern
Describe the rash presentation (timing, description, location) associated with each of the following diseases.
Coxsackievirus type A
Hand-foot-mouth disease
Vesicular rash on palms and soles
Vesicles and ulcers in oral mucosa
Describe the rash presentation (timing, description, location) associated with each of the following diseases.
Streptococcus pyogenes
Scarlet fever
Eryhthematous, sandpaper-like rash with fever and sore throat
A 50-year-old man crashes on a motorcycle on the highway and sustains a right anterior hip dislocation and knee trauma. Now he cannot adduct his hip or plantar flex on that side. Which nerves are injured?
Obturator nerve (L2-L4): decreased adduction, decreased thigh sensation (medial) Tibial (L4-S3): loss of inversion and plantarflexion. Inability to curl toes and loss of sensation on sole of foot
