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94 Cards in this Set
- Front
- Back
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A 50 year old man has ascites from a large hepatic tumor composed of vascular spaces lined by pleomorphic cells that are positive for CD34, CD31 and Von Willebrand factor. What two agents are most likely the cause?
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Thorotrast
Vinyl Chloride |
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What is the difference between centriacinar and panacinar emphysema?
Where are they mostly found |
Centriacinar - only affects respirtory bronchioles
Found in upper lobes Panacinar - affects respiratory bronchioles + Alveolus Found in lower lobes |
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What kind of emphysema is the most common cause of spontaneous pneumothorax in young people?
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Distal Acinar Emphysema
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What are the two major mechanisms by which a pt. gets emphysema?
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Smoking -> increased elastase from PMN’s and macrophages = Centriacinar emphysema!!
Decreased API = Panacinar emphysema!! |
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What are the three ways that smoking causes emphysema?
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Recruiting neutrophils (PMNs) into lung from smoke activated macrophages
Stimulating elastase release and activity (causes damage) Inactivating API by oxidants in tobacco smoke |
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What are the two reasons that in emphysema part of each inspiration is trapped in the acinus?
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Elastase = increased residual volume in alveoli
Fibrosis = diminished caliber of bronchioles |
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What are the two main pathologic causes of chronic bronchitis?
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Chronic irritation by inhaled substances
Microbiologic infections |
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What is the normal ratio of the Reid Index?
What does an increased Reid Index indicate? |
Normal is < 0.5
Indicates chronic bronchitis |
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What are the three consequences of airway hyper-responsivenss in asthma?
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Bronchoconstriction
Mucous hypersecretion Edema |
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In asthma what is the link between the antigenic trigger & inflammatory response?
What other cells are important in inflammation? |
TH2 immune response
Mast cells release histamine -> eosinophils |
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What are the two most common causes of bronchictasis?
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Postpneumonic infection (mechanical stress)
Cystic fibrosis (most common cause) |
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If a patient comes in stating that every morning he wakes up with tons and tons of sputum that has puss in it, what is the most probable diagnosis?
What disease might he have? |
Bronchietasis
Cystic Fibrosis |
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What is Pneumoconioses?
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A non-neoplastic lung rxn to inhalation of:
Organic dust, mineral dust, or chemical fumes/vapors |
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What are the symptoms of an acute reaction in hypersensitivity pneumonitis?
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Dyspnsia
Cough Chills Fever Myalgia |
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What is the difference between the fibrosis alvolitis seen in asbestosis and silicosis?
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Asbestosis = base of lung
Silicosis = upper/apex of lung |
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What is the pathologic feature for sarcoidosis?
What kind of lymphocytes are present at the site of dz? |
Non-caseating epitheloid granulomas
CD4 + lymphocytes |
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What is the serum sodium level in hyperaldosteronsim?
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Normal b/c of the increased BNP balances it out
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What is the most common cause of rhinitis?
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Adenovirus
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What are the two most common bacterial causes of lobar pneumonia?
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Strep. pneumoniae (95%)
Klebsiella pneumoniae |
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What are the three major causes of death in COPD?
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Right sided heart failure (more in bronchitis)
Respiratory acidosis Collapse of lung secondary to pneumothorax (most in centriacinar emphysema) |
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What are the two pathological findings in Alzheimer's dz?
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Extracellular senile plaques - from beta amyloid
Intracellular neurofibrillary tangles - from paired helical filaments w/ Tau protein |
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What is the mechanism by which oral contraceptives cause hypertension?
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Estrogen increases angiotensinogen synthesis by the liver = increased ATN = increased Aldosterone
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In non-obese patients, how does obstructive sleep apnea cause systemic hypertension?
What about in obese pt's w/ OSA? |
Hypoxia induced incresae in SNS
Multiple mechanisms - insulin resistance, hyperlipidemia, increased RAAS |
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How does obstructive sleep apnea cause pulmonary hypertension?
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Hypoxic induced vasoconstriction of pulmonary precapillary arterioles
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In the circulatory system what part has the most resistance?
What part has the most capacitance? |
Arterioles
Veins |
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What is the major determinant of left ventricular afterload?
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Arterioles
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What are the symptoms & physical findings a patient in Stage 1 (compensated) shock?
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Symptoms - anxiety
PE - tachycardia & pallor |
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What are the symptoms & physical findings a patient in Stage 2 (decompensated) shock?
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Symptoms - orthostatic hypotension, chest pain, confusion, decreased urine output
PE - increased SNS = sweaty, cold hands, tachycardia, tachypnea, acrocyanosis (blue extremities) |
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What are the 7 symptoms & physical findings a patient in Stage 3 shock?
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Anaerobic metabolism -> increased blood lactate
Metabolic acidosis -> vasodilation Impaired myocardial contractility Diastolic myocardial dysfunction GI dysfxn -> cytokine mediated vasodilation Acute kidney failure -> decreased urine output ARDS -> hypoxema |
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If a patient comes in with a pulse rate of 130, BP of 80/70, a respiratory rate of 35, anxiously complaining of light headedness upon standing up. Finally by the time he gets a bed in the ER he is confused.
What stage & class of shock would he be in? What % of blood loss brought on the symptoms? |
Stage 2, Class III
40% blood loss (2,000 mL) |
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If a patient comes in with a pulse rate of 110, BP of 120/110, a respiratory rate of 25, somewhat anxious about his slight lightheadedness upon standing up.
What stage & class of shock would he be in? |
Stage 2, Class II
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If a patient comes in with a pulse rate of 90, BP of 125/80, a respiratory rate of 20, somewhat anxious and feeling funny.
What stage & class of shock would he be in? |
Stage 1, Class I
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What is the fundamental incidence of risk?
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Incidence
Incidence = Absolute risk |
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What epidiomiological test is used to calculate the incidence of a disease?
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Absolute Risk = # of incidence/ total # at risk
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What epidiomiological test measures the strength of an association between a factor and a certain outcome?
(ie. risk factor)? |
Relative Risk
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True or False
The higher the relative risk the less likely there is an association with it causing the disease? |
False
The MORE likely |
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What are the top five causes of death in the US?
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Cardiovascular Dz
Cancer COPD Stroke Accidents |
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What are the top 2 "actual" causes of death in the US?
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Tobacco
Poor diet/physical inactivity |
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What is the leading cause of mortality in:
Ages <1-44? Ages 45-64? Ages 65+ |
Unintentional Injuries (MVA)
Cancer (lung, colon, breast/prostate) Heart dz |
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Screening for cervical or colorectal cancer is what kind of prevention?
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Secondary prevention
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Administering a flu shot is what kind prevention?
Treating a patient who has HTN with an ACE inhibitor is what kind of prevention? |
Primary prevention
Tertiary prevention |
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Model deals with perceived benefits and and threat to making health changes.
What model of health behavior change is this? |
Health Belief Model
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Model deals with the stages of change when a person tries to make health changes.
What model of health behavior change is this? |
Transtheoretical Model
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Model focuses on a patient centered counseling session?
What model of health behavior change is this? |
Motivational Interviewing
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What are the microscopic findings in Parkinson's dz?
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Atrophy of substantia nigra
Loss of dopaminergic neurons Eosinophilic inclusions (lewy bodies) in substantia nigra or locus ceruleus |
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What pathologic findings correlate with the severity of Alzheimer's dz?
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Neurofibrillary Tangle densities
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What class of drugs are recommended to use first when moderate hypertension has not responded adequately to treatment?
What class of drugs are the 2nd line agents for this type of problem? |
Beta Blockers or ACE inhibitors
Clonidine & Methyldopa (Sympatholytics) |
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What is the drug of choice for hypertension that occurs during pregnancy?
What drugs should NOT be given? |
Methyldopa
ACEi's and ARB's |
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What are the first-line drug therapy for mild to moderate hypertension?
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Beta Blockers
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What class of drugs should be used in the treatment of HTN in patients who had an MI?
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Beta blockers
ACE inhibitors |
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What is the drug of choice for a hypertensive emergency?
What are 3 adverse SE of this drug? |
Nitroprusside
Reflex tachycardia, Cyanide toxicity, Methemoglobinemia |
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What is the drug of choice for Stage 1 hypertension (the first drug you should give when a pt has HTN)?
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Thiazide diuretics:
Hydrochlorothiazide |
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What are the MRI findings one would suspect in a patient with Alzheimer's dz?
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Diffuse atrophy, with prominent hippocampus atrophy
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What are the three autopsy features one would suspect in a patient with Alzheimer's dz?
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Senile plaques
Neurofibrilary tangles Granulovacuolar degeneration |
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What is the drug used in treatment of advanced Alzheimers?
What is the MOA? |
Memantine
NMDA receptor antagonist = block glutamate release |
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What antihypertensive drug has the adverse side of effect of causing hemolytic anemia with a positive direct Coombs test?
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Methyldopa
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What antihypertensive drug has the side effect of causing hirsutism & pericardial effusion?
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Minoxidil
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What antihypertensive drug relaxes the smooth muscle of the prostate, and thus is useful in the tx of benign prostatic hyperplasia?
What are the adverse effects of this drug? |
Prazosin & Terazosin
Orthostatic hypotension on the first dose |
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What kind of calcium channel blocker is more effective in the treatment of HTN?
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Dihydropyridines -> nefidipine
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If on an MRI you see diffuse Lewy bodies all over the brain, what three symptoms should you look for?
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Fluctuating dementia/cognition w/ great variation in attention & alertness
Recurrent visual hallucinations Motor features of parkinsonism |
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Where are Lewy bodies mostly found in idiopathic Parkinson's disease?
Where are Lewy bodies mostly found in diffuse lewy body disease? |
Subcortical regions
Cortical regions |
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If a chronic alcoholic comes in with dementia, what vitamin deficiency would you suspect?
What are the 3 classic features of this disease? |
Thiamine deficiency -> Wernicke's Encephalopathy
Opthalmoplegia - biltaeral CN VI Encephalopathy Gait instability - midline truncal ataxia |
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What are some unique features of Korsakoff's syndrome?
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Both anterograde and retrograde memory deficit
Little insight Profound confabulation |
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What is the triad of symptoms for a patient with normal pressure hydrocephalus?
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Gait apraxia
Dementia - "withdrawn, depressed" Urinary incontinence |
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What is the triad of symptoms in Cruetzfeldt Jakobs disease?
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Rapidly progressive dementia
Non-epileptic myoclonic jerks Aaxia (wide based gait) |
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What are the three bacteria that most commonly cause "cavities" in the lungs?
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Staph. aureus
Klebsiella pneumoniae Myocobacterium tuberculosis |
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What drug acts as a partial agonist to the opoid receptors?
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Buprenorphine
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In what class of substance abuse drugs is the overdose stupor, coma, and respiratory depression?
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Alcohol
Barbiturates & Benzodiazepines Opiates Inhalants |
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If a patient has noticeably been doing drugs and comes in and "feels no pain" when the nurses are trying to put restraints on him, what drug was he most likely on?
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PCP
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What is the primary class of drugs used for safe detoxification of alcohol?
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Benzodiazepines
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In which class of abuse substances are the manifestations of withdrawal not life-threatening?
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Opiates
Are life threatening in CNS depressants (alcohol, barbituates, benzodiazepines) |
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What medication should you give to an alcoholic who wants to drink mildly but does not want to fall into excessive drinking?
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Naltrexone
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What are the physical signs of Class I hemorrhagic shock?
What is the % of blood loss? What is the volume of blood loss? |
No change in BP, slight increase in HR
10-15% blood loss 560-750 |
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What are the physical signs of Class II hemorrhagic shock?
What is the % of blood loss? What is the volume of blood loss? |
Orthostatic hypotension, tachycardia (HR>100)
15-30% 750-1500 |
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What are the physical signs of Class III hemorrhagic shock?
What is the % of blood loss? What is the volume of blood loss? |
Supine hypotension, tachycardia (HR > 120)
30-40% 1500-2000 ml |
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By how much does the blood volume have to decrease by and for how long for MODs to occur?
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> 40% (>2000 ml)
more than 2 hrs |
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When does cerebral ischemia begin to develop?
Why is this important? |
When mean arterial pressure < 60 mm Hg
At this point the CNS will fail to produce adequate levels of SNS vasopressors = dilation = death |
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What is one of the earliest CNS manifestations of hypovolemic shock?
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Astrocyte dysfunction =
confusion, restlessness, lethargy, asterixis |
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What are the physical signs of Class IV hemorrhagic shock?
What is the % of blood loss? What is the volume of blood loss? |
Supine hypotension, Tachycardia (HR > 140)
> 40% > 2000 ml |
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Which portion of the kidney is most susceptible to ischemic injury?
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Third portion of proximal tubule
Thick ascending limb Both in the medulla |
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What cells are most susceptible to ischemic damage in the liver?
What cells are least susceptible to ischemic damage in the liver? |
Hepatocytes around central veins
Hepatocytes around portal triad |
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What % of NaCl comprises a hypotonic solution?
What % of NaCl comprises a isotonic solution? What % of NaCl comprises a hypertonic solution? |
.45%
.90% 3-5% |
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What are the components of Ringer's lactate?
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NaCl
KCl CaCl2 Na lactate -> HCO3 |
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What types of fluid are most appropriate to resuscitate patients with hypovolemic shock?
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Isotonic solutions - lactated Ringer's & .90% NaCl
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What is the criteria for systemic inflammatory response syndrome (SIRS)?
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At least two of the following
Oral temp >38 or <36 RR > 20 or PaCO2 < 32 HR > 90 WBC > 1200 or <4,000 |
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What is the criteria for sepsis?
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Criteria of SIRS + presence of documented or suspected infection
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What is the criteria for severe sepsis?
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Criteria of sepsis + dysfunction in at least one distant organ
If > 2 organs affected = MODS |
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What is the criteria for septic shock?
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Hypotension and inadequate tissue perfusion that CAN'T be corrected with fluids
DON'T need to have bacteria in the blood |
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What is the cascade of events occuring normally in the infection of E. coli?
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Lipopolysacchardie binding protein -> attaches to acetylated lipid A -> CD14 on Monocyte -> TLR4 -> TLR4 dimer -> NF KB -> IL-1 & TNF alpha -> septic shock
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What are the intracellular pattern recognition receptors?
What are the membrane bound pattern recognition receptors? |
NOD-1 & NOD-2
Toll-like (TLR's) or peptidoglycan receptors |
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What is the definition of shock according to BP?
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Supine systolic BP is < 90
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What is the most significant event of going from class II -> III hypovolemic shock?
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Orthostatic hypotension -> Supine hypotension
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What are the two cell types that are most affected by lung hypoperfusion?
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Capillary endothelium = leak fluid
Type II pneumocytes = decrease surfactant production |
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What is the most hypotonic intravenous fluid you can give?
Where does it mostly go? |
5% dextrose
Mostly goes into the cells (intracellular) |
