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95 Cards in this Set
- Front
- Back
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What is the main distinguishing factor between Autism and Asperger's syndrome?
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Asperger's has no significant delay in language or cognitive development.
Autism does |
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What are the 4 medications used in the treatment of ADHD?
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CNS stimulants (dextroamphetamine)
NE reuptake inhibitor (atomoxetine) TCA's (desipramine = sudden death) Clonidine |
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What are 4 effective treatment options for autism?
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Structured classroom
Behavioral modification Education & Training of parents SSRI's or atypical antipsychotics |
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What is the most common cause of hypoxemia?
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V/Q mismatch
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What is the difference between CO and SVR b/w sepsis and severe hypoxemia?
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Sepsis = low CO w/ vasodilation
Severe hypoxemia = high CO w/ vasodilation |
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What is the only cause of hypoxemia in which administration of 100% FiO2 does not increase PaO2 >600?
What does the A-a gradient look like in these patients? |
Shunt
Increased |
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What is the only cause of hypoxemia in which the A-a gradient is normal?
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Hypoventilation
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A high capillary filtration coefficient (Kf) represents what?
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High H20 permeability
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True or False
A LOW osmotic reflection coefficient indicates low protein permeability with little effect on fluid movement? |
False
Low coefficient = high protein permeability |
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What is the main cause of hemodynamic pulmonary edema?
What is the main cause of permeability pulmonary edema? |
Increased pulmonary capillary hydrostatic pressure
Damage of pulmonary vascular endothelium |
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Does pulmonary edema:
Increase or decrease lung compliance? Increase or decrease small airway resistance? |
Decreases lung compliance
Increases airway resistance b/c of bronchospasms (triggered by J receptors) |
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What is the reason that alveolar edema causes severe hypoxemia at rest?
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Intrapulmonary shunting
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What are the two major changes in starling forces that cause permeability pulmonary edema?
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Increased filtration coefficient (Kf)
Decreased osmotic reflection coefficient (sigma) |
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What is the main interleuken that is chemotactic for circulating neutrophils?
What cell releases this? |
IL-8
Macrophages in response to acute lung injury |
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When does the exudative phase of ARDS occur?
What is its main characteristic? |
0-4 days
Neutrophil accumulation -> hyaline membranes |
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When does the proliferative phase of ARDS occur?
What is its main characteristic? |
4-7 days
Type II proliferation & increased macrophage release of cytokines -> fibroblast proliferation |
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When does the fibrotic phase of ARDS occur?
What is its main characteristic? |
>7 days
Fibrin deposition & collagen organization |
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What class of drugs are the drug of choice for treating severe hypertriglyceridemia & chylomicronemia syndrome?
What are two examples of drugs in this class? |
Fibrates (Fibric acid derivatives)
Fenofibrate & Gemfibrozil |
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What is the mechanism of action for fibrates?
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Increasing PPAR alpha transcription = increased fatty acid oxidation
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What is the best drug available for increasing HDL cholesterol?
In what group of people should you avoid giving this drug? |
Niacin (Nicotinic Acid)
Diabetics |
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What drug is used exclusively in tx of status epilepticus?
Is it available IV? |
Benzodiazepines (diazepam, lorazepam)
Yes |
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What drug is mostly indicated in the treatment of absence seizures in children?
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Ethosuximide
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What is the DOC for treatment of epileptic activity in a women during pregnancy?
What is its most common SE? |
Lamotrigine
Rash |
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If you have a patient who is being treated for a generalized seizure syndrome and complains of selective word finding difficulty, what drug are they currently on?
What other side effects are common? |
Topiramate
Numbness & tingling around mouth Weight loss Kidney stones |
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What are the two most common acute side effects of phenytoin?
What are the 4 most common chronic side effects of phenytoin? |
Nystagmus & gait instability
Gingival hyperplasia, Hirsutism, Peripheral Neuropathy, Osteomalacia |
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What drug would you choose in an individual who is overweight and has seizures?
What is a unique SE of this drug? |
Toprimate - b/c causes weight loss
Word finding difficulty |
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What are the reasons why mechanical ventilators cause MODS?
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Increase Fas-ligand & IL-6 production!
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What T lymphocyte is predominant in emphysema?
What cell type would you ONLY find in emphysema that arose as a result of smoking? |
TH1
Cytolytic CD 8 T cells |
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What is the fundamental abnormality of COPD?
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Increased resistance to expiratory airflow
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What are the cell types most responsible for tissue destruction in centrilobular emphysema?
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Macrophages = increased matrix metalloproteinases
CD8 cytolytic T cells = increased perforin & granzyme |
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What is the cell type most responsible for tissue destruction in panacinar emphysema?
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Neutrophils = increased serine proteases which degrade lung elastin
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What are the two centers that modulate pain signals in the dorsal horn of the spinal cord?
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Raphe nucleus
Locus Ceruleus |
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What are the two most common causes of Lhermitte's sign?
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B12 deficiency
Tertiary Syphillis |
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What kind of sensory fiber type carries itch pain?
Is it myelinated or unmyelinated? |
C type
Unmyelinated |
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What is the main inducer of nociception?
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Substance P
Histamine has a minor effect |
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What is the drug of choice for a person with pain from peripheral neuropathy?
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Gabapentin
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What are the 5 anticonvulsants that can be given IV?
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Phenytoin
Phenobarbital Valporic Acid Benzodiazepines Levetiracetam |
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If a patient presents with deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release. Where is the lesion most likely?
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Apneustic respirations
In the ponse (pontine hemorrhage) |
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If a patient presents in a coma with mid position & regular pupils that do not react to light but do react to pain and accommodation, where is the lesion?
What disease is most associated with this? |
Lesion in the bilateral prectectal area
Tertiary syphillis |
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If a patient has a 3rd nerve palsy and coma what would you suspect?
If a patient has a 3rd nerve palsy and a headache, what would you suspect? |
Uncal herniation
Posterior communicating aneurysm |
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State the site of the lesion that corresponds:
Cheyne-Stokes respirations ? Central neurogenic hyperventilation? Apneustic breathing? Ataxic/Biot's breathing? |
Bilateral hemispheric or diencephalic damage
Midbrain damage Pons damage Medulla damage |
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If a patient presents with a abrupt onset coma and bilateral pinpoint pupils, what is the most likely diagnosis?
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Hemorrhage in the pons
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Why does the equal pressure point (EPP) move closer to the alveoli in patients with emphysema?
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B/c of the increased positive pleural pressure they have to create in order to offset the decreased elastic recoil
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When a normal adult takes a deep breath beginning at FRC, by how much does his volume increase for each 1 cm H20?
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~200 mls
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True or False
If a patient with emphysema were to take a deep breath beginning at the same FRC as a normal adult, his lung volume WOULD increase >200 mls for each 1 cm H20? |
True
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What is the beneficial effect of hyperinflation in emphysema?
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Decreased airway resistance
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What is the best physical exam indicator of emphysema?
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Breath sounds of diminished intensity
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True or False
One is more likely to hear crackles in emphysema then in chronic obstructive bronchitis? |
False
Crackles are more common in COB |
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What is the reason that hypoxemia is more severe in chronic obstructive bronchitis, than in emphysema?
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COB has a lower V/Q ratio due to decreased Ventilation and normal pulmonary blood flow
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What are the three spirometric lung volumes that are increased in COPD?
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Residual volume
Total Lung Capacity Functional Residual Capacity |
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What is the most sensitive measure of small airway disease in emphysema?
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FEF 25-75
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In emphysema what spirometric volume is increased the most?
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Residual Volume
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What phospholipid derived substance causes relaxation of ASM?
What prostaglandin causes constriction of ASM? |
PGE2
PGD2 & PDF2a |
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What are the two reasons that emphysema causes hypoxemia?
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V/Q mismatch - b/c of dynamic compression
Diffusion impairment - b/c destruction of capillaries |
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In emphysema are the relative values of V/Q high or low
at the base? at the apex? What do the V/Q ratios do in chronic obstructive bronchitis? |
At the base they are LOW
At the apex they are HIGH They are decreased in both the apex in base |
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What are the two reasons why patients with emphysema get pulmonary hypertension?
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Capillary destruction = increased pulmonary resistance
Vasoconstriction of low V/Q areas (specifically the base) |
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What are the three causes of airway obstruction in chronic obstructive bronchitis?
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Mucous gland hypertrophy & hyperplasia
Inflammation from macrophages & neutrophils Airway fibrosis from macrophages |
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What are the two reasons for hypoxemia in chronic obstructive bronchitis?
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Low V/Q ratio
Hypoventilation |
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What is the main site of pathalogic changes in emphysema?
What is the main site of pathalogic changes in COB? |
Respiratory bronchioles
Conducting airways |
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What is a non cholinergic neurostransmitter that causes proliferation and contraction of airway smooth muscle in asthma?
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Substance P
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What are the two drugs used in the treatment of pain in peripheral neuropathy?
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Gabapentin - DoC
TCA (amitriptyline) |
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What is the most common cause of focal CNS disease in a patient with AIDS?
What is the most common cause of fungal infection infection in a patient with AIDS? |
Toxoplasmosis
Cryptococcis neoformans |
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If a patient presents with a sudden onset double vision, eye pain, and his eyes down and out with dilated pupils what would you suspect?
What if they had constricted pupil? |
Dilated pupil = post. communicating artery aneursym
Normal pupil = diabetic induced stroke |
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If a diabetic patient presents with abrupt and excruciating pain in the proximal thigh with loss of patellar reflex, what test should you do?
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Diabetic amyotrophy
MRI of the lumbosacral spine |
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If a diabetic patient presents with a slowly progressive numbness and tinging of the toes of both feet that have a painful/burning quality, what other 5 symptoms would you expect to find?
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Patient has peripheral neuropathy
Orthostatic hypotension Resting tachycardia Erectile dysfuction Loss of all sensory modalities Absent ankle jerk |
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If on an MRI for an HIV patient you see multiple lesions in the basal ganglia with a ring like pattern around the lesion, what would you suspect is the problem?
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Toxoplasmosis encephalitis
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What are the 3 major distinguishing features b/w toxoplasmosis and CNS lymphoma presentation in HIV patients?
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CNS lymphoma - Slower onset, without a fever, most likely a single lesion on MRI
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What nonadrenergic, noncholinergic inhibitory neuron causes ASM relaxation?
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Vasoactive intestinal peptide (VIP)
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What are the cell types that orchestrate the inflammatory response in asthma?
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TH2
TH17 |
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What IL is important for the development, activation, and survival of eosinophils?
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IL-5
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What cell type is especially important in severe persistent asthma and viral induced asthma?
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Neutrophils
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What is the predominant mechanism for irreversible airway obstruction in chronic asthma?
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Airway remodeling due to:
- Extracellular matrix deposition - Fibrosis |
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What two cell types are predominantly activated by TH1 in emphysema?
What two cell types are predominantly activated by TH2 in asthma? |
Neutrophils & Macrophages
Eosinophils & Basophils |
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What are the predominant airway inflammatory cells in allergic asthmatics?
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Eosinophils
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What mediator amplifies the asthmatic response by triggering mast cell release of histamine & tryptase?
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Eosinophil derived PEROXIDASE
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What are the 4 actions of histamine?
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Increase vascular permeability
Contraction of ASM Mucus production Generates prostaglandins |
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True or False
Prostaglandin D2 & F2 induce bronchorelaxation? |
False
They cause bronchoconstriction |
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What are the two major actions of major basic protein?
What cell releases it? |
Stops respiratory cilia from beating
Blocks M2 receptors Eosinophils |
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What are the two functions of tryptase?
What cell releases it? |
Degrades bronchodilatory VIP
Increases ASM responsiveness to histamine Mast cells |
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What is the only prostaglandin that is a vasodilator?
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PGE2
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What are the two drugs that will block the early phase response of asthma if administered prior to antigen exposure?
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Beta agonists
Cromolyn |
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What are the two drugs that will prevent the late phase response of asthma after the early phase has run its course?
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Glucocorticoids
Cromolyn |
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What are two drugs that inhibit mast cell mediator release?
By what mechanism does it do this? |
Beta agnosits
PGE2 It increases cAMP levels in mast cells |
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What are the 5 preformed granule mediators that are released from mast cells in the early phase response of asthma?
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Histamine
Heparin Tryptase Eosinophil & Neutrophil chemotactic factor TNF-alpha |
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What is the most common infectious cause of non-allergic (intrinsic) asthma?
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Rhinovirus
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What are the two most important triggers for nocturnal asthma?
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Gastric reflux
Airway cooling |
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What is the common denominator of why acute asthma attacks occur in adults?
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Parasympathetic hyperactivity
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What is the mechanism by which increased ACh causes vasoconstriction?
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M3 activation = increased DAG & IP3 = increased Ca
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What kind of COX inhibitors worsen the symptoms of Samter triad?
Why? |
COX 1
Cause there to be leukotriene production and less PGE2 |
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What are the 3 preformed granule mediators that are released from mast cells in the late phase response of asthma?
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Leukiotriene D4
Prostaglandin D2 IL-5, 8, 13 (attract eosinohpils) |
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What are the 4 direct triggers for mast cell release in intrinsic asthma?
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C3a and C5a
Interleukins 4, 6 Substance P ACh |
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True or False
Beta agonists WILL block the late response after they had the early response in asthma? |
False
They will NOT work b/c the late response is NOT mediated by mast cells |
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What is the only drug that will work in both the early and the late response of asthma?
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Cromyln
B/c decreases mast cell degranulation & decreases inflammatory response |
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What is the triad of symptoms seen in Semter's triad?
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Asthma
Aspirin induced bronchospasms Nasal polyps w/ allergic rhinitis |
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What are the three mechanisms by which respiratory infections lead to asthma?
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Decreased nuetral endopeptidase = increased substance P
Causes direct dysfunction of M2 receptors Increase interferon = decrease tcr of M2 |
