Overall review 3
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| What is Rituximab? | Monoclonal antibody directed against the CD20 antigen
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| What is the CD to which Rituximab is directed against? | CD20
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| What common drug is used in non-Hodgkin lymphomas that has proven efficacy? | Rituximab
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| What substances' concentration increase as they travel along the proximal tubule? | Creatinine and Urea
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| Do the concentrations of bicarbonate, glucose, and amino acids, increase or decrease as they travel along the proximal tubule in the nephron? | Decrease
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| What are some common substances that decrease concentration as they travel along the proximal tubule of the nephron? | Bicarbonate, glucose, and amino acids
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| Which electrolytes have no change in concentration as they travel along the PCT of nephron? | Sodium and Potassium
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| Which substances are the ones with the lowest concentration as they travel along the PCT? | Glucose and amino acids
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| Does creatinine or urea has a higher concentration as the length of the PCT travel increases? | Creatine
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| Are most malignant pleural effusion exudative or transudative? | Exudative
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| What are some ways that exudative pleural effusions form in malignancies? | 1. Inflammation-induced increase in vascular permeability (leading to increase inflow),
2. Blockage of pleural fluid reabsorption by Parietal pleura lymphatics (leading to decreased outflow
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| What causes the increase inflow of fluid leading the exudative plural effusions in cancer patients? | Inflammation-induced increase in vascular permeability
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| What are some common cell adhesion molecules? | Fibronectin, collagen, and laminin
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| What is the process of adhesion of cells? | Cells adhere to extracellular matrix involves integrin-mediated binding to fibronectin, collagen, and laminin
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| What type of hormone is insulin? | Anabolic hormone that acts via receptor Tyrosine kinase to increase the synthesis of glycogen, proteins, fatty acids, and nucleic acids
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| What enzyme aids the functioning of insulin? | Receptor Tyrosine kinase
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| How is the rash of measles? | Maculopapular rash that starts on the face and spreads downwards
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| What is pathognomonic of Measles? | Koplik spots
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| How are the Koplik spots? | Tiny white or blue-gray lesions on the buccal mucosa
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| What disease is associated with Koplik spots? | Measles
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| What the most characteristic imaging finding of Toxoplasmosis? | Multiple ring-enhancing lesions in the brain
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| What are some clinical features of Toxoplasmosis? | Multiple ring enhancing lesions in brain imaging, seizures, and headaches
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| What are the penicillin-binding proteins to which Cephalosporins and penicillin bind to? | Transpeptidases
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| What are Transpeptidase? | Penicillin-binding proteins
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| What type of drugs use Transpeptidases in order to function? | Penicillins and Cephalosporins
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| What is a common way a Cephalosporin acquires antibiotic resistance? | A change in PBP structure that blocks the cephalosporin binding site
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| What type of antibodies are created by cold agglutinins? | IgM antibodies
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| What is common cause of CAP that result in cold agglutinins? | Mycoplasma pneumoniae
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| Cold agglutinins = | IgM antibodies
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| How do cold agglutinins work? | Bind to RBCs and cause clumping/agglutinations at low body temperatures
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| What are conditions leading to cold agglutin formation? | Mycoplasma pneumoniae infection, infectious mononucleosis and some hematologic malignancies
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| What type of virus causes Molluscum contagiosum? | Poxvirus
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| How is Mollluscum contagiousum presented? | Small, firm, round, papules that often have a central umbilication
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| Who are at greater risk for Molluscum contagiosum? | Immunocompromised (HIV) and sexually active
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| What are the histological findings of Molluscum contagiosum biopsy? | Intracytoplasmic Eosinophilic inclusion bodies of poxvirus in keratinocytes
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| What pathogens cause purely toxin-mediated watery diarrhea? | V. cholerae and Enterotoxigenic E. coli
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| What is the result of ETEC or V. choleare not causing cell death by toxins? | No erythrocytes and no leukocytes are noted on stool microscopy
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| What are the stool microscopic findings of dysentery? | - Fecal polymorphonuclear WBCs
- +/- RBCs
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| What pathogen causes Enteric fever? | Salmonella typhi
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| What are the classic stool microscopic findings of Enteric fever? | Fecal mononuclear WBCs
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| What is the MOA of Sulfonylureas? | Inhibit ATP-sensitive potassium channels on the pancreatic B-cell membrane, inducing depolarization and L-type Calcium channel opening
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| Which calcium channels are opened with Sulfonylureas? | L-type calcium channels
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| What is the result of increased calcium influx into Pancreatic B-cells by Sulfonylureas? | Increase insulin release independent of blood glucose concentrations
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| Is the release of insulin by Pancreatic B-cell by Sulfonylurea therapy, dependent or independent, of serum glucose concetration? | Independent from glucose concentration in blood
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| What is a possible dangerous adverse effect of Sulfonylureas? | Hypoglycemia
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| Why are sulfonylureas often causative of hypoglycemia? | They induce release of insulin by pancreas despite low serum glucose concentration
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| What is Gynecomastia? | Development of glandular breast tissue in males
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| Which SERM is known to reduce risk of gynecomastia? | Tamoxifen
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| Which type of male are at higher risk of developing gynecomastia? | Men receiving androgen deprivation therapy for prostate cancer
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| What is Phentermine? | Norepinephrine-releasing agent
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| Sympathomimetic weight loss drug indicated for short-term treatment of obesity | Phentermine
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| How does Phentermine work? | Stimulate and inhibit the reuptake of norepinephrine
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| What is COX-2? | Inducible enzyme upregulated during inflammation by IL-1 and TNF-alpha
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| Common selective COX-2 inhibitor | Celecoxib
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| How do Selective COX 2 inhibitors work? | Decrease inflammation by inhibiting COX-2 production of proinflammatory arachidonic acid metabolites
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| Why are COX-2 inhibitors often used in patients with PUD? | Since they do not affect COX-1, they have minimal gastroduodenal toxicity
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| Proinflammatory cytokines: | IL-1 and TNF-alpha
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| What is PD-L1 role in T-cell exhaustion? | PD-L1 binds to PD-1 on cytotoxic CD8+ T-cells, resulting in inhibiting their response
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| What is a common way that cancer cell may avoid immune recognition by T-cells? | Overexpressing PD-L1, leading to PD-1 binding to PD-L1, and inhibiting CD8+ activity
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| What Ligand is associated with CD8+ T-cell exhaustion, leading cancer cells to evade immune response? | Programmed Death-Ligand 1 (PD-L1)
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| What is Mycophenolate? | Immunosuppressive drug that inhibits inosine 5'-monophosphate dehydrogenase in the denovo purine synthesis pathway
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| Does Mycophenolate affect the de novo purine or pyrimidine synthesis pathway? | De novo Purine synthesis pathway
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| Which enzyme is inhibited by Mycophenolate? | Inosine 5'-monophosphate dehydrogenase
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| What common immunosuppressive drug is known to inhibit inosine 5'-monophosphate dehydrogenase | Mycophenolate
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| What is the reason the Mycophenolate is a distinctive immunosuppressive drug? | Specific suppression to lymphocyte proliferation, due to activated lymphocytes lack an established purine salvage pathway, that is present in other hematopoietic cell lines
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| What drug is used to treat Methanol or ethylene glycol intoxication? | Fomepizole
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| What is the MOA of Fomepizole? | Competitive inhibitor of alcohol dehydrogenase
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| A competitive inhibitor would (pharmacokinetic): | Increase Km without reducing Vmax
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| Is Km or Vmax increased with a competitive inhibitor? | Km
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| What is the change in Vmax with a competitive inhibitor? | None: Vmax is not altered
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| What is the expected shifting on the curve caused by an increase in Km? | Right shift of the curve
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| If the Km of a drug is increased, it is expected for the graphed curve to shift to the right or left? | Right
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| What type of metabolic acidosis is caused by Ethylene glycol and methanol? | Anion gap metabolic acidosis
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| What type of intoxication is known to result in anion gap metabolic acidosis and elevated osmolar gap? | Ethylene glycol and methanol
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| What does the use of Fomepizole help in methanol and ethylene glycol toxicity? | Reduces the rate of conversion of the alcohol into their toxic metabolites
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| If methanol and ethylene glycol are relative harmless in respect to toxicity, why then the use of fomepizole? | Both create highly toxic metabolites by enzymatic action of alcohol dehydrogenase and aldehyde dehydrogenase
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| What is a common anticancer drug associated with development of Dilated Cardiomyopathy? | Trastuzumab
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| What is Trastuzumab? | Monoclonal antibody that blocks HER-2 to disrupt malignant cell signaling and encourage apoptosis
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| What is an indirect role of HER-2? | Helps preserve cardiomyocyte function
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| How is DCM due to Trastuzumab presented? | Decrease in myocardial contractility without cardiomyocyte destruction or myocardial fibrosis
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| What is Tocolysis? | Inhibition of uterine contractions
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| What causes inhibition of uterine contractions? | B2-adrenergic receptor stimulation
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| What is the ocular (eye) effects of Alpha-1 receptor stimulation? | Contraction of the ocular pupillary dilator muscle, resulting in mydriasis (pupillary dilation)
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| What disease is due to antibodies against hemidesmosomes ? | Bullous pemphigoid
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| Where is the location at which hemidesmosomes are attacked by autoantibodies in Bullous pemphigoid? | Basement membrane of the Dermal-epidermal junction
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| What is the consequence of antibodies attacking hemidesmosomes in Bullous pemphigoid? | The entire epidermis separates from the dermis and form tense, subepidermal blisters
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| Suprasellar pituitary tumor | Craniopharyngioma
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| What is a Craniopharyngioma? | Suprasellar tumor found in children and composed of calcified cysts containing cholesterol crystals
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| What is the composition of a Craniopharyngioma? | Calcified cyst containing cholesterol crystals
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| A craniopharyngioma is a derivation of which embryonic tissue? | Remnants of Rathke's pouch
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| What is a common embryonic precursor of the anterior pituitary? | Rathke's pouch
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| What cranial tumor, especially pituitary tumor, is seen as a derivative of the remnants of the Rathke pouch? | Craniopharyngioma
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| What is the MCC of Subdural hematoma? | Rupture of Cortical bridging veins
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| How is a Subdural hematoma (SAH) often clinically presented? | Gradual onset of headache and confusion
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| If the patient presents with a gradual onset of headache and confusion, it is more likely to be an Epidural or Subdural hematoma? | Subdural hematoma
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| What is the classic shape of the Subdural hematoma in a CT? | Crescent-shaped mass (hemorrhage)
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| What is the MCC of an Epidural hematoma? | Rupture of the MMA (middle meningeal artery)
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| What is the CT classic finding of an epidural hematoma? | Biconvex hematoma
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| What are the key clinical features or symptoms presented by a patient with Epidural hematoma? | "lucid interval", followed by a loss of consciousness
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| What is Sarcoidosis? | CD4+ T cell mediated disease, in which large numbers of CD4+ lymphocytes release IFN-gamma and TNF-alpha to drive macrophage activation and granuloma formation
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| Is Sarcoidosis, CD4+ and CD8+, mediated disease? | CD4+ mediated
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| In Sarcoidosis, what cytokines are secreted by CD4+ T lymphocytes? | IFN-gamma and TNF-alpha
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| What are the findings in bronchoalveolar lavage fluid in pulmonary sarcoidosis? | Lymphocytic predominance with a HIGH CD4+/CD8+ ratio
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| What condition is associated with an high lymphocyte CD4+/CD8+ ratio? | Sarcoidosis
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| What are the features shared by all Primary Thrombotic Microangiopathy (TMA) syndromes? | Activation of platelet and diffuse microthrombosis in arterioles and capillaries
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| What are common clinical features of TMA syndromes? | Hemolytic anemia with schistocytes, thrombocytopenia, and organ injury (brain , kidneys, and heart)
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| What is Follicular Lymphoma? | The most common indolent non-Hodgkin lymphoma in adults
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| What are some Follicular lymphoma features and characteristics? | - B-cell origin
- Presents with painless waxing and waning (fluctuating) lymphadenopathy
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| What is the translocation associated with Follicular lymphoma? | t(14; 18)
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| What is the result of the t(14;18)? | Overexpression of the BCL-2 oncogene
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| What hematologic malignancy is associated with an overexpression of BCL-2 oncogene? | Follicular lymphoma
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| What promotes the formation of Uric acid kidney stones? | 1. Low urine pH (acidic urine)
2. GI bicarbonate loss due to chronic diarrhea
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| How does a low urine pH promote formation of uric acid stones? | Increased formation of insoluble uric acid over soluble urate ion
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| How does chronic diarrhea promote formation of uric acid stone? | It develops metabolic acidosis due to the loss of bicarbonate and prosecution of acidic urine
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| What is the neoplasm most strongly associated with Zollinger-Ellison syndrome? | Gastrinoma
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| Which ulcerative condition is strongly associated with Gastrinomas? | Zollinger-Ellison syndrome
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| Where are gastrinomas located? | Small intestine/ Pancreas
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| What are the clinical signs and symptoms caused by Gastrinomas? | Peptic ulcers (especially in distal doudenum), heartburn, and diarrhea
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| Where are ulcers of ZES most likely to develop? | Distal doudenum
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| What are some hormonal responses seen with ZES? | Elevated gastrin levels that rise in response to exogenous secretin administration
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| In normal gastric G cells, what is the function of Secretin? | Inhibits release of gastrin
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| Which cells normally secrete Gastrin in the stomach? | Gastric G cells
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| How is atopic dermatitis characterized? | Epidermal barrier dysfunction due to loss-of-function mutations in filaggrin, a key epidermal component
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| What protein is very likely to mutated in Atopic Dermatitis? | Filaggrin
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| What occurs in Atopic dermatitis in respect to pathogenesis? | Increased transepidermal water loss, skin permeability, and inflammation results in erythematous dry skin and pruritus
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| What is the term used to refer to the appearance of skin in atopic dermatitis in chronic disease aggravated by repeated scratching? | Lichenification
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| What is the result to a ventricular heart chamber undergoing eccentric ventricular hypertrophy? | Dilated cavity with relatively thin ventricular wall due to addition of myocardial contractile fibers in series
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| In a dilated ventricle due to eccentric hypertrophy, why are the ventricular wall relatively thin? | Due to myocardial contractile fibers added in series in response to volume overload
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| A heart problem, that leads to a volume overload problem, will present eccentric or concentric ventricular hypertrophy? | Eccentric ventricular hypertrophy
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| What is the result of chronic aortic regurgitation? | Aortic root dilation
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| What is the MCC of nephrotic syndrome in children? | Minimal change disease
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| What specific protein is loss in urine in a kid with MCD? | Albumin
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| What is the result of hypoalbuminemia in nephrotic syndromes? | Reduced plasma oncotic pressure, which causes a fluid shift into the interstitial spaces, leading to edema
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| A reduction of plasma oncotic pressure, leads to fluid to flow in or out the cell? | Out the cell and into the interstitial space
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| What is the result of increased fluid in the interstitial space? | Edema
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| What is the result of hypoalbuminemia, or low-oncotic pressure, on lipid synthesis? | Leads to increased production of lipoproteins in liver (hyperlipidemia)
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| In the process of Nephrotic syndrome, the decrease in Oncotic pressure has to results which are: | 1. Increased liver proteins in lipid synthesis ---> hyperlipidemia
2. Hypovolemia and increased ADH and aldosterone --> increased water retention and Na+ ----> edema
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| What are two important enzymes involved in DNA synthesis during the S-phase of the cell cycle? | Dihydrofolate reductase and,
DNA polymerase
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| What is the function of the active form of Rb protein? | Regulates cell cycle progression by preventing transition from the G1 phase to the S-phase
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| Is the Rb protein activated in phosphorylated or dephosphorylated form? | Dephosphorylation Rb protein - active
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| What does the phosphorylation of the Rb protein causes? | Inactivates the protein, allowing cells to progress thru the G1/S checkpoint and proliferate
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| Why is a mutated-phosphorylation of the Rb protein a cause of cancer? | It does not allow malignant cells to stay arrested in the G1/S checkpoint, and instead allows them to advance to S-phase and proliferate
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| What are some features or characteristics of REM sleep? | Dreaming and voluntary muscle paralysis, and most often in the final third of the night
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| In which third of the night, is a person most likely to be in REM sleep? | Final third
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| On which phase, of sleep are nightmares most commonly seen? | REM sleep
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| Does a nightmare or night-terror have no recollection of the dream? | Night terror
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| Which is a non-REM parasomnia, nightmare or night-terror? | Night terror
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| What are some characteristics of Night Terrors? | Incomplete arousals and lack of recall of dream content
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| If a kid wakes up in fear, and vividly explains the dream to the mother, is the kid referring to a nightmare or a night terror? | Nightmare
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| Husband wakes up wife in the middle of the night because she was clearly having a "bad dream". Upon waking he asks her about it, but she cannot remember anything. Nightmare or night terror? | Night terror
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| What are the auscultation findings of Mitral Stenosis? | 1. Loud S1
2. Early diastolic opening snap after S2
3. Low pitched diastolic rumble beast heard at the cardiac apex
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| Which cardiac murmur has a Opening snap immediately after S2? | Mitral stenosis
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| Auscultation reveals: Loud S1 + Opening snap + diastolic rumble best heart at cardiac apex. Dx? | Mitral stenosis
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| What causes the Opening snap in Mitral stenosis? | Sudden opening of the mitral valve leaflets, wh th Left-venctrilcelar pressure fall below the Left atrial pressure at the beginning of diastole
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| What is the term used for the sound made when the mitral valves open, as the LV pressure falls below the LA pressure? | Opening snap
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| In graphs depicting pressures of the Aorta, Left atrium, and Left ventricle, used in common heart murmurs, what is a good mnemonic to recall the order of valve opening and closing? | "coco"
Mitral closes, Aortic opens, Aortic closes, Mitral Opens
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| What is a major consequence of atrial remodeling? | Atrial fibrillation
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| Conditions such as HF, hypertension, and mitral valve disease often cause atrial structural changes, which may cause which abnormal heart rhythm? | Atrial fibrillation
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| On top of atrial remodeling or structural changes, what other factor may lead to propagation of AFIB? | Atrial conduction system changes
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| What hormone, secreted by the hypothalamus, regulates the release of TSH? | TRH
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| Is the release of TSH controlled by Thyroid hormone, under positive or negative feedback? | Negative feedback
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| A small change in Thyroid hormone levels, may represent a large change in: | TSH
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| What is the most sensitive test to diagnose primary hypothyroidism? | Serum TSH
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| Gilbert syndrome is a hereditary _____________________. | Hyperbilirubinemia
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| What type of hyperbilirubinemia is seen in Gilbert syndrome? | Indirect hyperbilirubinemia
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| What causes the indirect hyperbilirubinemia in Gilbert syndrome? | Decreased bilirubin conjugation
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| What is the clinical profile of a patient with Gilbert syndrome? | Recurrent, self-resolving episodes of scleral icterus and jaundice triggered by stress (illness, infection, trauma)
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| What are the ways Calcium efflux is mediated in cardiac cells? | 1. Na+/ Ca2+ exchange pump
2. Sarcoplasmic Ca2+- ATPase pump
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| Does calcium efflux from the cardiac cells promote relaxation or contraction? | Relaxation
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| IV fluids increase: | Intravascular and left ventricular end-diastolic volumes
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| What is the physical effect of increasing preload on the heart? | Stretches the myocardium and increases the end-diastolic sarcomere length, leading to an increase in stroke volume (SV), and cardiac output (CO) by the Franklin-Starling mechanism
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| What is the relationship between changes in preload and CO and SV? | An increase in preload will cause an increase in CO and SV
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| What is Colonic diverticulosis? | Multiple sac-like outpouching within the sigmoid colon
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| What are the MC complication of colonic diverticulosis? | Diverticular bleeding and diverticulitis
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| What some common risk factors contributing in development of diverticulosis? | 1. High red meat dietary intake and fat
2. Low fiber diet
3. Obesity and decreased physical activity
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| What cranial is affected resulting in hyperacusis? | Facial nerve
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| What is hyperacusis? | Increased sensitivity to sound
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| What is the complication of damage of CN VII close to origin from the brainstem? | Hyperacusis
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| What is angiogenesis? | Process in which new blood vessels are formed
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| In what phase of wound healing does angiogenesis takes place mostly? | Proliferation phase
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| What are some growth factors that stimulate Angiogenesis? | Fibroblast growth factor (FGF) and VEGF
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| What wound healing process is stimulated by FGF and VEGF? | Angiogenesis
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| What are physical complications of ALS? | 1. Respiratory failure dueto inspiratory muscle weakness (reduced vital capacity)
2. Expiratory muscle weakness (weak cough)
3 Bulbar dysfunction ( dysphagia, and chronic aspiration)
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| What dysfunction causes dysphagia and aspiration in ALS patients? | Bulbar dysfunction
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| What type of necrosis is seen in Aortic disserction? | Cystic medial degeneration
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| What is the classic histologic finding in aortic dissection? | Cystic medial degeneration
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| What occurs due to cystic medial degeneration in aortic dissection? | Collagen, elastin, and smooth muscle are replaced by basophilic mucoid extracellular matrix with elastic tissue fragmentation
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| What replaces the collagen, elastin, and smooth muscle of aorta in aortic dissection? | Basophilic mucoid extracellular matrix with elastic tissue fragmentation, and cystic collection mucopolysaccharide
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| What causes most commonly Spinal Cord compression? | Local extension of vertebral metastases into the epidural space
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| In order to produce Spinal Cord compression due to vertebral metastases, into which area is the malignancy spread? | Epidural space
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| What are the early and more common signs and symptoms of Spinal Cord compression? | Severe back pain worse at night, motor weakness, and/or sensory deficits
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| What are common risk factors associated with AAA? | 1. Age > 60
2. Smoking,
3. Hypertension
4. Male gender
5. Family hx
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| What changes in the vessel cause Abdominal Aortic aneurysm? | Chronic transmural inflammation and extracellular matrix degradation with the wall to the aorta
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| AAA is usually below with arterial bodies? | Renal arteries
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| What severe, and possibly fatal condition of the aorta is often found below the renal arteries? | Abdominal Aortic aneurysm
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| What is Rhabdomyolysis? | Release of intracellular muscle contents (myoglobin, electrolytes) due to myocyte injury
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| What are common causes of Rhabdomyolysis? | Crash injury, seizures, or drug use (statins)
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| What secretes Heme pigment? | Pigment released from myoglobin after degradation in the kidney
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| What condition can be caused by the release of heme pigment? | Toxic tubular cells and can cause acute tubular necrosis
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| What is a key vignette UA description of Myoglobinuria? | Positive blood on urine dipstick in the absence of RBCs on microscopic urinalysis
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| What are two main causes of Cushing syndrome? | 1. Pituitary adenoma
2. Ectopic (paraneoplastic) ACTH secretion
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| What condition is associated with elevated ACTH levels? | Cushing syndrome
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| The elevated secretion of ACTH in Cushing syndrome suggest which primary etiology if a high dose dexamethasone test suppresses ACTH secretion? | Pituitary adenoma
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| What etiology is suggested or most likely causative of Cushing syndrome, if a high dexamethasone test DOES NOT suppress ACTH secretion? | Ectopic ACTH secretion, most likely due to Small cell Lung cancer
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| Which lung malignancy is associated with developing Cushing syndrome, that does not suppress ACTH release with high DEXA test? | Small cell lung cancer
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| What is the pathogenesis of Cardiac tamponade? | Restriction of diastolic filling of the right-sided heart chambers, with engorgement and decrease with inspiratory collapse of the IVC
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| Which side heart chambers are seen affected by reduced diastolic filling in cardiac tamponade? | Right-sided heart chambers
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| What is an important feature involving blood pressure in Cardiac tamponade? | Pulsus paradoxus
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| What is 'pulsus paradoxus'? | > 10 mmHg drop in systolic BP during inspiration
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| Decrease in BP >10 mmHg during inspiration | Pulsus paradoxus
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| Which Starling force is mainly changed or modified in development of Transudative effusions? | Hydrostatic or oncotic pressures
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| What are the main conditions that lead to Transudative effusions development? | Heart failure (HF), cirrhosis, and nephrotic syndrome
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| What is the most common cause of Exudative effusions? | Inflammation and consequent increase vascular membrane permeability
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| What are conditions often associated with Exudative effusions? | Infection, malignancy, and rheumatic diseases
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| Transudative or Exudative effusion. High ratio of pleural fluid to serum total protein (>0.5) | Exudative effusion
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| Transudative or Exudative effusion. High ratio of pleural fluid to lactate dehydrogenase (>0.6) | Exudative effusion
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| Which type of effusion is expected to bee seen in a patient with high absolute levels o f lactate dehydrogenase? | Exudative effusion
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| A patient with an reduced ejection fraction, and dyspnea, is likely to to develop transudative or exudative pleural effusion? | Transudative effusion
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| AAT-1 deficiency patient with abnormal AST/ALT, will most likely develop transudative or exudative effusion? | Transudative effusion
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| Which levels are measured to definice either transudative or exudative effusion? | Serum total protein and Lactate Dehydrogenase in relation to pleural fluid level
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| How is VSD auscultation description? | Harsh, holosystolic murmur of the LLSB
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| What is the anatomical site best to auscult a VSD? | Lower Left Sternal Border (LLSB)
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| Which chamber of the heart is seen with an increased oxygen saturation in setting of VSD? | Right-ventricle
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| What producers the increase in oxygen saturation seen in the RV seen in VSD? | Left-to-Right shunt of oxygenated blood from the Left ventricle to the right ventricle
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