Bbc Session 7

Front 1

What causes a blowing murmur vs. harsh murmur?

Back 1

blowing- blood flowing wrong way across valve

Harsh- bloot hitting tissue (stenotic valve)

Front 2

What are the causes of mtral regurgitation?

Back 2

advanced MVP, rheumatic heart disease, damage from infectious endocarditis, papillary, muscle rupture secondary to MI, CHF

Front 3

Most ASD are d/t defecct with...?

Back 3

ostium secundum, fenestrated ovale fossa

Front 4

Components of tetralogy of fallot?

Back 4

VSD, overarching aorta, right ventricular hypertrophy, subpulmonic stenosis

Front 5

Coarctation of the aorta adult vs. infant type

Back 5

all inherited, circumferential narrowing

infant type is preductal, poor prognosis

adult type is postductal, still get some blood flow is distal to branches of aorta, may only have decreased blood flow in descending

Front 6

Stable vs. unstable angina

Back 6

stable is exercised induced, relieved with rest or nitro, neg enzymes

unstable- also ST depression, from disruption of plaque folowed by formation of a superimposing thrombosis, d/t persistent but disrupted plaque obstructs blood flow, elevated CKMB

MI is unstable angina that lasts long enough to cause cell death

Front 7

Q wave vs. non-Q wave MI

Back 7

non Q wave- inner 1/3-1/2 of wall infarcted vs. whole wall

Front 8

Renin angiotensin aldosterone system and CHF

Back 8

JG cells release renin in respnse to decreased pressure, leads to conversion of angiotensinogen to Ang I, ACE turns it into Ang II which cuases vasoconstriction and stimulates aldosertone from adrenal, inadequate renal perfusion in CHF stimulates this and makes it worse

Front 9

Infective endocarditis causes emboli of aggreagated bacteria leading to...

Back 9

Roth spots in eye, Janeway lesions on Palms and soles, and Osler nodes secondary to these emboli

Acute- staph and strep

subacute- strep virdians from mouth or e coli from butt

Front 10

3 causes of non-infective endocarditis

Back 10

acute rheumatic fever- autoantibody following strep pyogenes infection leading to pancaditis and mitral valve damage

Marantic endocarditis- thrombi on endocardium following severe chronic illness (adenocarcinoma)

Libman-Sacks- vegetations of antigen-antibody complex causes vlave damage in SLE

Front 11

Most common causes of 3 types of pericarditis:

1. Fibrinous
2. Serous
3. suppurative

Back 11

fibrinous- transmural MI or Dressler syndrome

Serous- Coxsackie B virus, uremia, acute rhematic fever, SLE

Suppruative- purulent, invasion of staph or strep

Front 12

Criteria for acute rheumatic fever

Back 12

3-4 weeks after infection with strep

Aschoff body- focal area of myocardial inflammation containling enlearged myocytesa and mutlinuclearted giant cells

migratory polytarthtitis, cardditis, subq nodules, erythmea marginatum, syndeham's chorea

fever, arthralgia, prolonger PRI, history of previous episode

Front 13

FEV1/FVC ratio, significance and findings in COPD, restrictive disease

Back 13

FEV1- low in obstructive, normal in restrictive

FVC- total amount of aexhaled air

FEV1/FVC- low in obstructive, normal 80% in restrictive

Front 14

Criteria for chronic bronchitis

Back 14

symptoms present for 3 months for 2 consecutvie years, hypoxemic earlyin disease, later edema secondary to right heart failure from restricted pulmonary blood flow, rhonchi on auscultation

Front 15

Bronchiectasis

Back 15

irreversible, focal bronchial ilatiion accomapned by infection

Kartagener- dfect in cilia -> recurrent infections -> bronchiectasis, situs inversus, steritlity hearing deficits

CF- recurrent infections -> broncheiectasis, copius sputum

Front 16

Sarcoidosis

Back 16

non-caseating granulomas in lung serrounded or replaced by fibrosing scars, other tssues can also be affected, dyspnea, cough, night sweats, bilatera hilar adenopahy, sarcoidosis of parotids

Front 17

Adult ARDS vs. Neonatal

Back 17

adults- d.t diffuse injury to endothelium causing edema followed by inflammation leading to rapid collagen accumulation

neonatal- insufficienct surfactant low L:S ratio

Front 18

Penumoconiosis

Back 18

macrophages phagocytose non-degradable irritants in lung parnechyma -> relase of ROS and immune mediators -> fibrosis increases with each

asbestosis, antracosis (coal), berylisosis, silicosis

Front 19

Hypersenstivity penumonitis

Back 19

, extrinsic allergic alveolitis repeated inhalation of allergens tat causes inflamamtion and fibrosis

farmer's lung- thermophilic actinomycetes on hey, tobacco wokers,s bagassois

Front 20

Area most prone to lumbar herniation?

Back 20

L4-L5 d/t narrowing of posterior longitudinal ligament begins to narrow to only half the width at L1, spinal cord ends at L1-2

Front 21

Rachischisis

Back 21

completely open spine, none of the vertebra have lamina

Front 22

Spinal stenosis

Back 22

spinal canal narrowing causing pressure on the nerve toorts or the cord, most common form d/t degenerative arthrtic changes with chaneges in disc, radicular pain exacerbated by standing, walking and backward bending

Front 23

Comb tx for Wilm's tumor?

Back 23

Renal tumor in young kids, dactinomycin and vincristine

Dactinomycin

Vincristine- inhibts microtubule formation, can cause peripheral neuropathy

Dactinomycin sits in groove in DNA prevents syntehsis

Front 24

Adverse effects of cyclophosphamide and cisplatin and L-asapariganse

Back 24

Cyclophosphomide- alklating ahent can cause hemorhagic cystitis leading to baldder fibtrosis

Cisplatin- causes inter strand cross links between nucleotides causes peripheral neuropathy

L-aspariginase- prone to allergic reactions, decreased clottin g factors, deprives tumor cells of asparigine kills them

Front 25

Drug of choice for AML, ALL, Hodkin's?

Back 25

AML- cytarybine, stomatitis, NV

6-MP for ALL

Vincristine for Hodgkin;s

Doxorubicin- dialted cardiomyopathyq

Front 26

Most concerning adverse effects of alkylating agents?

Back 26

Secondary cancers

Mechlorathemine, cyclophosphamide, chlorambucil, lomustine, buslfan, melphalan

Front 27

DOC for testicular and blader CA

Back 27

cisplatin, primary side effects are in kdineys and brain

Front 28

MOA for leuprolide and use

Back 28

treatment for prostate cancer, synthetic GnRH feedback inhibits sex hormone synthesis

Front 29

Paclitaxel and docetaxel

Back 29

inhibit microtubule disaasemblie, white ells can still function by forming but can;t disassemble -> apoptosis

dose limiting BMD,

Front 30

PGE2

Back 30

mediates pain sensitiviation in inflaamartory process, inhibited by NSAIDs, also acts on hypothalamic thermoregulatory center to elevate it's set point

but PGs also decrease stomach secretions and increase protective mucus, woops...

Front 31

How does ASA cause initial resp alkalosis?

Back 31

uncouples ox phos leding to accumulation of CO2 causing hyperventilation

Front 32

Acetomenaphin MOA

Back 32

does not have peripheral anti-inflammatory effect, action in CNS cyclooxygenase reduces fever and pain perception

Front 33

Patient presents with MR, lens dislocation and elevated homocyteine in urine, enzyme defect?

Back 33

Homocystinuria, cystathionine synthetase

Front 34

Hartnup disease

Back 34

neutral AA trasnproter problem leads to deficit of tryptophan -> niacin deficiit -> pellagra

Front 35

Patient presents with arthritis and dark urine, alkaptonuria is a defect in

Back 35

homogentisate oxidase, can't convert homogentisate to acetoacetate

Front 36

Albinism and PKU

Back 36

alibinism- no tyrosinase, but can still make catecholamines via tyrosine hydroxylase

PKU- defective phenylaalnine hydroxylase- need to supplement tyrosine to make catecholamines

Front 37

What is the pathophys of maple syrip urine disease?

Back 37

defecttive branched chain decarboxylase, can;t metabolize valine, leucine and isoleucine, accumulation gives urine a sweet odor

Front 38

Which sugars are reducing sugars?

Back 38

glucose, glactose and fructose

sucrose is not

available O2 for redox reaction

Front 39

Enzymes that phosphorylate glucose, prevent exit from cell.

Back 39

Hexokinase in muscles has hix affinity, inhibited by G-6-P

Glucokinase- only in liver, has a low affinity (high Vmax) and no feedback inhibition, only active when glucose is high

Front 40

Which bond in cellulose can't be broken down in humans?

Back 40

B1-4 bond , makes it indigestible

Front 41

Fructosuria vs. frucotose intolerance

Back 41

fructosuria- fructokinase defect, benign

intolerance- aldolase B defect leads to hypohlycemia and liver failure with consumption of fructose, fructose-1-P accumulates in lvier, inhbits glycogenolysis and gluconeogenesis

Front 42

Galactosemia

Back 42

galactokinase deficit is rare, benign, cataracts

uriddly-trasferase defect is common, early MR

Front 43

Von Gierke vs. Pompe vs. McArdle

Back 43

Von Gierke- G6 phosphatase defect, hepatorenallmegaly, fasting hypoglycemia and acidosis, can't make glycogen

Pompe- a-lugosidase cardiac failure, mucle hypotonia, death before 2, alternate glycogen breakdown pathway

McArdle- skeletal muscle glycogen phosphorylase- exercise inducd cramps, can't use stored glycogen

Front 44

Hurler vs. Hunter

Back 44

HJurler - a-l iuduronidase prob, corenal clouding and MR, AR
Hunter- no clouding, MR, a-L iduronidase, XLR

Front 45

Important FA's product of fatty acid synthesis and precursor to prostaglandins

Back 45

Palmitic acid- 16:0

Arachidonic acid 20:4

peripheral sclerosis is invovled with saturated fat intake, trans fatty acids also bad

Front 46

Bile acids

Back 46

primary- cholic acid from cholesterol

secondary- deoxycholic from intetinal bacteria, conjugated

Conjugate- ionized in body, forms micelles with dietary fats

95% of bile salts reabsorbed in the ileum (enterohepatic circulation)

Front 47

Life cycle of lipoproteins

Back 47

chylomicrons from small insetin (blocked by ezetimibe) or from enterohepatic circulation inhibited by resins, become TGs via liporotein lipase enter fat and muscle cells, liver makes in VLDL to IDL to LDL

Niacin decraeases excretion of VLDL, HMG COA reductase is de novo synthesis

Front 48

X-linked sphingolipidoses

Back 48

Fabry, a-galactosidase, reddish purple ras kidney and heart failure, angiokeratoma

Front 49

AR sphinoglipidoses

Back 49

Gaucher B-clucosidase, hepatosplenomegaly, glcuocerebrosides

Nieman Pick- sphingomyelin- hepatosplenomegaly, foamy cells

Krabbe- galactocerebrosieds- blindness, deafnees, convulsions

metachromatic leukodystriohy- progressive paralysis, sulfatides

Tay-Sachs- jews, blind, cherry red macula, gangliosides

Front 50

Causes of prophoryia?

Back 50

dieting, steroids, sulfonamides and other drugs for acute intermittent, no photosensitivity and abd pain, deaminase decraeased action causes build up of prophobilinogen

Lead poisoning- ALA-protoporprhpyrin leads to anemia, micrcytic, hypochrome, basophili stipplin

Front 51

Substrates for gluconeogenesis from muscle, RBCs and fat

Back 51

Muscle and RBCs produce lactate

Fat cells release TGs -> glycerol

Front 52

Vitamin deficiences effects for: B1, B2, B6, pantothenate, biotin

Back 52

B1- decarboxylations, beriberi
B2- flavins, glossitis, cheilosis
B6- transaminations and deaminations, MICROCYTIC anemia and neuropathy

pantothenate- CoA- headache and N

Biotin- carboxylations- seborrheic dermatitis, nervous disorders