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amboss > cardio 1 > Flashcards

cardio 1 Flashcards

1
Q

causes of viral myocarditis

A

parvovirus B19, HHV-6, HIV, and adenovirus.

picorna (coxsackie)

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2
Q

signs of MI but no cardio markers elevated

A

unstable angina

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3
Q

which beta blockers from the selective type has an effect on B2 rec too

A

labetolol

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4
Q

pulsus parodoxus

A

seen in cardiac tamponade or constrictive pericarditis

decrease in pressure on deep insp

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5
Q

pulsus parvus et tardus

A

aortic stenosis

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6
Q

he patient’s history of pharyngitis 2 weeks ago and the palpable non-blanching skin lesions with arthritis and abdominal pain are classic signs of

A

HSP

small cell vasculitis

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7
Q

blood brain barrier composed of

A

Composed of three layers: pedicles (foot processes of astrocytes), a basal membrane, and capillary endothelial cells bound by tight junctions.

damage to tight junctions can lead to edema

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8
Q

what is the function of PDGF in atherosclerosis

A

binds to tyrosine kinase receptors and stimulates the transition of cells from the G1 phase to the S phase. PDGF is released at atherosclerotic lesion sites by platelets and macrophages and stimulates proliferation and migration of smooth muscles cells in the tunica intima,

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9
Q

how is the thrombus formed after atheroma

A

matrix metalloproteinases is thought to be responsible for breaking down the fibrous cap of an atheroma. Matrix metalloproteinases, which are secreted by inflammatory cells in the atheroma (e.g., macrophages), weaken the fibrous cap by breaking down the extracellular matrix. Subsequently, minor stress can rupture the fibrous cap and expose the atheroma’s highly thrombogenic lipid core. It is this event that then causes the acute, total obstruction of the vessel and subsequent myocardial infarction.

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10
Q

bronchial artery originates

A

from internal thoracic arteries
branch of thoracic aorta
LEFT originates directly from thoracic aorta

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11
Q

what happens in ischemic muscle

dysfunction of sarcoplasmic ca channel

A

production of lactid acid due to anaerobic resp
inc in H+…. this gets throw out and Na+ is absp in
Na brings water along —– cell swelling

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12
Q

idarucizumab

A

dabigatran reversal
direct thrombin inhibitor
used fro —- venous thromboembolism and a fib

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13
Q

drug prescribed in anaphylactic shock

how does it affect the pacemaker action potential

A

catecholamines
increase Na and ca influx in PHASE 4
adenosine also works on PHASE 4 —- increases the K conductance —– decreases HR

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14
Q

what phase determines Heart rate

A

PHASE 4

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15
Q

Nonbacterial verrucous thrombi on the undersurface of the mitral valve are suggestive of

A

licman sack

SLE

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16
Q

subacute endocarditis

A

strept viridians
opt res, alpha hemolytic…

staph epidermis … venous catethers

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17
Q

infective endocarditis

A

most common staph aureus

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18
Q

damage to which artery in cervial esophagus dissection

A

The inferior thyroid artery originates from the thyrocervical trunk (left) or subclavian artery (right). It supplies the cervical portion of the esophagu

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19
Q

freidrich ataxia

A

deg of lateral corticospinal tract ( spastic paralysis)
deg of spinocerebellar tract ( ataxia)
dorsal columns (dec vib sense proprioception)
common cause of death —– HF
Autosomal recessive

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20
Q

fredreich ataxia gene

A

fraxatin ch 9

mitochondrial dysfunction

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21
Q

most common consequence of pt with right sided IE

A

pulomary embolism

Bacterial colonization of the heart valves can lead to the formation of thrombi and subsequent bacterial emboli.

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22
Q

he patient’s early-onset coronary heart disease and marfanoid habitus (tall and thin stature with increased arm span, arachnodactyly) in combination with a history of deep vein thromboses (DVTs) and learning disability raise concern

A

homocystinuria

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23
Q

Fever, pleuritic chest pain, pericardial friction rub (high-pitched scratching sound), and a pericardial and unilateral pleural effusion occurring 3 weeks after an MI

A

dressler

immune complex-mediated damage (type III hypersensitivity reaction) to the pericardium.

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24
Q

nitrate tolerance

A

Development of tolerance is a typical side-effect of chronic nitrate therapy. The mechanism underlying nitrate tolerance is not completely understood but is thought to involve decreased sensitivity of the vascular endothelium to nitrates. The most effective strategy to prevent this is intermittent therapy with nitrate-free intervals of at least 8 hours, which would be accomplished by avoiding isosorbide dinitrate at night.

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25
Q

free wall rupure after mi

A

within 2 weeks
can lead to cardiac tamponade
previous MI is protective

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26
Q

time line for ventricular anneurysm post MI

A

few weeks to months

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27
Q

interventricular septal rupture

A

due to macrophages

3-5 days

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28
Q

pt under treatment for afib and heart failure
attempts suicide
abd pain, hyperkalemia, blurry vision

A

digoxin toxicity
cholinergic = diarrhea vomiting nausea yellow vision
hyperkalemia

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29
Q

BBlockers overdose

A

verdose would likely cause hypotension, bradycardia, bronchospasm, and hypoglycemia

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30
Q

woman has a pruritic, red-brown rash over the medial ankles, varicose veins, and bilateral lower extremity edema. Her occupation likely requires her to stand for prolonged periods. These findings suggest

A

stasis dermatitis due to chronic venous insuff

Dermal deposition of hemosiderin is a key feature of stasis dermatitis.

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31
Q

differentiate ulcers caused bby PAD

A

they are well demarcated
painful
claudication, hair loss on the leg, or nail changes.

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32
Q

pt undergoes cardiac catheterization and 2 weeks later returns with low urinary output
high creatinine levels
mottle purple discoloration of feet and ischemic changes on big toe

A

cholestrol embolization syndrome
skin description is livedo reticularis due to vessel spasm
very high Cr due to AKI

txt stop anticoag therapy and begin statins

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33
Q

physiological effect of sotalol

A

BB with K channel blocking ability

decreased conduction through AV node

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34
Q

how do BB lead to decrease in AV node conduction

A

blocking b1 rec leads to DECREASED sympathetic tone —– decrease in HR
K+ blocking effect of sotalol …. increased myocyte AP duration due to delayed efflux of K+.—— increased ERP and prolonged QT

slow av cond is eveident by increase PR interval on ecg

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35
Q

prolonged repolarization caused in which classes of antiarrythmic drugs

A

2 and 4
2- BB
4- calcium cb
both act on pacemaker action potention

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36
Q

which class of antiarythmics works by decreased conduction in cardiac myocytes and purkinje fiber

A

Decreased conduction in cardiac myocytes and Purkinje fibers is the mechanism by which sodium channel blockers (class I antiarrhythmics) function.

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37
Q

mechanism of fibrates

A

increase LPL activity — breaks down TG
also INCREASE ppar ALPHA (not gamma) activity—- actually it is the activation of this that increases LPL activity

also increases HDL prodcution
leads to gall stone risk
Fibrates are associated with an increased risk of cholesterol gallstones because they inhibit the cytochrome p450 enzyme cholesterol 7-α hydroxylase (↑ cholesterol and ↓ bile acid concentration in bile).

38
Q

role of PPAR GAMMA

A

transcription factor that increases the sensitivity to insulin
GLITAZONES
side effects include = weight gain, edema, risk of fracture

39
Q

how does glucagon work in BB toxicity

A

Glucagon increases intracellular cAMP by activating adenylate cyclase, which improves cardiac contractility and heart rate while bypassing the beta receptors. It also improves hypoglycemia.

40
Q

similarities and diff between digoxin and BB toxicities

A

BOTH CAUSE HYPOTENSION AND BRADYCARDIA

bb- wheezes or brnochospasm , hypoglycemia

digoxin – abdominal problems, blurry vision yellow vision

41
Q

most common heart malformation in down syndrom

A

AVSD

atrioventricular septal defects

42
Q

Recurrent episodes of pain, swelling, and erythema in various locations in a patient with a history of pancreatic cancer are suggestive of

A

migratory thrombophlebitis

trosseau

43
Q

which vein courses medial to the medial condyle of the femur

A

Great saphenous vein

44
Q

most common vein involved in migratory thrombophlebitis

A

GSV saphenous
also popliteal vein can be involved but remember its location is in the popliteal fossa not medial to the medial femural condyle

45
Q

right broncial artery catheter route after entering the femoral artery

A

thoracic aorta—–right posterior intercostal artery —– right bronchial artery

46
Q

left bronchial arteries originate from

A

directly thoracic aorta

47
Q

internal thoracic artery

A

supplies the anterior post chest wall

originates from subclavian artery

48
Q

right bronchial arteries orginate from

A

interCOSTAL arteries whch are branches of the thoracic aorta

49
Q

abnormal placement of infundibular septum leads to whcih congenital heart disease

A

TOF

50
Q

absent fusion of septum primum and septum secundum

A

PFO

51
Q

Elevated pulmonary artery pressure in a 6 hours old new born raises suspicion for
what is the txt for this condition

A

PPHN persistent pulmonary HTN of newborn
inhaled NO, increases CGMP by ACTIVATING guanyl cyclase and causes vessel dialation without really affecting the systemic resistence

52
Q

after NO treatment in a baby with PPHN the baby develops tachypnea with blue grey discoloration of lips toes and nails
why is this>

A

NO treatment can cause oxidation of Fe 2+ to fe 3+ …. oxidized state of iron cannot carry o2
METHEMOGLOBIN basically
side effects of inhaled NO in neonates include platelet dysfunction, pulmonary edema, and the formation of peroxynitrites.

53
Q

inhibits mitochondrial cytochrome c oxidase

A

Cyanide poisoning
treated with METHEMOGLOBIN
iron in oxidized state can bind to cyanide and treat the condiiton

54
Q

african american with isolated HTN DOC

A

clorthiadone
thiazide
block nacl at DCT

55
Q

african pt HTN with metabolic syndrome

A

dihydropyridine CCB

56
Q

an artery that travels along the external branch of superior laryngeal nerve

A

superior thyroid artery which is a direct branch of the ECA

57
Q

indications for a high risk of DVT

A

recent surgery within 4 weeks
swelling of area
malignancy

58
Q

pt presents with DVT
lost 7 kg
smoked 1 pack for 25 yeasr
edema of forearm with overlying erythema and a tender cord like structure
duplex shows thrombosis of left basilic and external jugular veins
whats the diagnosis? how to confirm?

A

history of thrombosis and superficial migratory thrombophlebitis — migratory thrombophlebitis
raises suspicion for a hypercoagulable state

must do CT abdomen to confirm trosseau syndrome due to pancreatic cancer

59
Q

a drug that prevents voltage gate dependent calcium entry into myocytes used for trating A FIB can have a side effect like?

A

gingival hyperplasia
nondehydropryridine like verapamil —- rate control

  1. slow down AV conduction
  2. reduces ventricular rate
60
Q

tinnitus can be a SE of which antiarrythmic drug

A

quinidine I A

cinchonism prolong qt and hypoT

61
Q

old pt microscopin exam of heart shows brown perinuclear inclusions and isolated deposits of abnormally folded natriuretic peptide

A

most likely lipoduscin deposits that result from lysosomal oxidation

62
Q

what are the heart findings in advance age

A

sigmoid shaped intraventricular septum
increased myocyte size with reduced numbers
deposition of normal transthyretin protein in ventricles

63
Q

amyloid proteins appear

A

eosinophilic glassy homogenous deposits

64
Q

old woman collapses while walking briskly
grade 3 ejection systolic murmur
intensity decreases with hand grip mannv

A

think aortic stenosis

dystrophic calicfication of valve

65
Q

what is dystrophic calcification

A

localized calcification in abnormal /damaged tissue in patients with normal calium levels

66
Q

which murmurs increase with handgrip test

A

AR MR VSD

67
Q

granulomatous nodules on mitral valve are assoc with

A

RHD

68
Q

dabigatran mechanism and indications

A

direct thrombin inhibitor

prophylaxis of thromboembolism

69
Q

drug indicated in PAD that inhibits platelet aggreg and cuases vasodialation too

A

cilostazol

PDE 3 inhibitor— increases cAMP

70
Q

pt has 10 month history of crampy left lower extremity pain that is exacerbated while walking and releived by rest
smokes 1 pack for 40 yeasr
dry and hairless skin over left foot

A

PAD

intimal plaque in post tibial artery

71
Q

systemic hyperplastic arteriosclerosis

A

small vessel disease
in the setting of sever hypertension (180/120)
onion skin due to the intimal response

72
Q

a drug is prescribed to increase contractility
selectively inhibits an isoenzyme that is responsible for the degradation of cyclic adenosine monophosphate
what is this drug? and SE?

A

milrinone
PDE 3 inhibitor

inhibits myosin light chain kinase (cannot phosphorylate myosin) —– leads to muscle relaxation

so SE would be hypotension

73
Q

which condition with chorea (repetitive movemnts) and psychiaric complications leads to early dementia

A

huntington

74
Q

what are aschoff bodies composed of

A

necrotic debris, t cells, plasma cells, and cardiac histiocytes

75
Q

old pt dies and autopsy done ventricles are normal
microscopic image is shown
yellow brown perinuclear inclusions

A

normal aging

lipofuscin due to oxidation of phospholipid molecules

76
Q

deposition of wild type transthyretin is seen in?

A

senile amyloidis

PLUS CARDIOMEGALY AND VENTRICULAR THICKENING

77
Q

yellow brown perinuclear inclusions VS brown sarcoplasmic perinuclear granules

A

1 seen in normal aging due to oxidation of phospholipid molecules
2 seen in hemochromatosis

78
Q

aortic stenosis due to metastatic calcification can be caused due to which conditions

A

primary hyperthyroidism
sarcoidosis
multiple myeloma
CKD

79
Q

splenic infarcts causes include a fib and intravascular hemolysis how will you differentiate between both

A

so in intravascular hemolysis other signs like anemia, hyperbilirubinema and increase LDH can be seen also shcitocytes on smear

in a fib pt may have increase LDH but not other anemic symptoms

80
Q

formation of giant cells in the tunica media

A

giant cell arteritis

81
Q

what breaks down the fibrous cap of the atheroma

A

metalloproteinases secreted by inflammatory cells

82
Q

what is characteristic of Myxomatous degeneration of mitral valve in MVP

A

derman sulfate

deposition of glycosaminoglycans

83
Q

65 years old patient has wide pulse pressure and hypertension
165/79
what can be the cause

A

age>60 means decreased complianvce of arteries

ISOLATED SYSTOLIC HYPT

84
Q

the handgrip mnnvr increases murmurs of which heart defects

A

MR AR and VSD

85
Q

drugs that cause torsade pointes

A 
ABCDE
anti IA arrythmatics (quinidine procainamide dysopyradmide)
anti IIIA (sotalol ibutilide)
antibiotics
antipscycotics
antidepressant
antiemetics
86
Q

which anti III arythmatic does not lead to torsade pointes but still has long QT has a SE

A

amiodarone

87
Q

dyspnea with a high pitched blowing diastolic murmur at right upper sternal border suggests?

A

aortic regurgitation

88
Q

what conditon can aortic dissection lead to?

A

if the dissection reaches the aortic valve ring it can cause regurgitation

89
Q

dipyridamole

A

PDE3 inhibitor

causes coronary vasodialation via activation of A2A rec

90
Q

pt with chest pain is given dipyridamole/ regadenoson and then comes back with ST depression and twave depression
what is the underlying mechanism

A

coronary steal syndrome

coronary vasodialation causes blood to be shunted towards the healthier heart making the situation worse

91
Q

young female with BP of 185/125
papilledema and severe headaches
flank bruit

A

Fibromuscular dysplasia

DO CT or ultrasonography

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