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88 Cards in this Set
- Front
- Back
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What are the four areas in the brain that have selective vulnerability due to generalized hypotensive stroke?
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Boundary "Watershed" zone
Laminar Necrosis - layers 4-6 Hippocampus - Sommer sector Purkinje cells - Cerebellum |
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What is the most common cause of a CNS stroke due to CNS hemorrhage?
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Hypertension!!
Most in basal ganglia, with the lateral aspect being less fatal |
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HTN causes what kind of anuerysms in the brain?
What vessels are mostly affected? |
Charcot-Bouchard aneurysms
Mostly affects striate arteries in basal ganglia |
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If a patient comes in with the "worst headache ever" (thunderclap), what is the dx?
What kind of aneurysm caused this? |
Basilar Subarachnoid Hemorrhage
Charcot-Bouchard Aneurysm |
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If on a muscle biopsy you see perivascular inflammation in muscle fibers, what disease would you suspect?
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Dermatomyositis
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What drug may result in irreversible peripheral neuropathy?
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Vincristine
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What are the three pathologic features of de-innervated neurogenic atrophy?
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Angular atrophic fibers
Fiber-type grouping & group atrophy Target fibers |
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If a 20 year old patient presents with a Kayser Flescher ring, what exam findings would you suspect?
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Wilson's Dz:
- "wing beating" tremor - dystonia - dysarthria - rigidity - low ceruloplasmin - high urine copper level |
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If you have a young patient (<40) with a movement disorder, automatically what dz should you consider?
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Wilson's dz
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If a young female patient comes in with dementia and abnormal "fidgetiness", what other symptoms would you expect?
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Huntington's Dz
- personality disorder - memory loss - later on will have dystonia - a family history!! |
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What are the three main features of Huntington's dz?
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Dementia & personality disorder
Chorea Family history |
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What trinucleatide repeat would you find a young patient with wild movements (chorea)?
Where would they have atrophy in an MRI? |
CAG
Caudate nucleus |
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What drug induces hemolytic anemia, through extravascular hemolysis?
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Penicillin
Cephalosporin |
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What antibody type is the causative agent for intravascular hemolysis?
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IgM
IgG = extravascular hemolysis |
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True of False
Compliment is activated in an immune hemolytic anemia caused by methyldopa? |
False
It causes IgG to attack RBC's, but NOT intravascular hemolysis |
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What 3 cancers are associated with the EB virus?
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Burkitt's Lymphoma
Nasopharyngeal Carcinoma B-Celly Lymphoma |
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With is the classic triad of a person infected with Herpes Virus 4?
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Ebstein Barr Virus
Fever Really bad unresponsive sore throat Enlarged posterior cervical lymph nodes |
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What is the mechanism of for an EBV infection?
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Virus attaches to C3d on B lymphocytes = infiltrate cell -> production of antigens = increased T killer lymphocytes
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What two dz are mostly commonly associated with a ruptured spleen?
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Malaria
Mono infection |
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What are the symptoms of a person with drug induced hemolytic anemia?
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Dark urine
Fatigue Shortness of breath Tachycardia |
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A patient is undergoing a treatment when suddenly develops hyperventilation, tachycardia, urticaria, flushing, and deep back pain, what is the problem?
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RBC Incompatability transfussion
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True of False
One would expect a severe hemoglobinuria in a patient who has an Rh incompatability transfussion? |
False
Only in ABO incompatability |
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Will lifting weights, increase of decrease the intensity of an early diastolic murmur?
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Aortic Regurg
Will increase it, b/c isometric exercise = increase in afterload |
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What are the three chief determinants of oxygen consumption during contraction?
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Heart Rate
Contractility Afterload |
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In the heart when is MVO2 the highest?
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During isovolemic contraction
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True of False
The A-V O2 difference for the coronary circulation is the largest of any organ in the body? |
True, normally extracts >70% of oxygen
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What is the formula for blood flow in the coronary circulation?
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Q = (Aortic diastolic pressure - right atrial pressure)/ coronary resistance
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Where does most coronary vascular resistance occur?
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Intramyocardial arterioles
Extramyocardial Prearterioles |
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When is extracoronary resistance highest?
When is extracoronary resistance lowest? |
Highest - Ejection phase of systole
Lowest - Passive filling of diastole (in early diastole) |
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What is the net effect of sympathetic activation on epicardial coronary arteries?
What if you used a beta blocker? |
Mild Dilation
Mild vasoconstriciton b/c of alpha 1 effect of NE |
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What does the presence of an S3 along with an early diastolic and mid-systolic murmur indicate?
Heard w/ bell or diaphragm? |
LV dysfunction
Bell |
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What are two main causes for acute aortic regurg?
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Infectious endocarditis = perforated valve
Aortic root dissection |
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What coronary vessels have SNS receptors?
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Epicardial coronary arteries
Large extra-myocardial arterioles |
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What kind of thalessemia causes more severe hemolytic anemia?
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Beta Thalassemia b/c causes formation of Heinz bodies = extravascular hemolysis
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By what age will Beta thalessemia major present symptoms?
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6 months
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What are the two reasons that the prognosis of Beta thalessemia major is poor?
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Iron overloaded = cardiac dz:
- Too many transfussions - increased Fe absorption in GI b/c hepcidin is downregulated |
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Sickle cell anemia is due to what point mutation?
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Causes Valine to replace Glutamic Acid
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If a patient present with continuous hiccups what area of the CNS would you suspect has a problem?
What artery is most likely involved? |
Nucleus ambiguus
PICA |
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If a patient presents with a loss of vision in one eye, with started with a "curtain being pulled down". What vessel occlusion is the problem?
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Extracranial Carotid Artery Emboli
Do a carotid ultrasound |
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True or False
If the symptoms of a TIA last for several hours but resolved at 23 hours, they most likely did NOT have a stroke |
False
They did have a stroke |
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What artery supplies Broca's & Wernicke's?
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Broca's - Anterior branch of MCA
Wernicke's - Posterior branch of MCA |
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If a calculus patient comes in with a sudden loss of ability to perform mathematical calculations, where is the infarction?
What other symptoms would you suspect? |
Angular & Supramarginal gyrus
Agraphia, finger agnosia, left-right confusion |
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What two features are common in a patient with a nondominant hemisphere stroke?
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Anosognosia
Asomatosognosia |
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Abulia, slowness in respoding and lack of spontaneity is characteristic of what stroke?
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Bilateral ACA stroke
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If a patient has a contralateral homonymous hemianopsia w/ a beaklike spared zone horizontally, what artery would you expect to be involved?
What part of the brain? What other signs? |
Anterior Choroidal Artery
Posterior limb of internal capsule Contralateral hemiplagia & hemisensory loss, no aphasia or neglect |
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What distinguishes an MCA stroke from an anterior choroidal artery stroke?
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No cortical signs (aphasia, neglect) in the anterior choroidal artery stroke
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What is the hallmark finding of a posterior circulation stroke?
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Ipsilateral cranial nerve w/ a contralateral body deficit
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If a patient presents with decreased sensation on the left face, but weakness on the right arm and leg what kind of stroke would you suspect?
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Posterior Circulation Stroke
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What artery is responsible for lateral medullary syndrome?
What artery is responsible for medial medullary syndrome? |
Posterior Inferior Cerebellar Artery
Distal vertebral artery/ anterior spinal artery |
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What are the symptoms in medial medullary syndrome?
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CST = Contralateral arm & leg weakness (NO FACE weakness)!!!
Medial lemniscus = Contralateral loss of vibration & proprioception Hypoglossal nucleus – Tongue deviation to the side of the lesion |
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What are the symptoms in lateral medullary syndrome?
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Vestibular nuclei = vertigo & nystagmus
Descending sympathetic – Horner’s syndrome Nucleus ambiguus – Dysphagia, dysphonia, hiccups Inferior Cerebellar Peduncle & inferior cerebellum = Ipsilateral ataxia Spinal trigeminal tract – Ipsilateral decreased pain & temp of the face Spinothalamic tract (STT) – Decreased pain & temp of arm & leg numbness |
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What class of drugs mostly causes vasodilation of veins more than arteries?
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Nitrates
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What nitrate has a very high first pass metabolism?
What phase reaction is done to which increases is inactivation? |
Isosorbide dinitrate
Phase II - glucuronide conjugation |
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What two myocardial ischemia drugs have an anti-arrhythmic activity?
What class are they in? |
Calcium Channel Blockers
Verapamil Diltiazem |
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What is the drug of choice for treatment of stable angina?
Pt who has angina only upon exertion and goes away with nitroglycerin? |
Ranolazine
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What is the cause of elevated intracellular Ca levels in reperfusion injury?
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Free radicals causing lipid peroxidation of myocardial cell membranes
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Myocardial cell necrosis begins after coronary blood flow has been interrupted for how long?
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20-30 minutes
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What are 4 consequences of having decreased intracellular pH in myocardial ischemia?
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Decreased Myofilament Ca sensitivity
Decreased Glycolysis = decreased ATP Increased Na/H XChanger = increased IC Na Increased proteolysis of intracellular proteins |
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What is a basic consistent cellular finding in myocardial ischemia?
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Intracellular Ca overload
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What is the first functional manifestation of myocardial ischemia?
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Regional Diastolic Dysfunction b/c of decreased Ca cycling due to too much intracellular Ca
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What is a somewhat effective Tx for relieving the diastolic dysfunction of ischemic heart disease?
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Calcium Channel Blockers
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What is the most important cause of ischemic heart disease?
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Atherosclerosis
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What is the initaiting event for atherosclerosis?
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When oxidized-LDL binds coronary endothelial cells
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What vascular has a fibrous cap?
What is the cap composed of? |
Atherosclerosis
Vascular smooth muscle & collagen over a lipid laden core |
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What is the coronary lesion responsible for chronic stable angina?
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A stable thick fibrous cap
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What is a clinically useful predictor for the presence and severity of coronary atherosclerosis?
What cytokine triggers it? |
C-reactive protein (CRP)
IL-6 |
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What triggers a coronary thrombosis?
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Rupture of a thin, fibrous capped atherosclerotic plaque
CD4-TH1 lymphocyte |
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Where in a blood vessel does atherosclerosis development first occur?
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In the intima
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What are the three key elements for the diagnosis of Schizophrenia?
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At least 2 of: delusion, hallucination, disorganized though/speech, catatonic, "negative symptoms"
At least 6 month duration Decrement in social & occupational functioning |
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What are the negative symptoms that contribute to a schizophrenic's ability to function in daily life?
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Blunted or flat affect
Loss of motivation = apathy Diminished use of speech Impaired goal-directedness |
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What is the prevalence of schizophrenia in the population?
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1%
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What is the key difference between a person with schizophrenia and one with a delusional disorder?
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NO major decline in functioning in life
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What DNA virus has an RNA dependent DNA polymerase?
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Hepatitis B virus
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What are the only 2 DNA viruses that carry their own polymerase?
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HBV -> RNA-‐dep.DNA pol.
Pox -> DNA-‐dep.RNA pol. |
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What viruses carry enzymes?
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All negative sense (-) RNA viruses
Retroviruses Hepatitis B Poxviruses |
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If you see a child with "slapped cheek" rash, what virus would you suspect?
What is a distinguishing feature of this virus? |
Parvovirus B19
Only ssDNA virus |
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What DNA virus causes:
UTI's? Progressive Multifocal Leukoencephalopathy? |
Polyomaviruses:
BK JC |
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What is the only hepatitis virus that has DNA?
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HBV
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What is the main difference between acute and chronic infection of HBV?
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Only anti-HBc IgG
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What virus uniquely uses a DNA-dependent RNA polymerase?
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Poxvirus
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What is the most common cause for transmural myocardial infarctions?
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Thombus causing complete occlusion of large epicardial artery
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What is the magic number in making a distinction between and STEMI & a non-STEMI during a complete coronary artery obstruction?
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> 30 min = STEMI
< 30 min = non-STEMI |
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What vessels are involved in a coronary artery spasm?
What anatomic area in the vessel plays an important part in this? |
Large epicardail a.
Endothelial dysfunction |
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What is the most common mechanism by which cocaine & amphetamines cause acute cardiac injury?
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They increase NE = coronary artery spasm
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What are 4 precipitating factors of chronic stable angina?
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Increase Afterload - HTN, AS
Increase HR - Exercise, excitement Increase NE = SNS activation Decrease O2 supply = anemia, lungs |
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What is the chemical mediator responsible for pain in chronic stable angina?
How is the signal carried? |
Adenosine
Through perivascular afferent sympathetic nerve endings |
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What are two ECG findings during a stable angina attack?
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ST segment depression
T wave inversion |
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What is the only type of angina that DOES NOT cause an ST elevation?
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Variant angina
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