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NPLEX I > Anderson Cardio > Flashcards

Anderson Cardio Flashcards

1
Q

What is the most common cardiac congenital defect?

A

Interventricular Septal Defect

SSX: asymptomatic holosystolic murmur or CHF, increase risk of endocarditis

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2
Q

What four abnormalities form the Tetralogy of Fallot?

A

VSD, dextraposed aorta overriding the VSD, pulmonic stenosis, RV hypertrophy

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3
Q

What condition may a bicuspid aortic valve lead to later in life?

A

Aortic stenosis

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4
Q 
What's happening? 
S1
S2
Between S1 and S2
Between S2 and S1
A

Closure of mitral/tricuspid valves
Closures of aortic/pulmonic valves
Systole
Diastole

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5
Q

Right and left coronary arteries fill during _________. (diastole or systole)

A

Diastole - blood falls down into the vasculature.

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6
Q

Which is larger right or left coronary artery? What part of the heart do they feed?

A

Right is larger and supplies right and posterior left ventricle.

Left carries less blood , but divides and fess the anterior and lateral portions of the left ventricle.

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7
Q

Describe the conduction of the heart starting with the SA node and the location.

A

SA node - right atrium
AV node - right atrium
Right bundle of his - right ventricle (unifascicular)
Left bundle of his - left ventricle (bifascicular)

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8
Q 
Acute or Subacute Bacterial Endocarditis: 
More rare
Abnormal heart
Normal Heart 
Virulent organisms
Low virulence organism
A 
Acute
Subacute
Acute 
Acute
Subacute
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9
Q

What infection precedes rheumatic heart dz?

A

Grp A beta-hemolytic strep

AI, endocarditis esp of left valves, mitral stenosis, migratory polyarthritis

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10
Q

What histological finding is pathognomonic for rheumatic heart dz?

A

Aschoff bodies.

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11
Q

What is the MC valve disease?

A

Mitral Valve Prolapse

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12
Q

What condition is often the result of arteriosclerosis and a congenitally bicuspid aortic valve?

A

Aortic stenosis

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13
Q

What is the MC cause of myocarditis?

A

Viral infection (e.g. coxsackie B, flu, CMV, ECHO)

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14
Q 
List common organisms that cause myocarditis: 
Bacterial 
Rickettsial
Viral
Parasitic
Immune
A 
Staph, strep, cornebacterium diptheria
Typhus, Rocky Mt. Spotted Fever
Cocksackie B, Flu, CMV, ECHO
Toxoplasmosis, Trypansosoma cruzi, Trichinosis 
SLE, Scleroderma

Effects: Flabby ventricular myocardium, four chamber dilation, endocardium and valves unaffected, may be asymptomatic or get CHF.

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15
Q

What is the MC form of cardiomyopathies?

A

Dilated - young adults. Bilateral heart failure.

SSX: acute onset exertional intolerance (DOE)

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16
Q

What are the three forms of cardiomyopathy?

A

Dilated, restrictive, hypertrophic

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17
Q

Idiopathic Hypertrophic Subacute Stenosis (IHSS) pathology.

A

Interventricular septum is hypertrophies/anterior leaflet of mitral valve misplaced. Outflow is restricted. Wall of left ventricle hypertrophied.

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18
Q

What is restrictive cardiomyopathy usually secondary to?

A

Lysosomal storage disease or connective tissue/deposition disease. E.g. Hurler’s, Pompe’s, sarcoidosis, hemochromatosis.

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19
Q

Term for blood in the pericardial sac. Often occurs with MI where there is traumatic perforation.

A

Hemopericardium - causes cardiac tamponade

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20
Q

Where does METS to the heart mostly come from?

A

Lungs

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21
Q

Name the node:
Right vagus nerve
Left vagus nerve

A

SA

AV

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22
Q

Describe the process of muscle contraction.

A

Action potential - Ca influx - Ca binds Tp/Tm - actin/myosin binding - ATP to ADP - muscle contraction - relaxation - Ca returns to sarcoplasm via T-tubules

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23
Q

What two enzymes are responsible for phosphorylating actin/myosin?

A

Calmodium and light chain kinase

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24
Q

How do you modulate cardiac muscle strength?

A

Manipulating Ca channels - cAMP mechanism

Cardiac muscle does not recruit individual muscle units, syncytium - the whole thing contracts.

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25
Name the muscle type: (cardiac/smooth/skeletal) Recruitment of motor units/AP frequency regulates strength AP duration regulates strength Membrane potential/biochemical modulation of Ca sens regulates strength
Skeletal Cardiac Smooth
26
What is the longest vein in the body? Where does it come off of?
The great saphenous vein. | Come off femoral vein.
27
Arteriosclerosis vs. Atherosclerosis
Arteriosclerosis - thickening and loss of elasticity of arterial wall. Literal hardening of arteries Atherosclerosis - intimal thickening and lipid deposition
28
Name the pathology: vasculitis of small/medium cranial vessels especially the temporal artery. Genetic predisposition, HA, pain tenderness, facial pain. What is the most serious complication?
Temporal Arteritis Blindness
29
Name the pathology: MC in young men, heave smokers, nodular phlebitis, instep claudication, gangrene, inflammation of arteries of extremeties
Thromboangiitis Obliterans/Buerger's
30
Idiopathic vascular spasm causing extremities to turn white/blue/black.
Raynaud's dz
31
Emboli vs. Thrombi
``` Thrombi = clotted blood Emboli = anything in the blood that shouldn't be there ```
32
Name the pathology: HIV infected patient, purple/black papules that may scale, metastatic, and deadly
Kaposi's Sarcoma
33
Name the pathology: Children born with large hemangioma in place of an organ (eye/brain)
Lindau von Hipple
34
Where does the largest decrease in pressure occur in the vascular system?
Arterioles
35
T/F: Hypertension is most commonly symptomatic.
F
36
``` Essential or Secondary HTN: 95% of cases Lifestyle causes Renal disease ETOH abuse ```
Essential Essential Secondary Secondary
37
Right ventricular hypertrophy secondary to pulmonary HTN?
Cor pulmonale
38
What is the difference between serum and plasma?
Serum = plasma - clotting factors
39
``` Heme or Non-Heme iron: Requires transferrin Comes from meat AKA Rust Oxidizes without transferrin Unregulated uptake ```
``` Non-heme Heme Non-heme Non-heme Heme ```
40
Ferrous vs. Ferric
Ferrous 2+ | Ferric 3+
41
Free iron absorption is blocked by...
High plasma Fe, phytates, tannins, oxylates, phosphates.
42
Iron chelator that is released when infection is active to sequester Fe from bacteria.
Lactoferrin
43
What enzymatic process of forming the heme?
B6 + Succinate (succinyl-CoA) , Glycine (ALA synthase) ALA (ALA Dehydrogenase) Porphyrin (ferrochelatase - requires Ferrous 2+) *Ferric is converted to Ferrous via CYP 450* HEME
44
What enzyme puts Ferrous 2+ in the porphyrin molecule creating heme?
Ferrochelatase
45
What is methemoglobin?
Fe 3+ iron instead of Fe 2+ - binds much more strongly to O2
46
Once the iron and globulins are broken down, what is left over?
Biliverdin
47
Bilirubin is conjugated to "direct" bilirubin in what organ?
Liver
48
What inhibits the conjugation pathway?
Acetaminophen, hepatitis, toxic ingestion (mushrooms)
49
Where is biliverdin converted to "Indirect" or unconjugated bilirubin? What cofactor is required?
Reticulo-endothelial cells | NADPH
50
Name the pathology: overproducing a certain porphyrins and they are excreted in urine.
Porphyria
51
R vs. T Hemoglobin 4 open O2 sites No open O2 sites
R | T
52
What are the globulin subunits of adult hemoglobin?
2 alpha, 2 beta
53
Normal pH of the blood?
pH 7.37-7.4 Slightly more acidic in venous supply due to CO2
54
O2 saturation of arterial vs. venous blood.
Arterial 97% | Venous 70%
55
What stimulates oxygen release from hemoglobin?
Increased acidity, CO2, temp, 2,3 BPG | Increase salt-bridge formation.
56
What are the three forms of CO2 carried to lungs?
1) dissolved CO2 2) Carbaminohemoglobin 3) HCO3- hydrated CO2 90%!!!
57
What enzyme takes CO2 and H2O to become H2CO3, but can also reverse the reaction?
Carbonic anhydrase
58
Describe the Bohr Effect.
Makes CO2 into bicarb - in periphery Makes bicarb into CO@ - in lungs Equal and opposite.
59
What two enzymes does lead interfere with causing microcytic anemia?
ALA dehydrogenase, ferrochelatase.
60
Most common cause of hemolytic anemia?
G6P deficiency
61
Name the anemia: bite cell anemia/heinz bodies teardrop cells/basophilic stippling/target cells pancytopenia, failure of myeloid stem cells splenomegaly leg ulcers, strokes, claudication
``` G6P deficiency Thalassemia Anaplastic anema G6P deficiency Sickle cell ```
62
Name the pathology; myeloproliferative dz, high Hgb, viscous blood, tx is phlebotomy
Polycythemia vera
63
Thalassemia major vs. minor
Major inherit genes from both parents (alpha or beta) Inherit gene from one parent (alpha or beta) Alpha has 4 genes, Beta has 2 genes
64
What cancer of plasma cells causes Bence-Jones proteins in urine?
Multiple myeloma
65
Which leukemia is MC in children?
Acute Lymphoblastic Leukemia
66
Which leukemia is MC in adults? What is the histological finding?
Acute Myeloblastic Leukemia | Auer rods
67
What form of leukemia is associated with the Philadelphia chromosome? Which cell line is involved?
Chronic Myelogenous Leukemia | Can be any cell type
68
What is the MC overall Leukemia and MC after 60yo? Which cell line is involved?
Chronic Lymphocytic Leukemia | Well-differentiated B-Cell
69
What leukemia has B-cells with hair-like projections?
Hairy Cell Leukemia
70
Vitamin K dependent clotting factors?
2, 7, 9, and 10
71
Which pathway is measured by PTT? Which is measured by PT/INR?
Intrinsic | Extrinsic
72
What are the active substance causing positive feedback in the clotting cascade?
Thrombin
73
What doe Poiseuille's Equation give us?
Resistance
74
``` Name that clotting disorder: Facto VIII def, Factor IX def, male only Facto VIII activating protein deficiency, milder Vitamin deficiency for factors 2,7,9, 10 ```
Hemophilia A Hemophilia B Von Willebrand's Vit K def
75
What are three general causes of thrombocytopenia?
Increased destruction - e.g. AI Decreased production - e.g. congenital or acquired (i.e. drug) Increased consumption - e.g. DIC seen in sepsis or with embolism during childbirth
76
How does the body respond to hemorrhage (decrease arterial pressure)?
1) Baroreceptor reflex - Increase HR, contractility, vasoconstriction 2) Increase Renin - Increase Angiotensin II leading to increased aldosterone, Na+ reabsorption, increase blood volume 3) Hydrostatic pressure drops, increases fluid absorption, increase blood volume
77
T/F: Edema occurs when hydrostatic pressure exceeds oncotic pressure.
T
78
Transudate vs. Exudate
Trans - protein poor, found in edema secondary to the alteration of Starling's forces Ex - protein rich, found in acute inflammatory states
79
T/F: Interstitial edema = pitting edema
T
80
What is anasarca?
Generalized edema
81
What are the three stages of shock?
1) Nonprogressive stage - like hemorrhage 2) Progressive stage - hypoperfusion and metabolic acidosis 3) Irreversible shock - end organ damage and death
82
T/F: Lymphatics absorb the difference between hydrostatic and oncotic pressure in the arteries.
F, in the capillaries.
83
Name the lymphoma: B-cell lymphoma, associated with EBV/malaria infxn Young adults or 60yo, Reed-Sternberg cell Most common lymphoma, more deadl
Burkitt's - maxilla or mandible Hodgkin's - curable, familial Non-hodgkin's - assoc with Burkitt's and Immunoblastic lymphomas
84
What is the main point of the Frank Starling Law?
It established the physiologic limits of the heart in terms of blood volume. Changes in arterial pressure have little effect on the rate of pumping by the heart (WNL). Patient with heart failure have a narrowed limit.
85
T/F: Cardiac Output = Heart Rate x Stroke Volume
T
86
Causes of right sided CHF
Emphysema, mitral stenosis, left ventricular failure
87
Causes of left sided CHF
Ischemic heart dz, systemic hypertension, aortic or mitracl valve dz

NPLEX I (12 decks)

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