www.natures.

ir
More Free USMLE , MCCEE ,MCQe and AMQ Flashcards

What is diet-derived
Chylomicron
triglyceride?

Chylomicron is _____ during

absent
fasting

Chylomicrons form ______ if

turbid supranate
increased

What is liver-derived
VLDL
triglyceride?

Hypertriglyceridemia causes
plasma
turbidity in ______

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

IDL
LDL
What transports cholesterol? LDL

What is equation to
LDL= CH - HDL - TG/5
calculate LDL?

Is fasting required for serum

no
CH?

What is good cholesterol? HDL

What are source of

HDL
apolipoproteins?

What removes cholesterol

from plaques for disposal in HDL
the liver?

High VLDL causes Low

HDL
_____
 - Low CPL
What is Type I
or
Hyperlipoproteinemia?
- Low Apo C-II

What is Type II High LDL due to Low LDL

Hyperlipoproteinemia? receptors

What is pathognomonic for

familial Achilles tendon xanthoma
hypercholesterolemia?

What is Type III

Deficiency of Apo E
Hyperlipoproteinemia

What is pathognomonic for

Type III Palmar Xanthoma
Hyperlipoproteinemia?

What is Type IV
High VLDL`
Hyperlipoproteinemia?

What is the most common

cause of Type IV Alcohol Excess
hyperlipoproteinemia?
 What is the most common Type IV
lipid disorder? Hyperlipoproteinemia

What is pathognomonic for

Type IV Eruptive Xanthoma
Hyperlipoproteinemia?

- Decrease carbohydrate
What is treatment for Type
intake
IV Hyperlipoproteinemia?
- Decrease alcohol intake

What is Type V
High VLDL + Chylomicrons
hyperlipoproteinemia?

Type V hyperlipoproteinemia Hyperchylomicronemia

causes what syndrome? Syndrome

Low
- chylomicrons
What is Apo B deficiency?
- VLDL
- LDL

What is dystrophic
calcification in muscular Medial calcification
arteries?
 What is endothelial cell
Atherosclerosis
injury?

What play pivotal roles in - platelet

atherosclerosis? - macrophages

What is pathognomonic
Fibrous cap
lesion of atherosclerosis?

What is an excellent marker

of disrupted fibrous C-reactive Protein
plaques?

What is the most common Abdominal aorta (No vasa

site for atherosclerosis? vasorum)

- aneurysms
What are complications of
- thrombosis
atherosclerosis?
- ischemia

What ares associated

- Diabetes Mellitus
conditions of
- Hypertension
arteriolosclerosis?
What is the most common
aneurysm in men >55 AAA
years?

- left flank pain

What is the rupture triad for
- hypotension
AAA?
- pulsatile mass

What are fungal vessel - Aspergillus

invaders of Mycotic - Candida
Aneurysms? - Mucor

What are bacterial vessel - B. Fragilus

invaders of Mycotic - P. Aeruginosa
Aneurysms? - Salmonella

Where does CNS berry Junction communicating

aneurysms occur? branch with main vessel

What causes aortic arch - Tertiary syphilis

aneurysms? - Vasa vasorum Vasculitis

What does syphilic - aortic regurgitation

aneurysms produce? - bounding pulses
What is most common death
in Marfan syndrome and Aortic Dissection
EDS?

What is cystic medial

Aortic Dissection
degeneration?

What are features of aortic - pain radiating to back

dissection? - absent pulse

What is most common

cause of death in aortic Cardiac Tamponade
dissection?

What does superficial

Valve incompetence
varicosities cause?

What is the most common

Stasis of blood flow
cause of phlebothrombosis?

What is a sign of DVT? Stasis dermatitis

What is pain and tenderness
Thrombophlebitis
overlying the vein?

What is compression of SVC

by primary lung cancer SVC Syndrome
called?

What is common among Thoracic Outlet Syndrome

weight lifters? (tight scalenus muscles)

Acute Lymphangitis is
usually due to cellulitis Streptococcus pyogenes
caused by:

Turner's webbed neck is a

lymphatic
____ abnormality

Bacillary angiomatsosis is Bartonella henselae

caused by ? (common in AIDS)

Antibodies against
What is ANCA?
components of neutrophils
 What does small vessel
palpable purpura
vasculitis have?

What does medium-sized - thrombosis

vessel vasculitis have? - aneurysm formation

What does large vessel - absent pulse

vasculitis have? - stroke

What does systolic BP

Stroke volume
correlate with?

What does diastolic BP

tonicity of TPR arterioles
correlate with?

In pathogenesis of
hypertension, what is renal retention of sodium
commonly involved?

What is most common type

Essential HTN
of hypertension?
What is the most common
cause of secondary Renovascular hypertension
hypertension?

In men, what causes

Atherosclerosis
renovascular hypertension?

In women, what causes

fibromuscular hyperplasia
renovascular hypertension?

What does renovascular

activation of RAA system
hypertension due to?

In renovascular HTN, there

Plasma renin activity (PRA)
is increased ____ activity

PRA is high in where? involved kidney

What does fibromuscular 'beaded' appearance of

hyperplasia look like? renal artery
 1) acute MI
What are complications of
2) stroke
HTN in descending order?
3) renal failure
-Granulomatous large
vessel vasculitis involving
aortic arch
vessels[Vasculitis]
Takayasu arteritis
-Young Asian women and
("pulseless disease")
children
Vasculitis?
-Absent upper extremity
Epidemiology/ Etiology?
pulse
Clinical/Lab
Discrepancy in blood
Findings/Treatment?
pressure between arms > 10
mm Hg
Visual defects, stroke
Treatment: corticosteroids
 -Granulomatous large
vessel vasculitis involving
superficial temporal and
ophthalmic arteries.
-Adults > 50 years of age
-Temporal headache, jaw
Giant cell (temporal) arteritis
claudication (pain when
Vasculitis?
chewing stretches inflamed
Epidemiology/ Etiology?
artery)
Clinical/Lab
Blindness on ipsilateral side
Findings/Treatment?
Polymyalgia rheumatica
(muscle and joint pain;
normal serum creatine
kinase)
Increased ESR
Treatment: corticosteroids
 -Necrotizing medium-sized
vessel vasculitis involving
renal, coronary, mesenteric
arteries
-Middle-aged men
Association with HBsAg
(30%)
Polyarteritis nodosa -Vessels at all stages of
acute and chronic
Vasculitis? inflammation
Epidemiology/ Etiology? Focal vasculitis produces
Clinical/Lab aneurysms
Findings/Treatment? Organ infarction in kidneys,
heart (acute MI), bowels
(bloody diarrhea), skin
(ischemic ulcer), testicle
Angiography and biopsy of
lesions confirm the
diagnosis.
Treatment: corticosteroids
 -Necrotizing medium-sized
vessel vasculitis involving
coronary arteries
-Children < 5 years of age
Boys > girls
Cause unknown (probably
infectious)
Children of Asian descent
have highest incidence
Surpassed acute rheumatic
Kawasaki disease
heart disease as most
common acquired heart
Vasculitis?
disease in children
Epidemiology/ Etiology?
-Fever, erythema and
Clinical/Lab
edema of hands and feet
Findings/Treatment?
convalescing with
desquamated rash; cervical
adenopathy; oral erythema
and cracking of the lips
Abnormal ECG (e.g., acute
MI)
Treatment: intravenous
immunoglobulin; aspirin;
corticosteroids
contraindicated
 -Medium-sized vessel
vasculitis with digital vessel
thrombosis and damage to
neurovascular compartment
-Men 25-50 years of age
who smoke cigarettes
Middle East, Far East, Asia
Thromboangiitis obliterans
has highest prevalence
(Buerger's disease)
-Resting pain on the forefoot
is characteristic, with
Vasculitis?
possible ischemic ulcers or
Epidemiology/ Etiology?
gangrene of foot/toes; upper
Clinical/Lab
limb ischemia (40% to 50%
Findings/Treatment?
of patients) with ulceration
and gangrene; Raynaud's
phenomenon.
Treatment: smoking
cessation essential;
intravenous iloprost
(prostaglandin analogue)
 -Medium-sized vessel
vasculitis involving digital
vessels in fingers and toes;
also tip of nose and ears in
some cases
-Young women
Raynaud's disease
Exaggerated vasomotor
response to cold or stress
Vasculitis?
-Paroxysmal digital color
Epidemiology/ Etiology?
changes (white-blue-red
Clinical/Lab
sequence)
Findings/Treatment?
Ulceration and gangrene in
chronic cases
Treatment: avoid cold
temperatures (gloves);
calcium channel blockers
(e.g., nifedipine)
 -Medium-sized vessel
vasculitis involving digital
vessels in fingers and toes;
also tip of nose and ears in
some cases
Raynaud's phenomenon -Adult men and women
Secondary to other diseases
Vasculitis? (e.g., systemic sclerosis,
Epidemiology/ Etiology? CREST syndrome, SLE)
Clinical/Lab -Systemic sclerosis and
Findings/Treatment? CREST syndrome: digital
vasculitis with vessel
fibrosis, dystrophic
calcification, ulceration,
gangrene
Treatment: see above
 -Necrotizing medium and
small-sized vessel vasculitis
involving lung (infarctions,
renal vessels)
-Childhood to middle age
-Necrotizing granulomas in
skin, upper respiratory tract
(nasopharynx-saddle nose
deformity, chronic sinusitis,
collapse of trachea), lower
Wegener's granulomatosis
respiratory tract (cavitating
nodular lesions)
Vasculitis?
Necrotizing vasculitis in
Epidemiology/ Etiology?
lungs (infarction,
Clinical/Lab
hemoptysis), kidneys
Findings/Treatment?
(crescentic
glomerulonephritis) c-ANCA
antibodies (>90% of cases)
correlate erratically with
therapy
Treatment: corticosteroids,
cyclo-phosphamide
3 Cs: c-ANCA,
corticosteroids,
cyclophosphamide
 -Small vessel vasculitis
involving skin, lung, brain,
GI tract, and postcapillary
venules and glomerular
capillaries
Microscopic polyangiitis -Children and adults
Precipitated by drugs (e.g.,
Vasculitis? penicillin), infections (e.g.,
Epidemiology/ Etiology? streptococci), immune
Clinical/Lab disorders (e.g., SLE)
Findings/Treatment? -Vessels at same stage of
inflammation
Palpable purpura,
glomerulonephritis
p-ANCA antibodies (>80%
of cases)
-Small vessel vasculitis
Churg-Strauss syndrome
involving skin, lung, heart
vessels
Vasculitis?
-Children and adults
Epidemiology/ Etiology?
-Allergic rhinitis, asthma
Clinical/Lab
p-ANCA antibodies (70% of
Findings/Treatment?
cases), eosinophilia
 -Small vessel vasculitis
involving skin, GI, renal, joint
vessels
-Children and young adults
Males > females
Most common vasculitis in
children
IgA-anti-IgA
immunocomplexes
-Often follows a viral URI,
group A streptococcal
pharyngeal infection-
Henoch-Schönlein purpura pathogens may act as an
antigen trigger that causes
Vasculitis? antibody formation leading
Epidemiology/ Etiology? to immunocomplex
Clinical/Lab formation
Findings/Treatment? Palpable purpura of buttocks
and lower extremities
Polyarthritis (80%),
nephropathy (80%), GI
bleeding
Recurrence may occur in
one third of cases
Most have spontaneous
recovery in 4 months without
therapy.
Treatment: corticosteroids
mainly used if severe GI
disease or renal disease
 -Small vessel vasculitis
involving skin, GI tract, renal
vessels
Different types of
cryoglobulinemia (mixed,
monoclonal, polyclonal)
-Adults
Cryoglobulinemia Association with HCV, type I
MPGN, multiple myeloma
Vasculitis? (monoclonal type)
Epidemiology/ Etiology? -Cryoglobulins:
Clinical/Lab immunoglobulins that gel at
Findings/Treatment? cold temperatures
Palpable purpura, acral
cyanosis of nose and ears
and Raynaud's
phenomenon (reverses
when in warm room);
glomerulonephritis; arthritis;
abdominal pain
 -Small vessel vasculitis
involving skin vessels
-Children and adults
Involves all microbial
pathogens
-Involves all microbial
pathogens Rocky Mountain
spotted fever: tick
Infectious vasculitis
transmission of Rickettsia
rickettsiae
Vasculitis?
Organisms invade
Epidemiology/ Etiology?
endothelial cells producing
Clinical/Lab
vasculitis Petechiae on
Findings/Treatment?
palms spread to trunk
Disseminated
meningococcemia due to
Neisseria meningitides
Capillary thrombosis
produces hemorrhage into
skin and confluent
ecchymoses

p-anca. HBsAg+ in 30%,

Lab findings in PAN
anemia, leukocytosis
 Segmental necrotizing
vasculitis in three stages:
fibrinoid necrosis with
Microscopic features of PAN neutrophils, fibroblast
proliferation, nodular fibrosis
with loss of internal elastic
lamina

p-anca. HBsAg+ in 30%,

Lab findings in PAN
anemia, leukocytosis

Segmental necrotizing
vasculitis in three stages:
fibrinoid necrosis with
Microscopic features of PAN neutrophils, fibroblast
proliferation, nodular fibrosis
with loss of internal elastic
lamina
Affects all organs except
lungs. Fever,
hematuria/renal
Clinical features of PAN
failure/hypertension,
abdominal pain/GI bleeding,
myalgia/arthralgia
Bilateral pneumonitis with
nodular and cavitary
Clinical features of Wegner
infiltrates, chronic sinusitis,
granulomatosis
nasopharyngeal ulcerations,
renal disease
 Necrotizing vasculitis of
small vessels (granulomas),
Microscopic features of necrotizing granulomas of
Wegner granulomatosis respiratory tract, focal
necrotizing
glomerulonephritis

Lab findings in Wegner

c-anca
granulomatosis

Treatment of Wegner
cyclophosphimide
granulomatosis

Throbbing unilateral
Clinical features of temporal headache, visual
arteritis disturbances, jaw
claudication
Segmental granulomatous
vasculitis with
multinucleated giant cells
Microscopic features of
and fragmentation of the
temporal arteritis
internal elastic lamina with
intimal fibrosis and luminal
thickening
Diagnosis, lab findings and Dx.: biopsy of temporal
treatment of temporal artery. Lab: increased ESR.
arteritis Rx.: steroids
 Loss of pulse in upper
Clinical features of extremities, visual
Takayasu asteritis disturbances, neurologic
abnormalities
Granulomatous vasculitis
with massive intimal fibrosis,
Microscopic features of
thickening of the aortic arch
Takayasu arteritis
and narrowing of the major
arterial branches
Severe pain in affected
extremity, thrombophlebitis,
Clinical features of Raynaud phenomenon,
Buerger's disease ulceration and gangrene.
Associated with heavy
cigarette smoking
Recurrent neutrophilic
vasculitis with
Microscopic features of
microabseses, segmental
Buerger's disease
thrombosis and vascular
insuficiency
Affects children < 4. Acute
febrile illness, conjuctivitis,
Clinical features of
maculopapular rash,
Kawasaki disease
lymphadenopathy, coronary
aneurysms in 70% of cases
Segmental necrotizing
Microscopic features of
vasculitis with coronary
Kawasaki disease
aneurysms
 Diseases that feature SLE, CREST, Buerger,
Raynaud phenomenon atherosclerosis

Small artery vasospasm

resulting in blanching
Raynaud diseasse cyanosis of fingers and toes
precipitated by cold
temperature and emotions
IgA-C3 immunocomplexes,
IgA nephropathy (Berger
Henoch-Schonlein purpura
disease), palpable purpura
on buttocks

Hyperlipidemia,
Major risk factors for
hypertension, smoking,
atherosclerosis
diabetes

Most common sites for Abdominal aorta followed by

atherosclerosis coronary arteries

Ischemic heart disease,

abdominal aortic aneurysm,
peripheral vascular disease
Complications of (pain, pulselessness,
atherosclerosis paresthesia, claudication),
TIA (vertebral basilar
oclussion), renovascular
hypertension (high renin).
 Retention of sodium and
water with increase in stroke
volume (systolic pressure).
Sodium in smooth muscle
Pathophysiology of essential
opens up calcium channels
hypertension
with vasoconstriction of
arterioles (increased
diastolic pressure). Low
renin hypertension.
Concentric ventricular
hypertrophy, AMI, hyaline
Complications of arteriosclerosis,
hypertension nephrosclerosis and CRF,
intracranial bleeds,
athersoclerosis
Atherosclerosis of renal
artery orifice in males or
fibromuscular hyperplasia in
women. Severe
Renovascular hypertension
hypertension, epigastric
bruit. High renin
hypertension. Screen with
captopril.
 In renovascular
hypertension there's
decreased RPF and high
levels of renin and
angiotensin II. With captopril
(ACE inhibitor), there's loss
of negative feedback on
Captopril screening test for
renin and exagerated high
renovascular hypertension
levels of renin post-
stimulation. The test has the
potential for renal failure if
bilateral renal artery
stenosis is present as AII is
responsible for maintaining
renal blood flow.
MC site is abdominal aorta
below renal arteries (no
Ahterosclerotic aneurysms vasa vasorum). Pulsitile
mass with pain and
abdominal bruit
Obliterative endarteritis of
vasa vasorum with ischemia
and atrophy of ascending
Syphilitic aneurysm aorta, aortic insuficiency,
airway encroachment and
laryngeal nerve involvment
(brassy cough)
Marfan, Ehlers-Danlos,
Associated diseases of
copper deficiency (no lysyl
dissecting aortic aneurysm
oxidase)
 Acute retrosternal severe
Signs and symptoms of chest pain, aortic
dissecting aortic aneurysm insuficiency and cardiac
tamponade
Phlebothrombosis is venous
thrombosis of deep veins
without inflamation or
Phlebothrombosis Vs.
infection. Thrombophlebitis
Thrombophlebitis
is venous thrombosis of
superficial veins due to
inflamation and infection
Leg swelling, warmth,
erythema. Increased venous
pressure from deep to
superficial veins (which
drain in deep veins)
Signs, symptoms, diagnosis
produces varicosities in
and complications of DVT
superficial system.
Complications are
thromboembolism,
thrombophlebitis. Dx.:
Doppler
Palpable cord, pain,
induration, warmth,
Signs, symptoms and erythema. MCC is
causes of thrombophlebitis superficial varicose veins,
phlebothrombosis,
catherthers, drug abuse
Clinical features of varicose Edema, thrombosis, stasis
veins dermatitis, ulcerations

Compression of SVN by
primary lung cancer. Blue
discoloration of the face,
Clinical features of superior
arms and shoulders,
vena cava syndrome
dizziness, convulsions,
visual disturbances,
distended jugular veins
Malignant endothelial cell
tumor caused by HHV-8.
Clinical features of Kaposi
Multiple red-purple patches,
sarcoma
plaques or nodules. Spindle
shaped cells

What does Chylomicron do Transports diet derived

? TG(triglyceride) in the blood

When is Chylomicron
during fasting
absent?

Chylomicron forms into

turbid supranate
what?
 (VLDL) Very low density it transports liver-
lipoprotein transports what synthesized (TG) to the
to the blood? blood

What does
hypertriglyceridemia causes
hypertriglyceridemia cause
turbidity in plasma
in plasma?
VLDL (very low density
lipoprotein ) -> IDL
what is the source of fatty
(intermediate-density
acids an glycerol?
lipoprotein) -> LDL (low-
density lipoprotein)

what does LDL (Low-density

cholesterol
lipoprotein) transport?

LDL = CH (cholesterol) -
How is LDL (Low-density HDL (High-density
lipoprotein) calculated? lipoprotein) - TG
(triglyceride)/5

Serum CH (cholesterol) serum CH does not need

does it need fasting? fasting

High density lipoprotein

(HDL) is good or bad "good CH"
cholesterol?
 HDL is a source of ____? source of apolipoproteins

HDL removes cholesterol

HDL removes cholesterol
from plaques for disposal in
from where?
the liver

an increase of VLDL causes

↑ VLDL causes ↓ HDL
what in HDL?

Type 1 hyperlipoproteinemia
causes what change in CPL ↓ CPL (capillary lipoprotein
(capillary lipoprotein lipase) lipase)
and apo CII(apolipoprotein or ↓ apo CII
CII)?
Type 2 hyperlipoproteinemia
↑ LDL causes ↓ LDL
what happens to LDL (Low-
receptors
density lipoprotein)?

what is pathognomonic for

familial Achilles tendon xanthoma
hypercholesterolemia
type III
hypercholesterolemia, if
there is a deficiency in apo ↑ remnants
E (apolipoprotein E) what
happens to the remnants?
 type III
hypercholesterolemia
palmar xanthomax
causes what physical
change?
type IV hyperlipoproteinemia
is the most common lipid
↑ VLDL
disorder what happens to
the VLDL?

type IV hyperlipoproteinemia
is most commonly caused alcohol excess
by?

what are the symptom(s) of

type IV eruptive xanthomas
hyperlipoproteinemia?

type IV Rx what should be ↓ carbohydrate and alcohol

done as treatment? intake

Type V hyperlipoproteinemia
what happens to VLDL and ↑ VLDL + chylomicrons
chylomicrons?

What syndrome results from

hyperchylomicronemia
Type V
syndrome
hyperlipoproteinemia?
in Apolipoprotein B (apo B)
in Apolipoprotein B
deficiency what happens to
deficiency:
the chylomicrons, VLD,
↓ chylomicrons, VLD, LDL
LDL?

medical calcification of dystrophic calcification in

arteriosclerosis = ? muscular arteries

platelets/ macrophages
in atherosclerosis what
pivotal roles
happens to cause cell
[they adhere to damaged
injury?
endothelium...]

pathognomonic lesion of
fibrous cap = ?
atherosclerosis

What does the C-reactive excellent marker of

protein used for predicting? disrupted fibrous plaques

Where is the most common Abdominal aorta; no vasa

site for atherosclerosis? vasorum

What are complications that

aneurysms, thrombosis,
develope from
ischemia
atherosclerosis?
 hyaline arteriolosclerosis
diabetes mellitus
has what associated
hypertension
conditions?

who is abdominal aortic aneurysm is most common

aneurysm most common in? in men older than 55 years

What is the most common

rupture triad:
complication of abdominal
left flank pain; hypotension;
aortic aneurysm and what
pulsatile mass
happens?

aspergillus
what fungi invade vessels in
candida
mycotic aneurysm? (3)
mucor

what bacteria invade Bacteroides fragilis

vessels in mycotic pseudomonas aeruginosa
aneurysm? (3) salmonella

CNS berry aneurysms occur junction communicating

where? branch with main vessel

aortic arch aneurysm infects tertiary syhilis;

how = ? vasa vasorum vasculitis
 produces aortic
syphilitic aneurysm
regurgitation;
produces whats?
bounding pulses

what is the most common

cause of death in Marfan aortic dissection
syndrome and EDS?

aortic dissection is caused cystic medial degeneration

by? (CMD)

Aortic dissection has what pain radiates into the back;

clinical findings? absent pulse

what is the most common

cardiac tamponade
cause of Aortic dissection ?

superficial varicosities
valve incompetence
causes?

phlebothrombosis is caused
stasis of blood flow
by?
Stasis dermatitis is a sign of DVT (deep vein
? thromboses)

thrombophlebitis causes pain and tenderness

pain where? overlying the vein

compression of Superior
SVC (Superior vena cava)
vena cava by primary lung
syndrome = ?
cancer

Thoracic outlet syndrome is

weight lifters
common among what
- tight scalenus muscles
group?

acute lymphangitis is streptococcus pyogenes

caused by? cellulitis

What is Turner's webbed

lymphatic abnormality
neck caused by?

bacillary angiomatosis, what bartonella henselae;

are the clinical findings? common in AIDS
 ANCA (Antineutrophil
antibodies against
cytoplasmic antibodies)
components of neutrophils
causes what?

small vessel vasculitis

palpable purpura
appears as what?

medium-sized vessel thrombosis

vasculitis causes what? aneurysm formation

large vessel vasculitis

absent pulse, stroke
causes what?

systolic blood pressure

stroke volume
correlates with what?

tonicity of TPR (total

Diastolic blood pressure
peripheral resistance)
correlates with what?
arterioles

pathogenesis of renal retention of sodium

hypertension =? commonly involved
what is the most common
essential hypertension
type of hypertension?

what is the most common

type of secondary renovascular hypertension
hypertension?

atherosclerosis in men
renovascular hypertension
fibromuscular hyperplasia in
causes what?
women

How does renovascular activation of RAA (renin-

hypertension pathogenesis angiotensin-aldosterone)
=? system

PRA (plasma renin activity)

↑ in involved kidney
relates to renovascular
↓ in unaffected kidney
hypertension how?

fibromuscular hyperplasia "beaded" appearance of

appearance = ? renal artery

descending order
what are the complications -acute MI
involved in hypertension? -stroke
-renal failure