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491 Cards in this Set
- Front
- Back
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Hodgkin's prognosis
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stage of disease and type of Hodgkins most important factors
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Alkylating agents in Rx of Hodgkins
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T risk for second malignancies (leukemia, NHL)
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Langerhan's histiocytes
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CD1 positive, Birbeck granules
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Letterer-Siwe disease
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malignant histiocytosis < 2-yrs-old, diffuse eczematous rash, organ involvement
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Hand-Christian-Christian disease
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malignant, lytic skull lesions, diabetes insipidus, exophthalmos
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Eosinophilic granuloma
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benign histiocytosis, lytic bone lesions with pathologic fractures
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Mast cells
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release histamine (pruritus, swelling), metachromatic granules positive with toluidine blue
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Urticaria pigmentosum
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localized mastocytosis, skin lesions swell and itch with scratching
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Amyloid
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twisted (3-sheet, apple green birefringence
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Primary amyloidosis
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AL amyloid derived from light chains, plasma cell disorders
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Secondary amyloidosis
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AA amyloid derived from serum-associated amyloid, chronic infections
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Alzheimer's disease
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amyloid precursor protein gene product chromosome 21, amyloid-p
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Gaucher's disease
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macrophages have fibrillary appearance, deficiency glucocerebrosidase
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Niemann Pick's disease
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macrophages have soap bubble appearance, deficiency sphingomyelinase
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Hypersplenism
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splenomegaly, peripheral blood cytopenias, portal hypertension MCC
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Splenic dysfunction
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Howell Jolly bodies, susceptible to Streptococcus pneumoniae sepsis
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Anticoagulants
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tissue plasminogen activator, heparin, PGI2, ATIII, protein C/S
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Heparin
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enhances ATIII activity (neutralizes all factors except V, VIII, fibrinogen)
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Protein C/S
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neutralize V and VIII
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Procoagulants
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coagulation factors, thromboxane A2 (platelet aggregation, vasoconstrictor)
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Protein C and S
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inactivate factors V and VIII, enhance fibrinolysis
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Von Willebrand factor
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complexes with factor VIII to enhance VIII
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Platelets
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receptors for von Willebrand factor and fibrinogen, synthesize thromboxane A2
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Gplb
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platelet receptor for von Willebrands factor
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GpIIb
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IlIa
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Extrinsic system factor
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VII
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Intrinsic system factors
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XII, XI, IX, VIJI
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Final common pathway factors
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X, V, prothrombin (II), fibrinogen (I)
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Factor XIQ
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cross-links insoluble fibrin, strengthens fibrin clots
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Vitamin K-dependent factors
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prothrombin, VII, IX, X, protein C and S
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Factors consumed in a clot
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fibrinogen, prothrombin, V, VIII, fluid is called serum
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Plasmin
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cleaves fibrinogen and insoluble fibrin into degradation products
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Bleeding time
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evaluates platelet function (adhesion, release reaction, aggregation)
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Aspirin
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MCC of a prolonged bleeding time
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Tests for vWF
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ristocetin cofactor assay, vWF antigen assay, agar electrophoresis
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PT
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evaluates extrinsic pathway to fibrin clot
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PTT
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evaluates intrinsic pathway to stable fibrin clot
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Fibrinolysis tests
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fibrin(ogen) degradation products, D-dimers (cross-linked insoluble fibrin)
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S/S platelet dysfunction
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cannot form temporary plug, epistaxis, petechiae, bleeding from scratches
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Idiopathic thrombocytopenic purpura (ITP)
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children, antibodies against GpIIb
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Chronic autoimmune thrombocytopenic purpura
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SLE, antibodies against GpIIb
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Heparin
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thrombocytopenia due to IgG antibody against heparin attached to PF4 on platelets
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PF4
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heparin neutralizing factor
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HTV
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thrombocytopenia MC hematologic abnormality, similar to ITP
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TTP
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platelet thrombi develop in areas of endothelial damage in small vessels, consumption of platelets
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S/S
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fever, thrombocytopenia, renal failure, hemolytic anemia with schistocytes, CNS deficits Lab
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findings TTP
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thrombocytopenia, prolonged bleeding time, normal PT and PTT
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HUS
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similar to TTP, endothelial injury from Shiga-like toxin of 0157
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S/S factor deficiency
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no stable fibrin clot- late rebleeding, monorrhagia, GI bleeding, hemarthroses
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Hemophilia A
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XR, hemarthroses, prolonged PTT, -l factor VIII activity, normal VIII antigen
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Von Willebrand's disease
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AD, platelet adhesion defect + factor VIII deficiency
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Lab findings in VWD
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I vWF, VIII antigen, and VIII
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Desmopressin acetate
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Rx of choice for mild von Willebrand's disease and hemophilia A
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Circulating anticoagulants
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antibodies destroy coagulation factors
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Lab finding in circulating anticoagulant
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prolonged PT and/or PTT corrected with mixing studies
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Vitamin K deficiency
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4- epoxide reductase activity (4 function vitamin K), hemorrhagic diathesis, t PT
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Causes vitamin K deficiency
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antibiotics MC, newborn, malabsorption, warfarin
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DIC
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activation coagulation system from release of tissue thromboplastin and/or endothelial cell damage
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DIC
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consumption coagulation factors by fibrin clots, patient also anticoagulated
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Causes
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septic shock MCC, rattlesnake bite, massive trauma, amniotic fluid
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S/S
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bleeding from all scratches, holes, needle sites
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Lab findings DIC
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thrombocytopenia, t PT and PTT, D-dimers (best test), anemia
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Antiphospholipid antibodies
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lupus anticoagulant and anticardiolipin antibodies, vessel thrombosis
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Warfarin
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inhibits epoxide reductase, PT best test but PTT also prolonged
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Warfarin
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full anticoagulation in 3 days when y-carboxylated prothrombin disappears
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Warfarin
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ingredient in rat poison, danger to children in households with grandparents on warfarin
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Rx warfarin overanticoagulation
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intramuscular vitamin K (6-8 hrs), fresh frozen plasma (immediate)
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Heparin
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enhances ATIII, PTT best test but PT also prolonged
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OC
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estrogen T coagulation factor synthesis and i ATIII, predisposes to thrombosis
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Factor V Leiden
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MC hereditary thrombosis, resistant to degradation by protein C/S
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ATIH deficiency
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no prolongation of PTT with administration of heparin
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Hemorrhagic skin necrosis
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post-warfarin therapy in patient with heterozygote protein C deficiency
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M cells
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specialized cells that transfer foreign antigens to lymphocytes in Peyer's patches
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Blood group O
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some patient have anti-AB-IgG antibodies, increased incidence duodenal ulcers
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Blood group A
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increased incidence of gastric carcinoma
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Newborns
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do not have natural blood group antibodies at birth (e.g., anti-A-IgM)
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Elderly
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may lose natural blood group antibodies, no hemolytic reaction to mismatched blood
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Rh antigens
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inherited in autosomal codominant fashion, Rh antigens include D, C, c, E, e
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Atypical antibodies
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antibodies against Rh or non-Rh blood group antigens (e.g., anti-D)
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Duffy antigen
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receptor for Plasmodium vivax, blacks often lack Duffy antigen
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Antibody screen
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indirect Coomb's test, detects atypical antibodies in serum
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Cytomegalovirus
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MC infection transmitted by blood transfusion, MC antibody
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Hepatitis C
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MCC of post-transfusion hepatitis
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Major crossmatch
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patient serum reacted against donor RBCs, does not guarantee RBC survival
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Universal donor
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blood group O, no antigens on the surface of RBCs
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Universal recipient
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blood group AB, no natural blood group antibodies in serum
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Packed RBC transfusion
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raises Hb by 1 gm/dL and Hct by 3%
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Cryoprecipitate
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fibrinogen and factor VIII
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Fresh frozen plasma
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replacement for multiple factor deficiencies (e.g., cirrhosis, DIC)
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Allergic transfusion reaction
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type I IgE-mediated hypersensitivity reaction
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Febrile transfusion reaction
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recipient anti-HLA antibodies react against donor leukocytes
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Intravascular HTR
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transfusion of ABO incompatible blood (e.g., A person receives B blood)
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Extravascular HTR
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antibody attaches to donor RBCs, macrophage phagocytosis and hemolysis
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Positive direct Coomb's test
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present in both types of hemolytic transfusion reactions
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S/S
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jaundice, no increase in Hb, hemoglobinuria
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ABO HDN
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mother O and baby A or B, transplacental passage of maternal anti-AB-IgG
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ABO HDN
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positive direct Coomb's test, spherocytes, MCC unconjugated hyperbilirubinemia first 24-hrs
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Rh HDN
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mother Rh (D antigen) negative and fetus Rh (D antigen) positive
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Rh HDN
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no hemolysis in first Rh incompatible pregnancy
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Rh HDN
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maternal anti-D crosses placenta, potential for hydrops fetalis, high risk for kernicterus
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Rh immune globulin
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anti-D, coats D antigen site on fetal RBCs in maternal circulation
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Rh HDN lab
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positive direct Coomb's, severe anemia and hyperbilirubinemia
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ABO HDN
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protects mother from Rh sensitization (development of anti-D antibodies)
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O Rh negative mother with A Rh positive baby
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A+ cells destroyed by mothers anti A-IgM
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Blue fluorescent light
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converts unconjugated bilirubin in skin into harmless water soluble dipyrrole
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MV auscultation
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apex
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TV auscultation
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left parasternal border
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AV auscultation
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right 2nd intercostal space
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PV auscultation
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left 2nd intercostal space
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SI
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closure MV and TV
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S2
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closure AV and PV
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Inspiration
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split in A2 and P2, due to increased blood in right side of heart
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S3
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abnormal, due to blood entering volume overloaded ventricle in early diastole
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Causes S3
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valve regurgitation, congestive heart failure
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S4
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abnormal, due to blood entering non-compliant ventricle with atrial contraction in late diastole
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Causes S4
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volume overloaded ventricle, hypertrophy
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Murmurs
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stretching valve ring or damage to valve
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Inspiration
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increases right sided abnormal heart sounds and murmurs
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Expiration
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increases left sided abnormal heart sounds and murmurs
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Stenosis murmurs
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problem in opening valve
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Regurgitation murmurs
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problem in closing valve
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Valves opening in systole
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AV and PV
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Valves opening in diastole
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MV and TV
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Valves closing in systole
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MV and TV
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Valves closing in diastole
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AV and PV
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LDL
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primary vehicle for carrying cholesterol
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VLDL
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primary vehicle for carrying liver-synthesized triglyceride
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Familial hypercholesterolemia (type H)
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AD, deficiency of LDL receptors, t LDL
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Type ni hyperlipoproteinemia
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deficiency apo E, t remnants (chylomicron, intermediate density)
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Type IV hyperlipoproteinemia
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t VLDL, alcoholics
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Apo B deficiency
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deficiency apo B48 (chylomicrons) and B100 (VLDL), 4- CH and TG
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Clinical findings in apo B deficiency
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malabsorption, hemolytic anemia
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Atherosclerosis
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reaction to injury of endothelial cells
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Risk factors
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smoking, T LDL, T homocysteine, Chlamydia pneumoniae infection
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Cells involved
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platelets, macrophages, smooth muscle cells, T cells with cytokine release
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Fibrous plaque
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pathognomonic lesion of atherosclerosis
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C-reactive protein
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marker of an inflammatory atheromatous plaque
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Inflammatory atheromatous plaque
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predisposes to platelet thrombosis
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Increased plasma homocysteine
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t vessel thrombosis, folate (MC)/vitamin Bi2 deficiency
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Hyaline arteriolosclerosis
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small vessel disease of DM and hypertension, excess protein in vessel wall
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Mechanisms hyaline arteriolosclerosis in DM
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non-enzymatic glycosylation
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Non-enzymatic glycosylation
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glucose attaches to amino acids in BM, causes T permeability to protein
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Mechanisms hyaline arteriolosclerosis in hypertension
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pressure pushes proteins into vessel wall
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Abdominal aortic aneurysm rupture
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due to atherosclerosis, flank pain, hypotension, pulsatile mass
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Syphilitic aneurysm
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vasculitis of vasa vasorum of aortic arch, aortic regurgitation
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Aortic dissection
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due to hypertension and collagen tissue disorders (e.g., Marfan)
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Cystic medial degeneration
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elastic tissue degeneration creates spaces filled with mucopolysaccharides
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Intimal tear in aorta
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due to wall stress from hypertension and structural weakness
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Types of dissection
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proximal (MC), distal or combination of both
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S/S proximal aortic dissection
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chest pain radiating to back, lack of pulse, cardiac tamponade MC COD
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Marfan's
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AD, fibrillin defect, aortic regurgitation/dissection, lens dislocation, MVP with sudden death
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MC COD Marfan's and Ehlers Danlos
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aortic dissection
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Phlebothrombosis
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stasis of blood flow, deep veins below knee MC site
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Pulmonary thromboembolism
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emboli originate from femoral veins
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Superficial migratory thrombophlebitis
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sign of carcinoma of head of pancreas
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Thoracic outlet syndrome
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absent radial pulse with positional change
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Turner's syndrome
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lymphedema hands/feet in newborn, preductal coarctation
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Spider telangiectasia
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arteriovenous fistula, due to hyperestrinism (cirrhosis, pregnancy)
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Capillary hemangioma in newborn
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regress with age, do not surgically remove
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Kaposi's sarcoma
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HHN-8, vascular malignancy, MC cancer in AIDS
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Bacillary angiomatosis
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Bartonella henselae, vascular infection in AIDS
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Small vessel vasculitis
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palpable purpura, e.g., Henoch Schonlein purpura
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Muscular artery vasculitis
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vessel thrombosis with infarction, e.g., classical polyarteritis nodosa
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Elastic artery vasculitis
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absent pulse, stroke
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Takayasu's arteritis
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pulseless disease young Asian woman
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Giant cell arteritis
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temporal artery granulomatous vasculitis, ipsilateral blindness (ophthalmic artery)
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Classical polyarteritis nodosa
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muscular artery vasculitis with vessel thrombosis infarction
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Path findings
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vessel inflammation at different stages, aneurysms from vessel weakness
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S/S
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infarctions in kidneys, skin, GI tract, heart, HBsAg in 30%
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Diagnosis
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angiography identifies aneurysms and thrombosis
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Kawasaki's disease
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coronary artery vasculitis/thrombosis/aneurysms in children
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S/S
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chest pain, desquamating rash, swelling hands/feet, cervical lymphadenopathy
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Rx
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IV y-globulin
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Buerger's disease (thromboangiitis obliterans)
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smoker's digital vasculitis, digital infarction
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Raynaud's syndrome
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digital vasculitis in PSS and CREST syndrome
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S/S
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digital pain, white-blue-red color changes
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Cryoglobulinemia
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protein gels in cold temperature, Raynaud's syndrome, HCV association
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S/S
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acral cyanosis relieved by coming indoors
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Wegener's granulomatosis
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association with c-ANCA, sinusitis, lung infarction, crescentic GN
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Microscopic polyangiitis
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palpable purpura, crescentic GN, association with p-ANCA
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Henoch-Schonlein purpura
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IgA-anti-IgA ICs, palpable purpura buttocks/legs, arthritis, IgA GN
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Serum sickness vasculitis
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e.g., horse antivenin in Rx of rattlesnake envenomation
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Rocky Mtn spotted fever
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tick borne Rickettsia infection, vasculitis causes petechia on palms -» trunk
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Meningococcemia
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sepsis causes petechia/ecchymoses, potential for Waterhouse Friderichsen syndrome
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Essential HTN blacks
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defect in renal excretion of sodium,t plasma volume, 4 PRA
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Renovascular HTN
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atherosclerosis renal artery in men, fibromuscular hyperplasia renal artery women
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S/S
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epigastric bruit, t PRA affected kidney, I PRA unaffected kidney
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Endocrine HTN
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1° HPTH, Graves/hypothyroidism, Cushings, 1° aldosteronism, pheochromocytoma
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Hypertension
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LVH MC complication, AMI MC COD followed by stroke and renal failure
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Afterload
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resistance ventricles contract against
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Preload
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volume ventricles must eject
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Concentric LVH
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increased afterload, e.g., essential HTN, aortic stenosis
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LVH with dilation/hypertrophy
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increased preload, e.g., valve regurgitation, left to right shunts
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LHF
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forward failure, pulmonary edema, pillow orthopnea, paroxysmal nocturnal dyspnea
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Systolic dysfunction
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LHF due to decreased ventricular contractility (ischemia)
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Diastolic dysfunction
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LHF due to decreased ventricular compliance (hypertrophy)
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RHF
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backward failure, t venous hydrostatic pressure, neck vein distention, hepatomegaly, edema
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ACE inhibitors
|
decrease afterload and preload in heart failure
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Diuretics in CHF
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reduce preload
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Non-pharmacologic Rx in CHF
|
restrict salt and water
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AMI
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MC COD in United States, left anterior descending coronary artery thrombosis MCC
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Exertional angina
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coronary artery atherosclerosis, subendocardial ischemia, ST depression
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Prinzmetal's angina
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coronary artery vasospasm, transmural ischemia, ST elevation
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Sudden cardiac death
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death within 1 hr of symptoms
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Path findings
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severe coronary artery atherosclerosis, absence of occlusive thrombosis
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LAD coronary artery
|
anterior portion left ventricle, anterior 2/3rds IVS
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RCA
|
posterior portion left ventricle and papillary muscle, inferior 1/3rd IVS, right ventricle
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AMI
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rupture of inflammatory plaque produces platelet thrombus
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Ventricular fibrillation
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MC COD in AMI
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AMI
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no gross changes until 24 hrs
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S/S AMI
|
retrosternal pain radiating down arms, diaphoresis
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AMI ruptures
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3rd-7th day
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Anterior wall rupture
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MC type, LAD thrombosis, cardiac tamponade
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Posteromedial papillary muscle rupture
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RCA thrombosis, mitral regurgitation with LHF
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IVS rupture
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LAD thrombosis, left to right shunt, RHF
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Mural thrombus
|
anterior AMI, danger embolization
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Pericarditis
|
first week in transmural AMI, 6 wks later autoimmune
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S/S
|
friction rub, leaning forward relieves pain
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Ventricular aneurysms
|
late manifestation of AMI, precordial systolic bulge, CHF MC COD
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Right ventricular infarction
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RCA thrombosis, hypotension, RHF, preserved left ventricular function
|
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Diagnosis of AMI
|
CK-MB and troponins, CK-MB absent by 3 days, troponins last 7-10 days
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LDH isoenzymes
|
no longer used, LDH 1/2 flip indicates AMI
|
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Reinfarction
|
reappearance CK-MB after 3 days
|
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ECG findings in AMI
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inverted T waves, ST elevation, Q waves
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Ejection fraction
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EF = stroke volume/left ventricular end-diastolic volume, 80/120 = 0.66
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By-pass surgery
|
use internal mammary artery and saphenous veins ("arterialize" after 10 yrs)
|
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Angioplasty complication
|
localized dissection with thrombosis
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Umbilical vein
|
highest O2 saturation
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Ductus arteriosis in fetus
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shunts blood from pulmonary artery to aorta, PGE keeps it open
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Ductus arteriosus in newborn
|
closes and becomes ligamentum arteriosum
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Eisenmenger's syndrome
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cyanosis due to reversal of left to right shunt
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VSD
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MC congenital heart disease, f Sa02 right ventricle (RV), pulmonary artery (PA)
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ASD
|
patent foramen ovale, t Sa02 right atrium (RA), RV, PA, MC adult congenital heart disease
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Down syndrome
|
endocardial cushion defect (combined ASD and VSD)
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PDA
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machinery murmur, close with indomethacin, t Sa02 PA
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Tetralogy of Fallot
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degree of pulmonic stenosis determines if cyanosis is present
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Tetralogy of Fallot
|
4- Sa02 left ventricle, aorta
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Tetralogy of Fallot
|
ASD and PDA are cardioprotective
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Complete transposition
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cyanosis, aorta empties RV, PA empties left ventricle
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Complications cyanotic heart disease
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2° polycythemia, infective endocarditis, metastatic abscesses
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Pre-ductal coarctation
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Turner's syndrome
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Post-ductal coarctation
|
constriction distal to ligamentum arteriosum
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S/S
|
upper extremity HTN, claudication, rib-notching, activation RAA also causes HTN
|
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Acute rheumatic fever
|
type II hypersensitivity, group A streptococcus pharyngeal infection
|
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Acute rheumatic fever
|
sterile vegetations mitral valve (regurgitation), myocarditis with Aschoff nodule
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S/S
|
polyarthritis (MC), carditis, erythema marginatum, rheumatoid nodules, chorea
|
|
|
Mitral stenosis
|
chronic rheumatic fever, opening snap followed by mid-diastolic rumble
|
|
|
Mitral stenosis
|
left atrial dilation/hypertrophy- atrial fibrillation, thrombus, pulmonary edema, RHF
|
|
|
MVP
|
myxomatous degeneration of mitral valve, common in Marfan syndrome, Ehlers Danlos
|
|
|
S/S
|
mid-systolic click followed by a murmur, palpitations, chest pain, rupture of chordae
|
|
|
MVP click/murmur close to SI
|
decrease preload (stand, Valsalva, anxiety)
|
|
|
MVP click/murmur close to S2
|
increase preload (supine, squat, clench fist)
|
|
|
Mitral regurgitation
|
pansystolic murmur, S3 and S4 common
|
|
|
Causes
|
LHF, infective endocarditis, acute rheumatic fever
|
|
|
Aortic stenosis
|
systolic ejection murmur, syncope and angina with exercise, hemolytic anemia
|
|
|
Aortic stenosis murmur increased preload
|
worsens obstruction and increases murmur intensity
|
|
|
Aortic stenosis murmur decreased preload
|
decreases obstruction and decreases murmur intensity
|
|
|
Causes
|
bicuspid aortic valve, age-related sclerosis
|
|
|
Aortic regurgitation
|
bounding pulses, early diastolic blowing murmur
|
|
|
Austin Flint murmur
|
diastolic murmur, regurgitant flow on anterior leaflet mitral valve
|
|
|
Significance Austin Flint murmur
|
sign for AV replacement
|
|
|
Causes aortic regurgitation
|
essential HTN, infective endocarditis, acute rheumatic fever, dissection
|
|
|
Tricuspid regurgitation
|
pansystolic murmur T intensity with inspiration
|
|
|
Causes
|
endocarditis IV drug abuse, RHF, carcinoid heart disease
|
|
|
Carcinoid heart disease
|
tricuspid regurgitation, pulmonic stenosis
|
|
|
Infective endocarditis (BE)
|
Streptococcus viridans MCC, Staphylococcus aureus MCC IVDA
|
|
|
BE prosthetic heart valve
|
Staphylococcus epidermidis (coagulase negative)
|
|
|
BE ulcerative bowel disease
|
Streptococcus bovis
|
|
|
S/S
|
IC vasculitis- Roth spot, splinter hemorrhages, regurgitant murmurs, metastatic abscesses
|
|
|
Lab findings
|
positive blood culture
|
|
|
Libman Sacks endocarditis
|
sterile vegetations mitral valve associated with SLE
|
|
|
Coxsackievirus
|
MCC of myocarditis (lymphocyte infiltrate in myocardium) and pericarditis
|
|
|
Parasitic cause myocarditis
|
leishmania in Chagas disease
|
|
|
Pericardial effusion
|
all chamber pressures are uni formally increased
|
|
|
S/S
|
muffled heart sounds, pulsus paradoxus, inspiratory neck vein distention
|
|
|
Dx and Rx
|
echocardiogram, pericardiocentesis, respectively
|
|
|
Pulsus paradoxus
|
drop in blood pressure > 10 mm Hg with inspiration
|
|
|
Constrictive pericarditis
|
TB MCC worldwide, pericardial knock
|
|
|
Congestive cardiomyopathy
|
generalized chamber enlargement, low ejection fraction
|
|
|
Causes
|
postpartum, cardiotoxic drugs, hypothyroidism, alcohol
|
|
|
Hypertrophic cardiomyopathy
|
MCC of sudden death in young person (due to conduction defects)
|
|
|
Site of obstruction
|
anterior leaflet mitral valve drawn against asymmetric thickened IVS
|
|
|
Effect decreased preload on systolic murmur
|
worsens obstruction and increases murmur intensity
|
|
|
Effect increased preload on systolic murmur
|
reduces obstruction and decreases murmur intensity
|
|
|
Restrictive cardiomyopathy
|
decreased compliance
|
|
|
Causes
|
iron, amyloid, glycogen, sarcoidosis, tropical endocardial fibrosis
|
|
|
Cardiac myxoma
|
benign tumor left atrium, embolization, syncope
|
|
|
Cardiac rhabdomyoma
|
childhood tumor, association with tuberous sclerosis
|
|
|
U wave
|
hypokalemia, MCC diuretic therapy (e.g., thiazides, loop diuretics).
|
|
|
Peaked T wave
|
hyperkalemia, MCC renal failure
|
|
|
ST depression
|
subendocardial ischemia (e.g., classical angina pectoris).
|
|
|
ST elevation
|
transmural ischemia (e.g., AMI), pericarditis, ventricular aneurysm
|
|
|
Atrial fibrillation
|
MC chronic arrhythmia, absent P waves, danger for embolization
|
|
|
Ventricular premature beats
|
wide QRS complexes, MC arrhythmia in coronary care unit
|
|
|
Ventricular fibrillation
|
MCC of death in an AMI
|
|
|
Anterior AMI
|
Q waves I V1-V4
|
|
|
Inferior AMI
|
Q waves in II, III, and aVF. Right coronary artery thrombosis.
|
|
|
Wolff-Parkinson-White
|
short PR interval with normal P wave, delta wave on upstroke of R wave
|
|
|
Alveolar Oz calculation
|
%02 breathing (713) - PCO2/0.8
|
|
|
Increased A-a gradient
|
primary lung disease, left to right shunts in heart
|
|
|
Forced vital capacity
|
total amount of air expelled after a maximal inspiration
|
|
|
Forced expiratory vol'
|
*ue 1 second
|
|
|
Choanal atresia
|
cyanotic when breast feeding, turns pink when crying
|
|
|
Nasal polyps
|
allergic (MC, adults only), aspirin, cystic fibrosis
|
|
|
Nasal polyp in a child
|
requires sweat test to exclude cystic fibrosis
|
|
|
Triad asthma
|
patient on aspirin (pain syndrome) with nasal polyps, asthma
|
|
|
Obstructive sleep apnea (OSA)
|
snoring with intervals of apnea (respiratory acidosis with hypoxemia)
|
|
|
S/S
|
danger cor pulmonale, requires sleep test, Rx- 02 with continuous positive airway pressure
|
|
|
Sinusitis
|
maxillary sinusitis MC in adults, ethmoiditis MC in children, S. pneumoniae MC
|
|
|
Nasopharyngeal carcinoma
|
association with EBV, metastasize to cervical nodes
|
|
|
Laryngeal carcinoma
|
smoking MCC, hoarseness, squamous cell carcinoma
|
|
|
Resorption atelectasis
|
MCC of fever 24-36 hrs after surgery
|
|
|
S/S
|
I percussion, absent fremitus, breath sounds, inspiratory lag, elevated diaphragm
|
|
|
RDS
|
decreased production surfactant, airway collapse, hyaline membranes
|
|
|
Type II pneumocytes
|
synthesize surfactant (lecithin, phosphatidylcholine), stored in lamellar bodies
|
|
|
Surfactant
|
reduces surface tension in airways, t synthesis Cortisol, thyroxine, 4- synthesis insulin
|
|
|
Causes RDS
|
prematurity, maternal diabetes, C-section
|
|
|
Maternal diabetes
|
maternal hyperglycemia -> fetal hyperglycemia -> t fetal insulin which i surfactant
|
|
|
Complications RDS
|
02 FR injury (blindness, bronchopulmonary dysplasia), necrotizing enterocolitis
|
|
|
Typical community acquired pneumonia
|
Streptococcus pneumoniae MCC
|
|
|
Typical pneumonia
|
bronchopneumonia, lobar pneumonia
|
|
|
S/S
|
productive cough, consolidation- ■I percussion, T tactile fremitus
|
|
|
Atypical community acquired pneumonia
|
interstitial pneumonia, Mycoplasma pneumoniae MCC
|
|
|
S/S
|
low grade fever, non-productive cough, no signs consolidation
|
|
|
Nosocomial pneumonia
|
Pseudomonas aeruginosa MCC (respirators), others- & aureus, E. coli
|
|
|
Rhinovirus
|
MCC common cold, hand to mouth transmission
|
|
|
Respiratory syncytial virus
|
MCC pneumonia and bronchiolitis in child
|
|
|
Parainfluenza virus
|
MCC croup in child, trachea area of obstruction
|
|
|
Cytomegalovirus
|
basophilic intranuclear inclusion surrounded by halo
|
|
|
Influenza
|
superimposed pneumonia with S. aureus increases mortality
|
|
|
Rubeola
|
Warthin-Finkeldey multinucleated giant cells
|
|
|
Chlamydia pneumoniae
|
atypical pneumonia, association with coronary artery disease
|
|
|
Chlamydia trachomatis
|
pneumonia in newborns, staccato cough, wheezing
|
|
|
Coxiella burnetii
|
only rickettsia without a vector
|
|
|
Mycoplasma pneumoniae pneumonia
|
crowded condition, cold agglutinins, azithromycin
|
|
|
Streptococcus pneumoniae pneumonia
|
gram positive diplococcus, azithromycin
|
|
|
Staphylococcus aureus pneumonia
|
tension pneumatocysts in children with cystic fibrosis
|
|
|
Corynebacterium diphtheriae
|
toxin produces ADP ribosylation of elongation factor 2
|
|
|
Haemophilus influenzae
|
exacerbation chronic bronchitis, acute epiglottis in children
|
|
|
Inspiratory stridor child
|
croup, epiglottitis
|
|
|
Pseudomonas aeruginosa
|
MCC of pneumonia and death in cystic fibrosis, green sputum
|
|
|
Klebsiella pneumoniae
|
mucoid sputum in alcoholic
|
|
|
Legionella pneumophila
|
silver stain, water coolers/mist (grocery produce, restaurants, zoo rain forest
|
|
|
Mycobacterium tuberculosis
|
strict aerobe, MC COD due to infectious disease worldwide
|
|
|
Candida albicans
|
vessel invader, yeasts and pseudohyphae
|
|
|
Cryptococcus immitis
|
pigeon excreta, narrow-based bud
|
|
|
Aspergillus fumigatus
|
septate hyphae with fruiting body, fungus ball, extrinsic asthma, vessel invader
|
|
|
Mucor species
|
non-septate, vessel invader, frontal lobe abscess in DKA
|
|
|
Coccidioides immitis
|
Southwest deserts, inhalation arthrospores in dust, spherule with endospores
|
|
|
S/S
|
erythema nodosum (painful nodules lower legs)
|
|
|
Histoplasma capsulatum
|
Ohio/central Mississippi river valley, excreta bats (spelunker), chickens
|
|
|
H. capsulatum
|
simulates TB, yeasts phagocytosed by macrophages
|
|
|
Blastomyces dermatitidis
|
overlaps histoplasmosis, broad-based buds, skin lesion simulates cancer
|
|
|
Pneumocystis carinii
|
cysts and trophozoites, pneumonia in HIV, Rx- trimethoprim/sulfamethoxazole
|
|
|
Primary TB
|
upper portion lower lobe, lower portion upper lobe
|
|
|
Primary TB
|
Ghon focus (subpleural caseation), Ghon complex (spread to hilar nodes)
|
|
|
Reactivation TB
|
cavitating lesion in upper lobe, kidney MC extrapulmonary site
|
|
|
MAI
|
atypical TB, MC TB in AIDS
|
|
|
CF
|
AR, 3 nucleotide deletion chromosome 7, defective CFTR (degraded in Golgi apparatus)
|
|
|
S/S
|
pneumonia, malabsorption, males sterile, + sweat test, P. aeruginosa pneumonia MC COD
|
|
|
Lung abscess
|
MCC aspiration oropharyngeal material (mixed aerobe/anaerobe), x-ray- air/fluid level
|
|
|
Aspiration sitting
|
posterobasal segment right lower lobe
|
|
|
Aspiration supine
|
superior segment right lower lobe
|
|
|
Aspiration right side
|
right middle lobe, posterior segment right upper lobe
|
|
|
Pulmonary thromboembolism
|
most derive from femoral vein
|
|
|
Bronchial artery
|
branch of aorta/intercostal artery, protects against developing pulmonary infarction
|
|
|
Saddle embolus
|
sudden death due to acute right heart strain
|
|
|
S/S pulmonary infarction
|
dyspnea and tachypnea, pleuritic chest pain, pleural effusion
|
|
|
Dx
|
ventilation/perfusion scan, respiratory alkalosis, hypoxemia
|
|
|
Pain on inspiration
|
pleuritic inflammation, pulmonary embolus, pneumonia, pneumothorax
|
|
|
Pathogenesis pulmonary hypertension (PH)
|
hypoxemia and respiratory acidosis
|
|
|
Hypoxemia + respiratory acidosis
|
vasoconstriction pulmonary vessels, vasodilation cerebral vessels
|
|
|
Causes PH
|
1° lung disease (COPD, restrictive), recurrent emboli, mitral stenosis, OSA, left-right shunts
|
|
|
Cor pulmonale
|
PH + RVH
|
|
|
S/S
|
dyspnea, accentuated P2 (PH), parasternal heave (RVH)
|
|
|
Restrictive lung disease
|
-l compliance, t elasticity, interstitial fibrosis/edema
|
|
|
Restrictive lung disease (RLD)
|
I all volumes and capacities, t FEVisec/FVC ratio
|
|
|
ARDS
|
RLD, non-cardiogenic pulmonary edema due to alveolar injury
|
|
|
ARDS
|
neutrophil destruction type I and II pneumocytes, hyaline membranes
|
|
|
Causes
|
septic shock (MC), aspiration gastric contents, severe trauma
|
|
|
Pneumoconiosis
|
inhalation mineral dust causing interstitial fibrosis, particles < 0.5 um reach alveoli
|
|
|
Caplan syndrome
|
pneumoconiosis + rheumatoid nodules in lungs
|
|
|
Coal worker's
|
"black lung" disease, progressive massive fibrosis, no increased incidence cancer or TB
|
|
|
Silicosis
|
quartz, nodular opacities, foundry workers, t incidence cancer and TB
|
|
|
Sources asbestos
|
roofing material, old buildings (9/11), pipe-fitter shipyard
|
|
|
Ferruginous bodies
|
asbestos fiber coated by iron
|
|
|
Asbestosis
|
benign pleural plaques (MC), bronchogenic carcinoma (MC cancer), mesothelioma
|
|
|
Mesothelioma
|
malignancy of serosa, no smoking association
|
|
|
Sarcoidosis
|
RLD, MC non-infectious lung and liver granulomatous disease
|
|
|
S/S
|
dyspnea, hilar adenopathy (non-caseating granulomas), uveitis, nodular skin lesions
|
|
|
Lab findings
|
T ACE, hypercalcemia (macrophages synthesize 1-a-hydroxylase)
|
|
|
Kveim test
|
intradermal injection sarcoid antigens causes skin reaction
|
|
|
Farmer's lung
|
RLD, lung reaction against thermophilic bacteria in moldy hay
|
|
|
Silo filler's disease
|
RLD, reaction against nitrogen dioxide in fermenting corn
|
|
|
Byssinosis
|
RLD, reaction against cotton, linen, hemp products in textile industry
|
|
|
Goodpasture's syndrome
|
RLD, anti-BM antibodies, begins in lungs and ends in renal failure
|
|
|
Collagen vascular RLD
|
SLE, rheumatoid arthritis, systemic sclerosis
|
|
|
Drugs RLD
|
amiodarone, bleomycin, busulfan, cyclophosphamide, methotrexate, nitrofurantoin
|
|
|
Obstructive lung disease
|
T compliance, -l elasticity
|
|
|
Obstructive lung disease
|
T RV, TLC, i TV, VC, I FEV]sec and FVC, i FEVlsec/FVC ratio
|
|
|
Obstructive lung disease
|
asthma, emphysema, chronic bronchitis, bronchiectasis
|
|
|
Asthma
|
extrinsic (type I hypersensitivity) and intrinsic types
|
|
|
S/S
|
expiratory wheezing (inflamed terminal bronchioles), LTC4,-D4,-E4 bronchoconstrictors
|
|
|
Charcot Leyden crystals
|
derive from crystalline material in eosinophil granules
|
|
|
Lab findings
|
initial respiratory alkalosis, respiratory acidosis requires intubation
|
|
|
Emphysema
|
destruction elastic tissue respiratory unit, lung hyperinflation, smoking MCC, pink puffer
|
|
|
Respiratory unit
|
respiratory bronchiole, alveolar duct, alveoli
|
|
|
Radiograph emphysema
|
f AP diameter, depressed diaphragms, vertical heart
|
|
|
Pathogenesis
|
4- AAT, T neutrophil destruction elastic tissue
|
|
|
Centriacinar emphysema
|
destruction/distention respiratory bronchioles upper lobe in smokers
|
|
|
Panacinar emphysema
|
destruction/distention entire respiratory unit lower lobes, AAT deficiency
|
|
|
Paraseptal emphysema
|
upper lobe destruction/distention alveolar ducts, alveoli, pneumothorax
|
|
|
Lab findings
|
normal to decreased PC02 (respiratory alkalosis)
|
|
|
Chronic bronchitis
|
productive cough 3 months/2 consecutive years, blue bloater (cyanosis)
|
|
|
Site of obstruction
|
terminal bronchioles (proximal to respiratory unit)
|
|
|
Lab findings
|
respiratory acidosis/hypoxemia
|
|
|
Bronchiectasis
|
obstruction/infection key causes, dilated bronchi/bronchioles extend to periphery
|
|
|
Causes
|
CF MCC, TB, immotile cilia syndrome
|
|
|
Immotile cilia syndrome
|
absent dynein arm in cilia, sinusitis, infertility, bronchiectasis, situs inversus
|
|
|
Central lung cancers
|
squamous cancer and small cell cancer, men > women
|
|
|
Peripheral lung cancers
|
adenocarcinoma, women > men
|
|
|
Squamous lung cancer
|
cavitate, secrete PTH-related protein
|
|
|
Small cell carcinoma
|
neuroendocrine tumor, secrete ACTH and ADH
|
|
|
Bronchioloalveolar carcinoma
|
no smoking relationship, lung consolidation resembling pneumonia
|
|
|
Scar carcinoma
|
usually adenocarcinoma developing in old TB scar
|
|
|
Bronchial carcinoid
|
low grade malignant, hemoptysis, rare cause carcinoid syndrome
|
|
|
Metastatic lung cancer
|
more common than primary cancer, breast cancer MCC
|
|
|
Pancoast tumor
|
squamous carcinoma posterior mediastinum, destruction superior cervical ganglion
|
|
|
S/S
|
Horner's syndrome- lid lag, miosis, anhydrosis, lower brachial plexus injury
|
|
|
Solitary coin lesion
|
granuloma MCC
|
|
|
Superior vena caval syndrome
|
primary lung cancer obstructs vessel, venous congestion
|
|
|
Anterior mediastinal masses
|
thymoma, nodular sclerosing Hodgkin's, teratomas
|
|
|
Posterior mediastinal masses
|
usually neurogenic tumors of ganglia
|
|
|
Myasthenia gravis
|
B cell hyperplasia of thymus MC abnormality, association with thymoma
|
|
|
Thymoma
|
association with hypogammaglobulinemia, autoimmune disease, pure RBC aplasia
|
|
|
Pleural effusions
|
transudates or exudates, CHF MCC
|
|
|
Spontaneous pneumothorax
|
rupture subpleural or intrapleural bleb, air/pleural cavity pressure same
|
|
|
S/S
|
pleuritic chest pain, dyspnea, tracheal shift ipsilateral side, absent breath sounds
|
|
|
Tension pneumothorax
|
flap-like pleural tear, increased pleural cavity pressure, compression atelectasis
|
|
|
S/S
|
as above except tracheal shift to opposite side
|
|
|
Cleft lip/palate
|
failure of fusion of facial processes
|
|
|
Herpes labialis
|
multinucleated giant cell with acidophilic intranuclear inclusions on Tzanck prep
|
|
|
Hairy leukoplakia
|
EBV glossitis, pre-AIDS defining lesion, not precursor to cancer
|
|
|
Mumps
|
bilateral parotitis, unilateral orchitis, t amylase
|
|
|
Diphtheria
|
pseudomembrane pharynx and trachea with cervical lymphadenopathy
|
|
|
Congenital syphilis
|
notched central incisors
|
|
|
Actinomycosis
|
anaerobic gram + filamentous bacteria, complication extracted dental abscess
|
|
|
S/S
|
draining sinuses with sulfur granules
|
|
|
Exudative tonsillitis
|
majority are viral, 20% group A streptococcus
|
|
|
Oral thrush
|
common in newborn, pre-AIDS defining lesion, yeasts and pseudohyphae
|
|
|
Dental caries
|
Streptococcus mutans
|
|
|
Peutz-Jegher's syndrome
|
mucosal pigmentation, hamartomatous polyps
|
|
|
Leukoplakia/erythroleukoplakia
|
biopsy to rule out squamous dysplasia or cancer
|
|
|
Squamous cell carcinoma
|
smoking and alcohol association, lower lip MC site
|
|
|
Smokeless tobacco
|
verrucoid squamous cell carcinoma
|
|
|
Gum hyperplasia
|
phenytoin, pregnancy, scurvy
|
|
|
Pleomorphic adenoma
|
MC benign tumor of salivary glands, parotid MC site
|
|
|
Mucoepidermoid carcinoma
|
MC malignant tumor major and minor salivary glands
|
|
|
Dysphagia for solids only
|
lesion obstructing esophagus, e.g., cancer, web
|
|
|
Plummer-Vinson syndrome
|
iron deficiency anemia causes esophageal web, glossitis, achlorhydria
|
|
|
Dysphagia for solids and liquids
|
motor abnormality, e.g., achalasia MCC, PSS or CREST syndrome
|
|
|
TE fistula
|
polyhydramnios, proximal esophagus ends blindly, distal esophagus derives from trachea
|
|
|
VATER syndrome
|
vertebral abnormalities, anal atresia, TE fistula, renal disease/radius abnormality
|
|
|
Zenker's diverticulum
|
MC pulsion diverticulum of esophagus, halitosis
|
|
|
GERD
|
relaxation of lower esophageal sphincter (LES) with acid reflux
|
|
|
GERD
|
MCC nocturnal cough and asthma
|
|
|
AIDS esophagitis
|
Candida MC, CMV, HSV
|
|
|
Barrett's esophagus
|
glandular metaplasia distal esophagus in GERD
|
|
|
Complications of Barrett's
|
precursor for adenocarcinoma, stricture
|
|
|
Esophageal varices
|
dilated left gastric coronary vein, sign portal hypertension from cirrhosis
|
|
|
Mallory Weiss syndrome
|
tear of distal esophagus from retching in alcoholic or bulimic
|
|
|
Boerhaave's syndrome
|
rupture of distal esophagus from retching, pneumomediastinum
|
|
|
Hamman's mediastinal crunch
|
pneumomediastinum (air in subcutaneous tissue)
|
|
|
LES ganglion cells
|
contain VIP- relaxes LES
|
|
|
Achalasia
|
failure relaxation LES (no VIP), absent ganglion cells myenteric plexus
|
|
|
S/S
|
aperistalsis/dilation of esophagus, regurgitation undigested food at night
|
|
|
X-ray achalasia
|
bird's beak appearance
|
|
|
Acquired achalasia
|
Chagas' disease, leishmania destroy ganglion cells
|
|
|
Distal adenocarcinoma esophagus
|
MC primary cancer, due to Barrett's esophagus
|
|
|
Squamous cell carcinoma of esophagus
|
smoking MCC, alcohol also causes
|
|
|
Melena
|
sign of upper GI bleed, acid changes Hb to hematin, peptic ulcer disease MCC
|
|
|
Hematemesis
|
vomiting blood, peptic ulcers MCC
|
|
|
Congenital pyloric stenosis
|
hypertrophy pyloric muscle, vomiting non-bile stained fluid in 2-4 weeks
|
|
|
Acute hemorrhagic (erosive) gastritis
|
NSAIDs MCC
|
|
|
Mucous barrier stomach
|
maintained by PGE, misoprostol PGE analog
|
|
|
Type A chronic gastritis
|
due to PA, achlorhydria with t serum gastrin
|
|
|
Type B chronic gastritis
|
due to H. pylori, involves pylorus and antrum
|
|
|
H. pylori
|
curved rod, urease producer, MCC PUD, adenocarcinoma, gastric lymphoma
|
|
|
Gastric ulcer
|
lesser curvature pylorus and antrum, poor defense against acid, food aggravates pain
|
|
|
Duodenal ulcer
|
never malignant, t acid production, food relieves pain
|
|
|
Perforated peptic ulcer
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air under diaphragm causes pain in left shoulder
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