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OS-Cardio

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himubuwe's version from 2015-05-23 20:11

Circle of Willis

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LabelAnswer
AAnterior cerebral artery
BAnterior comm artery
COpthalmic artery
DMiddle cerebral artery
EInternal carotid
FPosterior communicating
GPosterior cerebral
HSuperior cerebellar
IAnterior inferior cerebellar
JPontine
KBasilar
LPosterior Inferior cerebellar
MVertebral
NAnterior spinal
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: Leprosy
Question Answer
TuberculoidMild
TuberculoidTh1
TuberculoidMacrophages kill M.Leprae
TuberculoidDamages skin & cutaneous nerves, small number of well demarcated plaques with decreased sensation
+Lepromin testTuberculoid due to STRONG Th1
LepramatousSevere
LepramatousDissemeniated
LepramatousTh2 acid fast bacili accumulation within macrophages
LepramatousNumerous poorly demarcated plaques all over the body
Lepromin testDifferentiate Tuberculoid or Lepramatous
-Lepromin testLepramatous due to WEAK Th1
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Stroke

Anterior circulation

ArterySx
MCA-CONTRA Upper limb(Motor and sensory)
-Wernicke's and Broca's area
Anterior cerebral arteryCONTRA Lower limbs (Motor and sensory)
Lateral striates(off MCA)-Go to Striatum and internal capsule
-CONTRA hemiplegia=2ndary HTN(Lacunar infarct)=bc they are small.
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Question Answer
ASA-Lateral corticospinal(movement)(A)=CONTRA hemiparesis(Lower Limb)

-Caudal medulla=hypoglossal nerve=IPSI dysfunction(deviates IPSI)
PICerebellarA1)Lateral medulla
-Spinothalamic tract=Limb+Face(Decre pain and Temp)
-Nucleus ambiguus(CN9, 10,11)=
-Inferior cerebellar peduncle
-IPSI horners


(UNIQUE TO PICA)
AICerebellarA
1)Lateral pons
-Facial nucleus=
*paralysis
* decre Ant 2/3 taste
*IPSI hearing affected
-Spinal trigeminal = Decre pain and temp in face


(UNIQUE TO AICA)
PCA-CONTRA hemianopsia w/ macular sparing
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Question Answer
AComm->stroke
-VF defects
PComm-Aneurysm> stroke
-CN3 palsy"Down and Out"
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CV

Question Answer
Tanner stages1) prepubertal, elevation of only the papilla of the breast, fine villus hair

2)Begin puberty, palpable breast buds, enlarged areola, minimal course hair

3) Elevation of breast contour with areolar enlargement

4) 2ndary mound on the breast (areola)

5)Adult breast contour, recession of the areola to general contour of breast
Would you give a person who has WPW Procainamide?Yes, because it does NOT slow down conductance thru AV node= decrease chance of deviating towards accessory pathway and leading to V-fib(Like: Beta blocker, Adenosine, Verapamil, Digoxin, )(Bad AV Diffusion )
If a man was stabbed just to the right of mid-line of the thorax and he experienced a R-sided hydro-pneumothorax with these levels:

RBC=1000 cells
WBC=50
TAG=500
Cultures =neg

what would you suspect was hit ?
The HIGH TAG suggest Thoracic duct.
-Courses thru the diaphragmatic hiatus into the thorax ascending midline.

-Drains upper left and B/L LE vs the upper right= right lymphatic duct


-Emptying into the LEFT internal jugular vein
Drug X is a B1 antag but a M2 and M3 agonist

What will happen to HR if
1. X alone
2 X w/ atropine
3 X w/ tri-me-tha-phan
1=HR decrease

2=Decrease HR; atropine blocks M2-3

3= Decrease HR; Trimethaphan=ganglionic blocker= BARORECEPTOR-mediated reflexes. BUT the HR changes are due to direct binding of cardiac receptors
(Try-me not tha Gang)
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CV

Question Answer
If a pt comes to you w/ HA and heart palp and he's currently on digoxin and furosemide

ECG= flattenned T-waves and irreg rhythm


What can u give him to treat it?
Pt has hyPOkalemic metab alkalosis= S/e of thiazide and Loops

Vs HYPERkalemia=Peaked T-waves

Tx: give Spironolactone
Tx for RF. Acute vs ChronicAcute: Penicillin and salicylates

Chronic: valve repair
The order at which these enzymes rise during MI(best enzyme to use for Dx)

AST, CK-MB, LDH, Trop I
1. Troponin I (6hrs)
2.CK-MB(8-24hrs)
3. AST when CK-MB begins to decline(On CK's ASS)
4. LDH(2-7days)(Last )
Bradycardia TxAtropine

Or DE and EPI for Atropine resistant cases
Drug interaction btw Digoxin and QuinidineDigoxin levels will INCREASE

Sx:
-GI
-Visual
-CV
*premature ventricular contraction
* AV nodal block
*Slow Ventricular response
(DQ)
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CV

Question Answer
Drugs that cause "Lupus-like sx"DIL: "Hi, I Masterbate Quite Profusely Too..... Come See!!!"---Drug-induced lupus

H-Hydralazine
I-Isoniazid
---------------------------------------
M-Methyldopa, Minocycline
Q-Quinidine
P- Procainamide, phenytoin
T-Terbinafine
----------------------
C-Chlorpromazine
S-Sulfasalazine
What is side (R or L) is affected FIRST by CT?Right side because the RV walls are thinner...but ultimately CO is compromised
Kussmaul sign with CT or CP?Kussmual sign=Increase in JVP during inspiration

Seen with BOTH

1)CT=PP & Beck's triad:
- HypoTN(Less blood flow to systemic)
-Muffled Heart sounds
-JVD

2) CP=no Beck's triad
What does twitching when a BP cuff is used mean?


What role does Mg2+ play?
What is the other test called?
-TrOusseau sign= LOW Ca2+(Too Low)

-Mg is a cofactor in adenyl cyclase in the parathyroid

-Decreased Mg2+ levels cause decrease cAMP and therefore decreased PTH.

-Chvostek sign is one of the signs of tetany seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve
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Transplant rejections

Question Answer
Ischemia and necrosis-Hyperacute(minutes)
-Preformed(Type2 HS) from recipient
Vasculitis of graft cells and Interstitial lymphocytic infiltration-Acute(weeks)
-Reversible with immun suppress.
T cell and AB mediated-Months to years(Chronic)
-Obliterative vascular fibrosis
-MHC-nonself appears as MHC self with antigen
Macupapular rash, jaundice, H/S, diarrhea.

Seen in which types?
G-vs -H
-Length varies
-Bone and Liver transplant(RICH in lymphoctes)
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CreatineKinase

Question Answer Column 3
Glucocortico induced myopathyProgressive muscle weakness & atrophy withoutpain / Lower extremity muscles not involved-CK
Polymyalgia RheumaticaMuscle pain & stifness in shoulder neck & pelvic gridle / Worse in morning & with activity-CK
Inflammatory Myopathies(Dermatomyositis,polyomositis)Skin rash, Inflammatory arthritis,proximal muscle weakness↑CK
StatinProximal weakness & muscle pain few weeks after starting statin↑CK
Hypothyroid myopathyDelayed tendon reflex, myoedema↑CK
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Apolipoproteins

Question Answer
ApoA-ILCAT Activation(cholestrol esterification)
ApoB-48Chylomicron assembly and secretion by the intestine
ApoB-100ldl particle uptake by extrahepatic cells
ApoC-IILipoprotein lipase activation
ApoE-3 & -4VLDL and chylmicron remnant uptake by the liver
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Viral

Question Answer
Double stranded DNA -> Template+RNA -> Progeny Double stranded DNAHepatits B
One stranded DNA -> Template double stranded DNA -> Progeny one stranded DNAParvovirus B19
Non enveloped single stranded DNAParvovirus B19
Double stranded DNA -> Template double stranded DNA -> Progeny double stranded DNAPapovirus,Adenovirus,Herpesvirus,Poxvirus
Non enveloped Double stranded DNA virusAdenovirus
One stranded +RNA -> Template -RNA -> Progeny one stranded +RNAPoliovirus
One stranded +RNA -> Template double stranded DNA -> Progeny one stranded +RNARetrovirus
One stranded -RNA -> Template +RNA -> Progeny one stranded -RNAInfluenza,Measles, Rabies
Enveloped Double stranded DNA virusEBV
Enveloped - stranded RNA virusInfluenza, Paramyxovirus, Rhabdovirus
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Heart Murmurs

Question Answer
Holosystolic Murmur left sternal borderVSD
Fixed wide splitting of S2ASD
Continous MurmurPDA
Holosystolic Murmur on cardiac apex radiating to the axillaMR
Opening snap diastole with midsystolic rumble cardiac apexMS
Ejection murmur increases with standing upHCM
Ejection murmur decreases with standing upValvular Aortic Stenosis
S3Normal in young/pregnant - Abnormal can cause restrictive cardiomyopathy, Heart failure
S4Normal in adults - Acute Mi, Ventricular Hypertrophy
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Upper vs Lower

Question Answer
Muscle weakness with increased toneU
SpasticityU
Clasp Knife RigidityU
HyperreflexiaU
Upgoing Plantar reflexes(+Babinski)U
Flaccid ParalysisL
AreflexiaL
AtrophyL
FasciculationL
Poliomyelitis & Werdnig HoffmanL
ALSA&L
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Hypertension

Question Answer
HypertensionCharcot
Basal Ganglia, Cerebellum, Thalamus, PonsCharcot
<1mmCharcot
Intracerebral HemorrhageCharcot
Neurological problems with headacheCharcot
ADPKD, Ehlers-DhanosSaccular
Circle of willisSaccular
2-25MMSaccular
Subarachanoid HemorrhageSaccular
Sudden severe headache with no nuerologic signsSaccular
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Pressure

Question Answer
Right Atrium0-8
Right Ventricle4-25
PA9-25
Left Atrium2-12
Left Ventricle9-130
Aorta70-130
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Injury

Question Answer Column 3 Column 4 Column 5
EpiduralMiddle Meningeal ArterySkull & DuraLucid Interval followed by loss of consciousnessBiconvex Hematoma
SubduralBridging Cortical VeinsDura & ArachnoidGradual Headache & confusionCrescent Shaped moon
SubarachnoidAneurysm or Malformation of Posterior & Communicating ArteryArachnoid & PiaSevere headache/NuchalRigidityBlood in basal Cisterns
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Osmolarity

Question Answer Column 3 Column 4
ConditionUrine osmolarity post dehydrationUrine OS post vasopressin(adh)Serum Sodium
Normal>800<10% increaseNormal
Complete neurogenic Inspidious<300>50% increase>142
Nephrogenic Inspidious<300<50%increase>142
Primary Polydipsia(psychogenic)>500<10% increase<137
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Hypersensitivity

Question Answer Column 3 Column 4
Type 1IgEBasophils, MastcellAllergies, Anaphylaxis
Type 2IgG, IgMPhagocytes, Complement Mediated cell injuryAutoimmune Hemoolytic anemia(Bloodtransfusion), Goodpasture Syndrome
Type 3Deposition of Antibody-Antigen ComplexesNeutrophils,Complement activationPSGN,Lupus Nephritis, Serum Sickness
Type 4NoneTcell/MacrophagesContact dermatitis, Tuberculin Skin Test
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Osteomyelitis

Question Answer Column 3 Column 4
Childhood ageHematogenous seeding during an episode of bactremiaS.Aureus, S.PyogenesLong Bones
Sickle CellHematogenous seeding to infarcted boneSalmonella, S.AureusLong Bones
Pott DiseaseHematogenous seeding from lungsM. TuberculosisVertebrae
Diabetes MellitusContiguous spread from infected foot ulcerPolymicrobialBones of feet
Recumbent pts with impaired mobilityContiguous spread from pressure soresPolymicrobialSacrum Heel
Recent trauma or orthopedic surgeryDirect InoculationPolymicrobialVariable
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Cognitive test

Question Answer
OrientationProviding name, location and current date
ComphrensionFollowing Multistep commands
ConcentrationReciting months of the year backwards
Short termRecalling 3 unrelated words after 5 minutes
Long termSaying in detail a story from past
LanguageWriting full sentence with noun verb agreement
Executive FunctionDrawing a clock oriented to the time requested
Visual SpatialDrawing interesting pentagons
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Prevention

Question Answer Column 3
PrimaryPreventing a diseaseHealth Promotion - regular exercise, no smoking, weightloss
SecondaryDetecting a disease process before symptomsIndividual case finding(pap) OR Community Screening(healthfair)
TeritaryTreat disease to prevent progression/complicationsDiability Limitation(Diabetes control) OR Rehabilitation(Physical Therapy)
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Muscle aches

Question Answer Column 3
Anklosying SpondylitisProgressive pain and stiffness of spine, sacrolitisHLAB27 positive
FibromyalgiaDiffuse muscle pain, fatigue, neuropsychatric complains20-55yr old
Polymyalgia RheumaticaBilateral pain and stiffness in shoulders and hips with weightloss, fever Malaise50+ with Increased ESR
DermatomysitisBilateral proximal muscle weakness with violaceous eruption on the eyelids and kuncklesIncreased Creatine kinase
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