Goljan Usmle flash card

7/27/2019 Goljan Usmle flash card

1/39

www.natures.irMore Free USMLE , MCCEE ,MCQe and AMQ Flashcards

What is diet-derivedtriglyceride?

Chylomicron

Chylomicron is _____ during

fasting absent

Chylomicrons form ______ ifincreased

turbid supranate

What is liver-derivedtriglyceride?

VLDL

Hypertriglyceridemia causesturbidity in ______

plasma

VLDL----> _______ ---->

LDL

IDL
http://www.natures.ir/http://www.natures.ir/


2/39

What transports cholesterol? LDL

What is equation tocalculate LDL?

LDL= CH - HDL - TG/5

Is fasting required for serum

CH?no

What is good cholesterol? HDL

What are source ofapolipoproteins?

HDL

What removes cholesterolfrom plaques for disposal inthe liver?

HDL

High VLDL causes Low

_____

HDL


3/39

What is Type IHyperlipoproteinemia?

- Low CPLor

- Low Apo C-II

What is Type IIHyperlipoproteinemia?

High LDL due to Low LDLreceptors

What is pathognomonic forfamilial

hypercholesterolemia?Achilles tendon xanthoma

What is Type IIIHyperlipoproteinemia

Deficiency of Apo E

What is pathognomonic forType III

Hyperlipoproteinemia?Palmar Xanthoma

What is Type IVHyperlipoproteinemia?

High VLDL`

What is the most commoncause of Type IV

hyperlipoproteinemia?

Alcohol Excess


4/39

What is the most commonlipid disorder?

Type IVHyperlipoproteinemia

What is pathognomonic forType IV

Hyperlipoproteinemia?Eruptive Xanthoma

What is treatment for Type

IV Hyperlipoproteinemia?

- Decrease carbohydrateintake

- Decrease alcohol intake

What is Type Vhyperlipoproteinemia?

High VLDL + Chylomicrons

Type V hyperlipoproteinemiacauses what syndrome?

HyperchylomicronemiaSyndrome

What is Apo B deficiency?

Low

- chylomicrons- VLDL- LDL

What is dystrophiccalcification in muscular

arteries?

Medial calcification


5/39

What is endothelial cellinjury?

Atherosclerosis

What play pivotal roles inatherosclerosis?

- platelet- macrophages

What is pathognomonic

lesion of atherosclerosis?Fibrous cap

What is an excellent markerof disrupted fibrous

plaques?C-reactive Protein

What is the most commonsite for atherosclerosis?

Abdominal aorta (No vasavasorum)

What are complications ofatherosclerosis?

- aneurysms- thrombosis- ischemia

What ares associatedconditions of

arteriolosclerosis?

- Diabetes Mellitus

- Hypertension


6/39

What is the most commonaneurysm in men >55

years?AAA

What is the rupture triad forAAA?

- left flank pain- hypotension

- pulsatile mass

What are fungal vesselinvaders of Mycotic

Aneurysms?

- Aspergillus- Candida- Mucor

What are bacterial vesselinvaders of Mycotic

Aneurysms?

- B. Fragilus- P. Aeruginosa

- Salmonella

Where does CNS berryaneurysms occur?

Junction communicatingbranch with main vessel

What causes aortic archaneurysms?

- Tertiary syphilis- Vasa vasorum Vasculitis

What does syphilic

aneurysms produce?

- aortic regurgitation

- bounding pulses


7/39

What is most common deathin Marfan syndrome and

EDS?Aortic Dissection

What is cystic medialdegeneration?

Aortic Dissection

What are features of aortic

dissection?

- pain radiating to back

- absent pulse

What is most commoncause of death in aortic

dissection?Cardiac Tamponade

What does superficialvaricosities cause?

Valve incompetence

What is the most commoncause of phlebothrombosis?

Stasis of blood flow

What is a sign of DVT? Stasis dermatitis


8/39

What is pain and tendernessoverlying the vein?

Thrombophlebitis

What is compression of SVCby primary lung cancer

called?SVC Syndrome

What is common among

weight lifters?

Thoracic Outlet Syndrome

(tight scalenus muscles)

Acute Lymphangitis isusually due to cellulitis

caused by:Streptococcus pyogenes

Turner's webbed neck is a____ abnormality

lymphatic

Bacillary angiomatsosis iscaused by ?

Bartonella henselae(common in AIDS)

What is ANCA?Antibodies against

components of neutrophils


9/39

What does small vesselvasculitis have?

palpable purpura

What does medium-sizedvessel vasculitis have?

- thrombosis- aneurysm formation

What does large vessel

vasculitis have?

- absent pulse

- stroke

What does systolic BPcorrelate with?

Stroke volume

What does diastolic BPcorrelate with?

tonicity of TPR arterioles

In pathogenesis ofhypertension, what iscommonly involved?

renal retention of sodium

What is most common type

of hypertension?

Essential HTN


10/39

What is the most commoncause of secondary

hypertension?Renovascular hypertension

In men, what causesrenovascular hypertension?

Atherosclerosis

In women, what causes

renovascular hypertension?fibromuscular hyperplasia

What does renovascularhypertension due to?

activation of RAA system

In renovascular HTN, thereis increased ____ activity

Plasma renin activity (PRA)

PRA is high in where? involved kidney

What does fibromuscular

hyperplasia look like?

'beaded' appearance of

renal artery


11/39

What are complications ofHTN in descending order?

1) acute MI2) stroke

3) renal failure

Takayasu arteritis("pulseless disease")

Vasculitis?

Epidemiology/ Etiology?Clinical/Lab

Findings/Treatment?

-Granulomatous largevessel vasculitis involving

aortic archvessels[Vasculitis]

-Young Asian women andchildren

-Absent upper extremitypulseDiscrepancy in blood

pressure between arms > 10mm Hg

Visual defects, stroke

Treatment: corticosteroids


12/39

Giant cell (temporal) arteritisVasculitis?


Findings/Treatment?

-Granulomatous largevessel vasculitis involvingsuperficial temporal and

ophthalmic arteries.-Adults > 50 years of age

-Temporal headache, jawclaudication (pain when

chewing stretches inflamedartery)

Blindness on ipsilateral sidePolymyalgia rheumatica

(muscle and joint pain;normal serum creatine

kinase)Increased ESR



13/39

Polyarteritis nodosa

Vasculitis?Epidemiology/ Etiology?

Clinical/LabFindings/Treatment?

-Necrotizing medium-sizedvessel vasculitis involving

renal, coronary, mesentericarteries

-Middle-aged men

Association with HBsAg(30%)

-Vessels at all stages ofacute and chronic

inflammationFocal vasculitis produces

aneurysmsOrgan infarction in kidneys,

heart (acute MI), bowels(bloody diarrhea), skin

(ischemic ulcer), testicleAngiography and biopsy of

lesions confirm thediagnosis.



14/39

Kawasaki disease



-Necrotizing medium-sizedvessel vasculitis involving

coronary arteries-Children < 5 years of age

Boys > girls

Cause unknown (probablyinfectious)

Children of Asian descenthave highest incidence

Surpassed acute rheumaticheart disease as most

common acquired heartdisease in children

-Fever, erythema andedema of hands and feet

convalescing withdesquamated rash; cervicaladenopathy; oral erythema

and cracking of the lipsAbnormal ECG (e.g., acute

MI)Treatment: intravenous

immunoglobulin; aspirin;corticosteroidscontraindicated


15/39

Thromboangiitis obliterans(Buerger's disease)

Vasculitis?


Findings/Treatment?

-Medium-sized vesselvasculitis with digital vesselthrombosis and damage toneurovascular compartment

-Men 25-50 years of age

who smoke cigarettesMiddle East, Far East, Asia

has highest prevalence-Resting pain on the forefoot

is characteristic, withpossible ischemic ulcers or

gangrene of foot/toes; upperlimb ischemia (40% to 50%of patients) with ulcerationand gangrene; Raynaud's

phenomenon.Treatment: smokingcessation essential;intravenous iloprost

(prostaglandin analogue)


16/39

Raynaud's disease


Clinical/Lab

Findings/Treatment?

-Medium-sized vesselvasculitis involving digital

vessels in fingers and toes;also tip of nose and ears in

some cases

-Young womenExaggerated vasomotor

response to cold or stress-Paroxysmal digital colorchanges (white-blue-red

sequence)

Ulceration and gangrene inchronic cases

Treatment: avoid coldtemperatures (gloves);

calcium channel blockers(e.g., nifedipine)


17/39

Raynaud's phenomenon



-Medium-sized vesselvasculitis involving digital

vessels in fingers and toes;also tip of nose and ears in

some cases

-Adult men and womenSecondary to other diseases

(e.g., systemic sclerosis,CREST syndrome, SLE)-Systemic sclerosis and

CREST syndrome: digital

vasculitis with vesselfibrosis, dystrophic

calcification, ulceration,gangrene

Treatment: see above


18/39

Wegener's granulomatosis



-Necrotizing medium andsmall-sized vessel vasculitisinvolving lung (infarctions,

renal vessels)-Childhood to middle age

-Necrotizing granulomas inskin, upper respiratory tract(nasopharynx-saddle nosedeformity, chronic sinusitis,collapse of trachea), lowerrespiratory tract (cavitating

nodular lesions)Necrotizing vasculitis in

lungs (infarction,hemoptysis), kidneys

(crescenticglomerulonephritis) c-ANCAantibodies (>90% of cases)

correlate erratically withtherapy

Treatment: corticosteroids,cyclo-phosphamide

3 Cs: c-ANCA,corticosteroids,cyclophosphamide


19/39

Microscopic polyangiitis



-Small vessel vasculitisinvolving skin, lung, brain,GI tract, and postcapillaryvenules and glomerular

capillaries

-Children and adultsPrecipitated by drugs (e.g.,penicillin), infections (e.g.,

streptococci), immunedisorders (e.g., SLE)

-Vessels at same stage of

inflammationPalpable purpura,glomerulonephritis

p-ANCA antibodies (>80%of cases)

Churg-Strauss syndrome



-Small vessel vasculitisinvolving skin, lung, heart

vessels-Children and adults

-Allergic rhinitis, asthmap-ANCA antibodies (70% of

cases), eosinophilia


20/39

Henoch-Schnlein purpura



-Small vessel vasculitisinvolving skin, GI, renal, joint

vessels-Children and young adults

Males > females

Most common vasculitis inchildren

IgA-anti-IgAimmunocomplexes

-Often follows a viral URI,group A streptococcal

pharyngeal infection-pathogens may act as an

antigen trigger that causesantibody formation leading

to immunocomplexformation

Palpable purpura of buttocksand lower extremitiesPolyarthritis (80%),

nephropathy (80%), GIbleeding

Recurrence may occur inone third of casesMost have spontaneous

recovery in 4 months withouttherapy.


mainly used if severe GIdisease or renal disease


21/39

Cryoglobulinemia



-Small vessel vasculitisinvolving skin, GI tract, renal

vesselsDifferent types of

cryoglobulinemia (mixed,

monoclonal, polyclonal)-Adults

Association with HCV, type IMPGN, multiple myeloma

(monoclonal type)-Cryoglobulins:

immunoglobulins that gel atcold temperatures

Palpable purpura, acralcyanosis of nose and ears

and Raynaud'sphenomenon (reverseswhen in warm room);

glomerulonephritis; arthritis;abdominal pain


22/39

Infectious vasculitis

Vasculitis?


Findings/Treatment?

-Small vessel vasculitisinvolving skin vessels-Children and adultsInvolves all microbial

pathogens

-Involves all microbialpathogens Rocky Mountain

spotted fever: ticktransmission of Rickettsia

rickettsiaeOrganisms invade

endothelial cells producingvasculitis Petechiae onpalms spread to trunk

Disseminatedmeningococcemia due toNeisseria meningitidesCapillary thrombosis

produces hemorrhage intoskin and confluent

ecchymoses

Lab findings in PAN p-anca. HBsAg+ in 30%,anemia, leukocytosis


23/39

Microscopic features of PAN

Segmental necrotizingvasculitis in three stages:

fibrinoid necrosis withneutrophils, fibroblast

proliferation, nodular fibrosis

with loss of internal elasticlamina

Lab findings in PANp-anca. HBsAg+ in 30%,

anemia, leukocytosis

Microscopic features of PAN

Segmental necrotizingvasculitis in three stages:

fibrinoid necrosis withneutrophils, fibroblast

proliferation, nodular fibrosis

with loss of internal elasticlamina

Clinical features of PAN

Affects all organs exceptlungs. Fever,

hematuria/renalfailure/hypertension,

abdominal pain/GI bleeding,myalgia/arthralgia

Clinical features of Wegnergranulomatosis

Bilateral pneumonitis withnodular and cavitary

infiltrates, chronic sinusitis,nasopharyngeal ulcerations,

renal disease


24/39

Microscopic features ofWegner granulomatosis

Necrotizing vasculitis ofsmall vessels (granulomas),necrotizing granulomas of

respiratory tract, focalnecrotizing

glomerulonephritis

Lab findings in Wegnergranulomatosis

c-anca

Treatment of Wegnergranulomatosis

cyclophosphimide

Clinical features of temporal

arteritis

Throbbing unilateralheadache, visual

disturbances, jawclaudication

Microscopic features of

temporal arteritis

Segmental granulomatousvasculitis with

multinucleated giant cellsand fragmentation of the

internal elastic lamina withintimal fibrosis and luminal

thickening

Diagnosis, lab findings andtreatment of temporal

arteritis

Dx.: biopsy of temporalartery. Lab: increased ESR.

Rx.: steroids


25/39

Clinical features ofTakayasu asteritis

Loss of pulse in upperextremities, visual

disturbances, neurologicabnormalities

Microscopic features ofTakayasu arteritis

Granulomatous vasculitiswith massive intimal fibrosis,thickening of the aortic archand narrowing of the major

arterial branches

Clinical features ofBuerger's disease

Severe pain in affected

extremity, thrombophlebitis,Raynaud phenomenon,ulceration and gangrene.Associated with heavy

cigarette smoking

Microscopic features ofBuerger's disease

Recurrent neutrophilic

vasculitis withmicroabseses, segmentalthrombosis and vascular

insuficiency

Clinical features ofKawasaki disease

Affects children < 4. Acutefebrile illness, conjuctivitis,

maculopapular rash,lymphadenopathy, coronaryaneurysms in 70% of cases

Microscopic features ofKawasaki disease

Segmental necrotizingvasculitis with coronary

aneurysms


26/39

Diseases that featureRaynaud phenomenon

SLE, CREST, Buerger,atherosclerosis

Raynaud diseasse

Small artery vasospasmresulting in blanching

cyanosis of fingers and toesprecipitated by cold

temperature and emotions

Henoch-Schonlein purpura

IgA-C3 immunocomplexes,

IgA nephropathy (Bergerdisease), palpable purpura

on buttocks

Major risk factors foratherosclerosis

Hyperlipidemia,hypertension, smoking,

diabetes

Most common sites foratherosclerosis

Abdominal aorta followed bycoronary arteries

Complications ofatherosclerosis

Ischemic heart disease,abdominal aortic aneurysm,peripheral vascular disease

(pain, pulselessness,paresthesia, claudication),

TIA (vertebral basilar

oclussion), renovascularhypertension (high renin).


27/39

Pathophysiology of essential

hypertension

Retention of sodium andwater with increase in strokevolume (systolic pressure).Sodium in smooth muscle

opens up calcium channels

with vasoconstriction ofarterioles (increased

diastolic pressure). Lowrenin hypertension.

Complications ofhypertension

Concentric ventricularhypertrophy, AMI, hyaline

arteriosclerosis,nephrosclerosis and CRF,

intracranial bleeds,athersoclerosis

Renovascular hypertension

Atherosclerosis of renalartery orifice in males or

fibromuscular hyperplasia inwomen. Severe

hypertension, epigastricbruit. High renin

hypertension. Screen with

captopril.


28/39

Captopril screening test forrenovascular hypertension

In renovascularhypertension there's

decreased RPF and highlevels of renin and

angiotensin II. With captopril

(ACE inhibitor), there's lossof negative feedback on

renin and exagerated highlevels of renin post-

stimulation. The test has thepotential for renal failure if

bilateral renal arterystenosis is present as AII isresponsible for maintaining

renal blood flow.

Ahterosclerotic aneurysms

MC site is abdominal aortabelow renal arteries (novasa vasorum). Pulsitile

mass with pain andabdominal bruit

Syphilitic aneurysm

Obliterative endarteritis ofvasa vasorum with ischemia

and atrophy of ascendingaorta, aortic insuficiency,airway encroachment andlaryngeal nerve involvment

(brassy cough)

Associated diseases ofdissecting aortic aneurysm

Marfan, Ehlers-Danlos,copper deficiency (no lysyl

oxidase)


29/39

Signs and symptoms ofdissecting aortic aneurysm

Acute retrosternal severechest pain, aortic

insuficiency and cardiactamponade

Phlebothrombosis Vs.Thrombophlebitis

Phlebothrombosis is venousthrombosis of deep veins

without inflamation orinfection. Thrombophlebitis

is venous thrombosis ofsuperficial veins due to

inflamation and infection

Signs, symptoms, diagnosis

and complications of DVT

Leg swelling, warmth,erythema. Increased venous

pressure from deep tosuperficial veins (which

drain in deep veins)

produces varicosities insuperficial system.Complications arethromboembolism,

thrombophlebitis. Dx.:Doppler

Signs, symptoms andcauses of thrombophlebitis

Palpable cord, pain,induration, warmth,erythema. MCC is

superficial varicose veins,phlebothrombosis,

catherthers, drug abuse


30/39

Clinical features of varicoseveins

Edema, thrombosis, stasisdermatitis, ulcerations

Clinical features of superiorvena cava syndrome

Compression of SVN byprimary lung cancer. Bluediscoloration of the face,

arms and shoulders,dizziness, convulsions,

visual disturbances,

distended jugular veins

Clinical features of Kaposisarcoma

Malignant endothelial celltumor caused by HHV-8.

Multiple red-purple patches,plaques or nodules. Spindle

shaped cells

What does Chylomicron do?

Transports diet derivedTG(triglyceride) in the blood

When is Chylomicron

absent? during fasting

Chylomicron forms intowhat?

turbid supranate


31/39

(VLDL) Very low densitylipoprotein transports what

to the blood?

it transports liver-synthesized (TG) to the

blood

What doeshypertriglyceridemia cause

in plasma?

hypertriglyceridemia causesturbidity in plasma

what is the source of fattyacids an glycerol?

VLDL (very low densitylipoprotein ) -> IDL

(intermediate-densitylipoprotein) -> LDL (low-

density lipoprotein)

what does LDL (Low-densitylipoprotein) transport?

cholesterol

How is LDL (Low-densitylipoprotein) calculated?

LDL = CH (cholesterol) -HDL (High-densitylipoprotein) - TG(triglyceride)/5

Serum CH (cholesterol)does it need fasting?

serum CH does not needfasting

High density lipoprotein

(HDL) is good or badcholesterol?

"good CH"


32/39

HDL is a source of ____? source of apolipoproteins

HDL removes cholesterolfrom where?

HDL removes cholesterolfrom plaques for disposal in

the liver

an increase of VLDL causes

what in HDL? VLDL causes HDL

Type 1 hyperlipoproteinemiacauses what change in CPL(capillary lipoprotein lipase)and apo CII(apolipoprotein

CII)?

CPL (capillary lipoproteinlipase)

or apo CII

Type 2 hyperlipoproteinemiawhat happens to LDL (Low-

density lipoprotein)?

LDL causes LDLreceptors

what is pathognomonic forfamilial

hypercholesterolemiaAchilles tendon xanthoma

type IIIhypercholesterolemia, if

there is a deficiency in apoE (apolipoprotein E) whathappens to the remnants?

remnants


33/39

type IIIhypercholesterolemiacauses what physical

change?

palmar xanthomax

type IV hyperlipoproteinemiais the most common lipiddisorder what happens to

the VLDL?

VLDL

type IV hyperlipoproteinemiais most commonly caused

by?alcohol excess

what are the symptom(s) oftype IV

hyperlipoproteinemia?eruptive xanthomas

type IV Rx what should bedone as treatment?

carbohydrate and alcoholintake

Type V hyperlipoproteinemiawhat happens to VLDL andchylomicrons?

VLDL + chylomicrons

What syndrome results fromType V

hyperlipoproteinemia?

hyperchylomicronemia

syndrome


34/39

in Apolipoprotein B (apo B)deficiency what happens to

the chylomicrons, VLD,LDL?

in Apolipoprotein Bdeficiency:

chylomicrons, VLD, LDL

medical calcification ofarteriosclerosis = ?

dystrophic calcification inmuscular arteries

in atherosclerosis whathappens to cause cell

injury?

platelets/ macrophagespivotal roles

[they adhere to damagedendothelium...]

fibrous cap = ?pathognomonic lesion of

atherosclerosis

What does the C-reactiveprotein used for predicting?

excellent marker ofdisrupted fibrous plaques

Where is the most commonsite for atherosclerosis?

Abdominal aorta; no vasavasorum

What are complications thatdevelope from

atherosclerosis?

aneurysms, thrombosis,

ischemia


35/39

hyaline arteriolosclerosishas what associated

conditions?

diabetes mellitushypertension

who is abdominal aorticaneurysm most common in?

aneurysm is most commonin men older than 55 years

What is the most commoncomplication of abdominal

aortic aneurysm and whathappens?

rupture triad:left flank pain; hypotension;

pulsatile mass

what fungi invade vessels inmycotic aneurysm? (3)

aspergilluscandidamucor

what bacteria invadevessels in mycotic

aneurysm? (3)

Bacteroides fragilispseudomonas aeruginosa

salmonella

CNS berry aneurysms occurwhere?

junction communicatingbranch with main vessel

aortic arch aneurysm infects

how = ?

tertiary syhilis;

vasa vasorum vasculitis


36/39

syphilitic aneurysmproduces whats?

produces aorticregurgitation;

bounding pulses

what is the most commoncause of death in Marfan

syndrome and EDS?aortic dissection

aortic dissection is caused

by?

cystic medial degeneration

(CMD)

Aortic dissection has whatclinical findings?

pain radiates into the back;absent pulse

what is the most commoncause of Aortic dissection ?

cardiac tamponade

superficial varicositiescauses?

valve incompetence

phlebothrombosis is caused

by?

stasis of blood flow


37/39

Stasis dermatitis is a sign of?

DVT (deep veinthromboses)

thrombophlebitis causespain where?

pain and tendernessoverlying the vein

SVC (Superior vena cava)

syndrome = ?

compression of Superiorvena cava by primary lung

cancer

Thoracic outlet syndrome iscommon among what

group?

weight lifters- tight scalenus muscles

acute lymphangitis iscaused by?

streptococcus pyogenescellulitis

What is Turner's webbedneck caused by?

lymphatic abnormality

bacillary angiomatosis, what

are the clinical findings?

bartonella henselae;

common in AIDS


38/39

ANCA (Antineutrophilcytoplasmic antibodies)

causes what?

antibodies againstcomponents of neutrophils

small vessel vasculitisappears as what?

palpable purpura

medium-sized vessel

vasculitis causes what?

thrombosis

aneurysm formation

large vessel vasculitiscauses what?

absent pulse, stroke

systolic blood pressurecorrelates with what?

stroke volume

Diastolic blood pressurecorrelates with what?

tonicity of TPR (totalperipheral resistance)arterioles

pathogenesis of

hypertension =?

renal retention of sodium

commonly involved


39/39

what is the most commontype of hypertension?

essential hypertension

what is the most commontype of secondary

hypertension?renovascular hypertension

renovascular hypertension

causes what?

atherosclerosis in menfibromuscular hyperplasia in

women

How does renovascularhypertension pathogenesis

= ?

activation of RAA (renin-angiotensin-aldosterone)

system

PRA (plasma renin activity)relates to renovascular

hypertension how?

in involved kidney in unaffected kidney

fibromuscular hyperplasiaappearance = ?

"beaded" appearance ofrenal artery

what are the complicationsdescending order

-acute MI

Documents

Goljan Usmle flash card