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Undeleted > Cardio > Flashcards

Cardio Flashcards

1
Q

Cause of patent truncus arteriosus

A

failure of neural crest cells to form aorticopulmonary septum

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2
Q

Improper separation of aorticopulmonary septum

A

transposition of the great vessels

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3
Q

Drug for closure of PDA

A

indomethacin

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4
Q

Drug to maintain ductus arteriosus

A

PGE1 and PGE2

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5
Q

Cause of hoarseness/dysphagia with heart pathology

A

dilated L atrium

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6
Q

Drug class to decrease preload on heart

A

nitroglycerin (venodilators)

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7
Q

Drug class to decrease afterload on heart

A

hydralazine (vasodilators)

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8
Q

S3 heart sound

A

rapid filling (mitral regurg)/tensing of chorade tendiae
early diastole
“Kentucky”

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9
Q

S4 heart sound

A

L atrium pushing against stiff LV wall
late diastole
“Tennessee”

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10
Q

Wide S2 splitting

A

delay of RV emtpying

RBBB/pulmonic stenosis

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11
Q

Fixed S2 splitting

A

seen in ASD

increased RA and RV volumes

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12
Q

Paradoxical splitting of S2

A

delayed LV emtpying
seen in aortic stenosis/LBBB
during expiration

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13
Q

Sound for mitral/tricuspid regurg

A

holosystolic blowing murmur

assc with rheumatic fever/endocarditis

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14
Q

Sound for Aortic stenosis

A

crescendo-descrescendo systolic following ejection click

radiates to carotids

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15
Q

Sound for VSD

A

holosystolic machine like murmur

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16
Q

Sound for MVP

A

late systolic descrendo murmur

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17
Q

Sound for aoritc regurg

A

high pitched blowing diastolic decrescendo murmur

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18
Q

Sound for mitral stenosis

A

delayed rumbling in late diastole

secondary to rheumatic fever

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19
Q

Sound for PDA

A

continuous machine like murmur

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20
Q

Phases of ventricular AP

A

0-Na+ upstroke
1-K+ open,Na+ close
2-Ca2+ influx/K+ efflux balance (plateau)
3-K+ massive efflux repolarizes
4-high K+ permeability (flat hyperpolarized stage)

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21
Q

Phases of pacemaker AP

A

0-Ca2+ upstroke (Na+ closed, slow conductivity)
2-no plateau
3-Ca2+ inactivated/K+ efflux repolarizes
4-slow depolarization from spontaneous Na+ channels (I funny channels)

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22
Q

Normal PR interval

A

less than 200ms

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23
Q

Normal AV node delay

A

100ms

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24
Q

EKG with only irregular narrow QRS complexes

A

Atrial fibrillation

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25
Q

EKG with back to back atrial waves with QRS complexes at regular intervals

A

Atrial flutter

sawtooth pattern

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26
Q

Progressively lengthening PR interval with a dropped QRS complex at the end

A

2nd degree heart block type I

Wenckebach

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27
Q

PR interval over 200ms in length

A

1st degree heart block

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28
Q

Dropped QRS complexes with no PR interval change

A

2nd degree heart block type II

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29
Q

Independent atrial and ventricular depolarizations

A

3rd degree heart block

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30
Q

V1-wide rSR’ complex

I/V6-slurred S wave

A

R bundle branch block

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31
Q

V1-negative deflection with notching

I/V6-rSR’ complex

A

L bundle branch block

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32
Q

V1/V2 (-) deflection
V5/V6 (+) deflection
added together over 35mm

A

L ventricular hypertrophy
must be over 40
see T wave discordance/asymmetric T wave

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33
Q

R axis deviation (I deflected downward)
R/S > 1 on V1
Deep S wave on V6

A

R ventricular hypertrophy

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34
Q

Role of atrial natiuretic peptide

A

decrease blood volume
vascular relaxation and decreased Na+ resorption
constrict afferent, dilate efferent renal arterioles

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35
Q

QT prolongation resulting in polymorphic V tach

A

Torsades de pointes

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36
Q

Bypass of AV node and bundle of His

A

Wolff-Parkinson-White syndrome
no Q wave
delta wave with no PR segment
atria fire directly to ventricles

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37
Q

Brain center for BP maintenance

A

solitary nucleus
aortic arch/CN X
carotid sinus/CN IX

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38
Q

HTN
bradycardia
respiratory depression

A

Cushing rxn

increased ICP causes ischemia, increasing BP, which in turn results in bradycardia

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39
Q

Chemoreceptors for BP

A

Carotid/aortic bodies measure decreased oxygen/increased CO2/decreased pH
Central measures pH and CO2

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40
Q

Hypoxia in the lungs impact

A

Causes vasoconstriction

other tissues vasodilate in response to decreased O2

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41
Q

Pulmonary vascular hypertrophy/PAH
cyanosis/clubbing late in disease
L to R shunts

A

Eisenmenger’s syndrome

increased pulmonary resistance causes shunt to switch to R to L shunt

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42
Q

VSD
RVH
overriding aorta
pulmonic valve stenosis

A

Tetralogy of Fallot
PROVe
early cyanosis
squatting improves cyanosis

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43
Q

Early death

failure of aorticopulmonary septum to spiral

A

D transposition of the great vessels

need shunt to live allowing mix of blood

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44
Q

Rib notching
HTN in upper extremities
weak lower extremity pulses

A

Coarctation of the aorta
adult type
past ligamentum arteriosum

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45
Q

Cyanosis in lower extremities

goes away with indomethacin

A

patent ductus arteriosus
stays open with PGE1/2
machine like murmur
L to R shunt/LVH

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46
Q

22q11 syndrome assc with heart

A

Truncus arteriosus

Tetralogy of Fallot

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47
Q

Diabetic mother assc with heart

A

Transposition of the great vessels

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48
Q

Down syndrome assc with heart

A

ASD
VSD
AV septal defect

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49
Q

Xanthomas in Achilles
corneal deposits
ischemia of small vessels

A

Hyperlipidemia

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50
Q

Radial/ulnar artery calcification

pipstem arteries

A

Moenckeberg arteriosclerosis
calicification of media
no flow obstruction

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51
Q

Hyaline deposition in small arteries

A

Hyaline Arteriolosclerosis assc with essential HTN or diabetes mellitus

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52
Q

Onion skinning of small vessels

A

Hyperplastic Arteriolosclerosis assc with malignant HTN

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53
Q

Plaques on intima of arteries

A

atherosclerosis

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54
Q

Process of atherosclerosis

A 
LDL accumulation
foam cell formation
fatty streaks/smooth m. cell migration
extracellular matrix deposition
plaques form
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55
Q

Male smoker age 55
HTN
pulsatile mass in abd

A

Abd aortic aneurysm

assc with atherosclerosis

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56
Q

Pt sexually active
hypotension in extremities
also has Marfan’s syndrome

A

Thoracic aortic aneurysm

assc with HTN/cystic medial necrosis (Marfan’s)/tertiary syphilis

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57
Q

Mediastinal widening
diminished heart sounds
tearing chest pain

A

Aortic dissection

assc with Marfan’s

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58
Q

4-12 hrs post MI

A

coagulative necrosis

wavy fibers

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59
Q

12-24 hrs post MI

A

contraction bands from reperfusion

neutrophil migration

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60
Q

24-72 hrs post MI

A

extensive coagulative necrosis
acute inflammation around infarct
risk of fibrinous pericarditis

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61
Q

3-14 days post MI

A

macrophage migration
granulationx tissue at infarct margins
risk of free wall rupture (due to macrophages)

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62
Q

2 weeks post MI

A

contracted scar

63
Q

Dx for reinfarct of an MI

A

CK-MB

rises and falls within 48 hours

64
Q

S3 heart sound
dilated heart on echo
alcoholic

A

Dilated cardiomyopathy
assc with EtOH/Beriberi/Coxsackie B/cocaine/Chaga’s disease/hemachromatosis
also can be X-linked (eccentric hypertrophy from sarcomeres added in series)

65
Q 
Normal heart size
S4 heart sound
systolic murmur
syncope
young athlete
A

Hypertrophic cardiomyopathy
outflow obstruction of mitral valve leaflet
Beta-myosin heavy chain mutation
sarcomeres added in parallel (haphazard myocytes)
assc with Friedriech’s ataxia

66
Q

Causes of restrictive cardiomyopathy

A 
amyloidosis (Congo red stain)
sarcoidosis
Loeffler's syndrome (eosinophilia/fibrosis)
hemachromatosis
results in loss of heart compliance
67
Q

Pt has systemic lupus

eosinphilic/granular verucae on heart valves

A

Libman Sacks endocarditis

vegetations on both sides of valves

68
Q

IV drug user
rapid onset
splinter hemorrhages
tricuspid valve stenosis

A

Acute Bacterial endocarditis (S. aureus)
lg vegetations on previously normal valves
assc with IV drug use
R sided heart valves

69
Q 
Vegetations on damaged heart valves
Roth spots (on retina)
Osler nodes (on fingers)
Janeway lesions (on palms)
A

Subacute bacterial endocarditis (viridans strep)

assc with dental procedures

70
Q

Assc of endocarditis with prosthetic valves

A

S. epidermidis

71
Q

Endocarditis with colon cancer pts

A

Strep bovis

72
Q

Baterial endocarditis sx (5)

A 
Roth spots (retina hemorrhage)
Olser's nodes (painful papules on fingers)
Janeway lesions (emboli to palms/soles)
Splinter hemorrhages of nails
emboli
73
Q

Mitral valve regurg
Granuloma with giant cells
activated histiocytes
increased ASO titer

A 
Rheumatic fever
beta-hemolytic strep post pharyngitis
mitral/aortic valves most affected
mitral regurg, then stenosis late
Aschoff bodies (giant cells)
Anitschkows cells (activated histiocytes)
type II HS rxn, anti-M protein
74
Q

Jones criteria

A 
For rheumatic fever
Joints-migratory arthralgia
Heart-myocarditis
Nodules sub q
Erythema marginatum
Sydenham's chorea
75
Q

Pericarditis causes

A

Fibrinous-uremia/radiation/friction rubs seen
Serous-viral/RA/lupus
Suppurative/purulent-pneumococcus/strep

76
Q

JVD
hypotension
systolic BP more than 10 mmHP greater on inspiration

A 
Cardiac tamponade
pulsus paradoxus (inspiration increased intrathoracic pressure, increasing BP)
77
Q

Tree bark aorta
calcification at aortic root
aortic insufficiency

A

Tertiary syphilis
disruption of vasa vasorum in aorta
an cause aneurysm

78
Q

L atrium obstruction
syncope
40 y/o male

A

Myxomas

ball valve obstruction in atria

79
Q

Spider cells
pt also has Tuberous sclerosis
4 year old male

A

Rhabdomyoma

80
Q

Increased JVD with inspiration

A

Kussmaul’s sign

from restrictive cardiac pathology

81
Q

Unilateral headaches on L
73 y/o female
Lost sight out of L eye

A

Temporal (giant cell) arteritis
ophthalmic artery occlusion
granulomatous inflammation
assc with polymyalgia rheumatica

82
Q

Asian 51 y/o female
weak upper extremity pulses
ocular problems
skin nodules

A

Takayasu’s arteritis
pulseless disease
granulomatous thickening of aortic arch/great vessels

83
Q 
23 y/o male
Pt has Hep B
cutaneous eruptions at different stages
HTN
renal damage
A

Polyarteritis nodosa
renal involvement, no pulmonary
immune complex mediated
Fibrinoid necrosis

84
Q 
2 y/o Asian male
recovering from Chicken pox
strawberry tongue
erythema of hands/feet
cervical lymphadenitis
A

Kawasaki disease
follows viral infection
can develop coronary aneurysms
MI/rupture

85
Q

Male smoker 52 y/o
intermittent claudication
autoamputation of 2 fingers
Raynaud’s phenomenon seen

A

Buerger’s disease (thromboangiitis obliterans)
segmental thrombosing vasculitis
autoamputation of digits
tx with smoking cessation

86
Q

Lung and kidney damage
palpable purpura
(+) for p-ANCA

A

Microscopic polyangiitis
necrotizing vasculitis
pauci-immune GN
no granulomas

87
Q

Chronic sinusitis/otitis media
hemoptysis
hematuria

A 
Wegener's granulomatosis
lung and kidney involvement
granulomas present
(+) c-ANCA
focal necrotizing vasculitis
88
Q 
Has allergies
sinusitis
palpable purpura
wrist drop
hematuria
eosinophilia of vesels
A 
Churg-Strauss syndrome
highly allergic people
(+) p-ANCA
peripheral neuropathy
pauci-immune GN
granulomatous
89
Q 
6 y/o recovering from strep throat
palpable purpura on buttocks
arthralgia
melena
GI lesions of same stage
A

Henoch-Schoenlein purpura
childhood systemic vasculitis
IgA complex deposition
assc with IgA nephropathy

90
Q

Female pt with 1 X chromosome
mass on the neck
3 y/o

A

Cystic hygroma
assc with Turner syndrome
cavernous lymphangiomas of neck

91
Q

AIDS pt
skin papules
pt owns a cat

A

Bacillary angiomatosis
benign capillary skin papules
Bartonella henselae infections
mistaken for Kaposi’s

92
Q

Pt has mastectomy for breast cancer 5 years ago

has chronic edema of R arm and R chest

A

Lymphangiosarcoma

assc with post radical mastectomy and persistent lymphedema

93
Q

Mouth/skin/GI/respiratory tract purple lesions

pt has AIDS

A

Kaposi’s sarcoma

assc with HHV-8 and HIV

94
Q

Nevus flammus on face
seizures at early age
glaucoma
6 y/o

A

Sturge-Weber disease
capillary sized blood vessels
ipsilateral leptomeningeal angiomatosis (AVM)

95
Q

Lesion under the finger nail
extremely painful
red/blue color

A

Glomus tumor
benign
modified smooth m. cells of glomus body

96
Q

HTN tx for diabetics

A

ACEI’s

nephroprotective

97
Q

Essential HTN tx

A

thiazides

98
Q

MOA of CCB’s

A

block L-type calcium channels

99
Q

Cardiac and peripheral CCB’s

A

Cardiac-verapamil/diltiazem

Peripheral-amlodipine/nifedipine

100
Q

Given with beta blockers to prevent reflex tachycardia

A

Hydralazine
peripheral (arterial) vasodilator
can cause lupus like syndrome

101
Q

Can cause CN toxicity

decreased preload

A

nitroprusside

releases NO, vasodilates via cGMP increase

102
Q

Drug for tx of HTN with renal insufficiency

A

Fenoldopam

D1 agonist that vasodilates renal and other arterioles

103
Q

Contraindicated Beta blockers in angina tx

A

Pindolo/acebutolol

they are partial beta agonists

104
Q

Impact of HMG-Coa reductase inhibitors

A

very lg decrease in LDL
decrease in TG
increase in HDL

105
Q

Impact of Niacin on cholesterol

A

lg decrease in LDL
lg increase in HDL
decrease in TG

106
Q

Impact of bile acid resins on cholesterol

A

lg decrease in LDL

slight increase in HDL and TG

107
Q

Impact of ezetimibe on cholesterol

A

lg decrease in LDL

blocks cholesterol absorption

108
Q

Impact of fibrates on cholesterol (gemifibrozil/fenofibrate)

A

very lg decrease in TG
decrease in LDL
increase in HDL

109
Q

Risk with use of statins

A

rhabdomyolysis

hepatotoxicity

110
Q

Risk with use of niacin

A

hyperuricemia

111
Q

Risk of bile acid resins/fibrates

A

cholesterol gallstones

112
Q

Role of ApoE

A

on IDL’s and chylomicrons

uptake of remnants by liver

113
Q

Role of ApoA1

A 
activates LCAT (free cholesterol to esterified)
on HDL
114
Q

Role of ApoCII

A 
LPL cofactor (frees FA's)
on chylomicron/VLDL/HDL
115
Q

Role of ApoB48

A

chylomicron secretion by GI tract

on chylomicrons

116
Q

Role of ApoB100

A

binds LDL receptor

on VLDL/IDL/LDL

117
Q

MOA of digoxin

A

inhibit Na+/K+ ATPase, increasing Ca2+ conc (via decreased secondary Ca2+/Na+ transport)
Also stimulates vagus n.

118
Q

Side effects of digoxin

A

blurry yellow vision
hyperkalemia
AV block

119
Q

Phosphodiesterase inhibitors for antiplatelet effects

A

Cilostazol

dipyridamole

120
Q

Thienopyridines and MOA

A

clopidogrel/prasugrel/ticlopidine

inhibit ADP platelet aggregation

121
Q

Risk with thienopyridines

A

thombotic thrombocytopenic purpura

122
Q

Tx of warfarin overdose

A

Vit K

fresh frozen plasma

123
Q

Tx for heparin overdose

A

protamine sulfate

124
Q

Side effects of class 1A antiarrhythmics

A

quinidine-cinchonism (tinnitus)
procainamide-lupus like syndrome
disopyramide- anticholinergic
all can cause Torsades de pointes

125
Q

Use of Class 1A antiarrhythmics

A

reentry tachycardias

increase effective refractory period/QT interval

126
Q

Use of Class 1B antiarrhythmics

A

acute ventricular arrhythmias and digitalis induced arrhythmias
decreased AP duration

127
Q

Use of Class 1C antiarrhythmics

A

V tach going to V fib/intractable SVT

no effect on AP duration/prolongs refractory period

128
Q

Class 1C antiarrhythmic drugs

A

flecainide/propafenone

propafenone does not cause Torsades

129
Q

Class 1B antiarrhythmics

A

lidocaine/mexiletine/tocainide/phenytoin

side effect of CNS depression

130
Q

Class II antiarrhythmics

A

beta blockers
decrease SA and AV nodal activity (via cAMP decrease)
increase PR interval

131
Q

Class III antiarrhythmics

A

K+ channel blockers
amiodarone/ibutilide/dofetilide/sotalol
can cause Torsades
increase AP duration and QT interval

132
Q

Side effects of amiodarone

A

pulmonary fibrosis
hepatotoxicity
hyper/hypothyroid (iodine structure)
corneal deposits

133
Q

Class IV antiarrhythmics

A

CCB’s (verapamil/diltiazem)
decrease conduction velocity
increase PR interval
for SVT

134
Q

MOA of adenosine

A

increased K+ out of cells
hyperpolarizes the cell
for SVT
does not work with caffeine/theophylline

135
Q

Mg2+ tx for cardiac

A

Torsades de pointes

digoxin toxicity

136
Q

Given with beta blockers to prevent reflex tachycardia

A

Hydralazine
peripheral (arterial) vasodilator
can cause lupus like syndrome

137
Q

Cardiac and peripheral CCB’s

A

Cardiac-verapamil/diltiazem

Peripheral-amlodipine/nifedipine

138
Q

MOA of CCB’s

A

block L-type calcium channels

139
Q

Essential HTN tx

A

thiazides

140
Q

HTN tx for diabetics

A

ACEI’s

nephroprotective

141
Q

Lesion under the finger nail
extremely painful
red/blue color

A

Glomus tumor
benign
modified smooth m. cells of glomus body

142
Q

Nevus flammus on face
seizures at early age
glaucoma
6 y/o

A

Sturge-Weber disease
capillary sized blood vessels
ipsilateral leptomeningeal angiomatosis (AVM)

143
Q

Mouth/skin/GI/respiratory tract purple lesions

pt has AIDS

A

Kaposi’s sarcoma

assc with HHV-8 and HIV

144
Q

Pt has mastectomy for breast cancer 5 years ago

has chronic edema of R arm and R chest

A

Lymphangiosarcoma

assc with post radical mastectomy and persistent lymphedema

145
Q

AIDS pt
skin papules
pt owns a cat

A

Bacillary angiomatosis
benign capillary skin papules
Bartonella henselae infections
mistaken for Kaposi’s

146
Q

Female pt with 1 X chromosome
mass on the neck
3 y/o

A

Cystic hygroma
assc with Turner syndrome
cavernous lymphangiomas of neck

147
Q 
6 y/o recovering from strep throat
palpable purpura on buttocks
arthralgia
melena
GI lesions of same stage
A

Henoch-Schoenlein purpura
childhood systemic vasculitis
IgA complex deposition
assc with IgA nephropathy

148
Q 
Has allergies
sinusitis
palpable purpura
wrist drop
hematuria
eosinophilia of vesels
A 
Churg-Strauss syndrome
highly allergic people
(+) p-ANCA
peripheral neuropathy
pauci-immune GN
granulomatous
149
Q

Chronic sinusitis/otitis media
hemoptysis
hematuria

A 
Wegener's granulomatosis
lung and kidney involvement
granulomas present
(+) c-ANCA
focal necrotizing vasculitis
150
Q

Lung and kidney damage
palpable purpura
(+) for p-ANCA

A

Microscopic polyangiitis
necrotizing vasculitis
pauci-immune GN
no granulomas

151
Q

Male smoker 52 y/o
intermittent claudication
autoamputation of 2 fingers
Raynaud’s phenomenon seen

A

Buerger’s disease (thromboangiitis obliterans)
segmental thrombosing vasculitis
autoamputation of digits
tx with smoking cessation

152
Q 
2 y/o Asian male
recovering from Chicken pox
strawberry tongue
erythema of hands/feet
cervical lymphadenitis
A

Kawasaki disease
follows viral infection
can develop coronary aneurysms
MI/rupture

153
Q 
23 y/o male
Pt has Hep B
cutaneous eruptions at different stages
HTN
renal damage
A

Polyarteritis nodosa
renal involvement, no pulmonary
immune complex mediated
Fibrinoid necrosis

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