2nd BLOCK Flashcards
Class IV Antiarrhythmic • Verapamil • Lidocaine • Hydralazine • Dobutamine • Flecainide
Verapamil
A 59-year-old man with hypertension presents to his primary care physician with lower extremity edema.
Physical examination reveals pitting edema from the ankles to the knees bilaterally. The patient has begun on
furosemide. It is important for the physician to be aware of which of the following drug-to-drug interactions?
- Improves orthostatic hypotension
- Potentiates other antihypertensives
- Ototoxic when combined with thiazide diuretics
- Hyperkalemia with corticosteroids
Ototoxic when combined with thiazide diuretics
A man was knifed to the chest and is now in the ER presenting with the classic Beck’s triad. Which of the ff statements is true?
- This patient needs an emergency heart surgery
- The jugular veins are not prominent
- There will be sinus bradycardia
- The patient will have normal blood pressure
This patient needs an emergency heart surgery
Which of the following is an indication for surgical repair replacement of the mitral valve in a patient with mitral insufficiency?
- Abnormal exercise testing
- All of the above
- Recent onset of atrial fibrillation
- Any symptom, even if LV function is normal
All
A 20-year woman starts to develop subcutaneous nodules associated with erythema marginatum of the skin. She also begins to complain of pain in her knees and hips. The woman was hospitalized 3 weeks earlier due to a severe bout of acute tonsillopharyngitis. Which of the following serum laboratory findings is most characteristic of the disease?
- Elevated anti-streptolysin O
- Elevated C-reactive protein
- Positive RPR test
- Positive ANA test
Elevated anti-streptolysin O
Positive Inotropic Drug
- Dobutamine
- Hydralazine
- Flecainide
- Verapamil
- Lidocaine
Dobutamine
Which of the following pericardial diseases is likely to produce thick, pearly non-adherent epicardial plaque
more commonly referred to as “soldier’s plaque”?
• Caseous pericarditis
• Serous pericarditis
• none of the above
• Purulent pericarditis
• Chronic pericarditis
Chronic pericarditis
DESIRED VALUES: LDL Cholesterol
<100mg/dL
INTERPRET THE LEVELS OF LD: CSF in Hydrocephalus & seizures
LD2>LD1>LD3>LD4 >LD5
A patient was extracted at 6:00AM for Lipid Profile, with the following results: TAG = 200mg/dL
Total Cholesterol = 220mg/dL HDL cholesterol = 35mg/dL.
Analyze the patient’s LDL & VLDL, using Friedewald Equation:
145.0mg/dL LDL, 40.0mg/dL VLDL
General recommended age for surgical repair in patients with Aortic Coarctation
< 6 months
The most characteristic lesion seen in the heart of patients with acute rheumatic fever: [2 answers based on rc]
MacCallum plaques
Aschoff bodies
The following are considered cardinal anatomic changes seen in a heart affected with chronic rheumatic heart disease except:
- Well delineated valvular cusps and non-fusion of the commisures
- Thickening of the involved valve leaflets
- Shortening and fusion of the tendinous cords
- none of the above
- All of the above
All
Normal amount of fluid in pericardial sac
30-50 cc
When compared to percutaneous coronary intervention, coronary artery bypass
Provides a more complete relief of angina
The most common cyanotic heart anomaly
tetralogy of fallot
Not an acute adverse effect of organic nitrates:
- glaucoma
- tachycardia
- orthostatic hypotension
- throbbing headache
Glaucoma
What physical examination findings would be consistent with early signs of cardiac tamponade?
Muffled heart sounds
Which is the most appropriate statement regarding the difference between pericardial effusion and cardiac tamponade?
- Cardiac tamponade is a physiologic diagnosis with resultant hemodynamic consequences
- Pericardial effusion is a physiologic diagnosis with no hemodynamic consequences.
- Pericardial effusion is an anatomic diagnosis that has resultant hemodynamic consequences
- Cardiac tamponade is an anatomic diagnosis with no hemodynamic consequences
Pericardial effusion is an anatomic diagnosis that has resultant hemodynamic consequences
Stage B Heart Failure Therapy:
ACE inhibitors or ARBs in all patients; beta blocker in selected patients
The action potential in cardiac cells is divided into 5 phases, which include:
- Phase 0: a fast upstroke from the spontaneous increase in Na permeability
- Phase 1: partial repolarization from the activation of Na+ channels & leaking of K+
- Phase 2: plateau from the opening of calcium channels & outward leaking of K+
- Phase 3: spontaneous depolarization from gradual increase in Na permeability
- Phase 4: repolarization from opening of potassium channels
Phase 0: a fast upstroke from the spontaneous increase in sodium permeability
During the past 2 years, a 34-year old woman has had palpitations, fatigue and worsening chest pain. She was afebrile on physical examination. Her PR is 75/minute, RR of 15/ minute and BP of 110/70 mmHg. A midystolic click with late holosystolic murmur is noted on chest auscultation. The patient admitted to having one or two anxiety attach each month. Which of the following best explains the midsystolic click noted on auscultation?
- Incompetent valve
- Rupture of the tendinous cords
- Annular dilatation
- Snapping of the everted cusp
Annular dilatation
A 72-year old man who is very athletic and walks half marathons has been successfully treated for exercise-induced angina for several years. He recently has been complaining about being awakened at night with chest pain. Which of the following drugs would be useful in preventing this patient’s nocturnal angina?
- Nitroglycerin (transdermal)
- Esmolol
- Hydralazine
- Amyl nitrite
- Nitroglycerin (sublingual)
Nitroglycerin (transdermal)
A 54-year-old woman on antiarrhythmic drug therapy complained to her physician of palpitations, insomnia, diarrhea, and increased sweating for the past 3 weeks. Physical examination revealed a patient in moderate distress with mild hand tremors and exophthalmos. ECG showed atrial tachycardia. Which of the following drugs is she most likely taking?
- Amiodarone
- Propanolol
- Quinidine
- Digoxin
- Verapamil
Amiodarone
Which of the following is regarding the clinical manifestation of chronic pericardial effusion?
- Beck’s triad
- Hypertension
- Some patients maybe asymptomatic even on physical exertion
- Dyspnea and fatigue are common symptoms
Beck’s triad
A 45-year old female has had increasing fatigue, exertional dyspnea and episodes of mild chest pain for the past 7 months. On physical examination, she is afebrile. Her pulse is 79/ minute, respiratory rate of 15/minute and blood pressure if 120/70 mmHg. Her laboratory studies show normal levels of serum troponin I, glucose, creatinine and cholesterol. The patient was diagnosed of mediastinal malignancy 1 1/2 year prior to this admission. She received 7 cycles of radiation therapy, with the last treatment received 10 months prior to the current admission. Which of the following morphologic findings in the heart is most compatible with the condition?
- Asymmetric septal hypertrophy
- Bi-atrial dilatation and firm myocardium
- Four Chamber dilation and flabby myocardium
- Concentric hypertrophy
Bi-atrial dilatation and firm myocardium
Dronaderone:
An amiodarone derivative that does not have the iodine moieties that are responsible for thyroid dysfunction associated with amiodarone
REFERENCE VALUES: Lactate dehydrogenase (LDH)
80-280 U/L at 37 ⁰C
FREDRICKSON LIPOPROTEIN PHENOTYPING: Phenotypes - 111
Lipoprotein Elevation?
VLDL and CM
The drug of choice for torsades de pointes and digoxin-induced arrhythmias.
Magnesium sulfate
Electrical alternans is characterized by
Alternating low voltage and high voltage height of the QRS on the ECG tracing
Tamponade compresses the heart and the pressure increases the cardiac output.
False
A patient presents four weeks post myocardial infarction with fever, chest pain, dyspnea, palpitations,
lightheadedness, and confusion. The Cardiologist predicts the patient has Dressler’s Syndrome which is an
inflammatory condition of the pericardium. What will you most likely find on echocardiogram?
Pericardial effusion
A 20 year – old boy developed rapid onset of fever, with associated chills and malaise. Heart murmurs are
noted upon auscultation at the emergency room. He was immediately brought to the intensive care unit where
he expired after 4 days of confinement. The patient is a known Intravenous drug user. What clinical condition
did the patient likely succumbed to?
Acute infective endocarditis
Which medication should be administered to all patients with acute angina?
Nitroglycerin sublingual tablet
Which of the following statements is true regarding Atrial Septal Defect:
ASD result in an increase in pulmonary blood flow secondary to left to right shunting through the
defect
Class II antiarrhythmic drugs:
Inhibits phase 4 depolarization in SA and AV nodes
Class 1B Antiarrhythmic
Lidocaine
The closure of the ductus creates a fibrous cord called:
ligementum arteriosum
A pericardial effusion involves the presence of an abnormal amount or type of fluid within the pericardial space
True
FREDRICKSON LIPOPROTEIN PHENOTYPING: Phenotypes - 11a
Major Plasma Lipid Elevation?
Cholesterol
FREDRICKSON LIPOPROTEIN PHENOTYPING: Phenotypes - 11b
Lipoprotein Elevation?
LDL and VLDL
Centrally-acting sympathoplegic:
Clonidine
Cardiac tamponade is best defined as excessive fluid in the
Pericardium that leads to increased ventricular filling and decreased cardiac output.
The diagnostic procedure with the highest sensitivity of detecting a pericardial effusion or cardiac tamponade
is:
Two-dimensional echocardiogram.
