To Remember 6/7

Medicine Bl with Dr.lapp Daddy at University of Chapel Hill

About this deck

By: Brian Lappas
Created: 2012-06-07
Size: 113 flashcards
Views: 4

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Where do you aspirate a peanut while supine?

superior portion of Right inferior (lower) lobe

Where to the IVC perforate?

Where does the esophagus perforate and with what?

T10
Vagus nerves

Where does the aorta perforate and with what?

T12
Thoracic duct
Azygous vein

Radius changing in what direction causes lungs to want to collapse?

↓Radius more tendency to collapse

What is it called when a vasodilator aggravates ischemia by shunting blood from areas of high stenosis to areas of higher perfusion?

Coronary steal syndrome

Sudden cardiac death usually occurs why?

V fib

When do neutraphils enter after a MI?

after 48 hours
Extensive coagulation necrosis

When do macrophages enter after a MI?

After 5 days
Granulation tissue

What is the mechanism of a genetic defect of dilated congestive cardiomyopathy?

Cardiac cell cycloskeleton defect

Mitochondrial enzymes of oxidative phosphorylation defects

50% of hypertrpohic cardiomyopathies are what kind of inheritance?

What genetic condition is hypertrophic cardiomyopathy associated with?

Friedreich's ataxia

What is the early lesion of rheumatic fever?

MVP

What is the late lesion of rheumatic fever?

Mitral stenosis

What ius the mechanism of damage with rheumatic fever?

Type II hypersensitivity with antibodies to M protein

What EKG changes can you see with cardiac tamponade?

Increase QRS duration

What presents with "tree bark appearance" on aorta?

3 stage syphilis

What is the mech of destruction of 3 sypholitic heart disease?

Disrupts the vasa vasorum of aorta with subsequent dilation and calcification.

Child with rhabdomyomas may also have what tumors?

Tuberous sclerosis
Angiomyolipomas of liver
Astrocytomas

Big fear of Temporal arteritis?

Irreversable blindness due to opthalmic artery occlusion

Takayasu's arteritis presents with weak upper extremity pulses, what is the mechanism?

Granulomatous thicking of aortic arch and great vessels \

What vessels do temoral arteritis involve specifically?

Carotid artery
with focal granulomatous inflammation

What presents with "polymorphic cells and segmenting necrotizing vasculitis"?

Polyarteritis nodosa
HepB
Immune-complex mediated type III
Transmural with fibrinoid necrosis
NO Lungs

What is large fear of Kawasaki disease?

Coronary aneurysms

What presents with asthma and palpable purpura?

Churg-Strauss
Granulomatis vasculitis with eosinophilia
p-ANCA

What two things are p-ANCA?

Churg-Strauss
Primary sclerosing cholangitis

What presents with anti-mitochondrial antibodies?

Primary biliary cirrhosis
Autoimmune
↑ IgM

What is the risk of primary biliary cirrhosis?

Increase in cholestorol because of decrease bile salt secretion with pancreatic risk

How do you treat primary biliary cirrhosis?

Ursodiol (bile salts)

What is used to treat diabetic and post surgery gastroparesis?

Meto-clopramide
D2 blocker
↑ Parkinson effect
No digoxin

What is a Prostaglindin analogue that can be used to prevent NSAID induced ulcers?

Misoprostol

↑mucus, ↓acid

Maintain patent ductus arterosis

Increase uterine tone (abortions)

What drug is used to prevent nausea in ost-chemo patients and how?

Ondansetron
5-HT3 blocker acting centrally

Pulmonary hypertension causes what changes in the pulmonary arteries?

Intimal fibrosis
Medial hypertrophy
Atherosclerosis

Primary cause oof pulmonary hyertension is caused by what?

↑ smooth muscle proliferation from
BMPR2 mutation

How to calculate pulmonary vascular resistance?

PVR=
Pulm artery pressure- LA pressure
Divided by CO

Things that are perfusion limited?

Reach equilibration quickly; limited by blood flow
O2 (nrm)
CO2
N2O

What things are diffusion limited?

Does not equilibrate by time blood reaches end of capillary
O2 (pathological)
Fibrosis, emphysema
CO

What traumatic events give rise to fat emboli? How does it present?

(1) Long Bone Fracture

(2) Soft-tissue Trauma

Petichia rash
Confusion, ataxia
Reinal fat globulets

what is the major characteristic of Chronic Bronchitis?

Hypertrophy of mucus sectretng gland depth into bronchial wall

Mismatched ventilation & perfusion

Lung volumes and disease: obstruction

↑TLC
↑RV (dead space)
↓ FVC (lungs close earlier)
↓↓FEV1
↓FEV1/FVC <80%

Infection of bronchiectasis?

Aspergillosis

Sarcodosis restrictive lung disease shows what changes in ACE and calcium?

↑ACE
↑Ca++

Noncaseating granulomas in sarcoidosis are what?

Epitheliod macrophages or

Epitheloid histiocytes

Coal miner lung affect what lobe?

Upper

Coal minor's lung + rheumatoid arthritis is called what?

Caplans syndrome

How does silicosis make you more susceptable to TB?

Impairs macrophage phagocytotic ability
**The macrophages release of fibrogenic factors cause the fibrsosis and "Eggshell" calcification of hilar lymph nodes

Asbestosis occurs in what part of lung?

Lower

Fusiform rods are where and imply what?

In macrophages
Asbestosis

What can you give to infant with respiratory distress?

Thyroxine
Artificial surfactant

What leaks into alveoli in acute respiratory distress syndrome?

Protein-rich fluid
**Forming intra-alveolar hyaline membrane deposits.

ARDS pathogenisis?

Neutrophils release toxic substances
-Activating complement cascade & -Free radicals

What lung condition increases fremitus?

Pneumonia

What lung cancer devolops in previously damaged lungs?

Bronchial adenocarcinoma
↑ Clara & type II pneumocytes

What lung cancer grows along airway and can result in hypertrophic osteoarthropathy?

Bronchioloalveolar
↑ Clara & type II pneumocytes

What lung cancer presents with ↑PTH-like activity?

SCC

What lung cancer can present with Cushings syndrome?

Small cell

What lung cancer can present with Lambert-Eaton syndrome?

Antibodies against Ca++ channels

What tumor can lead to finrous deposits in right heart valves leading to RHF?

Carcinoid tumor

Where does mesothelioma develop?

Pleural space
"pleural effusions and pleural thickening"
*psammoma bodies

Hypersensitivity pneumonia is what type of reaction to an envoronmental antigen?

Mixed II/IV

3 things that cause a transudate pleural effusion?

Nephrotic syndrome
Cirrhosis
CHF

Name the 1st generation H1 blockers?

"CDD"
Chlorpheniramine
Diphenhydramine
Dimenhydrinate

What transcription factor activates TNFa?

NF-kB

What blocks NF-kB?

Beclomethasone
Prednisone

What asthma drug blocks actions of adenosine?

Theophylline

What asthma drug has a narrow therapeutic index for cardio and neurotoxicity?

Theophylline

What asthma drug inhibits phosphodiesterase to ↓cAMP?

Theophylline

What drug to treat pulmonary hypertension?

Bosentan
Antagonizes endothelin-1 receptors

What pulmonary drug antagonizes endothelin-1 receptors?

Bosentan
Pulmonary hypertension

What drug antogonizes NMDA glutamate receptors?

Dextromethorphan
cough suppressant that also blocks serotonin uptake and opiod agonist

Where is airways resistance the greatest in lung?

Larger airways: series
Smaller: parallel

Compare compliance work for obstructive vs restrictive lung disease?

Compliance work
↓ obstructive
↑ restrictive

Why does breathing at an elevated residual capacity in obstructive disease result in less effecient breathing?

Lungs are most compliant at midportion...breathing at partially inflated lungs results in more work against less compliant lungs

Compare elasticity of lungs between obstructive and restrictive disease?

↓elasticity obstructive
↑elasticity restrictive

What is the mech of respiratory depression of benzos, barbituates, opiods and general anesthetics?

Medullary respiratory center less responsive to increases in PaCO2.

What immunoglobulin is elevated in a person with asthma?

IgE

What is the main pathogenesis of asthma?

Hyperactivity of tracheobronchial tree to inflammatory mediators (leukotrienes with asprin for example)

Why does RV increase with asthma attack compared to emphysemsa?

Asthma: bronchial constriction
Emphysema: gas trapping

Compare wheezing in asthma vs COPD?

Asthma: inspiration and expiratory wheezes due to bronchiol constriction

COPD: expiraory only due to ↑ collapse of intrathoracic pressures causing airway collapse

Why are cromolyn sodium and medocromil useful for prevention but not trreatment of symptoms?

They inhibit mast cell degranulation and histamine release...
too late one symptoms have started

What is a main side effect of theophylline?

Lowers the seizure threshold

Compare asthma and hypersensitivity pneumonitis?

Hypersensitivy:
Type III/IV mediated
Does not involve IgE.
Does not involves bronchioles
Does not respond to albuterol

Dyspnea, fever, pulmonary infiltrates in an asthma patient that doesn't respond to inhaler is what?

Hypersensitivity to Aspergillus
Eosinophilic pneumonas

Giving O2 to a chronic COPD patient might respond how?

Hypoventilation because their respiratory center has "reset" and the higher O2 level makes them breath less

What changes in the heart might you see in a COPD patient?

RVH because the hypoxic lung vessels have been constricting, leading to increased pulmonery pressure

What cell produces elastase?

Neutraphil

How does ipratropium work with COPD?

Anticholinergic to prevent smooth muscle constriction

What acid-base abnormality is seen in COPD?

Respiratory acidosis (via depressed ventilation) with metabolic compensation

What can a mechanical ventilator do to a patient with COPD?

Cause them to increase their tidal volume too much, causing respiratory alkalosis that their kidneys can't compensate for

What is risk for asbestos and smoking?

↑bronchogenic risk
NO mesothelioma risk

How do ferruginous bodies stain?

+ Prussian blue
CHF will not stain blue
**Both have hemosiderin

How does anemia contribute to dypsnea?

Low O2 delivery causes increase lactic acid produciton which are sensed by the peripheral chemoreceptors.
**The peripheral chemoreceptors don't sense the total O2 content, only the PaO2 which is unaffected in anemia.

When do you see cyanosis?

Inadequate amount of oxygen in the ARTERIAL blood
when Hgb is <5 g/dL

How does CO poisoning affect PaO2?

It does not change the amount of dissolved O2 in the blood
**It does decrease Hgb saturation but this may not show up on pulse ox

Common damage in ARDS?

widespread pulmonary capillary endothelial damage

What can happen by delivering pure O2 to a ARDS patient?

damage by free radicals that exacerbates the condition

Why should you be careful in giving fluids to an ARDS patient?

Could exacerbate the pulmonary edema

Where are the Ca++ channels affected in Lambert-Eaton?

Presynaptic voltage-gated Ca++ channels

What produces the 1,25 D3 in sarcoidosis?

macrophages of the noncaseating granulomas

What does acidosis do to calcium levels?

Increases Ca++ levels via displacement from albumin

How is TB atacked into a latent infection resulting in a small calcified lesion?

Th1 (CD4+ cells) and macrophages

What must be known to do a PCR of a targeted gene sequence?

The flanking nucleotide sequences for primer placement

Deficiency of what vitamen could cause squamous metaplasia of epithelial cells?

Vit A
maintains differentiation of specialized epithelium like conjunctiva, respiratory, urinary tracts and other exocrine tracts (pancreas).

What drug must be processed by mycobacterial catalase-peroxidase for the drug to be active?

Isoniazid

MHC I cells present with antigen to cell surface with what attached?

B-microglobulins
(aids in transport to cell surface)

Where is antigen loaded on MHC I?

RER

Where is MHC II antigen loaded?

Loaded following release of invariant chain

acidified endosome

What is the antigen bound to on MHC I?

Peptide-binding groove of alpha chain

What is the antigen bound to on MHC II?

Peptide-bonding groove on both
alpha AND beta chain

What enzyme is specific to mast cell activation and often measured?

Tryptase

What is always the same between pulmonary and systemic circulation?

Blood flow per minute

What are Peptpstreptococcus and Fusobacterium species?

Normal oral flora.
**May be aspirated in a seizure patient

What is the histological finding in ARDS?

Alveolar hyaline membrane formation

About this deck

By: Brian Lappas
Created: 2012-06-07
Size: 113 flashcards
Views: 4

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis