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What accounts for 10% of all congenital heart defects?

Tetraology of fallot
What is tetraology of fallot?

Early cyanosis caused by a right to left shunt across the VSD.
Early cyanosis causes what?

Blue babies and death before puberty without surgical intervention.
What would a radiograph of tetralogy of Fallot (early right to left shunt) show?

Boot-shaped heart due to RVH.
What causes tetralogy of fallot?

anterosuperior displacement of the infundibular septum.
What can a patient do to improve symptoms of tetraolgoy of fallot?

Learn to squat which compresses the femoral arteries and increases pressure thereby decreasing the right to left shunt and directing more blood from the RV to the lungs.
What are the 4 things seen with tetraology of fallot?

1. Overriding aorta. 2. Pulmonary stenosis. 3. Right ventricular hypertrophy. 4. Ventricular septal defect.
What is another cause of tetraolgy of fallot?

Dextroposition of aorta.
How many babies are born a year with heart defects?

"about 25
What part of development will the heart be functioning?

by 10 weeks.
All congenital heart defects develop before when?

Before the 9th week of pregnancy.
What are the causes of congenital heart diseases?

"Most are unknown. Viruses
What virus can cause a congenital heart disease?

Rubella (german measles).
What type of congenital heart disease can alcohol cause?

Fetal alcohol syndrome (which is a complex syndrome associated with heart defects).
How will alcohol hurt a developing heart?

"Ethanol is toxic and destructive to heart cells
Several chromosomal abnormalities have been associated with congenital heart defects but which one was mentioned in the notes?

Down's syndrome.
What is the most common congenital heart diseases?

"Atrial septal defect
Right to left shunts clinically cause what?

"Early cyanosis ""Blue Babies"""
Left to right shunts clinically cause what?

"Late cyanosis ""blue kids""."
Name 5 things that can cause a right to left shunt?

1. Tetraology of fallot. 2. Transposition of great vessels. 3. Truncus arteriosus. 4. Tricuspid atresia. 5. total anomalous pulmonary venous return.
Which one of the 5 causes of right to left shunts is most common at birth and which one is the most common after 1 month?

Birth- Transposition of great vessels. After 1 month- tetralogy of fallot.
Name 3 things that can cause a left to right shunt list in order of prevalaence?

VSD > ASD > PDA
What is the most common congenital cardiac anomaly?

VSD.
What is Eisenmenger;s syndrome and what causes it?

"Any uncorrected VSD
What is an atrial septal defect?

"Septum of connective tissue which has not fully closed over after birth
What is a VSD?

"a left to right shunt which increased backflow of blood overburdens right ventricles and right ventrical hypertophies
What can be heard with a VSD?

"A distinct heart murmur
What are the treatments of VSD's?

Some small defects close spontaneously and large defects require surgery.
What is PDA?

A patent ductus arteriosus that normally closes only after birth.
PDA is maintained by what?

Patency is maintained by PGE synthesis and low O2 tension.
What is used to close a PDA?

Indomethacin.
What is Coarctation of the aorta?

Aortic stenosis.
Where will adult and infantile coarctation of the aorta happen at?

Adult- post DISTAL to ductus arteriosus. Infant- Pre or PROXIMAL to ductus arteriosus.
Coarctation of the aorta is associated with what?

"Turners syndrome
What is a clinical association of coarctation of the aorta?

"notching of the ribs
22q11 syndrome =?

"Truncus arteriosus
Down syndrome=?

"ASD
Congenital rubella=?

"Septal defects
Turners syndrome=?

Coarctation of aorta.
Marfans syndrome= ?

Aortic insufficiency (late complication).
Offspring of diabetic mothers = ?

Transposition of great vessels.
What will sudden occlusion of the lower limb/ smaller branches cause?

"Dry gangrene (black mummified)
What are the clinical presentations of a 10-25% occlusion by plaque?

"Asymptomatic
What are the clinical presentations of a 50-75% occlusion by non occlusive thrombus?

"Angia pectoris
What are the clinical presentations of a 100% occlusion by occlusive thrombus?

"Congestive heart failure
RCA (right coronary artery) occlusion involves what part of the heart?

"Posterior septum
LAD (Left anterior descending artery) occlusion involves what parts of the heart?

Anterior infarct.
LCA ( left coronary artery) occlusion involves what parts of the heart?

Lateral infarct.
Which artery is the widow maker?

LAD. The artery of sudden death. Causes 50% of MI.
What is esophageal varices?

Painless bleeding of submucosal vein in lower 1/3 of esophagus.
What is the overlying esophageal mucosa like with esophageal varix?

"generally normal
What is mallory-Weiss syndrome?

Painful mucosal lacerations at the gastroesophageal junction due to severe vomiting.
Severe vomiting seen with mallory-Weiss syndrome leads to what?

Hematemesis.
Mallory-Weiss syndrome is usually found in who?

Alcoholics and bulimics.
What is Boerhaave syndrome?

Transmural esophageal rupture/ tear due to violent retching (vomiting).
What is the most common anatomical location for Boerhaave syndrome?

"Left posterolateral wall of the lower third of the esophagus
Iatrogenic esophageal perforations will or will not count as Boerhaave syndrome?

Will not.
Boerhave syndrome is commonly associated with what?

Consumption of excessive food and or alcohol.
What is an esophageal stricture?

Narrowing or tightening of the esophagus.
Esophageal stricutre causes what?

Swallowing difficuties.
Esophageal stricutre is associated with what?

"Lye ingestion
What happens during healing of an esophageal stricutre?

Scar forms while the area heals causing the tissue to pull and tighten. This leads to difficultiy in swallowing food past area of healing.
What is plummer-vinson syndrome?

A triad of 1. Dysphagia (due to esophageal webs). 2. Glossitis. 3. Iron deficiency anemia (hypochromic microcytic).
What is the presentation of Plummer-Vinson syndrome?

"Burning sensation of the tongue and oral mucosa. Atrophy of lingual papillae produces a smooth
Will Plummer-vinson syndrome be benign or malignant?

Considered to be premalignant process.
What is Barrett's esophagus?

Glandular metaplasia- replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus. Due to chronic acid reflux (GERD).
What are the features of acute gastritis?

"Stress related
What are the features of chronic gastritis?

There are 2 types type A and Type B.
What is type A chronic gastritis like?

"Autoimmune (with pernicious anemia). Autoantibodies to parietal cells
What is type B chronic gastritis like?

Helicobacter pylori related. Risk of MALT lymphoma. Affects antrum.
What is the most common indication for emergent abdominal surgery in children?

Acute appendicitis.
What is the initial pain of acute appendicitis like?

Periumbilical pain.
Acute appendicitis has localized pain where?

at McBurney's point (lower right quadrant with rebound tenderness).
Appendicitis can also cause what symptoms?

"Nausea
What are some differential diagnosis of acute appendicitis?

"Diverticulitis
What are 2 broad groups of things that can cause intestinal obstructions?

"paralytic ileus
What are the types of hernias that cause intestinal obstructions?

"Indirect
What is an indirect hernia?

"it goes through the internal inguinal ring
What is an important landmark for an indirect hernia?

Enters the internal inuinal ring LATERAL to inferior epigastric artery.
Who will have an indirect hernia?

Infants when there is a failure of processus vaginalis to close. Much more common in males.
What is a direct hernia?

One that protrudes through the inguinal (hesselbach's) triangle. Goes through the external inguinal ring only. Covered by transversalis fascia.
What is the important landmark of the direct hernia?

Bulges directly through abdominal wall MEDIAL to inferior epigastric artery.
Who will have a direct hernia?

usually in older men.
What is a femoral hernia?

One that protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle.
A femoral hernia is seen with who?

More common in women.
What is Intussusception?

Telescoping of 1 bowel segment into distal segment; can compromise blood supply.
Intussusception is often due to what?

Intraluminal mass. Usually in infants.
What is Volvulus?

"Twisting of portion of bowel around its mesentery
Where will volvulus normally occur at?

Sigmoid colon because of redundant mesentery.
Volvulus is common among who?

Elderly.
What is the total lung capacity (TLC)?

around 6 liters.
What is the Vital capacity (VC) of the lungs?

around 4.5- 5 liters.
What is the lung residual volume (RV)?

Around 1 liter.
What is the lungs tidal volume?

The normal breathing and it is around 2-3 liters.
What is ARDS?

Adult respiratory distress syndrome.
What are the 9 causes of ARDS?

"1. Shock (secondary to trauma
What type of aspiration of fluids can lead to ARDS?

Gastric aspiration.
What are the 2 possible forms of ARDS?

alveolar-side injury. Endothelial cell injury.
What happens with alveolar-side damage with ARDS?

Increase alveolar capillary permeability and this leads to protein-rich leakage (EDEMA) into alveloi. This results in formation of intra-alveolar HYALINE membrane.
What is the pathophysiology of asthma?

Bronchial hyperresponsiveness causes reversible bronchoconstriction.
What are the clinical findings of asthma?

"SMOOTH MUSCLE HYPERTORPHY
Name 7 things that can trigger asthma attacks?

1. Pschological stress. 2. physical factors. 3. Exercise. 4. chemical irritants and air pollution. 5. bronchial infection. 6. viral URI. 7. Asprin.
What are curschmann's spirals?

Seen with asthma(and several other lung diseases)and it is a finding in the sputum of spiral shaped mucus plugs.
What are the 4 histopathology of asthma?

1. Mucus in lumen. 2. Inflammation and basement membrane thickening. 3. Enlarged mucous glands. 4. Smooth muscle hyperplasia.
What is pneumoconioses?

General term for inhalation-induced pathologies.
Pneumoconioses is aka?

Occupational lung disease.
What is the pneumoconioses seen with coal workers?

"Anthracosis ""black lung"""
What is the pneumoconioses seen with glass grinders disease?

Silicosis.
What is the pneumococises seen with asbestos?

Asbestosis.
What is the pneumoconioses seen with beryllium?

Berylliosis.
What is the pneumoconioses seen with iron?

Siderosis.
What is the pneumoconioses seen with cotton?

Byssinosis.
What will asbestosis cause?

Fibrosis of mainly the lower lobes.
What is atelectasis?

collapse of the lungs
What is the most common cause of atelectasis?

Post surgical.
Name 3 other types of atelectasis besides post surgical?

1. Collapse (pneumothorax). 2. Compression (hydrothorax). 3. Obstruction (tumor).
What is the difference between a gastric and duodenal peptic ulcer?

Gastric- pain can be greater with meals. Duodenal- pain decreases with meals.
Where will a ulcerative collitis be found at? Where will Chron's disease be found at?

"Ulcerative collitis-Diffuse
What is the difference in inflammation between chron's and ulcerative colitis?

"Chrons- transmural
What are the complications with chrons and ulcerative colitis?

"Chrons- malabsorption
Name 4 types of COPD's (chronic obstructive pulmonary diseases)?

1. Chronic bronchitis. 2. Emphysema. 3. Bronchiectasis. 4. Asthma.
What is chronic bronchitis?

Hypertrophy of mucus- secreting glands in the bronchioles.
What is the Reid index?

Gland depth / total thickness of bronchial wall.
What is the reid index like for chronic bronchitis?

> 50%.
What are the clinical findings of chronic bronchitis?

"Wheezing
What is emphysema?

Enlargment of air spaces and decreased recoil resulting from destruction of alveolar walls.
What are the clinical findings of Emphysema?

"Dyspnea
What would the chest of an emphysema patient look like?

Barrel-shaped chest.
What causes emphysema?

Smoking.
What will an x-ray of an emphysema patient look like?

Barrel chest and flat diaphragm.
What will cause more dyspnea bronchitis or emphysema?

Bronchitis.
What is the difference of sputum between bronchitis and emphysema?

Bronchitis- mucopurulent. Emphysema- mucoid.
Who will be cyanotic bronchitis or emphysema patients?

Bronchitis.
Who will have peripheral edema bronchitis or emphysema patients?

Bronchits.
What are the radiographic findings of chronic bronchitis?

Densities are seen.
What is bronchiectasis?

Chronic necrotizing infection of bronchi that permanently dilates the airways.
Bronchiectasis is associated with what?

"Bronchial obstruction
Bronchiectasis can develop what?

Aspergillosis.
What is the morphology of bronchiectasis?

Cylindrical and saccular.

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2011-11-10T15:23:44Z

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