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103 Cards in this Set
- Front
- Back
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Where does erythropoiesis take place in the fetus?
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“Young liver synthesizes blood”
Fetal: Yolk sac, Liver, Spleen, Bone Marrow Adult: Vertebrae, Sternum, Pelvis, Ribs, Cranial bones, Tibia and femur |
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What adult structures are derived from the 3rd, 4th, and 6th aortic pouches?
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3rd arch: common carotid artery, proximal party of internal carotid
4th arch (left): aortic arch 4th arch (right): proximal part of right subclavian artery 6th: proximal part of pulmonary arteris, ductus arteriosus |
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Next step in tx of otitis media if resistant to amoxicillin
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Amoxicillin c. clavulanic acid
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Prophylaxis against bacterial endocarditis
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Penicillin V, aminopenicillin, 1st generation cephalosporin (cephalexin)
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Increases the nephrotoxicity of aminoglycosides
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Cephalosporins
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Sufficient for the tx of syphilis
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Penicillin G
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Single dose tx for gonorrhea
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Ceftriaxone
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What genetic abnormality is commonly associated c. endocardial cushion defect?
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Trisomy 21, Down’s Syndrome
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Ascending aorta and pulmonary trunk are derived from what embryonic structure?
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Truncus arteriosus
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Coronary sinus is derived from what embryonic structure?
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Left horn of sinus venosus
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Superior vena cava is derived from what embryonic structures?
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Right common cardinal vein
Right anterior cardinal vein |
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The smooth parts of the left and right ventricles are derived from what embryonic structure?
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Bulbus cordis
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The smooth part of the right atrium is derived from what embryonic structure?
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Right horn of sinus venosus
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Trabeculated left and right artia are derived from what embryonic structure?
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Primitive atria
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Trabeculated parts of the left and right ventricles are derived from what embryonic structure?
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Primitive ventricle
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What structure divides the truncus arteriosus into the aorta and pulmonary trunk and what is the cellular origin?
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Aorticopulmonary septum or spiral septum
Neural crest derivative |
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What fetal vessels have the highest oxygenation?
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Umbilical vein, contains the MOST highly oxygenated blood
Ductus venosus Inferior vena cava Right atrium |
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What mechanism closes the ductus arteriosus?
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Breathing → increase in oxygenated blood into aorta → decrease prostaglandins
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What mechanism causes the foramen ovale to close?
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Breathing → decrease in pulmonary resistance → increase in LA pressure
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What germ layer gives rise to the retina
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neuroectoderm
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What germ layer gives rise to the salivary glands
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surface ectoderm
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What germ layer gives rise to the pancreas
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endoderm
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What germ layer gives rise to the muscles of the abdominal wall
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mesoderm
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What germ layer gives rise to the thymus
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endoderm
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What germ layer gives rise to the spleen
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mesoderm
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What germ layer gives rise to the aorticopulmonary septum
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neural crest, ectoderm
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What germ layer gives rise to the anterior pituitary
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surface ectoderm
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What germ layer gives rise to the posterior pituitary
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neuroectoderm
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What germ layer gives rise to the bones of the skull
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neural crest, ectoderm
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What germ layer gives rise to the cranial nerves
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neural crest, ectoderm
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1st generation Cephalosporins:
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Proteus mirabilis
E.Coli Klebseilla pneumonia Gram (+) cocci |
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2nd generation Cephalosporins:
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H. Influenzae
Enterobacter Neisseria Proteus mirabilis E.coli Serratia marcescens Gram (+) cocci |
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3rd generation Cephalosporins:
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Serious Gram (-) infxns
Pseudomonas Neisseria gonorrhea |
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4th generation Cephalosporins (Cefapine)
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Gram (+) infxns
Gram (-) infxns Pseudomonas |
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Classic symptoms of carcinoid syndrome
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“BFDR”
Bronchospasm and wheezing Flushing Diarrhea Right sided heart murmurs or lesions |
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Most common cardiac congenital abnormality
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Ventral septal defect (VSD)
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Components of Tetralogy of Fallot:
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Pulmonary stenosis
Right ventricular hypertrophy Overriding aorta Ventral septal defect |
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How do the vessel attach with transposition of Great Vessels
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Pulmonary trunk attaches to the left ventricle
Aorta attaches to the right ventricle |
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Pt present c. HTN in the arms and weak pulses in the feet, what do they have?
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Coarctation of the aorta
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Describe the blood flow in patent ductus arteriosus
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-aorta → pulmonary artery
-left-to-right shunt |
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What heart defect is associated c. chromosome 22q11 deletion
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Truncus arteriosus, tetralogy of Fallot
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What heart defect is associated c. Down syndrome
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Endocardial cushion defect
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What heart defect is associated c. congenital rubella
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PDA, pulmonary artery stenosis
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What heart defect is associated c. Turner syndrome
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coarctation of aorta, bicuspid aortic valve
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What heart defect is associated c. Marfan syndrome
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Aortic insufficiency
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Tx of acute pulmonary edema
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“LMNOP”
-loops -morphine- helps c. air hunger? -nitrates -oxygen -positioning (sit pt at edge of bed, let blood pool in legs –better than lungs) and pressors |
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Signs of right-sided heart failure
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Peripheral signs and symptoms
-Lower extremity edema -jugular venous distension -Hepatosplenomegaly |
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Signs of left-sided heart failure
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Respiratory and pulmonary symptoms
-Dyspnea on exertion -Orthopnea -Paroxysmal nocturnal dyspnea -pulmonary congestion symptoms |
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How does poor cardiac output lead to an increase in aldosterone
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-Decreased CO → low BP
-Juxtaglomerular cells secrete renin -Renin activates the RAS →aldosterone levels |
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Medications used to tx chronic heart failure:
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Improve survival:
-ACE inhibitors and ARBs -Aldosterone antagonists -B-blockers Symptomatic relief: -diuretics -digoxin -nitrates and other vasodilators |
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MOA of cardiac glycosides like digoxin
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-inhibit Na/K ATPase
-increase intracellular Ca2+ concentration → increase contractility of heart |
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Which rickettsial species has properties that are unique from the other organisms and what are they?
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Coxiella burnetii:
-(-) Weil-Felix reaction -No vector and aerosol transmission -Endospore- survive outside for a long time -No rash -Interstitial pneumonia |
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Classic presentation of congenital pyloric stenosis:
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-palpable epigastric olive mass
-poor feeding -projectile vomiting -hypochloremic metabolic alkalosis -hypokalemia -2wks of age, most common reason for surgery in 1st month of life |
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Heart failure
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increase in capillary pressure
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Liver failure
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decrease in oncotic pressure
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Renal failure
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decrease in plasma protein, decrease in plasma colloid osmotic pressure
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Infxns and toxins
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increased capillary permeability
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Nephrotic syndrome
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decreased plasma protein, decreased plasma colloid osmotic pressure
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Lymphatic blockage
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increased osmotic pressure
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Burns
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increased capillary permeability
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IV infusion of albumin or clotting factors
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increased plasma proteins, increased plasma colloid osmotic pressure
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Venous insufficiency
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increase capillary pressure
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What is the primary energy source of a pt who hasn't eaten in 2days
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Fatty Acids
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Where does FA degradation take place
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Mitochondria
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Where does FA synthesis take place
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Cytoplasm
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Where does glycolysis take place
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Cytoplasm
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Where does the TCA cycle take place
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Mitochondria
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Where does the ETC take place
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Mitochondria
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Where does gluconeogenesis take place
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Mitochondria and cytoplasm
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Where does Protein synthesis (RER) take place
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Cytoplasm
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Where does the urea cycle take place
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Mitochondria and cytoplasm
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Where does steroid synthesis (SER) occur
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Cytoplasm
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Where does heme synthesis take place
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Mitochondria and cytoplasm
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When might you hear an S4 heart sound?
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Hypertrophic cardiomyopathy
Aortic Stenosis Chronic HTN c. LVH Post-MI |
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When does isovolumetric contraction take place?
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During QRS, after mitral valve closure but before aortic valve opens
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How does an increase in afterload impact the stroke volume, assuming contractility remains constant?
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Decrease stroke volume
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What impact does an increase in contractility have on stroke volume assuming preload and afterload remain constant?
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Increase in stroke volume
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What heart sound is associated c. dilated CHF
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S3
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What heart sound is associated c. chronic HTN
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S4
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What gives rise to the jugular venous A, C, and V waves?
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A wave: Atrial contraction
C wave: Ventricular contraction V wave: Atria filling against closed tricuspid valve |
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What worm infxn is contracted by eating undercooked fish and causes inflammation of the biliary tract?
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Clonorchis sinensis
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What is the most common protozal infxn in the US?
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Toxoplasma gondii
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What is the cause of Chagas’ disease?
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Trypanosoma cruzi
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What is the most common helminthic infxn in the US?
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Enterobius vermicularis
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What is the snail host that causes “swimmer’s itch”?
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Schistosoma mansoni
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What causes diarrhea in campers and hikers
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Giardia lamblia
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What disease is transmitted in raw meat or infected cat feces?
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Toxoplasma
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What is the effect of stress on adipocytes?
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High stress:
Sympathetic stimulation → Epi and NE released from adrenal medulla Activates hormone-sensitive TG lipase in fat cells -Rapid breakdown of TGs -Mobilization of fatty acids used by muscles as energy Release of ACTH from anterior pituitary |
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Obligate anerobic bacteria
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Nocardia
Pseudomonas aeruginosa Mycobacterium tuberculosis Bacillus species |
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What causes a diastolic murmur?
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-Mitral/Tricuspid stenosis (should be open during diastole)
-Aortic/Pulmonic regurgitation |
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What causes a systolic murmur?
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-Aortic/Pulmonic stenosis (should be open during systole)
-Mitral/Tricuspid regurgitation |
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What murmurs are heard best in left lateral decubitus position?
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Mitral regurgitation and mitral stenosis
Left-sided S3 and S4 heart sounds |
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Which heart murmur is associated c. weak pulses?
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Aortic stenosis
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Crescendo-decrescendo systolic murmur heard best in the 2nd-3rd right inner space close to the sternum
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Aortic stenosis
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Early diastolic decrescendo murmur heard best in along the left side of the sternum
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Pulmonic regurgitation
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Late diastolic decrescendo murmur heard best along the left sternal
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Tricuspid stenosis
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Pansystolic or holosystolic murmur heard best at apex and often radiated to left axilla
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Mitral regurgitation
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Late systolic murmur preceded by mid-systolic click
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Mitral prolapse
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Crescendo-decrescendo murmur heard best at 2nd-3rd left interspace close to sternum
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Pulmonic stenosis
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Pansystolic or holosystolic murmur heard best along left lower sternal boarder that radiates to right lower sternal border
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Tricuspid regurgitation or VSD
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Rumbling late diastolic murmur with opening snap
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Mitral stenosis
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Continuous machine-like murmur
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Patent ductus arteriosus, PDA
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High-pitched diastolic murmur associated c. widened pulse pressure
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Aortic regurgitation
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