uWorld 52 Flashcards
myocardial oxygen extraction exceeds that of any other tissue or organ in the body
due to high degree of oxygen extraction, increases in myocardial oxygen demand (doing exercise) are med by what
nearly proportionate increase in coronary blood flow
the greatest difference in O2 content is between the aorta and what vessel in the body
coronary sinus (coronary venous blood is draining here)
what distinguishes coronary circulation from the rest of the body
heart muscle is PERFUSED during DIASTOLE
myocardial O2 extraction is very high
myocardial oxygen demeaned and coronary blood flow are tightly coupled
where do the PCL and ACL attache
PCL: ANTEROlateral surface of MEDIAL FEMORAL CODYLE and POSTERIOR part of intercondylar area of TIBIA
ACL: ANTERIOR portion of intercondylar area of TIBIA and the POSTEROmedial surface of the LATERAL FEMORAL CONDYLE
whats the transverse genicularr ligament do
attaches the medial and lateral menisci anteriorly on the proximal articular surface
what you see on fine needle aspiration of HASHIMOTO
mononuclear parenchymal infiltration (lymphocytes and plasma cells) with well-developed GERMINAL CENTERS
HURTHLE CELLS- large oxyphilic cells filled with granular cytoplasm- FOLLICULAR EPITHELIAL CELLS that have undergone MALIGNANT CHANGE
what is the “triangle of treatment” for thyrotoxicosis aimed at minimizing
- thyroid hormone synthesis and release
- peripheral conversion of T4 to the more active T3 (inhibits iodothyronine doiodinase)
- sympathetic outflow and/or its actions on target tissue
beta-blockers are effective at treating what part of thyrotoxicosis
peripheral conversion of T4 to the more active T3
sympathetic outflow and/or its actions on target tissue
what is akathisia
subjective restlessness with inability to sit still
days to weeks after starting antipsychotic treatment
inability to sit or stand in one position and may pace frequently or demonstrate other restless behaviors
in most states minors can consent to what
PRENATAL CARE diagnosis and treatment of STDs CONTRACEPTION DRUG or ALCOHOL REHABILITATION emergency care
what do you use to treat AGITATION and PSYCHOSIS associated with DELIRIUM
HALOPERIDOL (and other HIGH POTENCY first generation antipsychotics)
or some second-generation antipsychotics can be used (not clozapine though)
what is doxepin
TCA
what is an allosteric activator of the first step of gluconeogenesis
ACETYL-CoA (step is done by enzyme PYRUVATE CARBOXYLASE making oxaloacetate- BIOTIN dependent and occurs in mitochondria)
ALKAPTONURIA is characterized by a deficiency in what conversion pathway
TYROINE to FUMARATE
dysfunctional HOMOGENTISATE OXIDASE (AR disorder)
thoracodorsal nerve innervates what
LATISSIMUS DORSI- should extension, adduction, and internal rotation
P-glycoprotein is what kind of protein
TRANSMEMBRANE patient that functions as an ATP-DEPENDANT efflux pump
broad specificity for HYDROPHOBIC compounds
human multi drug resistance (MDR1) gene
can reduce influx of drugs into the cytosol and increase efflux form the cytosol, thereby preventing the action of chemotherapeutic agents
what are the pH, bicarb, and CO2 levels in ASPRIN OVERDOSE (4-5 hours after ingestion)
at this point most likely mixed RESPIRATORY ALKALOSIS (direct brain stimulation- happens FIRST) and ANION GAP METABOLIC ACIDOSIS
pH is actually close to normal (7.38) b/c of mixed respiratory alkalosis and metabolic acidosis
PaCO2 is hella LOW (20) b/c respiratory alkalosis
Plasma HCO3- is hella LOW (12) b/c of metabolic acidosis
patients with adult-type coarctation of the aorta commonly die of what?
HYPERTENSION-ASSOCIATED complications:
left ventricular failure
rupture dissecting aortic aneurysm
intracranial hemorrhage
increased risk for ruptured intracranial aneurysm because of the increased incidence of congenital berry aneurysms of the circle of Willis as well as aortic arch hypertension
people with ASD can get what problem
CHRONIC PULMONARY HYPERTENSION as a result of left-to-right intracardiac shunt
eisenmenger syndrome is the late-onset reversal of the shunt due to pulmonary vascular sclerosis
closer of the ASD can prevent this
what is the immunochemistry seen with hydatiform moles
complete: p57 NEGATIVE
partial: p57 POSITIVE
extremely high beta-hCG levels of a complete hydatifiform mole can cause what
HYPEREMESIS GRAVIDARUM
PRE-ECLAMPSIA
HYPERTHYROIDISM
THECA-LUTEIN CYSTS
fun facts: BUNCH OF GRAPES macroscopically and dont forget the “SNOWSTORM” appearance on ultrasound
what is the ATTRIBUTABLE RISK PERCENT in the EXPOSED (ARPexposed)
important measure of the impact of a risk factor
represents the excess risk in an exposed population that can be explained by exposure to a particular risk factor
ARPexposed = 100*[(risk in exposed- risk in unexposed)/risk in exposed]
ARPexposed = 100* [RR-1)/RR]
what is a COMPLETE ATRIOVENTRICULAR VANAL sepal defect
most common type of cardiac defect in patients with DOWN SYNDROME
failure of endocardial cushion fusion results in an OSTIUM PRIMUM ASD; a VSD; and a single, large COMMON AV VALVE
significant left-to-right shunting and AV valve regurgitation lead to excessive pulmonary blood flow and symptoms of HEART FAILURE
AV valve regard (HOLOCSTOLIC, heard best at APEX)
increased pulmonary venous return (MID-SYSTOLIC RUMBLE)
what are the ADRs of nitrates
HEADACHES, CUTANEOUS FLUSHING, lightheadedness, HYPOTENSION, and REFLEX TACHYCARDIA
CONTRAINDICATED in hypertrophic cardiomyopathy , RV infraction , PDE inhibitors
what is CEFEPIME
4th generation CEFALOSPORIN that CAN treat PSEUDOMONAS
patients with acute viral hepatitis typically present how
FEVER, malaise, ANOREXIA, nausea/vomiting, RUQ pain
choestatic symptoms after a week or so: jaundice, purpuritis, DARK-COLORED URINE and echoic stools (lacks bilirubin pigment)
what is a functional heart murmur
due to hemodynamic changes, in the absence of any fixed vance lesions
dilation of left ventricle in response to increased preload can result in functional mitral regurgitation, which can be eliminated by preload reduction and reduced by after load reduction
what is the UBIQUITIN PROTEASOME PATHWAY (UPP) is essential for what
breakdown of intracellular proteins, both native and foreign, and helps recycle them into the amino acid building blocks
ubiquitin functions as a tag that is attached to proteins to mark them for destruction
process performed by UBIQUITIN LIGASES, enzymes that recognize specific protein substrates and catalyze ubiquitin attachment
tagged proteins are then taken up by the proteasome, where they are broken down into their constituent oligopeptides and , eventually, amino acids
what is the role of the ubiquitin proteasome pathway (UPP) in immune response
related to its ability to DEGRADE FOREIGN INTRACELLULAR PROTEINS, such as viral particles
these proteins are degraded to an appropriate size, coupled to MHC CLASS I protein complex in the endoplasmic reticulum, and then presented on the cell surface for recognition by CYTOTOXIC CD8+ lymphocytes
pericarditis 4 days after MI is due to what
pericardial inflammation OVERLYING the NECROTIC SEGMENT of MYOCARDIUM
fibrinous or serofibrinous
short lived and usually disappears with 1-3 days of aspiring therapy
(fun fact: dressler syndrome is weeks to months after)
what is seen in Dressler Syndrome
1 week to months after MI
fever, pleuritis, leukocytosisi, pericardial friction rub, and chest radiograph evidence of new pericardial or pleural effusions
autoimmune polyserositis provoked by antigens exposed or created by infarction of the cardiac muscle
pericardium is usually DIFFUSELY INFLAMED
other serial surfaces including the lung pleura may be involved
generally responds to aspirin, NSAIDS, and/or glucocorticoids
the infusion of glucose without thiamine in a patient with chronic thiamine deficiceny precipitates what
ENCEPHALOPATHY
confusion, ataxia, and ophthalmoplegia from the triad of Wernicke encephalopathy
hemorrhage into the maxillary bodies is characteristic
what is an acer rod
AZUROPHILIC GRANULES found in cytoplasm of myeloblasts
stain positively for MYELOPEROXIDASE
what is seen in FANCONI ANEMIA
inherited cause of aplastic anemia
present with SHORT STATURE and ABSENT THUMBS and is associated with an increased risk of malignancy (myelodysplastic syndrome, acute myeloid leukemia)
what is myelodysplastic syndrome
caused by defect in stem cell maturation leading to ineffective differentiation of cell lines and, therefore, pancytopenia
bone marrow biopsy will be hyper cellular with abnormally differentiated cells (misshapen nuclei)
primarily occurs in patients over 65
what is AXONAL REACTION
changes seen in neuronal body after the axon is severed
cell body shows sings of CELLULAR EDEMA
SWOLLEN and ROUNDED, with the NUCLEUS displaces to the PERIPHERY
NISSL substance becomes FINE, GRANULAR and DISPERSED throughout the cytoplasm (central chromolysis)
becomes visible 24-48 hours after the injury
maximal changes in the neuronal body occurs approximately 12 days after the injury
these changes reflect increased synthesis of protein by the cells in order to regenerate the severed axon
what is Wallerian degeneration
occurs in the segment of axon that has lost connection with the cell body
represents the degeneration of axon an dymelin distal to a point of injury
fist: swelling and irregularity are noted in the distal segment of the axon
within a week the axon is destroyed and its fragments are digested by Schwann cells and macrophages
degeneration of the proximal segment extend to the closest node of Ranvier
benzene causes what
aplastic anemia
what is retinopathy of prematurity
use of concentrated oxygen therapy for neonatal respiratory distress syndrome may be complicated by abnormal RETINAL NEOVASCULARIZATION and is a major cause of blindness in developed nations
thought to be VEGF reuptake mediated from return to regular air after temporary local hyperoxia in the retina
what is terbutaline
a beta-mimetic tocolytic drug used to delay labor and delivery by suppressing uterine contractions
use has been linked to an increased risk of neonatal intraventricalr hemorrhage, hypoglycemia, hypocalcemia, and ileus
what are the complications of surfactant treatment
transient hypoxia and hypotension, blockage of an endotracheal tube, and pulmonary hemorrhage
where do charcot-bouchard aneurysms occur
basal ganglia
cerebellum
thalamus
pons
intracerebral hemorrhage
progressive neurologic deficits, headaches may follow
what is the most common cause of lobar/cortical parenchymal hemorrhage
cerebral amyloid angiopathy
what is hypertensive encephalopathy
PROGRESSIVE headache and nausea/vomitting followed by non localizing neurologic symptoms (confusion)
patients deep intracranial hemorrhage makes hypertensive vasculopathy more likely
what is hypoxic encephalopathy
caused by decrease oxygenation of the blood (due to cardiac arrest)
often present with decreased consciousness (coma or vegetative state)
what does squatting do in mitral valve prolapse
makes the murmur disappear
(mid systolic click followed by late systolic murmur is MVP w/ mitral regurgitation- click is from sudden tensing of chord tendinae as they are pulled tight by leaflets)
what is seen in the myxomatous lesions of MVP
proliferation of spongiosa of valve leaflets, fragmentation of elastin fibers with increase in mucopolysaccharide and type III collagen deposits
what happens to murmur in hypertrophic cardiomyopathy when squatting
decreases in intensity (due to increase left ventricular volume and decreased outflow tract obstruction)
systolic murmur at cardiac apex
