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109 Cards in this Set

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Which pathology:
Lens-shaped lesion on head CT
Epidural hematoma
Which pathology:
Common underlying cause of Intussusception
Meckel's diverticulum
Adenovirus infection of Peyer's Patches
Which pathology:
No milk production in the postpartum period
Sheehan's Syndrome
Which pathology:
Pigmented hamartomas in the iris
Leisch-Nodules of Fibromatosis
Which pathology:
Howell-Jolly bodies
DNA remnants in asplenia
Which pathology:
Cancer a/w asbestos
Malignant mesothelioma
Bronchogenic carcinoma
Which pathology:
Owl's eye inclusions
CMV
Which pathology:
Owl's eye nucleus
Hodgkin's Lymphoma
Which pathology:
Owl's eye protozoan
Giardia
Which pathology:
50-year-old male with new, unexplained skin yellowing and no other symptoms
Painless jaundice-->pancreatic cancer at head of pancreas
Drug class:
Cholestyramine
Bile acid binding resin

Can also bind to C. diff toxin
Drug class:
Clarithromycin
Macrolide
Drug class:
Venlafaxine
SNRI anti-depressant
Drug class:
Famotidine
H2RA
Drug class:
Fluphenazine
Typical Neuroleptics, high potency
Drug class:
Fluvoxamine
SSRI
Drug class:
Phentolamine
Reversible, non-selective alpha-blocker
Drug class:
6-mercaptopurine
Anti-cancer drug that inhibits purine synthesis
Drug class:
Captopril
ACE inhibitor
Drug class:
Selegiline
MAOI used in PD
Drug class:
Trazodone
anti-depressant, beware of priapism

(class = "serotonin modulator")
Drug class:
Terbinafine
Anti-fungal--oncomycosis
Drug class:
Carteolol
Beta-blocker--glaucoma
Drug class:
Clozapine
Atypical anti-psychotic
Type of information relayed:
Ventral posterior lateral (thalamus)
Somatosensory info from body
Type of information relayed:
Lateral geniculate (thalamus)
Visual retina-->occipital lobe
Type of information relayed:
Ventral posterior medial (thalamus)
Somatosensory from face
Type of information relayed:
Ventral anterior (thalamus)
Motor basal ganglia-->cortex
Antidote:
Copper, gold, arsenic
Penicilliamine (Copper pennies!)
Antidote:
Arsenic, mercury, gold
Dimercuprol
Antidote:
t-PA, streptokinase
Aminoproic acid
Antidote:
Digitalis
Stop dig
Administer Mg2+
Anti-dig Antibody if there are additional arrhythmias
What are the 4 main pharmacokinetic equations?
Vd = IV Drug Dose/[ ]Drug in plasma

CL = 0.7xVd/Half-Life

Loading dose = Css x Vd

Maintenance Dose = Css x Cl
Where does fetal erythropoiesis take place?

In which bones does adult erythropoiesis take place?
Fetal: Yolk sac, liver/spleen, bone marrow (in this order--Young Liver Synthesizes Blood)

Adult: vertebrae, sternum, ribs, cranial bones (and up to age 25: femur, tibia)
Which artery damaged:
Aneurysm causes the eye to look down and out
Posterior communicating a
Which artery damaged:
Aneurysm may cause bilateral loss of lateral visual fields
Anterior communicating a
Which artery damaged:
Broca's or Wernicke's aphasia
MCA
Which artery damaged:
Unilateral lower extremity sensory and/or motor loss
ACA
Which artery damaged:
Unilateral facial and arm sensory and/or motor loss
MCA
Which hormones use steroid receptors?
Steroid: E2, PG, T, aldosterone, vit D, T4, glucocorticoids--all go directly to nucleus
Which hormones use tyrosine kinase receptors?
Insulin, IGF-1, FGF, PDGF, PL, GH
What structures comprise the alveolar diffusion barrier?
Type I epithelial cell (pneumocyte)
Basement Membrane
Tight Junctions (continuous endothelium)
Type I vs Type II Pneumocytes:
Role
Type I Cells comprise 96% of alveolar surface and line alveoli; squamous for optimal gas diffusion (thin)

Type II secrete surfactant (dipalmitoyl phosphatidylcholine)--decreases surface tension; serve as precursors to Type I cells (during lung damage); secreting things, so they're CUBOIDAL
Which lung is more at risk of an inhaled foreign body?

Why?
Right lung bc right bronchus is wider and more vertical than left
What is the most common tracheoesophageal fistula?
Blind esophageal pouch--esophageal atresia, lower esophageal segment attaching to trachea (connecting stomach to trachea)
What structures perforate the diaphragm?

At what levels?
T8 - IVC
T10 - esophagus, vagus (2 trunks)
T12 - aorta (red), thoracic duct (white), azygous vein (blue)

I (IVC) ate (8) ten (10) eggs (esophagus) at (aorta) twelve (12).
Where does diaphragmatic pain refer?
Refers to shoulder
What histological change takes place in the trachea of a smoker?
Metaplasia: ciliated columnar epithelium becomes squamous
A patient in the ER is anaphylactic.

You make an incision beneath the thyroid cartilage to establish an airway.

What structure was cut?
Cricothyroid membrane
What cell type proliferates during lung damage?
Type II pneumocytes
What amniotic fluid measurement is indicative of fetal lung maturity?
Lecithin:Sphingomyelin > 2
A young women presents with infertility, recurrent URIs, and dextrocardia.

Which of her proteins is defective?
Kartagener's Syndrome: Non-fnal ciliated cells secondary to Dynein arm defect
What structures transverse the diaphragm and at what vertebral level do they pass through?
T8 - IVC
T10 - Esophagus and vagus nerve
T12 - Aorta, thoracic duct, azygous vein
Effect of prostaglandins on respiratory system.
Decrease bronchial tone (relax bronchi); so if give an NSAID, may actually cause bronchial spasm in some individuals.
Effect of histamine on respiratory system.
Histamine causes tissue edema-->narrows bronchial lumen
Kallikrein:
Where is it made?
Effect?
Kallikrein is made by the lungs and activates bradykinin (cough)
1. Inspiratory reserve volume
2. Tidal volume
3. Expiratory reserve volume
4. Residual volume
5. Inspiratory capacity
6. Vital Capacity
7. Functional Reserve Capacity
8. Total lung capacity
The following lung volumes are obtained from an elderly smoker:
FRC: 5.0 L
IRV: 1.5 L
IC: 2.0 L
VC: 3.5 L

What is his total lung capacity?
TLC = FRC + IC
7L = 5.0L= + 2.0L
Equation for determining physiologic dead space.
Vd = Vt x (PaCO2 - PeCO2)/PaCO2

Tells you what percentage of your tidal volume is dead space.
When does the collapsing force of the lungs negate the expanding force of the chest wall?

What are alveolar and airway pressures like?
At FRC, where alveolar and air pressure are both 0.
R vs T forms of hemoglobin:
General differences
Conditions favoring each
R (relaxed) form has high affinity for O2 (300x). Positive cooperativity and negative allostery

T (taut) form has low affinity for O2

High Cl-, H+, CO2, 2,3-BPG, and high temp favor T form (low affinity for O2) over R form. Shifts dissociation curve to right, leading to inc'd O2 unloading.
Oxygen-hemoglobin curve:
Factors affecting right/left shift
Right shift means higher PO2 (need more oxygen to achieve 50% Hgb saturation)

Conditions favoring right shift:
Inc'd metabolic needs, inc'd PCO2, inc'd temp, inc'd H+, dec'd pH, high altitude, inc'd 2,3.-DPG

Left Shift: Lower PO2 necessary for 50% Hgb saturation (greater O2 affinity)

Factors favoring left shift:
Dec'd metabolic needs, dec'd PCO2, dec'd temp, dec'd H+, inc'd pH, dec'd 2,3-DPH (FETAL HgB)
Methemoglobin:
What is it?
How does it differ from hemoglobin?
Synthesis?
Treatment?
Methemoglobin is the oxidized form of Hgb--FERRIC (FE3+) and cannot bind O2 readily, but does bind CN- readily

Methemoglobin typically caused by nitrates (and other drugs)--nitroglycerins

Tx: METHYlene blue
Cyanide Poisoning:
Treatment
1) Nitrates to elevate methemoglobin (has high affinity for CN-)
2) Thiosulfate to form thiocyanate and then renally excreted
Carboxyhemoglobin:
What is it?
Form of HgB bound to CO in place of O2. CO has 200x greater affinity than O2 for Hgb.

Causes dec'd O2-binding capacity with left shift in O2-hemoglobin dissocn curve, thus, dec'd oxygen unloading in tissues
How would a change in PAO2 result in cor pulmonale?
Dec'd PAO2 --> hypoxic vasoconstriction in lungs to shift blood away from poorly ventilated regions

Chronic vasoconstriction-->pulmonary hypertension-->cor pulmonale (and subsequent right ventricular failure, JVD, edema, hepatomegaly)
Diffusion vs Perfusion limitations:
Describe each
Provide examples (normal and abnormal)
Diffusion limited--O2 during emphysema, fibrosis; CO. Gas does not equilibrate by time blood reaches end of capillary.

Perfusion-limited: O2 (normal), CO2, N2O; gas equilibrates (Pa) early along length of capillary. Diffusion can only be inc'd if blood flow inc'd.
What substances are known to cause methemoglobinemia?
Chloroquine, primaquine
Dapsone, sulfonamides
Local anesthetics
Metocllopramide
Nitrates
A 42 year-old woman with fibroids is chronically tired.

What is the most likely diagnosis and what changes have occurred in the oxygen content and saturation?
Fibroids result in hypochromic anemia

No change in O2 content or saturation

Not as much Hgb to be saturated.
Patient is shown to have hypoxia and CXR reveals an enlarged heart.

What is the most likely cause of hypoxia?
Heart failure: Lungs not perfused well enough to oxygenate rest of body.
Pulmonary HTN:
Diagnostic criteria
Primary vs Secondary Pathophys
Normal pulmonary artery pressure = 10-14; pulm HTN ≥ 25 mmHg

Primary: inactivating mutation in BMPR2 gene (normal functions to inhibit vascular smooth muscle proliferation); poor prognosis

Secondary--due to COPD (destruction of lung parenchyma); mitral stenosis (inc'd resistance-->inc'd pressure); recurrent thromboemboli; autoimmune dz (systemic sclerosis), L-to-R shunt, sleep anpea, living at high altitudes (hypoxic vasoconstriction)
What is the effect of radius on pulmonary vascular resistance?
Resistance increases with radius to the FOURTH power
Equation for O2 content of blood
O2 content = (O2 Binding Capacity x Percent Saturation) + Dissolved O2
What is the effect of decreased hemoglobin levels on:
Arterial O2 blood content
O2 saturation
Arterial PO2
Dec'd hgb-->dec'd O2 content of blood
BUT
O2 saturation and arterial PO2 do NOT change.
Equation for oxygen delivery to tissues.
Oxygen delivery = CO x O2 content of blood
Alveolar gas equation
PAO2 = 150 - PaCO2/0.8
Equation for A-a gradient
Normal value?
What could increase A-a gradient?
PAO2 - PaO2
Normal value: 10-15 mmHg

THIS IS WHY YOU NEED THE ALVEOLAR GAS EQUATION

Inc'd A-a gradient:
Hypoxemia
Shunting
V/Q mismatch
Fibrosis (diffusion block)
Increased FIO2 (fraction of inspirated O2; if raise FIO2 too much, will overwhelm arterial O2 diffusion)
Age

A high A-a gradient is usually bad.
Describe an alternate measure of oxygenation to the A-a gradient.
PaO2/FiO2

300-500 mmHg is normal
<300: gas exchange deficit
<200: severe hypoxia (ARDS)
What are the three ways of achieving oxygen deprivation?
Hypoxemia - Dec'd PaO2 (high altitude, hypoventilation, R-to-L shunt (inc'd A-a gradient)

Hypoxia - Dec'd O2 delivery to tissues
Dec'd CO, hypoxemia, anemia, CN poisoning, CO poisoning

Ischemia - Lose blood flow
Impeded arterial flow
Reduced venous drainage
V/Q:
Apex of lung vs Base
Effect on Tb colonization
Apex of lung: V/Q = 3; wasted ventilation

At base of lung, V/Q = 0.6; wasted perfusion

Both ventilation and perfusion are greater at base of lung than at apex of lung!

TB thrives in high O2; flourishes at apex
When does V/Q approach:
0
1


When would 100% O2 help?
Ideally, ventilation is matched to perfusion so that V/Q =1.

With exercise (inc'd Q), there is vasodilation of apical capillaries resulting in a V/Q approaching 1

When V/Q = 0, there's an airway obstruction. Such as in shunt, where 100% O2 does not improve O2.

When V/Q approaches ∞, there is blood flow obstruction (physiologic dead space). Assuming <100% dead space, 100% O2 improves PO2
In what form is CO2 transferred from tissue to the lungs?

What facilitates O2 unloading at the tissue level and CO unloading at the lungs?
1. Bicarb (90%)

2. Bound to Hgb at N terminus of globin (NO HEME) as carbaminohemoglobin (5%); CO2 binding favors taut form (O2 unloaded)

3. Dissolved CO2 (5%)

In lungs, oxygenation of Hb promotes dissociation of H+ from Hb. This shifts equilibrium toward CO2 formation, therefore, CO2 released from RBCs (Haldane effect)

In peripheral tissue, inc'd H+ form tissue metabolism shifts curve to right, unloading O2 (Bohr effect).
What is the physiologic response to high altitude?
1. Acute inc in ventilation
2. Chronic inc in ventilation
3. Inc'd EPO; inc'd HCT, Hgb (chronic hypoxia)
4. Inc'd 2,3-DPG
5. Inc'd number mitochondria
6. Inc'd renal excretion of bicarb to compensate for respiratory alkalosis
7. Chronic hypoxic pulmonary vasoconstriction results in RVH (unwanted side effect bc can lead to cor pulmonale)
What is the physiologic response to exercise?
Inc'd CO2 production
Inc'd O2 consumption
Inc'd ventilation to meet O2 demand
No changes in PaO2 and PaCO2, but inc in venous CO2 content
Opening snap
Mitral Stenosis
Opportunistic infection in AIDS
PCP pneumonia
Osteomyelitis
Staph aureus
Osteomyelitis in sickle cell patients
Salmonella
Osteomyelitis with IVDU
Pseudomonas, Staph aureus
Ovarian metastasis from gastric carcinoma or breast cancer
Krukenberg tumor (mucin-secreting signet-ring cells)
Ovarian tumor (benign vs malignant)
Benign: Serous cystadenoma

Malignant: Serous cysteadenocarcinoma
Pancreatitis (acute vs chronic)
Acute: Gallstones, EtOH
Chronic: EtOH (adults), cystic fibrosis (kids)
Patient with ALL/CLL/AML/CML (ages)
ALL: Child
CLL: Adult >60
AML: Adult >60
CML: adult 35-50
Pelvic inflammatory disease
Neisseria gonorrhoeae (monoarticular arthritis)
Pituitary tumor
1. prolactinoma
2. somatotropic acidophilic adenoma
Primary amenorrhea
Turner syndrome (XO)
Primary bone tumor (adults)
Multiple myeloma
Primary hyperaldosteronism
Adenoma of adrenal cortex
Primary hyperparathyroidism
1. Adenomas
2. Hyperplasia
3. Carcinoma
Primary liver cancer
HCC (Chronic hepatitis, cirrhosis, hemochromatosis, alpha-1 antitrypsin)
Pulmonary HTN
COPD
Recurrent inflammation/thrombosis of small/medium vessels in extremities
Buerger's dz (strongly assocd w/tobacco)
Renal tumor
RCC; assocd w/von Hippel-Lindau and ADPKDl paraneoplastic syndromes (EPO, renin, PTH, ACTH)
RHF due to pulmonary cause
Cor pulmonale
S3 gallop
Inc'd ventricular filling (L-->R shunt, MR, LV failure [CHF])
S4 gallop
Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)
Secondary hyperparathyroidism
Hypocalcemia of chronic kidney dz
Sexually transmitted disease
Chlamydia--usually coinfected w/gonorrhea
SIADH (cause)
Small cell carcinoma of lung