Daily concept review 3

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lazzsant
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Daily concept review 3
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2012-11-03 19:05:19
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Daily concept review 3
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  1. Prolong QT interval causes
    • Macrolides (erythromycin)
    • Antimalarials (Chloroquine/ mephaquine)
    • Haloperidol
    • Risperidone
    • Methadone
    • protease inhbitors
    • Antiarrythmics (class 1A)
    • K+ channels blockers
  2. Treatment for the cause of delta waves on EKG
    • WOLFF- PARKINSON WHITE SYNDROME
    • Accessory conduction pathway from atria to ventricle

    • Procainamide
    • Amiodarone
  3. Treatment of the bug that can cause 3rd degree heart block
    Borreli burgdoferi - lyme disease

    • Adults - doxycycline
    • children- amoxicillin
    • pregnant- erythromycin
    • and ceftriaxone

    Late stage = minocycline(neuro) or ceftriaxone
  4. Barocreceptor response to decrease MAP
    • B1 - increase HR and contractility -> inc CO
    • a1- venoconstriction -> increase venous return -> increase CO
    • a1- arteriolar vasoconstriction -> inc TPR
  5. Autoregulation of blood flow to skeletal muscle
    Local metabolites- lactate, adenosine, and K+
  6. Common congeital heart disease seen in DiGeorge syndrome
    • tetralogy of Fallot
    • aortic arch anomalies
  7. Patient has hypertension in upper extremities and weak pulses in the lower extremities, what is the most common asosciation
    This is postductal coarctation of the aorta

    Association = bicupsid aortic valve

    Can result in aortic regurgitation
  8. Congenital cardiac defect seen with Congenital Rubella
    • septal defects
    • PDA
    • pulmonary artery stenosis
  9. Associated with Aortic dissection
    • Hypertension
    • cystic medial necrosis (Marfans)
  10. MI markers
    • troponin (0-8 hours) lasts longer
    • CKMB (8-24 hours) Down by day 2 = good for reinfarction sign
    • AST (1 day)
    • LDH (2-7 days)
  11. Causes of Dilated (congestive) cardiomyopathy
    • Alcohol abuse
    • wet Beriberi (Thiamine deficiency)
    • Coxsackie B virus myocarditis
    • chronic Cocaine use
    • Chagas disease
    • Doxorubicin toxicity (radical formation)
    • hemochromatosis
    • peripartum cardiomyopathy
  12. What is the cause of orthopnea
    Increased venous return in supine position exacerbates pulmonary vascular congestion
  13. Symptoms of bacterial endocarditis
    • Fever
    • Roth spots (white spots on retina surrounded by hemorrhage)
    • Osler nodes (painful lesions on finger pads)
    • Murmur
    • Janeway lesions (painless small erythematous lesions on palm or sole)
    • Anemia
    • Nail-bed hemorrhage
    • Emboli

    FROM JANE
  14. Rheumatic heart disease findings
    • HISTO
    • Aschoff bodies (granuloma with giant cells)
    • Anitschkow's cells (activatedhistiocytes)
    • elevated ASO titers = type II hypersensitivity (ab-M protein) Group A B-hemolytic Streptococci

    • Major criteria
    • Joints (migratory polyarthritis)
    • Pancarditis
    • Nodules (sub Q)
    • Erythema marginatum
    • Sydenhams chorea

    JONES
  15. p-ANCA vasculitides
    • Microscopic polyangiitis:
    • - necrotizing vasculitis (nongranulomatous)
    • - affects small vessels

    • Churg Strauss syndrome
    • - granulomatous vasculitis with eosinophilia
    • - presents with asthma, sinusitis, skin lesions, and peripheral neuropathy
    • - involve heart, GI, and kidneys
    • - affects small vessels
  16. Buergers disease
    • (Thromboangiitis obliterans)
    • Segmental thrombosing vasculitis of small and medium peripheral arteries and veins
    • Heavy smokers
    • Affects small and medium vessels

    • SX:
    • - intermittent claudication
    • - superficial nodular phlebitis
    • - cold sensitivity
    • - -> gangrene and autoamputation of digits

    TX: STOP SMOKING
  17. Glomus tumor
    • Vascular tumor
    • Benign, painful, red-blue tumor under fingernails.
    • Arises from modified smooth muscle cells of glomus body(in dermis of skin and involved in temp regulation)
  18. Diazoxide
    K+ channel opener -> hyperpolarizes and relaxes vascular smooth muscle.

    Cause hyperglycemia by reducing amount of insulin released
  19. B-blocker MOA
    • Inhibit Gs -> no increase in IC cAMP levels
    • relaxation of cardiac tissue and renal juxtaglomerular cells
  20. What lipid lowering drugs are known to cause hepatotoxicity
    Statins - HMG-CoA reductase inhibitor

    Ezetimibe - cholesterol absorption blocker

    Fibrates- upregulate LPL
  21. B1 receptors and contractility
    Gs -> PKA -> phosphorylation of L-type Ca2+ channels and phospholamban -> increased intracellular Ca2+ during contraction
  22. Class IB antiarrhythmics
    Lidocaine, Mexiletine, Tocainide

    • Dec AP duration
    • Prefers ischemic or depolarized Purkinje and ventricular tissue (post MI)
    • acute ventricular arrhythmias and digitalis induced arrhythmias
  23. What are the toxicities associated with class III antiarrhythmics
    • Sotalol - torsades de pointes, excessive B-block
    • ibutilide- torsades
    • bretylium- new arrhythmias, hypotension
    • amiodarone- pulmonary fibrosis, hepatoxicity, thyroid dysfunction, smurf
  24. Coronary steal
    Adenosine and dipyridamole (increases adenosine -> vasodilation) -> selective vasodilators of coronary vessels

    leads to coronary steal= blood from ischemic areas via microvessel collaterals
  25. How to differentiate pheochromocytoma and neuroblastoma via urine
    Pheochromocytoma: increased VMA(NEP breakdown product)

    Neuroblastoma: increased HVA (Dopamine breakdown product)
  26. Metyrapone
    • Blocks 11-Bhydroxylase -> increased deoxycortisol which leads to no feedback inhibtion -> inc ACTH = normal response
    • Also 17 hydroxy-corticosteroid in the urine
  27. How does gallstone ileus present?
    • Gas w/in gallbladder and biliary tree
    • Midabdominal pain due to gallstone in ileocecal valve
  28. Effect of lowering the cutoff point
    • increase sensitivity
    • increase true positives
    • big increase in false positives
    • decrease in positive predictive value
    • decrease in false negative
  29. How does Superior mesenteric artery obstruction present
    • Apple peel atresia
    • spiral around ileocecal valve
  30. Pancreatic pseudocyst
    granulation and no epithelial lining
  31. Gastrectomy needs this for life
    Lifelong parenteral B12
  32. NF-kB
    transcription factor for cytokine production
  33. Galacotsyle B-1,4 glucose
    Lactose
  34. opioid analgesics side effect -> RUQ pain
    contraction of smooth muscle in the sphincter of Oddi
  35. Shigatoxin mechanism
    inactivates 60s ribosomal subunit -> no protein synthesis
  36. Carcinoids
    malignant transformation of enterochromaffin cells
  37. Cricopharyngeal muscle dysfunction leads to
    Zenkers diverticulum
  38. Diffuse esophageal spasm
    uncoordinated peristalsis
  39. What stimulates pancrease to secrete HCO3-
    secretin from the duodenum
  40. Erosions do not invade the
    muscularis mucosa
  41. live attenuated virus leads to
    better mucosal IgA immunity
  42. C. dificile B toxin
    • actin depolymerization
    • loss of cellular integrity
    • cell death and mucosal necrosis
  43. Indirect inguinal hernia
    • Lateral to inferior epigastric artery
    • follows descent of testes into scrotum
    • covered by all 3 layers of spermatic fascia
  44. What is the most likely cause of an ulcer in the distal duodenum?
    • Zollinger-Ellison Syndrome
    • (nongastric neoplasm)
  45. Glucose suppression on E.coli enzymes
    Decrease in cAMP -> poor CAP binding -> dec lac operon
  46. How does candida spread hematogenously?
    In the case of neutropenia
  47. What is one difference between prokaryotic mRNA and eukaryotic mRNA
    Prokaryotic mRNA is polycistronic
  48. AN ulcer in the posterior aspect of the duodenal bulbar leads to what
    Hemorrhage via erosion of the gastroduodenal artery
  49. Arsenic poioning is treated with what antidote
    Dimercaprol

    (patient has garlic breath)
  50. Mechanism of Ribavirin
    inhibits viral RNA polymerase
  51. ETEC toxins
    • Heat labile = cholera like -> inc cAMP
    • Heat stabile -> inc cGMP -> inc guanylate cyclase
  52. What does C. jejunum casue
    Inflammatory gastroenteritis

    From domestic animals or contaminated food
  53. Crohns malabsorption presents with
    calcium oxalate kidney stones, anemia, hypoproteinemia, B12 and folate def., and gallstones
  54. Treatment for C. difficle
    Metronidazole
  55. Systemic mastocytosis
    Increased histamine -> increase gastric cell stimulation
  56. VIPoma
    • pancreatic cholera diarrhea
    • Treatment is somatostatin
  57. Where are lipids absorbed
    In the jejunum along with folate

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