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Cardiology > Cardiac pathology > Flashcards

Cardiac pathology Flashcards

1
Q

Most probably cause of HTN: paroxysms of increased sympathetic tone -> anxiety, palpitations, diaphoresis

A

Pheochromocytoma

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2
Q

Most probably cause of HTN: age of onset between 20 and 50

A

Given no other info, the most common cause is essential HTN (primary HTN)

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3
Q

Most probably cause of HTN: elevated serum creatinine and abnormal urinalysis

A

renal disease or CKD

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4
Q

Most probably cause of HTN: Abdominal bruit

A

Renal artery stenosis

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5
Q

Most probably cause of HTN: blood pressure in arms greater than in the legs

A

Coarctation of the aorta (postductal, adult type)

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6
Q

Most probably cause of HTN: family history of HTN

A

More likely to cause primary (essential) HTN

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7
Q

Most probably cause of HTN: tachycardia, heat intolerance, diarrhea

A

Hyperthyroidism

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8
Q

Most probably cause of HTN: hyperkalemia

A

Renal failure, renal artery stenosis

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9
Q

Most probably cause of HTN: episodic sweating and tachycardia

A

Pheochromcytoma

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10
Q

Most probably cause of HTN: abrupt onset in a patient younger than 20 or older than 50 and depressed serum K+ levels

A

Hyperaldosteronemia

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11
Q

Most probably cause of HTN: central obesity, moon shaped face, hirsutism

A

Cushings syndrome

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12
Q

Most probably cause of HTN: normal urinalysis and normal serum K+ levels

A

Primary (essential) HTN

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13
Q

Most probably cause of HTN: young individual with acute onset tachycardia

A

Think stimulant abuse: cocaine or other stimulants (meth, amphetamines, etc)

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14
Q

Most probably cause of HTN: hypokalemia

A

Hyperaldosteronism

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15
Q

Most probably cause of HTN: proteinuria

A

Renal disease

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16
Q

Which antihypertensive drug has SE of first dose orthostatic hypotension?

A

Alpha 1 blockers (zosin drugs -> prozosin, terazosin)

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17
Q

Which antihypertensive drug has SE of ototoxicity (esp w/ aminoglycosides)?

A

Loop diuretics

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18
Q

Which antihypertensive drug has SE of hypertrichosis?

A

Minoxidil

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19
Q

Which antihypertensive drug has SE of cyanide toxicity

A

Nitroprusside

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20
Q

Which antihypertensive drug has SE of dry mouth, sedation, severe rebound HTN

A

Clonidine (3x per day drug and if you skip a dose you will get severe rebound HTN)

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21
Q

Which antihypertensive drug has SE of reflex tachycardia

A

Hydralazine, DHP CCB’s, Nitrates (nitroglycerine, isosorbide dinitrate) -> anything that vasodilates

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22
Q

Which antihypertensive drug has SE of bradycardia, impotence, asthma exacerbation

A

Beta blockers

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23
Q

Which antihypertensive drug has SE of cough

A

ACE inhibitors (ACE also breaks down bradykinin normally, excess bradykinin with ACE I’s can cause cough)

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24
Q

Which antihypertensive drug needs to be avoided in patients with a sulfa allergy?

A

Loops, Thiazides

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25
Q

Which antihypertensive drug has SE of angioedema

A

ACE I’s (bradykinin in excess increases vascular permeability) -> swelling from lips to larynx -> life threatening

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26
Q

Which antihypertensive drug has SE of drug induced lupus

A

Hydralazine (SHIPP)

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27
Q

Which antihypertensive drug has SE of hypercalcemia and hypokalemia

A

Thiazides (Loops lose calcium, thiazides dont -> thiazides will cause hypercalcemia). Both thiazides and loops cause hypokalemia

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28
Q

Which antihypertensive drug has SE of hyperkalemia

A

ACE I’s and ARBs, potassium sparing diuretics

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29
Q

Which antihypertensives are safe to use in pregnancy?

A 
A Hy woman took a kNIFE into a METH LAB
Hydralazine
Nifedipine
alpha Methlydopa
Labetalol
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30
Q

**While on an ACE I a patient develops a cough. What is a good replacement drug and why doesnt it have the same effects

A

ARB (losartan, valsartan). No cough because it is inhibiting angiotensin at the receptor level. Does not inhibit ACE and therefore there are no increased levels of bradykinin which cause the cough.

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31
Q

Which lipid lowering agent matches the following description? SE: flushing

A

Niacin

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32
Q

Which lipid lowering agent matches the following description? SE: elevated LFTs, mysoitis

A

Statins, Fibrates

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33
Q

Which lipid lowering agent matches the following description? SE: GI discomfort, bad taste

A

Bile acid binding resins (Cholestyramine, Colestipol, colesevelam)

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34
Q

Which lipid lowering agent matches the following description? Best effect on HDL

A

Niacin (Vit B3)

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35
Q

Which lipid lowering agent matches the following description? best effect on triglycerides/ VLDL

A

Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate). Second best is omega 3 fatty acids.

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36
Q

Which lipid lowering agent matches the following description? best effects on LDL/ cholesterol

A

Statins

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37
Q

Which lipid lowering agent matches the following description? Binds C. diff toxin

A

Cholestyramine

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38
Q

A 50 year old man starts on lipid lowering medication. Upon his first dose, he develops a rash, pruritis, and diarrhea. What drug is he taking?

A

Niacin

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39
Q

How can the flushing reaction of niacin be prevented?

A

Aspirin. Decreases with long term place. Take it before bedtime.

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40
Q

What is the mechanism of action of the cardiac glycoside?

A

Inhibit the Na+/K+ ATPase -> decrease sodium gradient for Na+/Ca++ transporter -> increase Ca++ in the cell. Inotropy

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41
Q

** An abdominal aortic aneurysm (AAA) is most likely a consequence of what process?

A

Atherosclerosis. (Thoracic aortic aneurysm and aortic dissection tend to be caused by HTN and cystic medial necrosis of marfans)

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42
Q

What are the 5 deadly causes of acute chest pain?

A

Aortic dissection, MI, unstable angina, PE, Tension pneumothorax

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43
Q

A patient with poorly managed HTN has acute, sharp substernal pain that radiates to the back and progresses over a few hours. Death occurs in a few hours. Diagnosis?

A

Aortic dissection

44
Q

Chest pain with ST segment elevation only during brief episodes of chest pain. What is the most likely cause of the chest pain?

A

Prinzmetal angina

45
Q

Patient is able to point to localize the chest pain using one finger. What is the most likely cause of the chest pain?

A

Musculoskeletal

46
Q

Chest wall tenderness on palpation. What is the most likely cause of the chest pain?

A

Musculoskeletal

47
Q

Rapid onset sharp chest pain that radiates to the scapula. What is the most likely cause of the chest pain?

A

Aortic dissection

48
Q

Rapid onset sharp chest pain in a 20 year old a/w dyspnea. What is the most likely cause of the chest pain?

A

Spontaneous pneumothorax (lung collapses). Doesnt progress/ get worse and build up all that tension like in a tension pneumothorax.

49
Q

Occurs after heavy meals and improved by antacids. What is the most likely cause of the chest pain?

A

GERD.

Can also be esophageal spasm. Feels very much like myocardial pain. Not always associated with meals. Can also be relieved by nitroglycerin b/c relaxes smooth muscle (part of the esophagus). Never use pain relief with nitroglycerin as a diagnostic tool for cardiac pain. Tricky to diagnose.

50
Q

Sharp pain lasting hours-days and is somewhat relieved by sitting forward. What is the most likely cause of the chest pain?

A

Pericarditis

51
Q

Pain is made worse by deep breathing and/ or motion. What is the most likely cause of the chest pain?

A

Musculoskeletal

52
Q

Chest pain in a dermatomal distribution. What is the most likely cause of the chest pain?

A

Shingles (VZV). Can can be a prodrome.

53
Q

Most common cause of noncardiac chest pain.

A

GERD. But, esophageal spasm and musculoskeletal pain is also very common.

54
Q

Acute onset dyspnea, tachycardia, and confusion in a hospitalized patient. What is the most likely cause of the chest pain?

A

PE (this is the classic triad for PE in hospitalized patients -> must rule out PE)

55
Q

Pain began the day following an intensive new exercise program. What is the most likely cause of the chest pain?

A

Musculoskeletal

56
Q

During a high school football game, a young athlete collapses and dies immediately. What type of cardiac disease did he have?

A

Hypertrophic cardiomyopathy

57
Q

What heart sounds are considered benign when there is no evidence of disease?

A

Split S1, Split S2 on inspiration, S3 heart sound in a patient younger than 40, early quiet systolic murmur

58
Q

What defect is associated with the following type of murmur? Crescendo decrescendo systolic mumur best heard in the 2nd-3rd right interspace close to the sternum

A

Aortic stenosis

59
Q

What defect is associated with the following type of murmur? Early diastolic decrescendo murmur heard best along the left side of the sternum

A

Pulmonic regurgitation

60
Q

What defect is associated with the following type of murmur? Late diastolic decrescendo murmur heard best along the left side of the sternum

A

Tricuspid stenosis

61
Q

What defect is associated with the following type of murmur? Pansystolic (aka holosystolic or uniform) murmur best heard at the apex and often radiates to the left axilla.

A

Mitral regurgitation

62
Q

What defect is associated with the following type of murmur? Late systolic murmur usually preceded by a mid systolic click.

A

Mitral valve prolapse

63
Q

What defect is associated with the following type of murmur? Crescendo-decrescendo systolic murmur best heard in the 2nd and 3rd left interspaces close to the sternum

A

Pulmonic stenosis

64
Q

What defect is associated with the following type of murmur? Pansystolic (aka holosystolic or uniform) murmur best heard along the left lower sternal border and generally radiates to the right lower sternal border

A

Tricuspid regurgitation or VSD

65
Q

What defect is associated with the following type of murmur? Rumbling late diastolic murmur with an opening snap

A

Mitral stenosis

66
Q

What defect is associated with the following type of murmur? Pansystolic (aka holosystolic or uniform) murmur best heard along at the 4th-6th left intercostal spaces

A

Tricuspid regurgitation or VSD

67
Q

What defect is associated with the following type of murmur? Continuous machine-like murmur (in systole and diastole)

A

PDA

68
Q

High pitched diastolic murmur a/w a widened pulse pressure

A

Aortic regurgitation

69
Q

What are the most common causes of aortic stenosis?

A

Congenital bicuspid valve is very common (usually not clinically apparent until after age 40), senile or degenerative calcification is common (after age 60 typically), congenital unicuspid aortic valve is not common, chronic rheumatic heart disease can also cause aortic stenosis.

70
Q

**Know the classic descriptions of heart murmurs! Murmur heard best in left lateral decubitus position

A

Mitral regurgitation & Mitral stenosis are both best heard in the Mitral area (by the PMI) but will be heard even better when the patient is placed in the left lateral decubitus position.

Left S3 and S4 sounds will also be heard best in this position.

71
Q

An 80 year old man presents with a systolic crescendo-decrescendo murmur. What is the most likely cause?

A

Aortic stenosis from senile calcifications of the aortic valve (if this patient was a 50 year old man it would be more likely to be a congenital bicuspid aortic valve)

72
Q

What are the signs of right-sided heart failure? What are the signs of left sided heart failure?

A

Right -> increase JVP, liver congestion (nutmeg liver) -> hepatosplenomegaly, peripheral edema in the lower extremities

Left- dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, pulmonic congestion (w/ rales)

73
Q

What medications are used to treat chronic heart failure? What medications are used for acute heart failure?

A

CHF- Digoxin, beta blockers, ace inhibitors/ ARBs, diuretics

Acute exacerbation of CHF- stop the beta blocker + LMNOP
Loops
Morphine
Nitrates
O2
Positioning
Pressers
74
Q

**An IV drug user presents with chest pain, dyspnea, tachycardia, tachypnea. What is most likely the cause?

A

Bacterial endocarditis (may have also had heart murmur and fever associated). This could be a right sided endocarditis that sent emboli into the pulmonary arteries -> PE (lead to the pulmonary symptoms and reflex tach)

75
Q

A patient in a MVA presents with chest pain, dyspnea, tachycardia and tachypnea. What is the most likely cause?

A

Tension pneumothorax

76
Q

A post op patient presents with chest pain, dyspnea, tachycardia and tachypnea. What is the most likely cause?

A

PE

77
Q

A young girl with congenital valve disease is given penicillin prophylactically. In the ER, bacterial endocarditis is diagnosed. What is the next step in her management?

A

IV Vancomycin (drug of choice for empiric tx of bacterial endocarditis). When culture comes back, treat based on susceptibility.

78
Q

Under what circumstance might you see pulses paradoxus?

A

Cardiac tamponade&raquo_space; pericarditis, asthma, croup, OSA, severe COPD

79
Q

Which heart pathology has diffuse myocardial inflammation with necrosis and mononuclear cells?

A

Myocarditis

80
Q

Which heart pathology has focal myocardial inflammation with multinucleate giant cells?

A

Aschoff bodies = pathognomonic for rheumatic heart disease

81
Q

Which heart pathology has fever + IVDA + new heart murmur?

A

Bacterial endocarditis (now tricuspid is added to mitral and aortic as being a possible valve involved. Staph aureus, Pseudomonas, and Candida are also more likely causes).

82
Q

Which heart pathology has chest pain and course rubbing heart sounds in a pt with Cr of 5.0?

A

Uremic pericarditis

83
Q

Which heart pathology has tree-barking of the aorta

A

Syphilitic (tertiary) heart disease

84
Q

Which heart pathology has child with fever, joint pain, cutaneous nodules 4 weeks after a throat infection?

A

Rheumatic fever

85
Q

Which heart pathology has ST elevations in all EKG leads?

A

Pericarditis

86
Q

Which heart pathology has disordered growth of myocytes?

A

Hypertrophic cardiomyopathy

87
Q

Which heart pathology has an EKG that shows electrical alternans?

A

Cardiac tamponade

88
Q

Which vasculitis? weak pulses in upper extremities

A

Takayasu’s arteritis

89
Q

Which vasculitis? Necrotizing granulomas of the lung and necrotizing glomerulonephritis

A

Wegener’s granulomatosis

90
Q

Which vasculitis? young male smokers

A

Buerger’s disease (thromboangitis obliterans)

91
Q

Which vasculitis? young Asian women

A

Takayasu’s arteritis

92
Q

Which vasculitis? asthmatics

A

Churg-Strauss syndrome

93
Q

Which vasculitis? infants and young children involving the coronary arteries

A

Kawaski disease

94
Q

Which vasculitis? most common vasculitis

A

Temporal (giant cell) arteritis

95
Q

Which vasculitis? a/w hepatitis B infection

A

Polyarteritis nodosa

96
Q

Which vasculitis? Occlusion of the ophthalmic artery can lead to blindness

A

Temporal (giant cell) arteritis

97
Q

Which vasculitis? Perforation of the nasal septum

A

Wegener’s granulomatosis

98
Q

Which vasculitis? unilateral headache, jaw claudication

A

Temporal (giant cell) arteritis

99
Q

Which vasculitis? necrotizing immune complex inflammation of visceral and renal vessels

A

Henoch-Schonlein purpura

100
Q

Which vascular tumor? Benign raised red lesion about the size of mole in older patients

A

Cherry hemangioma

101
Q

Which vascular tumor? Raised, red area present at birth, increases in size initially and then regresses over time

A

Strawberry hemangioma

102
Q

Which vascular tumor? lesioned cause by lymphoangiogenic growth factors in an infected HIV patient

A

Kaposi’s sarcoma

103
Q

Which vascular tumor? Polypoid red lesion found in pregnancy or after trauma

A

Pyogenic granuloma

104
Q

Which vascular tumor? Benign, painful, red-blue tumor under fingernails

A

Glomus tumor

105
Q

Which vascular tumor? cavernous lymphangioma a/w Turner’s syndrome

A

Cystic hygroma

106
Q

Which vascular tumor? skin papule in AIDS patients caused by Bartonella henselae

A

Bacillary angiomatosis

Cardiology (4 decks)

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