03b: Cardio 2

Question 1

Most common cause of non-bacterial endocarditis is (X). What’s another common cause?

Answer 1

X = malignancy (esp mucinous adenocarcinoma)

Chronic inflamm disorders (SLE/Libman-Sacks, DIC/sepsis)

Question 2

PCWP in hemorrhagic shock is (increased/decreased). CO is (increased/decreased).

Answer 2

(Preload) decreased and CO decreased

Question 3

Rx for hemorrhagic shock

Answer 3

IV fluids (to increase preload and SV)

Question 4

Rx for cardiogenic shock

Answer 4

Inotropes or diuretics (depending on cause/preload status)

Question 5

A Pulmonary Embolus can put patient into (X) shock.

Answer 5

X = cardiogenic

Question 6

Which pH abnormality is a characteristic finding of shock?

Answer 6

Metabolic acidosis (with elevated anion gap) due to lactic acidosis (from impaired organ perfusion and tissue oxygenation)

Question 7

Cold and clammy skin is a finding in which type(s) of shock?

Answer 7

Cardiogenic and hemorrhagic

Question 8

Give two examples of high-output shock.

Answer 8

Septic and anaphylactic (both forms of distributive shock) - patient will have warm peripheries with rapid, bounding pulses

Heart’s increase in CO is an attempt to compensate for very low SVR

Question 9

Rx for distributive (septic, anaphylactic, CNS injury) shock

Answer 9

IV fluids and pressors

Question 10

Pt presents with fever and heart murmur. Retina has round white spots surrounded by hemorrhage called (X) spots. He has small, red, tender raised lesions on his palm called (Y). Diagnosis?

Answer 10

Bacterial endocarditis

X = Roth
Y = Osler nodes

Question 11

Pt presents with fever and small hemorrhages under nails. You also notice Janeway lesions, which are:

Answer 11

Small, painless, erythematous lesions on palms/soles

Diagnosis: bacterial endocarditis (esp since splinter hemorrhages/fever also present)

Question 12

Aschoff bodies are associated with (X) disease and histologically appear as:

Answer 12

X = rheumatic fever

Granulomas with giant cells

Question 13

Anitschkow cells are (X) cells seen in which disease?

Answer 13

X = enlarged macrophages with ovoid, wavy, rod-like nucleus

Rheumatic heart disease

Question 14

Otherwise healthy 30 yo M presents with mild fever, recent onset chest pain, and diffuse ST elevations on EKG. Most likely diagnosis/etiology?

Answer 14

Pericarditis (viral; likely Coxackie)

Question 15

60 yo F smoker with Hx of hypertension, DM II, rheumatoid arthritis presents with recent onset chest pain and friction rub. Which factor in hx put her at greatest risk/caused the disease?

Answer 15

Rheumatoid arthritis (Dx: pericarditis)

Question 16

45 yo F lifetime non-smoker with Hx of breast cancer presents with chest pain that is relieved by sitting up and leaning forward. Diagnosis? What’s the likely etiology/risk factor that caused the condition?

Answer 16

Acute pericarditis

Likely radiation exposure from breast cancer

Question 17

Pt with low BP, high JVP, and muffled heart sounds. Diagnosis?

Answer 17

Cardiac tamponade (Beck’s triad)

Question 18

Cardiac tamponade: which chamber has the highest pressure in diastole?

Answer 18

None - all four chamber pressures equilibrate in this condition

Question 19

Explain mechanism of pulsus paradoxus

Answer 19

Decrease in SBP by over 10 mmHg with inspiration;

Fluid accumulation limits RV expansion so an increase in venous return w inspiration causes bowing of septum into LV and decrease in EDV/SV

Question 20

The basis of heart disease in (1/2/3)o syphilis is destruction of:

Answer 20

3o syphilis

Vasa vasorum of aorta (w consequent vessel wall atrophy/dilatation)

Question 21

T/F: Tertiary syphilis causes aortic stenosis.

Answer 21

False - Aortic regurg (dilatation of aorta and valve ring)

Question 22

Most common heart tumor

Answer 22

Metastasis (ex: melanoma)

Question 23

Most frequent 1o cardiac tumor in kids is (X) and associated with which disease?

Answer 23

X = rhabdomyoma

Tuberous sclerosis

Question 24

Kussmaul’s sign mechanism/explanation:

Answer 24

Increase (instead of normal decrease) in JVP with inspiration

Due to impaired filling of RV (blood backs up); may be due to constrictive pericarditis, R heart tumors, or restrictive heart diseases

Question 25

Most common cause of death in lightning strike patient

Answer 25

Resp arrest

Question 26

Immune system, especially (cellular/humoral) and (X) cytokine(s), is of primary importance in giant cell arteritis.

Answer 26

Cellular X = IL-6

Question 27

Best initial test for giant cell arteritis is:

Answer 27

ESR (will be elevated; highly sensitive)

Question 28

T/F: Treatment precedes biopsy in temporal arteritis.

Answer 28

True (high-dose corticosteroids to prevent blindness)

Question 29

List the large vessel vasculitides. Star the one(s) with granulomatous inflammation.

Answer 29

1. Giant cell arteritis* | 2. Takayasu arteritis*

Question 30

Medium vessel vasculitides:

Answer 30

"PeeKaBoo" 1. Polyarteritis nodosa 2. Kawasaki 3. Buerger disease (thromboangiitis obliterans)

Question 31

40 yo M with Hx of Hep B, fever, palpable purpura, and RBCs in urine. Most likely diagnosis?

Answer 31

Polyarteritis nodosa

Question 32

Polyarteritis nodosa typically involves (X) vessels, but not (Y) vessels.

Answer 32

``` X = renal and visceral Y = pulmonary ```

Question 33

Histopath of polyarteritis nodosa:

Answer 33

Transmural inflammation with fibrinoid necrosis

Question 34

Polyarteritis nodosa Rx:

Answer 34

Corticosteroids and cyclophosphamide

Question 35

Kawasaki disease Sx:

Answer 35

"CRASH and burn" 1. Conjunctival injection 2. Rash (desquamating) 3. Adenopathy (cervical) 4. Strawberry tongue 5. Hand-foot changes (erythema, edema) 6. fever

Question 36

Most common cause of MI in kids is:

Answer 36

Kawasaki (can cause coronary a aneurysm/thrombosis)

Question 37

Kawasaki Rx:

Answer 37

IVIG and aspirin

Question 38

Autoamputation of digits in heavy smokers. Diagnosis?

Answer 38

Buerger disease (thromboangiitis obliterans)

Question 39

Rx of Buerger disease

Answer 39

Smoking cessation

Question 40

Disease associated with PR3-ANCA aka (X) and (c/p)-ANCA positivity

Answer 40

X = anti-proteinase 3 cANCA Granulomatosis with polyangiitis (Wegener)

Question 41

Granulomatosis with polyangiitis (Wegener) triad: (X) in vessels, (Y) in lung, (Z) in kidney.

Answer 41

``` X = focal necrotizing vasculitis Y = necrotizing granulomas Z = necrotizing glomerulonephritis (crescentic, rapidly progressive) ```

Question 42

Disease associated with MPO-ANCA aka (X) and (c/p)-ANCA positivity

Answer 42

X = anti-myeloperoxidase pANCA 1. Microscopic polyangiitis 2. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

Question 43

T/F: Wegener and Microscopic polyangiitis share the same histopathology

Answer 43

False - no granulomas in Micro Poly

Question 44

Key clinical distinguisher between Wegener and Microscopic polyangiitis

Answer 44

Involvement of nasopharynx in Wegener

Question 45

T/F: Wegener and Microscopic polyangiitis share the same treatment method

Answer 45

True - cyclophosphamide and corticosteroids

Question 46

Most common vasculitis associated with antibiotic use

Answer 46

Microscopic polyangiitis

Question 47

7 yo F with recent cold presents with palpable purpura on buttocks/legs. What's at the top of differential? What other two signs would you look for in triad?

Answer 47

Henoch-Schölein Purpura Arthralgia and GI pain

Question 48

Henoch-Schölein Purpura: vasculitis is the result of (X) formation

Answer 48

X = immune complex (IgA and C3 deposition in vascular lesions)

Question 49

(X) calcium channel blocker can be used to prevent (Y) complication following subarachnoid hemorrhage

Answer 49

``` X = nimodipine Y = cerebral vasospasm ```

Question 50

(X) drugs can be used to decrease the edema that's a side effect of (dihydropyridine/non-dihydropyridine) CCBs.

Answer 50

X = RAAS inhibitors (cause post-cap venule dilation to counter pre-cap arteriolar dilation by CCBs) Dihydropyridines

Question 51

Hydralazine frequently administered with (X) to prevent reflex (Y)

Answer 51

``` X = BB Y = tachycardia ```

Question 52

Digoxin (increases/decreases) HR by which mechanism

Answer 52

Decreases | Stimulates vagus nerve (decrease conduction at AV node)

Question 53

First-line agent for acute ventricular arrhythmia post-MI was once (X) antiarrhythmic but has been replaced with (Y).

Answer 53

``` X = lidocaine (class 1B) Y = amiodarone (class 3) ```

Question 54

Adenosine is a (short/long)-acting drug used to terminate certain forms of supraventricular tachycardias. How does this drug work?

Answer 54

Very short (15s) Rapid efflux of K from cells, hyperpolarization and decrease in Ca current (thus decreasing AV node conduction)

Question 55

(X) drug selectively inhibits funny Na channels, thus (shortening/lengthening) phase (0/1/2/3/4) and having (pos/neg) (chronotropic/inotropic) effect.

Answer 55

X = Ivabradine ("Iva dining in her bra looks FUNNY") Lengthening phase 4; negative chronotropic (decrease HR) without affecting inotropy