5/11 Cardio,Mixed Flashcards
Which organ is least vulnerable to arterial occlusion: (spleen, brain, kidney, liver or heart)
Liver because dual blood supply
Exception: liver transplantation because collateral blood supply is severed during transplantation
Opening snap of mitral stenosis
Occurs close to mitral valve opening
Risk of severe myopathy is increased when statins are given concurrently with
Fibrates (particularly gemfibrozil)
Impair the hepatic clearance of statins and lead to excessive blood levels
Increased risk with current use of niacin and exetimibe, but to a lesser extent
a-adrenergic agonists
Increase systolic and diastolic pressure by stimulating a-adrenreceptors in vascular walls, causing vasocontriction
Elevated systemic BP causes reflexive increase in vagal tone, resulting in decrease HR and slows AV node conduction
Nitrates SE
Headaches, cutaneous flushing, lightheadedness, hypotension, and reflex tachycardia (due to systemic vasodilation)
Number needed to treat (NNT)
Number of patients that need to be treated with a medication to avoid a negative outcome in one patient
1/ ARR = 1 / (control rate- treatment rate)
Lower NNT values represent more beneficial treatments
Most important steps for prevention of central venous catheter infections:
Proper hand hygiene
Full barrier precautions during insertion
Chlorhexidine skin disinfection
Avoidance of the femoral insertion site
Removal of the catheter when it is no longer needed
Wide, fixed splitting of the 2nd heart soudn
ASD
Can produce chronic pulmonary hypertension as a result of left to right intracardiac shunting
Closure of ASD may be required to prevent irreversible pulmonary vascular sclerosis and a permanent Eisenmenger syndrome
Cardiac tissue conduction velocity
AV node (slowest)
Ventricular muscle
Atrial muscle
Purkinje system (fastest)
Acquired QT prolongation
Electrolyte imbalances (hypokalemia, hypomagnesemia(
Class IA and III antiarrhythmics (quinidine, sotalol)
Antibiotics (macrolides, fluoroquinolones)
Methadone
Haloperidol
Dobutamine
B-adrenergic agonist with predominant activity on B1 receptors
Causes Gs protein GTP binding, activation of adenylyl cyclase and increased production of cAMP, leading to calcium channel activation (positive inotropic and chronotropic effect)
Rx of sustained arrhythmias post MI
Amiodarone
Lidocaine
Lidocaine
Class IB antiarrhythmic drugs
Binds to inactivated Na channels and rapidly dissociates
Effective in suppressing ventricular tachyarrhythmias induced by rapidly depolarizing and ischemic myocardium
Congenital aortic coarctation
Lower-extremity claudication
Blood pressure discrepancy between the upper and lower extremities
Delayed or diminished femoral pulses
Turner syndrome (45,XO) is associated with coarctation of the aorta in up to 10% of cases
Jervell and Lange-Nielsen syndrome
One of the most common congenital long-QT syndromes
AR
Accompanied by congenital neurosensory deafness
QT prolongation predisposes to syncopal episodes and possible sudden cardiac death due to torsades de pointes
Phospholipid content of amniotic fluid is determined in order to check for:
Fetal lung maturity
Phospholipids, including dipalmitoyl phosphatidylcholine (lecithin), are a major component of pulmonary surfactant
When the lecithin to sphingomyelin (L/S) ratio in amniotic fluid is >2, the fetal lung is considered mature (producing adequate surfactant)
Dx Treponema pallidum
Screening and confirmation serologic tests
Screening: RPR or VDRL (serum added to a mixture of cardiolipid, lecithin, and cholesterol)
Confirmatory: FTA-ABS (detects Abs against Treponema)
S1 radiculopathy
Sciatica, low back pain that radiates down the leg
Compression of lumbosacral nerve roots
Pain/sensory loss down the posterior thigh and calf to the lateral aspect of the foot
Weakness on thigh extension, knee flexion, foot plantarflexion, absent ankle jerk reflex
Tabes dorsalis
Increased incidence in HIV patients
HIV patients develop neurosyphilis more rapidly
Treponema pallidum spirochetes damage dorsal sensory roots > secondary degeneration of dorsal columns
Sensory ataxia, lancinating pains, argyll roberton pupils(accomodate but no rxn), positive Romberg sign, wide-based gait, loss of position and vibration sense
Tertiary neurosyphilis
Dopamine
Low doses stimulate D1 receptors in renal and mesenteric vasculature resulting in vasodilation and increase blood flow to these sites
Higher doses increase cardiac contractility by stimulation of beta-1 adrenergic receptors
Higher doses produce generalized vasoconstriction by an alpha-1 adrenergic effect
Patients experiences a major depressive episode should be carefully screened for
Past manic episodes to rule out bipolar disorder
Antidepressant monotherapy should be avoided in pateitns with bipolar disorder due to the risk of precipitating mania
Ecological study
Frequency of a given characteristic (e.g. Vit D intake) and a given outcome (MS) are studied using POPULATION data
Candida Albicans
True hyphae, “germ tubes” incubate at 37 C for 3 hours
Most common opportunistic mucosis
Frequent colonizer of human skin and mucous membrans
Normal inhabitant of the GI tract (including oral cavity) in up to 40% of the population
Common contaminant of sputum cultures
MOA of ANP, BNP, and NO
Active guanylyl cyclase and increase conversion of guanosine 5’-triphosphate to cyclic guanosine 3’-5’-monophosphate (cGMP)
Blood supply to the proximal ureter
Branches of the renal artery
Distal ureteral ischemia is a recognized complication of renal transplant and causes leakage of urine 5-10 days following transplant
Temporomandibular disorder (TMD)
Unilateral facial pain that worsens with jaw movement, headache, ear pain
Symptoms can originate from TMJ derangement, pathologic contraction of muscles of mastication or hypersensitivity of nerves that supply the jaw
Mandibular nerve (trigeminal nerve) supplies the middle ear and the muscles of mastication, can present with otologic symptoms and jaw pain
Minimal change disease
Most common cause of nephrotic syndrome in young children
Occurs after URI, immunization, insect bite
Edema, hyperlipidemia, hypoalbuminemia, proteinuria
EM shows diffuse podocyte effacement
Rx: reversible after corticosteroid therapy
Methtrexate as a drug of choice for non-surgical treatment of early, unruptured ectopic pregnancy
Competitively inhibits the enzyme dihydrofolate (DHF) reductase, which catalyzed the synthesis of tetrahydrofolate (an integral precursor of DNA synthesis)
DHF reductase inhibition causes the intermediate DHF (dihydrofolate polyglutamate) to accumulate intracellularly
What measure of central tendency is resistant to outliers?
THE MODE!!! (outliers are not likely to affect the most frequently observed value in a dataset!)
