Set 12 Flashcards
A central line is often placed in the subclavian vein to administer fluids and medications or to measure central venous pressure. What landmarks are used when placing a subclavian central line?
Thumb on middle third of clavicle, index finger on jugular notch (top of manubrium) - insert needle medially on inferior surface of the clavicle aiming below your thumb
Metastasis to the brain, liver, and bone commonly come from which locations?
Brain: lung, breast, GU, osteosarcoma, melanoma, GI, kidney (RCC)
Liver: colon»_space; stomach > pancreas, breast and lung
Bone: prostate (blastic), breast (blastic and lytic), thyroid, testes, kidney
What is the mechanism of organophosphate poisoning? What are the symptoms of cholinergic excess?
Organophosphates (such as parathion) —> Cholinesterase inhibitor poisoning (irreversibly inhibit AChE)
Diarrhea Urination Miosis (constriction of pupil) Bronchospasm Bradycardia Excitation of skeletal muscle and CNS Lacrimation Sweating Salivation
Which glycogen storage disease fits the following features?
Severe hypoglycemia with elevated blood lactate
Von Gierke disease (type I)
Glucose-6-phosphatase deficiency
Severe fasting hypoglycemia, increased glycogen in the liver, increased blood lactate, hepatomegaly
Which glycogen storage disease fits the following features?
Hypoglycemia without elevated blood lactate
Cori disease (type III) Milder form of type one with normal blood lactate levels Debranching enzyme (a-1,6-glucosidase) deficiency Gluconeogenesis is intact
Which glycogen storage disease fits the following features?
Cardiomegaly
Pompe disease (type II) “Pompe trashes the pump” -heart, liver, muscle Lysosomal a-1,4-glucosidase (acid maltase) deficiency
Which glycogen storage disease fits the following features?
Myoglobinuria associated with exercise
McArdle disease (type V) “McArdle=Muscle” Skeletal muscle glycogen phosphorylase deficiency Increased glycogen in muscle but cannot break it down, painful muscle cramps, myoglobinuria, arrhythmia from electrolyte abnormalities
What is the treatment of a pulmonary embolism?
IV Heparin or LMW Heparin
antithrombin activated and halts clot formation
What are the most common locations of lung cancer metastases?
Adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)
What are some of the functions of bile produced by hepatocytes and stored in the gallbladder? What hormone is the most potent stimulator of gallbladder contractions?
Functions of bile:
- Emulsifies large fat particles —> small fat particles
- Absorption of fat end-products
- Absorption of fat-soluble vitamins (A, D, E, K)
- Excretion (bilirubin, copper, cholesterol)
CCK (cholecystokinin)
What is the characteristic fetal complication associated with lithium use in pregnancy? What other agents used to treat bipolar disorder can be teratogenic, and what are their corresponding fetal effects?
Litium - Ebstein anomaly (atrialized RV) - tricuspid leaf valvlelets are displaced way down into the RV
Carbamazepine: Neural tube defects, craniofacial defects, IUGR (intrauterine growth restriction), developmental delay, hypoplastic fingernails
Valproate: Neural tube defects (valproate inhibits folate absorption)
Aripiprazole/risperidone: extrapyramidal symptoms (in newborns)
What anatomic structures are found in the retroperitoneum?
Suprarenal (adrenal glands)
Aorta and IVC
Duodenum (2-4th parts)
Pancreas (except tail) Ureters Colon (descending and ascending) Kidneys Esophagus (lower 2/3) Rectum (partially)
What are the common causes of Erb-Duchenne palsy? Where is the brachial plexus insult with Erb- Duchenne palsy?
“Waiter’s tip” caused by shoulder trauma (adults) and lateral traction on neck during delivery (infants)
Traction or tear of upper (Erb-er) trunk: C5-C6 roots. Deltoid/supraspinatus (abduction - arm hangs by side), infraspinatus (lateral rotation - arm medially rotated), and biceps brachii (flexion, supination - arm extended and pronated)
