2012 Module Exam Flashcards
Which drug causes leg edema? a- Centrally-acting drugs b- Spironolactone c- CCB d- B blockers e- ACEI f- ARBs g- Steroids
c- CCB
“Calcium channel blocker (CCB)‐related edema is quite common in clinical practice”
Infection 4 weeks after prosthetic aortic valve replacement?
Staphylococcus epidermidis
Which statement is correct about hypertension?
a- Treatment is indicated once the systolic pressure is above 160
b- Is the person start treating it, it will be well controlled
SBP > 160 indicates Grade II HTN, where lifestyle changes are initiated for several weeks, THEN BP drugs are added targeting <140/90
The patient has chest pain with ST elevation in the ECG in V3 to V6?
Anterior wall MI
V1-V2 are anteroseptal, V1-V4 are anterior (LAD), V4-V6 are anterolateral (LCX), which is in this case
what are the drugs that cause these side effects?
1- HTN:
2- Leg edema:
3- Cough:
Steroids
CCB
ACEI
Artery supplies SA node?
Nodal
Artery that arises from ascending aorta?
RCA
right and left coronary arteries
Mechanism of action of Aliskirin?
Renin inhibitor
What best describes the apex beat?
Most inferiolateral palpable area
What happens when the coronary perfusion pressure increases?
Arteriolar constriction
*Remember the myogenic mechanism to maintain blood flow (Q=dP/R so if P increases then R will increase by vasoconstriction to maintain Q)
CO is doubled, SVR is halved. What happens to MAP?
It remains the same
MAP=CO*SVR
What happens (to myocytes) when afterload increases?
Shortening of myocytes
*Afterload decreases the velocity of muscle fiber shortening with the same length of systole (in the first beat before interference of baroreceptors) longer myocytes at first beat
(The force of a muscle contraction declines with increasing velocity)
Type of endothelium in splenic sinus?
Discontinuous basal lamina
*Fenestrated capillaries are present in GIT mucosa, endocrine glands, renal glomerular and peritubular capillaries, choroid plexus and ciliary body. Sinusoids (aka discontinuous capillaries) are found in liver, spleen, and bone marrow
Histology of brachiocephalic?
Elastic lamella
All arrhythmia drugs share one thing, which is?
Decrease Phase 4
Which of the following does not increase JVP?
a. DVT
b. Cor pulmonale
c. Left side HF
c. Left side HF
* DVT could lead to pulmonary embolism→hypoxic pulmonary vasoconstriction→cor pulmonale. However, only large emboli (very rare, 5%) can cause acute right-sided HF not the small emboli (80%). Although the most common cause of right-sided HF is left- sided HF, but ISOLATED left-sided HF is well known NOT to raise JVP.
What does macrophage apoptosis indicate?
Reduce cellularity in advanced lesions
*In early lesions, M1 macrophage apoptosis is anti-atherogenic because they will be cleared by efferocytes and hence reducing cellularity. In advanced lesions, apoptosis is due to other factors like free cholesterol loading where the defective efferocytosis will lead to secondary necrosis
A palpable pulsating mass in a wall of a vessel that is subjected to rupture, thrombosis, or embolism?
Aortic aneurysm
What is the pharmacological effect of prolonged use of chlorohydrothiazide in reducing BP?
a- Decreases production of angiotensin II
b- Decreases vascular resistance
c- Antagonism of angiotensin receptors
d- Increases vascular calcium
b- Decreases vascular resistance
Which patient will benefit from DC shock?
Ventricular fibrillation
Mechanism of action of Heparin?
Accelerated the action of antithrombin III
Atrial contraction on ECG?
P wave
Last addition of volume at end of diastole?
Atrial kick
459 heart disease cases were selected and matched with 459 individuals with no history of heart disease. Cases were asked about their family history. What is the measure of association between heart disease and family history?
Odds ratio
What best explains reduced cardiac output in mitral stenosis?
Reduced preload
If EDV=140, ESV=70, and afterload=80, what is SV?
70
What is the characteristic of ischemic chest pain?
On and off radiating to the left arm
EMQ question: there were wave forms of aortic stenosis and aortic insufficiency
?
Chronic severe mitral regurgitation? (heard as)
Pansystolic murmur heard on apex
*Pansystolic murmur of mitral regurgitation (e.g. in IE, acute RF, chronic RHD if fibrosis in chordae tendinae) is best heart on left axilla
Causative microorganism of IV drug addicts?
Candida
Which feature of the aorta is responsible for maintaining the arterial blood pressure?
Internal elastic lamina
What happens at the end of ventricular diastole?
Closure of mitral valve
*Atrial kick concludes phase I of cardiac cycle not the closure of AV valves, which occurs in phase II in response to an increase in intraventricular pressure after QRS initiation
What causes the 1st heart sound?
Mitral valve closure
What is the hyperdynamic abnormality in severe anemia in a 35 year old?
a- Decreased resistance
b- Faster velocity
a- Decreased resistance
Although an increased velocity may occur in anemia due to increased CO, i.e. v=CO/(πr2), the direct consequence of anemia is decreased viscosity which decreases resistance (R=8ηl/ πr4) in a young patient.
What is the hyperdynamic abnormality in thrombo-embolus in a 47 year old woman?
Decreased diastole (??)
A 45 year old patient presented with chest pain that radiates to his back. He died a few days later. On autopsy, there was blood in the thoracic cavity and pericardium?
Aortic dissection or cardiac tamponade
*Cardiac tamponade common cause is chest trauma. It may also be caused by myocardial rupture and rarely by aortic dissection
A 25 year old professional swimmer has been experiencing exertional dyspnea. He died suddenly and on autopsy showed enlarged heart with asymmetrical septal hypertrophy. Histology shows myocyte disarray. What is the underlying etiology?
Genetic mutation (it appears to be a case of HCM with is 100% genetic)
A 35 year old asymptomatic woman with mid systolic murmur found on routine checkup. Echocardiogram shows hoody appearance and involvement of mitral valve?
Myxomatous degeneration
Which of the following occurs during rapid ejection (phase III of cardiac cycle)? a- 1st heart sound b- T wave on ECG c- Mitral valve closure d- Decreased aortic blood flow e- Increased ventricular pressure
e- Increased ventricular pressure
