Review for PBL set 2

Tetralogy of Fallot

Pulmonary stenosis, Right ventricular hypertrophy, overriding aorta, ventricular septal defect, BOOT SHAPED HEART

Dextrocardia

Kartagener syndrome, heart is situated of right side of heart instead of left

What arch gives rise to pulmonary arteries?

6th aortic arch

Defects in the neural crest cells lead to what heart development issues?

Conotruncal abnormalities: Transposition of great vessels, tet of fallot, Truncus arteriosus

Eintheoven’s law states:

Lead II = Lead I + Lead III

High pitched, blowing early diastolic decrescendo murmur

Aortic regurgitation

Drug users are at risk for what?

Endocarditis, staph aureus affecting tricuspid valve

Kawasaki disease’s most dangerous sequela is?

Coronary artery aneurysms

What is the disease that causes amputation of digits in heavy smokers?

Buerger diesase/Thromboangiitis obliterans

Associated with blindness and polymyalgia rheumatica

Giant cell arteritis

Cystic fibrosis, mode of transmission + gene

Chloride channel defect in CFTR, 25% recessive inheritance

Whipple’s dsiease

Caused by T. whipplei, Diagnosed via PAS-positive macrophages

Celiac disease is characterized by?

Villi atorphy, blunted villi

Familial Adenomatous Polyposis is due to a mutation in what?

APC suppressor gene

Peutz-Jeghers Syndrome is characterized by?

hyperpigmented macules and hamartomatous polyps in the GI tract

Crohn’s disease

Transmural, non-caseating granulomas, and fistulas

Ulcerative colitis

Mucosal inflammation, pseudopolyps and “lead pipe” colon

Mallory-Weiss Syndrome

Hematemesis after violent retching/vomiting

Esophageal varices are due to?

Dilated veins due to portal hypertension, high risk of fatal bleeding

High NADH/NAD+ ration inhibits gluconeogenesis

leading to hypoglycemia.

Rapidly progressive with pathology showing crescents in Bowman’s space

Crescentic Glomerulonephritis

Furosemide is what type of Diuretic?

Loop diuretic, cotransporter in the thick ascending limb

Mannitol is used for?

Osmotic diuretic used to decrease cranial pressure

Carbonic anhydrase inhibitor (acetazolamide) is used for?

altitude sickness + glaucoma

HUS is characterized by?

Triad of anemia, thrombocytopenia, and acute renal failure after e. coli

What is H.Pylori triple therapy?

Claritromycin +amoxicillin + PPI

What is used to treat candida?

Fluconazole

C. Diff causes what?

pseudomembranous colitis, treated with vanco

Which ACE inhibitor is teratogenic?

Lisinopril

What hypertension drug can be used for pregnant women?

Methyldopa

Fibrates like gemfibrozil work via what pathway to lower triglycerides?

PPAR-alpha

Beefy-red tongue +iron deficiency anemia + esophageal webs?

Plummer-Vinson syndrome

Patient with microcytic anemia and is elderly?

colorectal cancer

Syringomyelia

Cysts/cavitation in the spinal cord that affects CSF flow

Gyrae appearance of stomach?

Menetrier disease

Calculate stroke volume?

SV= End diastolic volume (bottom right corner of loop) - End systolic volume (bottom left corner of loop)

Hyperhomocysteinemia context?

Deficiency in folate or B12 can cause elevated levels of homocysteine in the urine. It is usually converted to methionine.

Hep B is most associated with?

Polyarteritis nodosa

Coca cola urine is associated with?

Alkaptonuria + arthritis or PSGN

Peripheral artery disease

thrombectomy, angioplasty, warfarin

Man goes for water polo?

Giardia

Large sessile polyps?

Villous Adenoma

Ejection fraction rate is what?

Dilated Cardiomyopathy, S3 sound

Atropine

anticholinergic and makes you dry, no sweat or saliva

You cannot give what two drugs?

beta blocker and calcium channel blockers

Kawasaki disease

can cause MI in young children, medium vessel vasculitis

Warfarin cannot be given with CYP inhibitors

Warfarin + statin

How to treat flushing from Niacin?

Give NSAIDS

Sodium vs. ECF volume

salt in diet increase=water is drawn out into blood vessels

Oligohydraminos is due to?

Bilateral renal agenesis =, can be due to lisinopril.

Reducing sugars in the urine?

Galactosemia

Long QT syndrome has

aspartate to arginine

Buerger’s disease:

skin ulcers

Woody, tree bark aorta

Tertiary syphilis

Lead I

RA, LA

Lead II

RA, LL

Lead III

LA, LL

Normal axis?

Lead I and AVF are positive

Left axis deviation?

Lead I +, AVF -

Extreme right axis deviation

both leads negative

Right axis deviation

Lead I-, AVf positive

A 50 year old caucasian woman presents to the clinic with intermittent difficulties swallowing solid foods over the past several months. She reports fatigue and intermittent lightheadedness but denies any unexpected weight loss or chest pain. Her medical history is significant for poor nutritional intake. Physical examination reveals pallor of the conjunctiva and a smooth erythematous tongue. Laboratory studies show microcytic anemia (71fL; reference range 80-100fL) and a serum ferritin of 8 ng/ml (reference range 20-200 ng/ml). A barium swallow shows a thin shelf like narrowing in the upper esophagus. Which of the following is the most likely diagnosis explaining this patient’s presentation?

A. Schatzki’s ring

B. Esophageal adenocarcinoma

C. Plummer Vinson Syndrome

D. Achalasia

E. Diffuse esophageal Spasm

C

A 50-year-old male arrives at the Emergency Department complaining of chest pain. He explains that he felt the pain while throwing a baseball with his son. He has no past history of chest pain with exercise.  His vitals included: heart rate: 115 bpm, blood pressure: 140/86 millimeters of mercury (mmHg), respiration rate: 18, body temperature: 98.7 degrees Fahrenheit. His EKG results show an ST depression. 

Which of the following medications would be expected to be prescribed to the patient to prevent a myocardial infarction? 

1. Celecoxib

2. Acetylsalicylic acid

3. Propranolol 

4. Atenolol 

5. Atorvastatin

B

A 35-year-old female patient with no history of smoking presents to the emergency department with several weeks of progressive fatigue. She reports worsening symptoms including episodes of chest pain and shortness of breath. She also notes episodic dizziness and gradual vision loss over the past few weeks. On physical examination, her blood pressure is difficult to obtain in the upper extremities, with markedly diminished radial pulses bilaterally. An angiography was conducted and showed significant narrowing of the bilateral subclavian arteries with areas of vessel wall thickening. A diagnosis of which large vessel vasculitis best explains the patient’s symptoms and etiology?

1. Giant cell arteritis

2. Takayasu arteritis

3. Thromboangiitis obliterans (Buerger disease)

4. Polyarteritis nodosa (PAN)

5. Kawasaki disease

1. Takayasu arteritis

A 6-month-old infant presents with episodes of cyanosis that worsen with crying and improve when the child is placed in a squatting position. Imaging shows: (1) pulmonary infundibular stenosis, (2) a large defect of the interventricular septum, (3) an overriding aorta arising directly above the septal defect, and (4) hypertrophy of the right ventricular wall due to increased right-sided pressure. The patient also has liver abnormalities and characteristic facial features, including a broad prominent forehead, deep-set eyes, and a small pointed chin. Which of the following molecular abnormalities is most likely responsible for this patient’s condition?

A. Failure of fusion of the membranous interventricular septum

B. Mutation in JAG1 disrupting NOTCH signaling required for neural crest cell development

C. Failure of conotruncal ridge formation

D. Failure of the conotruncal septum to follow its normal spiral course

E. Failure of the embryo to close the ventral body wall

B

A 64-year-old man with a history of long-standing hypertension presents for evaluation after several weeks of worsening blood pressure control. He reports intermittent headaches but denies chest pain or shortness of breath. Physical examination reveals a blood pressure of 176/94 mmHg. Laboratory studies show normal serum potassium and creatinine levels. Imaging demonstrates significant narrowing of the right renal artery.

Which of the following mechanisms is primarily responsible for the sustained elevation in this patient’s arterial blood pressure?

A. Increased atrial natriuretic peptide (ANP) release causing natriuresis and decreased     blood volume.

B. Decreased renin secretion due to increased perfusion of the affected kidney

C. Increased aldosterone secretion causing renal sodium and water retention with expansion of extracellular fluid volume.

D. Reduced erythropoietin production causing decreased blood viscosity and lower systemic vascular resistance.

E. Downregulation of angiotensin II receptors leading to increased arteriolar tone over time.

C