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52 Cards in this Set
- Front
- Back
What causes a blowing murmur vs. harsh murmur?
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blowing- blood flowing wrong way across valve
Harsh- bloot hitting tissue (stenotic valve) |
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What are the causes of mtral regurgitation?
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advanced MVP, rheumatic heart disease, damage from infectious endocarditis, papillary, muscle rupture secondary to MI, CHF
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Most ASD are d/t defecct with...?
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ostium secundum, fenestrated ovale fossa
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Components of tetralogy of fallot?
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VSD, overarching aorta, right ventricular hypertrophy, subpulmonic stenosis
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Coarctation of the aorta adult vs. infant type
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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 |
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Stable vs. unstable angina
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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 |
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Q wave vs. non-Q wave MI
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non Q wave- inner 1/3-1/2 of wall infarcted vs. whole wall
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Renin angiotensin aldosterone system and CHF
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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
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Infective endocarditis causes emboli of aggreagated bacteria leading to...
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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 |
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3 causes of non-infective endocarditis
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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 |
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Most common causes of 3 types of pericarditis:
1. Fibrinous 2. Serous 3. suppurative |
fibrinous- transmural MI or Dressler syndrome
Serous- Coxsackie B virus, uremia, acute rhematic fever, SLE Suppruative- purulent, invasion of staph or strep |
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Criteria for acute rheumatic fever
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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 |
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FEV1/FVC ratio, significance and findings in COPD, restrictive disease
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FEV1- low in obstructive, normal in restrictive
FVC- total amount of aexhaled air FEV1/FVC- low in obstructive, normal 80% in restrictive |
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Criteria for chronic bronchitis
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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
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Bronchiectasis
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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 |
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Sarcoidosis
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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
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Adult ARDS vs. Neonatal
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adults- d.t diffuse injury to endothelium causing edema followed by inflammation leading to rapid collagen accumulation
neonatal- insufficienct surfactant low L:S ratio |
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Penumoconiosis
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macrophages phagocytose non-degradable irritants in lung parnechyma -> relase of ROS and immune mediators -> fibrosis increases with each
asbestosis, antracosis (coal), berylisosis, silicosis |
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Hypersenstivity penumonitis
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, extrinsic allergic alveolitis repeated inhalation of allergens tat causes inflamamtion and fibrosis
farmer's lung- thermophilic actinomycetes on hey, tobacco wokers,s bagassois |
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Area most prone to lumbar herniation?
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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
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Rachischisis
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completely open spine, none of the vertebra have lamina
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Spinal stenosis
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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
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Comb tx for Wilm's tumor?
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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 |
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Adverse effects of cyclophosphamide and cisplatin and L-asapariganse
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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 |
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Drug of choice for AML, ALL, Hodkin's?
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AML- cytarybine, stomatitis, NV
6-MP for ALL Vincristine for Hodgkin;s Doxorubicin- dialted cardiomyopathyq |
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Most concerning adverse effects of alkylating agents?
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Secondary cancers
Mechlorathemine, cyclophosphamide, chlorambucil, lomustine, buslfan, melphalan |
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DOC for testicular and blader CA
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cisplatin, primary side effects are in kdineys and brain
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MOA for leuprolide and use
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treatment for prostate cancer, synthetic GnRH feedback inhibits sex hormone synthesis
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Paclitaxel and docetaxel
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inhibit microtubule disaasemblie, white ells can still function by forming but can;t disassemble -> apoptosis
dose limiting BMD, |
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PGE2
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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... |
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How does ASA cause initial resp alkalosis?
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uncouples ox phos leding to accumulation of CO2 causing hyperventilation
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Acetomenaphin MOA
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does not have peripheral anti-inflammatory effect, action in CNS cyclooxygenase reduces fever and pain perception
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Patient presents with MR, lens dislocation and elevated homocyteine in urine, enzyme defect?
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Homocystinuria, cystathionine synthetase
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Hartnup disease
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neutral AA trasnproter problem leads to deficit of tryptophan -> niacin deficiit -> pellagra
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Patient presents with arthritis and dark urine, alkaptonuria is a defect in
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homogentisate oxidase, can't convert homogentisate to acetoacetate
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Albinism and PKU
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alibinism- no tyrosinase, but can still make catecholamines via tyrosine hydroxylase
PKU- defective phenylaalnine hydroxylase- need to supplement tyrosine to make catecholamines |
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What is the pathophys of maple syrip urine disease?
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defecttive branched chain decarboxylase, can;t metabolize valine, leucine and isoleucine, accumulation gives urine a sweet odor
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Which sugars are reducing sugars?
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glucose, glactose and fructose
sucrose is not available O2 for redox reaction |
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Enzymes that phosphorylate glucose, prevent exit from cell.
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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 |
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Which bond in cellulose can't be broken down in humans?
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B1-4 bond , makes it indigestible
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Fructosuria vs. frucotose intolerance
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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 |
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Galactosemia
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galactokinase deficit is rare, benign, cataracts
uriddly-trasferase defect is common, early MR |
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Von Gierke vs. Pompe vs. McArdle
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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 |
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Hurler vs. Hunter
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HJurler - a-l iuduronidase prob, corenal clouding and MR, AR
Hunter- no clouding, MR, a-L iduronidase, XLR |
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Important FA's product of fatty acid synthesis and precursor to prostaglandins
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Palmitic acid- 16:0
Arachidonic acid 20:4 peripheral sclerosis is invovled with saturated fat intake, trans fatty acids also bad |
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Bile acids
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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) |
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Life cycle of lipoproteins
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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 |
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X-linked sphingolipidoses
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Fabry, a-galactosidase, reddish purple ras kidney and heart failure, angiokeratoma
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AR sphinoglipidoses
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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 |
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Causes of prophoryia?
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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 |
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Substrates for gluconeogenesis from muscle, RBCs and fat
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Muscle and RBCs produce lactate
Fat cells release TGs -> glycerol |
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Vitamin deficiences effects for: B1, B2, B6, pantothenate, biotin
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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 |