The Correct option is
DAlthough most people with mitral valve prolapse never have problems, complications can occur. Complications tend to occur in middle-aged or older adults.
- Mitral valve regurgitation.
- Heart valve infection (endocarditis).
- Heart rhythm problems (arrhythmias)
- cerebrovascular ischemic events
The Correct option is
CCauses of cor pulmonlae include:
- Severe, chronic obstructive lung disease, such as emphysema, recurrent pneumonia, bronchiectasis, silicosis, lung cancer, tuberculosis or collagen diseases.
- Small blood clots that travel to the lung from another body site (usually a deep vein in the calf of the leg) and obstruct lung blood vessels.
- Primary diseases of the heart, including rheumatic heart disease and congenital heart disease.
The Correct Answer is B
Sudden cardiac death (SCD) is an unexpected death due to cardiac causes occurring in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease in whom no previously diagnosed fatal condition is apparent. Most cases of SCD are related to cardiac arrhythmias. Approximately half of all cardiac deaths can be classified as SCDs. SCD occurs as the first expression of cardiac disease in many individuals presenting as out-of-hospital patients with cardiac arrest. According to the American Heart Association, more than 680 people experience sudden death each day in the United States. That is over 350,000 each year.
Sudden cardiac death (SCD) continues to be challenging problem for several decades due to the high mortality rate (85 to 90%) observed in out of hospital arrests. Also more than 50% of SCD are due to the ventricular tachyarrhythmia without myocardial infarction (MI). Although more than 80% of SCD events occur in individuals with coronary artery disease (CAD), evidence of acute MI is far less common.
The Correct option is D
Ischemia refers to a lack of oxygen due to inadequate perfusion. Ischemic heart disease is a condition of diverse etiologies, all having in common an imbalance between oxygen supply and demand.
When all age groups are considered, ischemic heart disease is the most common cause of death not only in men but also in women. Approximately 25 percent of patients who survive acute myocardial infarction may not reach medical attention, and these patients carry the same adverse prognosis as those who present with the classic clinical syndrome. Sudden death may be unheralded and is a common presenting manifestation of ischemic heart disease. Patients can also present with cardiomegaly and heart failure secondary to ischemic damage of the left ventricular myocardium that caused no symptoms prior to the development of heart failure; this condition is referred to as ischemic cardiomyopathy. In contrast to the asymptomatic phase of ischemic heart disease, the symptomatic phase is characterized by chest discomfort due to either angina pectoris or acute myocardial infarction.
The Correct option is
BCharacteristics of Left-Sided Heart Failure - Hypertrophy and dilation (except in mitral valve or other obstructions)
- 2° atrial enlargement and fibrillation
- Pulmonary congestion and edema: respiratory problems (ie dyspnea, SOB); left side of heart backs up into the lungs
- ¯Renal perfusion --> renin-angiotensin-aldosterone activation & prerenal azotemia (abn inc in urea and nitrogenous substances in blood plasma)
Characterisitcs of Right-Sided Heart Failure All of the following will be due to left sided heart failure but will also be found in Right sided heart failure. The below are SYSTEMIC VENOUS CONGESTION:
- Congestive hepatomegaly: liver with NUTMEG APPEARANCE
- Renal congestion ---> fluid retention/edema
- Venous congestion & hypoxia of CNS
- Pleural & pericardial effusion and ascites
- Dependent (pedal & pretibial) edema and anasarca
The Correct option is
CSyphilitic (Luetic) aneurysms
Occurs exclusively in late tertiary syphilis. Almost always occur in the
thoracic aorta and aortic arch. When luetic aortitis involves the aortic valve ring, the ring dilates causing aortic valvular insufficiency. Since the organisms lodge in the vasa vasorum of the aorta, there is an obliterative endarteritis of these vessels rimmed by an infiltrate of lymphocytes and plasma cells. With the subsequent inflammation there is destruction of elastic fibers within the aortic wall and scar formation. As the scars contract, the aortic intima is retracted leading to wrinkling or the
"tree-barking" change of the intima.
Syphilitic aneurysms can attain immense size contributing to other clinical problems including
1. respiratory difficulty due to encroachment on lungs and airways
2. difficulty in swallowing due to compression of the esophagus
3. persistent cough due to irritation of or pressure on the recurrent laryngeal nerves
4. pain caused by erosion of bone, e.g. ribs and vertebral column.
The Correct option is
CPerhaps the most important study ever done to reveal the relation of the risk factors to diseases due to atherosclerosis is that of Framingham that started in the early 1950’s. This, and later other studies, clearly showed that the following major modifiable risk factors are causaly related to atherosclerosis and its clinical sequelae:
- Smoking
- High blood cholesterol
- Hypertension
- Diabetes mellitus
- Inactivity/obesity
In addition, there are also four unmodifiable risk factors for atherosclerosis, namely:
- Age
- Male sex (or postmenopausal status)
- Family history of vascular disease
- Personal history of symptomatic vascular disease is another major risk for repeat events.
The Correct option is
CUlcers are defects in the gastrointestinal mucosa that penetrate the muscularis mucosae.
- A common disease（10% individuals）
- The most common Peptic Ulcers: Duodenal Ulcer & Gastric Ulcer
- DU＞GU，about 3：1
Causes
- Helicobacter Pylori（Hp）
- Acid & Peptic
- Nonsteroidal anti-inflammatory drugs（NSAIDs）
- Genetic factors
- Abnormal motor function
- Stress and psychologic factors
- Others：smoking,food and drink,infection of virus.
The Correct option is C
Remember the ABCD of critical care. This patient has collapsed. Immediate priority would be to resuscitate the patient first while looking for the contributing cause.
The Correct option is
CA high proportion of patients with colon cancer have a Family History of the disease. A history of colon Ca in 1st degree relatives is an important predictor. Even many "sporadic" polyps and cancers may have a genetic basis.
Clinical manifestations:Rt colon: (occult)- Slow bleeding leading to anemia.
- Obstructions are infrequent.
- May some day find large mass.
Left colon:- Narrower diam —> obstruction w/abdominal pain/cramping,
- Hematochezia
- narrowing of stool caliber.
- Much more symptomatic.
- 3/4 of these cancers occur in the distal path.
The Correct option is C
Vitamin K metabolism in the bowel can decrease because you are destroying the normal flora in the GI tract that synthesize vitamin K when one of the antibiotics that interfere with the normal flora of the gut .
The Correct option is C
Vitamin E is a fat-soluble vitamin that is gaining considerable attention due to its antioxidant properties. The main role of Vitamin E in the body is to protect the cells from reactive oxygen species (ROS). Oxygen, when unpaired in the body, is unstable and damaging therefore known as ROS. Antioxidants are a safeguard by giving up hydrogen molecules to stabilize the free oxygen. This is a process that inactivates the oxygen molecule from causing serious damage. It is suggested that ROS contribute to the hardening and clogging of the heart artery walls by reacting with low-density lipoproteins (LDL). This clogging and hardening can lead to stroke, heart attack, kidney damage and even death.
The Correct option is
EToxicities associated with Vitamin C
- Linus Pauling recommended taking about 10g/day for the common cold (although it probably cut down the course from 7 days to 6.5 days. “Is that significant? Who knows. If it works for some people, great”.
- 10g/day though is a lot. You can get nausea and diarrhea with that amount of vitamin C.
- You can also get stones in the bladder.
- Vitamin C will also acidify urine and cause a sickle cell crisis
- Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency tend to show hemolysis with large dose of vitamin c. How does this happen?
- G6PD is needed to produce NADPH. NADPH then will reduce glutathione from GS-SG state to GSH, GSH. This reduced state of glutathione is necessary for the membrane integrity of RBC.
- Massive doses of vitamin C will induce a large amount of enzyme to chew up the vitamin. Then, if you go cold turkey and stop the vitamin C intake, now all of a sudden, you have this large quantity of enzymes that will chew up every last molecule of vitamin C, thus inducing scurvy.
The Correct option is B
For B12 deficiency, parenteral administration of B12 is usually recommended. The duration of treatment is not as standardized as in case of iron deficiency anemia. Six to eight weeks treatment is usually described as sufficient. Decrease in MCV, reticulocytosis, and improvement in platelet and neutrophil counts are observed within few days.
The Correct option is
CDiphyllobothrium Latum (“fish tapeworm”)
-most infections asymptomatic
-occasionally epigastric pain, abdominal cramping, n/v, and weight loss
-may have low serum levels of vitamin B12, presumably because of the competition between the host and the worm for dietary vitamin B12
-small percentage develop clinical signs of vitamin B12 deficiency (megaloblastic anemia, neurologic manifestations: numbness, paresthesia, loss of vibration sense)
The Correct option is E
Naloxone has been shown to reverse alcohol-induced respiratory depression and coma.
The Correct option is C
Vitamin B12 is stored in the Liver. Stores may last for up to 6 months.
The Correct option is A
Hydralazine: May decrease the effect of pyridoxine
Isoniazid: May decrease the effect of pyridoxine
Levodopa: Pyridoxine may decrease the effect of levodopa
The Correct option is C
Pellagra is caused by a deficiency of the B vitamin niacin in the diet. Niacin refers to both nicotinic acid and nicotinamide. Nicotinamide is a component of two coenzymes, nicotinamide-adenine dinucleotide (NAD) and nicotinamide-adenine trinucleotide (NADP). These coenzymes are involved in oxidation-reduction reactions and are essential for metabolic processes in each cell in the body. A deficiency in niacin decreases the cellular function throughout the body. One symptom of niacin deficiency is diarrhea, which is one of the four D’s of pellagra-diarrhea, dermatitis, dementia, and death.
The Correct option is B
FMN and FAD. Like NAD/NADP, these coenzymes are usually bound non-covalently by their enzymes. (Occasional exceptions do occur). FMN is flavin mononucleotide (= riboflavin phosphate) and FAD is flavin adenine dinucleotide. FAD is FMN linked via a phosphate to AMP.
Riboflavin functions as the precursor for flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD).
Riboflavin deficiency can develop in patients with sever liver disease, diabetes mellitus, and achlorhydria.
The Correct option is
CToxicity - Vitamin A -HA, dizziness, blurred vision, clumsiness, birth defects,
- Vitamin D-Constipation, weakness, anorexia, weight loss, confusion
- B3-Niacin-Flushing, redness of skin,
- B6-pyridoxine-Numbness, paresthesia, ataxia
- Vitamin C-kidney stones
- Folate-can mask B12 deficiency
The Correct option is A
The Cardiovascular manifestations of beriberi most commonly encountered are dyspnea and palpitation on exertion, tachycardia and edema. The heart is generally enlarged both to the right and to the left. Systolic murmurs are common. Basilar pulmonary rales are frequent.
The important points in establishing the diagnosis of cardiovascular disease dependent on deficiency of Vitamin B1 are, in addition to those points already presented, the presence of other manifestations of Vitamin B1 deficiency, such as polyneuritis, or of deficiencies of other portions of the B complex, such as glossitis and pellagrous skin changes. Indeed it is rare to observe ‘beriberi heart’ without at least minimal signs of polyneuritis; the history of dietary inadequacy or of conditioning factors which lead to Vitamin B1 deficiency in spite of an apparently normal diet; the disappearance of signs and symptoms following adequate B1 therapy.
The Correct option is A
H. pylori is accepted as an etiologic factor in duodenal ulcers, peptic ulcer disease, gastric carcinoma, and primary B-cell gastric lymphoma.
The Correct option is
BGastric carcinoma -accounts for over 90% of malignant tumors of the stomach
- geographic differences in the incidence- 10 times higher in Japan than in the U.S. for example- environmental factors play role
- precancerous lesions for gastric carcinoma include:
- chronic atrophic gastritis with dysplasia- its association with PA
- adenomatous polyps with dysplasia
- chronic peptic ulcers
Grossly:-
- early cancer- =gastric carcinoma restricted to the mucosa and submucosa
- recognized in Japan- diagnosis by endoscopic examination and biopsy
- advanced gastric cancer- =gastric carcinoma that invades the gastric wall-presents as- endoscopic gross morphology:
- fungating mass that protrudes into the lumen- polypoid
- as a malignant ulceration with raised edges
- as an ulcer resembling the peptic ulcer
- as a diffusely infiltrating lesion that causes diffuse thickening of the gastric wall
Microscopically:
- all gastric carcinomas are adenocarcinomas of varying degree of differentiation
- the most common -poorly differentiated so called diffuse carcinoma of signet-ring cell type
- well differentiated carcinoma resembling the tubular adenocarcinoma of the intestine is less common = intestinal type of gastric cancer
Spread:
- gastric carcinoma is locally aggressive- rapidly spreads through the whole wall of the stomach
- lymphatic spread- rapid,
- lymph node metastases -spread along the surfaces of the peritoneum
- bloodstream spread- to the liver and lungs
Prognosis: depends almost entirely on the depth of invasion of the tumor
- Early gastric cancer- 5-year survival rate of 85%
- Advanced cancer- only 30%
The Correct Option is D
It is important to make sure that the diarrhea is not inflammatory and is non- bloody and that there is a low suspicion for Salmonella gastroenteritis, C. difficile or enterohemorrhagic E. coli.
The Correct option is
E- Thiamin is used to help release energy from carbohydrates
- Major sources of thiamin include pork, products, whole grains, ready-to-eat breakfast cereals, enriched grains, green beans, milk, orange, juice, organ meats, peanuts, and dried beans, and seeds
- Thiamine is commonly known as the "nerve vitamin".
- Deficiency in thiamine causes beriberi, which is characterized by muscular weakness, swelling of the heart, and leg cramps and may, in severe cases, lead to heart failure and death.
The Correct option is
EVitamin A deficiency (VAD) causes ocular manifestations, ranging from night blindness to xerophthalmia, resulting in blindness in severe cases. Vitamin A deficiency causes impaired immunity and is responsible for increased overall childhood mortality especially due to various infectious diseases, of which measles, acute respiratory infections, and diarrhoea are the most important ones.
- Vitamin A is found in liver, fish , fish oils, fortified milk and yogurt and eggs
- Provitamin A carotenoids mentioned before are mainly found in dark green and yellow-orange vegetables and some fruits
- Carrots, spinach, and other greens, winter squash, sweet potatoes, broccoli, mangoes, cantaloupe, peaches and apricots are examples of such sources
The Correct option is E
Vitamin K deficiency leads to bleeding tendencies due to deficiency of Vit.K dependent clotting factors. Reproductive problems arise with deficiency of Vitamin E.
The Correct option is D
Both vitamin B12 and folate deficiency cause an identical megaloblastic anemia
The Correct option is B
Barbiturates (eg, phenobarbital), methotrexate, nitrofurantoin, phenytoin, primidone, or pyrimethamine decrease the effectiveness of folic acid, leading to folic acid defieciency and anemia.
