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CARDIOVASCULAR > Cardio > Flashcards

Cardio Flashcards

1
Q

How is dilated cardiomyopathy manifested?

A

Systolic disfunction

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2
Q

How do ACE inhibitors produce angioedema?

A

Due to bradykinin accumulation

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3
Q

Early findings of reumathic fever

A

Migratory arhthritis
Pancarditis
Syndenham chorea

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4
Q

Late findings of rheumatic fever

A

Mitral regurgitation/ stenosis

Aortic valve less frequently involved

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5
Q

Which is the most common cause of nephritic syndrome in children worldwide?

A

Post streptococcal glomeruloneohritis

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6
Q

How is restrictive cardiomyopathy manifested?

A

With diastolic disfunction

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7
Q

What leaks in case of cell wall damage caused by ischemia of heart, brain or skeletal muscle cells?

A

Creatinine kinase

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8
Q

How is mitral stenosis heard?

A

Opening snap being heard after the S2 heart sound

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9
Q

Most common cause of mitral stenosis

A

Prior rheumatic fever

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10
Q

Low pitched murmur heard best at the sternal border with accentuation during handgrip exercise

A

Ventricular septal defect

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11
Q

Mid systolic pulmonary ejection murmur which results from increased flow across the pulmonic valve

A

Atrial septal defect

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12
Q

What does hand maneuver increase?

A

Afterload

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13
Q

How does systolic ejection murmur of hypertrophic cardiomyopathy decrease?

A

With maneuvers that increase afterload

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14
Q

Which maneuver decreases preload?

A

Valsalva maneuver

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15
Q

Which maneuver accentuates the systolic ejection murmur of hypertrophic cardiomyopathy?

A

Valsalva maneuver

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16
Q

Which maneuver accentuates aortic regurgitation murmur?

A

Maneuvers that accentuate afterload such as handgrip exercise

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17
Q

What is paradoxical embolism?

A

They originate in the systemic venous circulation and enter the systemic arterial circulation via intracardiac or intrapulmonary shunt

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18
Q

In whom can paradoxical embolism happen?

A

Patients with patent foramen ova,e , atrial septal defects, ventricular septal defects or Large AVMs

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19
Q

Wide and fixed splitting (no change with respiration) of the second heart sound S2

A

Atrial septal defects with left to right shunting

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20
Q

Early disstolic decrescendo murmur

A

Aortic regurgitation

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21
Q

Systolic ejection murmur that increases in intensity with standing

A

Hypertrophic cardiomyopathy

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22
Q

Diastolic murmur with presystolic accentuation

A

Mitral or tricuspid valve stenosis

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23
Q

What causes the diastolic murmur with presystolic accentuation in mitral or tricuspid valve stenosis?

A

due to atrial contraction

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24
Q

Which is a sign of delayed closure of the tricuspid valve?

A

Wide splitting of S1 that is accentuated by inspiration

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25
Q

What is associated to liver angiosarcoma?

A

With exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride

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26
Q

What does hepatic angiosarcoma express?

A

Tumor cell express CD 31 an endothelial cell marker

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27
Q

When does acute rheumatic fever occur after group A streptococcal pharyngitis?

A

10 day to 6 weeks after

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28
Q

Which group of age are most often affected by acute rheumatic fever?

A

Children between 5 and 15 years old

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29
Q

Which are the main clinical manifestations of Acute rheumatic arthritis fever?

A

Acute migratory poly arthritis and pancarditis

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30
Q

Signs of acute pancarditis

A

Weak heart sounds, tachycardia, pericardial friction rubs, and arrhythmia

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31
Q

What causes death in patients with acute reumathic fever?

A

Heart failure due to severe myocarditis

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32
Q

How long does mitral stenosis take to develop in case of Acute rheumatic fever?

A

Years or decades

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33
Q

On the ECG what correspond to phase 0 of ventricular myocyte action potential?

A

QRS complex corresponding to ventricular depolarization

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34
Q

Which drugs have shown slow progression of heart failure and reduce mortality in CHF?

A

Beta blockers and carvedilol i. Particular

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35
Q

How do beta blockers help in CHF?

A

Decrease cardiac work by slowing the ventricular rate and decreasing afterload

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36
Q

Refers to a conclusion that there is no difference between the groups studied when a difference truly exists

A

Beta error

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37
Q

Results from the inaccurate recall of past exposure by subjects

A

Recall bias

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38
Q

What is the main purpose to avoid observer bias?

A

The main purpose of blinding is to prevent patient or researcher expectancy from interfering with an outcome

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39
Q

How does digoxin primarily acts?

A

By inducing stimulation of the AV node of the vagus nerve causing slowing of conduction through the AV node

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40
Q

Possible findings of digitalis toxicity

A

Fatigue, blurry vision, changes in color perception, nausea and vomiting , diarrhea, abdominal pain, headache, dizziness, confusion and delirium
Bradycardia
Eventual ventricular tachycardia or ventricular fibrilation

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41
Q

Which electrolyte is mainly affected in digitalis intoxication? What could be seen?

A

K+

Seen as high serum levels of potassium

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42
Q

What is needed to treat digitalis toxicity?

A

Oral activated charcoal as a GI decontaminant
Management Of serum potassium levels by the use of insulin, kayexalate or hemodialysis
Digoxin specific antibody fragments

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43
Q

What should be avoided in digitalis intoxication?

A

Calcium gluconate

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44
Q

Which cardiac manifestations does digoxin intoxication might show?

A

AV block and ventricular tachycardia

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45
Q

After MI when can we see ruptured of ventricular free wall?

A

Generally occurs 3-7 days after the onset of total ischemis

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46
Q

Clinical manifestations of ruptured of ventricular wall

A

Profound hypotension and shortness of breath

On physical examination the heart sounds are muffled and the jugular venous pressure is elevated

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47
Q

Why can rupture of ventricular wall cause death?

A

Due to hemopericardium and cardiac tamponade

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48
Q

Most common cause of death in a patient hospitalized for a MI

A

Ventricular failure (cardiogenic shock) which is a 2/3 of death cause

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49
Q

In MI what causes weakening of ventricular walls?

A

After coagulative necrosis and neutrophil infiltration

May cause ventricular ruptured

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50
Q

Most common cause of subungual splinter hemorrhages

A

Microemboli from valvular vegetations of bacterial endocarditis

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51
Q

What could be found in case of bacterial endocarditis?

A

Regurgitation murmur

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52
Q

What are the Janeway lesions?

A

Septic embolization from infected cardiac wall vegetations

Localized in palms and soles

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53
Q

What compose Janeway lesions?

A

Bacteria, neutrophils, necrotic material ams subcutaneous hemorrhage

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54
Q

Which is the most common necrosis variant after MI?

A

Coagulative necrosis

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55
Q

When does coagulative necrosis develops?

A

After irreversible ischemic injury

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56
Q

Cellular changes in coagulative necrosis

A

Tissue architecture is preserved
Cells become anucleated with eosinophilic cytoplasm
Leukocytes eventually infiltrate necrotic tissue and digest cellular debris

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57
Q

When is liquefactive necrosis seen?

A

With focal bacterial infections that stimulate massive leukocyte recruitment

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58
Q

Where does liquefactive necrosis occur?

A

Central nervous infarcts

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59
Q

Where do we see fat necrosis?

A

Seen in acute pancreatitis

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60
Q

Morphology of fat necrosis

A

Saponification (chalky white deposits)

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61
Q

When is the saponification formed?

A

When fatty acids combine with calcium

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62
Q

When does caseous necrosis occur?

A

Most commonly with tuberculosis infection

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63
Q

What is the result of complete muscle ischemia for >30 minutes in MI?

A

Progressive cardiomyocyte death and coagulative necrosis

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64
Q

Yellow brown finely granular found in heart and liver cells

A

Lipid peroxidation

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65
Q

When are lipid peroxidation granules seen?

A

Seen in heart and liver aging or cachectic, malnourished patients

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66
Q

How are hemosiderin granules seen?

A

Brown pigments granules seen in iron overload

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67
Q

Dark brown to black pigmented granules

A

Melanin

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68
Q

Clear vacuoles within cytoplasm

A

Glycogen

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69
Q

Is a form of protein accumulation, typically appearing as glassy, homogenous pink deposit

A

Hyaline deposit

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70
Q

Which is the product of lipid peroxidation?

A

Lipofuscin, seen accumulated in aging cells (specially in patients with malnutrition and cachexia)

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71
Q

Percentage of total perfusion through the myocardium capillaries of the LV occurs during systole

A

10%, while the majority of left ventricular flow occurs during diastole

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72
Q

Which is the effect of nitric oxide within the vascular smooth muscle cell?

A

NO stimulates guanylate cyclase to convert GTP into cyclic guanosine monophosohate (cGMP)

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73
Q

What is the final effect of increased cGMP by Nitric oxide?

A

Decreased intracellular calcium concentration which leads to decreased activity of myosin light chain kinase and finally myosin light chain dephosphorylation and smooth muscle relaxation

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74
Q

In muscle what is the effect of muscle phosphorylation?

A

Contraction

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75
Q

What is the effect of chronic arteriovenous shunt?

A

Increase cardiac output because of increased sympathetic stimulation to the heart, decreased peripheral resistance and increase venous return

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76
Q

Drugs that inhibit cGMP degradation leading to its accumulation, which produce muscle relaxation

A

PDE Inhibitors (sildenafil, tadalafil, vardenafil)

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77
Q

How is atrial septal defect heard?

A

Fixed splitting of the second herat sound

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78
Q

When does S4 sound could be heard?

A

Occurs at the end of diastole just before S1

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79
Q

Associated with a mid systolic click and a mid to late systolic murmur

A

Mitral valve prolapse

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80
Q

What is associated to S4?

A

Due to decreased left ventricular compliance and is often associated with restrictive cardiomyopathy and left ventricular hypertrophy

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81
Q

When left anterior descending artery alone is occluded, which is the preferred vessel for bypass grafting?

A

Internal mammary (thoracic) artery

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82
Q

When multiple coronary arteries require vascularization, which is the preferred vessel to use?

A

Saphenous vein graft

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83
Q

Which is the longest vein in the body?

A

Great saphenous vein

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84
Q

Who forms the femoral triangle?

A

Inguinal ligament superiorly, sartorius muscle laterally, and adductor longus medially

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85
Q

Where are the majority of peripheral artery aneurysm formed?

A

In the popliteal artery

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86
Q

Adult derivative of first aortic arch

A

Part of maxillary artery

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87
Q

Adult derivative of second aortic arch

A

Hyoid artery

Stapedial artery

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88
Q

Adult derivative of third aortic arch

A

Common carotid artery

Proximal internal carotid artery

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89
Q

Adult derivative of fourt aortic arch

A

On left aortic arch

On right proximal right subclavian

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90
Q

Adult derivative of sixth aortic arch

A

Proximal pulmonary arteries

On left ductus arteriosus

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91
Q

From which structure does ductus arteriosus derivates?

A

From sixth aortic arch

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92
Q

What is the effect of carotid sinus massage?

A

Increases baroreceptor firing, and thus increases parasympathetic influence on the heart and vessels, and ultimately prolongs the AV node refractory period which stops AV re entrant tachycardias

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93
Q

Typically a re entrant circuit in the AV node

A

Paroxysmal supraventricular tachycardia seen in patients with no other disease

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94
Q

How is paroxysmal commonly manage?

A

With adenosine in the hospital setting, but vagal maneuvers such as carotid sinus massage and Valsalva can also be used

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95
Q

How is orthosthatic hypotension defined?

A

As a fall of >22 mm in systolic or > 10 mm in diastolic pressure when assuming upright posture

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96
Q

Who prevents cerebral hypoperfusion upon standing

A

a1 adrenergic receptors stimuli

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97
Q

Which is the most striking finding of pericarditis?

A

Pericardial friction rub

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98
Q

Chest pain sharp and pleuritic, and characteristically decreases when the patient sits up and leans forward

A

Acute pericarditis

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99
Q

Most common variant of pericarditis

A

Fibrinous or serofibrinous

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100
Q

Common causes of pericarditis

A

Myocardial infarction , rheumatic fever, uremia, viral infection

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101
Q

Paradoxical increase in the jugular venous pressure with inspiration

A

Kussmaul’s sign

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102
Q

When is kussmaul’s sign often found?

A

In chronic constrictive pericarditis

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103
Q

Differential diagnosis of kussmaul’s sign

A

Restrictive cardiomyopathy, severe right sided heart failure, tricuspid stenosis and cardiac tamponade

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104
Q

Drop in systolic blood pressure of 10 mmHg or more during inspiration

A

Pulsus paradoxus

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105
Q

When is Pulsus paradoxus found?

A

Cor pulmonale, constrictive (chronic) pericardial disease, and cardiac tamponade

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106
Q

Brief, high frequency, precordial sound heard in early diastole (shortly after S2)

A

Pericardial knock in patients with constrictive (chronic) pericarditis

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107
Q

What are fenfluramine, dexfenfluramine and phentermine?

A

Appetite suppressants

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108
Q

What is a secondary effect of appetite suppressants used for more tha 3 months?

A

Pulmonary hypertension

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109
Q

Pathologies associated to cerebral aneurysm?

A

Autosomal dominant polycystic kidney disease

Ehlers Danlos syndrome

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110
Q

What do pulmonary embolism patients develop?

A

Ventilation/perfusion (V/Q) mismatch

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111
Q

What is the result of pulmonary embolism?

A

Hypoxemia, causing subsequently hyperventilation and Respiratory ALKALOSIS

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112
Q

Increased pH and reduced PaCO2

A

Respiratory alkalosis

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113
Q

Increased pH and reduced PaCO2 + low PaO2

A

Acute Pulmonary embolism

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114
Q

pH of 7.30 and low HCO3-

A

Metabolic acidosis

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115
Q

pH of 7.32 and PaCO2 high, high HCO3-

A

Respiratory acidosis, with renal compensation

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116
Q

pH 7.47, low PaCO2 , low HCO3-

A

Respiratory alkalosis with partial renal compensation

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117
Q

PH 7.48 and high HCO3-

A

Metabolic alkalosis

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118
Q

Which is the first change in coronary artery atherosclerosis?

A

Endothelial cell injury

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119
Q

Inhibits platelet aggregation and also works as direct arterial vasodilator

A

Cilostazol

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120
Q

Clinical use for Cilostazol

A

In the treatment for intermittent claudication

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121
Q

Direct thrombin inhibitor

A

Argatroban

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122
Q

When is abciximab used?

A

Prior to percutaneous coronary intervention

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123
Q

Phosphodiesterase inhibitor used in patients with intermittent claudication

A

Cilostazol

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124
Q

Decreased femoral to brachial blood pressure ratio

A

Congenital coarctation of the aorta

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125
Q

Which enzyme is deficient in Ehlers Danlos syndrome?

A

Procollagen peptidase

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126
Q

Which is the effect of procollagen peptidase?

A

Transforms the procollagen into insoluble tropocollagen

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127
Q

How do macrophage reduce plaque stability of the intima?

A

By secreting metalloproteinases, which degrade collagen

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128
Q

Direct pathway of how HDL delivers cholesterol

A

Delivers cholesterol esters directly to the liver via a scavenger receptor (SCARB1)

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129
Q

Indirect pathway of how HDL delivers cholesterol

A

HDL transfer cholesterol to LDL and VLDL by cholesteryl ester transfer protein

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130
Q

Which are the most effective lipid lowering drugs for oreventing cardiovascular effects?

A

HMG CoA reductase inhibitors

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131
Q

When aren’t thiazides recommended?

A

For diabetic, gout or hypercalcemia

They can also cause hyponatremia

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132
Q

When are ACE inhibitors the drug of choice in hypertensive patients?

A

When diabetic and hypertension

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133
Q

In case of extravasation of NE what is recommended?

A

Infiltration of sodium chloride solution containing phentolamine mesylate
Must be given within 12 hours

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134
Q

What is phentolamine?

A

alpha receptor blocker

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135
Q

When is calcium gluconate used?

A

In severe hypocalcemia

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136
Q

What characterizes abdominal aortic aneurysm?

A

Transmural inflammation of the aortic wall

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137
Q

Cardiac action potential conduction where is the slowest

A

AV node

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138
Q

Cardiac action potential conduction where is the fastest

A

Purkinje system

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139
Q

Rate of each system id action potential

A

SA node 1.1m/sec
AV node .05 m/sec
His-Purkinje 2.2 m/sec
Purkinje- ventricles .3 m/sec

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140
Q

Adult onset asthma, eosinophilia, history of allergy, mono or poly neuropathy, migratory/ transient pulmonary infiltrates, and paranasal sinus abnormalities + pANCA

A

Churg Strauss syndrome

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141
Q

Which enzyme may be elevated in Sarcoidosis?

A

Angiotensin converting enzyme

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142
Q

Circulating autoantibodies against alpha 3 chain of collagen IV, which damage alveolar and glomerular basement membranes

A

Pulmonary goodpasture syndrome

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143
Q

Antibodies found in Scleroderma

A

Antibodies to Scl 70, a soluble nuclear antigen, and or anti centromere antibody

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144
Q

What is characteristic of Aspergillus fumigatus?

A

Eosinophilia and elevated IgE and IgG antibodies to Aspergillus fumigatus

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145
Q

What leaks in case of cell wall damage caused by ischemia of heart, brain or skeletal muscle cells?

A

Creatinine kinase

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146
Q

How is mitral stenosis heard?

A

Opening snap being heard after the S2 heart sound

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147
Q

Most common cause of mitral stenosis

A

Prior rheumatic fever

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148
Q

Low pitched murmur heard best at the sternal border with accentuation during handgrip exercise

A

Ventricular septal defect

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149
Q

Mid systolic pulmonary ejection murmur which results from increased flow across the pulmonic valve

A

Atrial septal defect

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150
Q

What does hand maneuver increase?

A

Afterload

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151
Q

How does systolic ejection murmur of hypertrophic cardiomyopathy decrease?

A

With maneuvers that increase afterload

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152
Q

Which maneuver decreases preload?

A

Valsalva maneuver

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153
Q

Which maneuver accentuates the systolic ejection murmur of hypertrophic cardiomyopathy?

A

Valsalva maneuver

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154
Q

Which maneuver accentuates aortic regurgitation murmur?

A

Maneuvers that accentuate afterload such as handgrip exercise

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155
Q

What is paradoxical embolism?

A

They originate in the systemic venous circulation and enter the systemic arterial circulation via intracardiac or intrapulmonary shunt

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156
Q

In whom can paradoxical embolism happen?

A

Patients with patent foramen ova,e , atrial septal defects, ventricular septal defects or Large AVMs

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157
Q

Wide and fixed splitting (no change with respiration) of the second heart sound S2

A

Atrial septal defects with left to right shunting

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158
Q

Early disstolic decrescendo murmur

A

Aortic regurgitation

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159
Q

Systolic ejection murmur that increases in intensity with standing

A

Hypertrophic cardiomyopathy

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160
Q

Diastolic murmur with presystolic accentuation

A

Mitral or tricuspid valve stenosis

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161
Q

What causes the diastolic murmur with presystolic accentuation in mitral or tricuspid valve stenosis?

A

due to atrial contraction

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162
Q

Which is a sign of delayed closure of the tricuspid valve?

A

Wide splitting of S1 that is accentuated by inspiration

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163
Q

What is associated to liver angiosarcoma?

A

With exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride

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164
Q

What does hepatic angiosarcoma express?

A

Tumor cell express CD 31 an endothelial cell marker

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165
Q

When does acute rheumatic fever occur after group A streptococcal pharyngitis?

A

10 day to 6 weeks after

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166
Q

Which group of age are most often affected by acute rheumatic fever?

A

Children between 5 and 15 years old

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167
Q

Which are the main clinical manifestations of Acute rheumatic arthritis fever?

A

Acute migratory poly arthritis and pancarditis

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168
Q

Signs of acute pancarditis

A

Weak heart sounds, tachycardia, pericardial friction rubs, and arrhythmia

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169
Q

What causes death in patients with acute reumathic fever?

A

Heart failure due to severe myocarditis

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170
Q

How long does mitral stenosis take to develop in case of Acute rheumatic fever?

A

Years or decades

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171
Q

On the ECG what correspond to phase 0 of ventricular myocyte action potential?

A

QRS complex corresponding to ventricular depolarization

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172
Q

Which drugs have shown slow progression of heart failure and reduce mortality in CHF?

A

Beta blockers and carvedilol i. Particular

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173
Q

How do beta blockers help in CHF?

A

Decrease cardiac work by slowing the ventricular rate and decreasing afterload

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174
Q

Refers to a conclusion that there is no difference between the groups studied when a difference truly exists

A

Beta error

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175
Q

Results from the inaccurate recall of past exposure by subjects

A

Recall bias

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176
Q

What is the main purpose to avoid observer bias?

A

The main purpose of blinding is to prevent patient or researcher expectancy from interfering with an outcome

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177
Q

How does digoxin primarily acts?

A

By inducing stimulation of the AV node of the vagus nerve causing slowing of conduction through the AV node

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178
Q

Possible findings of digitalis toxicity

A

Fatigue, blurry vision, changes in color perception, nausea and vomiting , diarrhea, abdominal pain, headache, dizziness, confusion and delirium
Bradycardia
Eventual ventricular tachycardia or ventricular fibrilation

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179
Q

Which electrolyte is mainly affected in digitalis intoxication? What could be seen?

A

K+

Seen as high serum levels of potassium

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180
Q

What is needed to treat digitalis toxicity?

A

Oral activated charcoal as a GI decontaminant
Management Of serum potassium levels by the use of insulin, kayexalate or hemodialysis
Digoxin specific antibody fragments

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181
Q

What should be avoided in digitalis intoxication?

A

Calcium gluconate

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182
Q

Which cardiac manifestations does digoxin intoxication might show?

A

AV block and ventricular tachycardia

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183
Q

After MI when can we see ruptured of ventricular free wall?

A

Generally occurs 3-7 days after the onset of total ischemis

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184
Q

Clinical manifestations of ruptured of ventricular wall

A

Profound hypotension and shortness of breath

On physical examination the heart sounds are muffled and the jugular venous pressure is elevated

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185
Q

Why can rupture of ventricular wall cause death?

A

Due to hemopericardium and cardiac tamponade

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186
Q

Most common cause of death in a patient hospitalized for a MI

A

Ventricular failure (cardiogenic shock) which is a 2/3 of death cause

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187
Q

In MI what causes weakening of ventricular walls?

A

After coagulative necrosis and neutrophil infiltration

May cause ventricular ruptured

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188
Q

Most common cause of subungual splinter hemorrhages

A

Microemboli from valvular vegetations of bacterial endocarditis

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189
Q

What could be found in case of bacterial endocarditis?

A

Regurgitation murmur

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190
Q

What are the Janeway lesions?

A

Septic embolization from infected cardiac wall vegetations

Localized in palms and soles

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191
Q

What compose Janeway lesions?

A

Bacteria, neutrophils, necrotic material ams subcutaneous hemorrhage

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192
Q

Which is the most common necrosis variant after MI?

A

Coagulative necrosis

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193
Q

When does coagulative necrosis develops?

A

After irreversible ischemic injury

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194
Q

Cellular changes in coagulative necrosis

A

Tissue architecture is preserved
Cells become anucleated with eosinophilic cytoplasm
Leukocytes eventually infiltrate necrotic tissue and digest cellular debris

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195
Q

When is liquefactive necrosis seen?

A

With focal bacterial infections that stimulate massive leukocyte recruitment

196
Q

Where does liquefactive necrosis occur?

A

Central nervous infarcts

197
Q

Where do we see fat necrosis?

A

Seen in acute pancreatitis

198
Q

Morphology of fat necrosis

A

Saponification (chalky white deposits)

199
Q

When is the saponification formed?

A

When fatty acids combine with calcium

200
Q

When does caseous necrosis occur?

A

Most commonly with tuberculosis infection

201
Q

What is the result of complete muscle ischemia for >30 minutes in MI?

A

Progressive cardiomyocyte death and coagulative necrosis

202
Q

Who mediates vasodilation stimuli of vascular endothelium?

A

Acetylcholine, bradykinin, serotonin, substance P and shear forces

203
Q

What is the effect of Acetylcholine, bradykinin, serotonin, substance P and shear forces in endothelium?

A

Increase in cytosolic calcium levels

204
Q

Once calcium is elevated in endothelial cells what is activated?

A

Endothelial nitric oxide synthase

205
Q

Which is the precursor of nitric oxide once stimulated by endothelial nitric oxide synthase?

A

Arginine
NADPH
O2

206
Q

What is activated by nitric oxide?

A

Guanylyl cyclase and increases formation of cyclic G,P

207
Q

What is the effect of high levels of cyclic GMP?

A

Activate protein kinase G, which causes a reduction in cytosolic calcium levels and relaxation of smooth muscle cells

208
Q

Which is the most common cause of death in patients suffering from myocardial infarction?

A

Ventricular fibrilation

209
Q

Which are the most lethal arrhythmias in patients with acute myocardial infarction?

A

Ventricular tachycardia and ventricular fibrillation

210
Q

Clinical findings of ruptured of the intraventricular septum

A

Hypotension, bi ventricular failure and a new murmur

211
Q

When does significant mural thrombosis occur after myocardial infarction?

A

Until three to seven days after the onset of infarction

212
Q

What is used to treat hypertensive heart failure?

A

Nitroprusside

213
Q

What is the effect of nitroprusside?

A

Decreases preload and afterload

Doesn’t affect contractility

214
Q

Short acting balanced venous and arterial vasodilator that decreases both preload and afterload

A

Nitroprusside

215
Q

Hereditary hemorrhagic telangiectasia

A

Osler Weber Rendu syndrome

216
Q

Mode of inheritance of Osler Weber Rendu syndrome

A

Autosomal dominant

217
Q

Better-known as encephalotrigrminal angiomatosis

A

Sturge Weber syndrome

218
Q

Findings of Sturge Weber syndrome

A

Presence of continuous facial angiomas as well as leptomeningeal angiomas
Mental retardation, seizures, hemiplegia coma and skull radio opacity

219
Q

When you see “tram track “ image on skull radiography what should you suspect?

A

Sturge Weber syndrome

220
Q

Capillary hemangioblastomas in retina and/or cerebellum as well as congenital cysts and/or neoplasm in the kidney liver and pancreas

A

Von Hippel Lindau

221
Q

What should be suspected when seeing cortical and subependymal hamartomas?

A

Tuberous sclerosis

222
Q

How is cardiac output affected when doing exercise?

A

Increase from a resting rate of 5 L per minute to approximately 20 L per minute during Maxima exertion

223
Q

What is the effect of sympathetic stimulation to the venous system?

A

Causes contraction, increasing venous return to the heart

224
Q

What is the effect of sympathetic in arterioles?

A

Contraction in arterioles in all tissues except that actively working muscles, effectively shunting blood toward exercising muscle

225
Q

When doing exercise how much is the pressure increased by sympathetic nervous system?

A

Typically increases only 20-40 mmHg during full body exercise

226
Q

When doing exercise which are local vasodilators?

A

Adenosine, potassium ions, ATP, CO2 and lactate

227
Q

Percentage of total cardiac output for renal bloodflow?

A

25%

228
Q

Elevation of the peak v wave pressure and an earlier upswing than would normally be seen

A

Mitral regurgitation

229
Q

Most common cause of right heart failure

A

Secondary to left heart failure

230
Q

Effects of increased Angiotensin II

A 
Sodium retention (direct effect)
Aldosterone production
Vasoconstriction
231
Q

In congestive heart failure how does it affects pressure?

A

Decreased renal flow causing increased renin which leads to increased arteriolar resistance
So… Increased pressure

232
Q

In the kidney what is activated by decreased GFR?

A

Macula densa increasing renin

233
Q

If heard in adults typically is a sign of left ventricular failure

A

S3

234
Q

When is S3 heart sound heard?

A

Forceful, rapid filling of a ventricle that has normal or elevated compliance
Normal or even decreased filling rates when ventricular compliance is low
Blood flowing into Overfilled ventricle with high end systolic volume

235
Q

When does bulging of intraventricular septum occurs?

A

In cardiac tamponade

236
Q

Which finding is common in cardiac tamponade?

A

Pulsus paradoxus

237
Q

Blowing, holsystolic murmur heard over the cardiac apex with radiation to the axilla

A

Mitral regurgitation

238
Q

How is aortic regurgitation heard?

A

Early diastolic murmur

239
Q

What may ascending aortic aneurysm develop?

A

Aortic regurgitation

240
Q

Mid systolic ejection murmur best heard over the right second intercostal space with radiation to the neck

A

A bicuspid aortic valve

Aortic stenosis

241
Q

Opening snap at the beginning of diastole with a low pitched, mid diastolic rumbling murmur heard best at the cardiac apex

A

Mitral stenosis

242
Q

In MI what is seen in 0-4 hours

A

No visible changes

243
Q

In MI what is seen in 4-12 hours

A

Wavy fibers with narrow, elongated myocytes

244
Q

In MI what is seen in 12- 24 hours

A 
Coagulation necrosis (loss of nuclei & striations)
Prominent neutrophilic infiltration
245
Q

In MI what is seen in 1-3 days

A

Disintegration of dead neutrophils and myofibers,

Macrophages infiltration a border areas

246
Q

In MI what is seen in 7-10 days

A

Robust phagocytosis of dead cells by macrophages,

beginning formation of granulation tissue at margins

247
Q

In MI what is seen in 10-14 days

A

Well-developed granulation tissue with neovascularization

248
Q

In MI what is seen in 2 weeks to 2 months

A

Progressive collagen deposition and scar formation

249
Q

Major changes in chronic ischemic heart disease

A

Subendocardial vacuolization

250
Q

Normal morphological changes in the aging heart include

A

Decrease in left ventricular chamber apex to base dimension, development of a sigmoid shape ventricular septum, myocardium atrophy with increased collagen deposition, and accumulation of cytoplasmic lipofuscin pigment within cardiomyocytes

251
Q

What is the problem of using around the clock nitrates?

A

Results in development of tolerance to nitrates

252
Q

Mineralocorticoid receptor antagonist

A

Spironolactone

Eplerenone

253
Q

Potassium sparing diuretics

A

Spironolactone

Eplerenone

254
Q

Which drugs Block the deleterious effect of aldosterone on the heart, causing regression of myocardial fibrosis and improvement in ventricular remodeling

A

Mineralocorticoid receptor antagonists
Spironolactone
Eplerenone

255
Q

Which drugs are recommended in heart failure therapy?

A

Mineralocorticoid receptor antagonist
ACE inhibitors
Beta blockers

256
Q

When are mineralocorticoid receptor antagonist contraindicated?

A

In patients with hyperkalemia or renal failure

257
Q

Most common side effects of mineralocorticoid receptor antagonists

A

Hyperkalemia and Gynecomastia

258
Q

Which is the first line of treatment in atrial fibrillation?

A

Calcium channel blockers
Diltiazem
Verapamil

259
Q

Which is the fsecond line of treatment in atrial fibrillation?

A

Digoxin

260
Q

How does digoxin decreases rate of AV conduction?

A

Through increased parasympathetic tone throughout its action on the vagus nerve

261
Q

How can Digoxin lead to ventricular tachycardia and dead?

A

By increasing intracellular calcium

262
Q

When is clinically recommended the use of adenosin?

A

In paroxysmal supraventricular tachycardia

263
Q

Between the arrhythmic drugs that cause torsades de points, with which one is less common to see this?

A

Amiodarone

264
Q

Nonselective betta antagonist

A

Propanolol

265
Q

Nonspecific alpha 1 and Alpha 2 Blocker with no beta effect

A

Phentolamine

266
Q

Nonselective beta adrenergic agonist that stimulates both beta receptors on muscular smooth muscle and cardiac receptors

A

Isoprotenerol

267
Q

Most common cause of atrial stenosis

A

Senile calcific aortic valve

268
Q

At what age is common to see senile calcification of aortic valve

A

7th decade of life

269
Q

Dominant Cardiac defect in DiGeorge syndrome

A

Tetralogy of Fallot and aortic arch anomalies

270
Q

What is mutated in Friedreich ataxia?

A

Frataxin

271
Q

What is frataxin?

A

A mitochondrial protein important in iron homeostasis and respiratory function

272
Q

Spinocerebellar degeneration with predominantly spinal ataxia

A

Friedreich ataxia

273
Q

Progression of Friedreich ataxia

A

Initial loss of sensory neurons in the dorsal root ganglia, with accompanying gait ataxia

274
Q

How does Marfan syndrome causes dissecting aortic aneurysm?

A

With cystic medial necrosis of the aorta

275
Q

Where is the mutation in Marfan syndrome?

A

In the gene that encodes fibrillin 1

276
Q

Heart defects associated to Down syndrome

A

Ostium primum ASD, regurgitant AV valves

277
Q

Which heart defect is seen in Friedreich ataxia

A

Hypertrophic cardiomyopathy

278
Q

Heart defect in tuberous sclerosis

A

Valvular obstruction due to cardiac rhabdomyomas

279
Q

Which syndrome is related to cause berry aneurysms?

A

Ehler Danlos syndrome

280
Q

What its associated to hyperplastic arteriosclerosis of renal arterioles?

A

Malignant hypertension

281
Q

It results from concentric lamellar reduplication of the intimal smooth muscle cells

A

Hyperplastic arterolosclerosis

282
Q

Findings on hyperplastic arteriolosclerosis

A

Concentric lamellar reduplication of the intima smooth muscle cells “onion skinning”

283
Q

Which structure composes most of the hearts anterior surface?

A

Right ventricle

284
Q

It is defined as a drop in arterial blood pressure during inspiration of over 10 mmHg

A

Pulsus paradoxus

285
Q

When does pulsus alternans occur?

A

Inpatients with left ventricular dysfunction

286
Q

It is defined as a beat to beat variation in the magnitude of the lse upressure in the presence of a regular cardiac rythm

A

Pulsus alternans

287
Q

Refers to a pulse with two distinct peaks, one during systole and the other during diastole

A

Dicrotic pulse

288
Q

When does dicrotic pulse is found?

A

Severe systolic dysfunction

289
Q

Refers to the pulse palpated in patients with aortic stenosis

A

Pulsus parvus et tardus

290
Q

In patients with hypertensive heart disease what causes pulmonary hypertension?

A

Vasoconstriction due to pulmonary venous congestion

291
Q

What should migratory thrombophlebitis make you think?

A

Cancer, leading to hypercoagulable state

292
Q

How does adenocarcinoma produce hypercoagulability?

A

Because they produce thromboplastin like substance

293
Q

What is Trousseau’s syndrome?

A

Migratory superficial thromboplebitis

294
Q

In the coronaries Vasculature who is responsible of dilation of large arteries and Pre arteriolar vessels?

A

Nitric oxide

295
Q

From whom is adenosine product?

A

ATP metabolism

296
Q

In the coronary system where does adenosine work?

A

In the small coronary arteries

297
Q

Which diseases can cause myocardial fibrosis?

A

Dermatomyocitis, muscular dystrophy, sarcoidosis, and scleroderma

298
Q

Most common causative organism of acute infective endocarditis

A

Staphylococcus aureus

299
Q

How is the valvular vegetation caused by S. Aureus formed?

A

Following bacterial binding, tissue factor expression results in platelet and fibrin deposition and the formation of a valvular vegetation

300
Q

Giant cell (temporal) arteritis

A

Takayasu arteritis

301
Q

Which is the most specific symptom of Giant cell arteritis?

A

Jaw claudication

302
Q

In Giant cell arteritis what does temporal artery biopsy demonstrates?

A

Granulomatous inflammation of the media

303
Q

These bacterias are able to adhere to the surface of tooth enameland heat valves

A

Viridians streptococci: S. Mutans and S. Sanguis

304
Q

What characteristic of streptococcus viridians let adhere to the surface of tooth enamel and heart valves and multiply in those locations?

A

Due to their ability to produce insoluble extra cellular polysaccharides (dextrans) using sucrose as a substrate

305
Q

Immune response caused by post streptococcal glomeruloneohritis

A

Type III (immune complex mediated)

306
Q

What is the result of post streptococcus glomerulonephritis?

A

Inflammation, renal dysfunction, hematuris and nephritic range protein

307
Q

From which the disease is migratory polyarthritis characteristic?

A

Rheumatic fever

308
Q

Agents that may cause anterior uveitis

A

Herpes viruses, syphillis, and Lyme disease

Inflammatory conditions such as the HLA B27 related diseases and sarcoid

309
Q

Most common cause of coronary sinus dilation

A

Elevated right sided heart pressure secondary to pulmonary artery hypertension

310
Q

Most common cause of fatigue and new onset Cardiac murmur in a young adult

A

Bacterial endocarditis

311
Q

Which Renal complication may be seen in patients with bacterial endocarditis?

A

Acute proliferative glomerulonephritis secondary to two collating immune complexes and there is Angelo and/or subepithelial deposition in the glomeruli

312
Q

Tumor associated release of procoagulants responsible for Trombophlebitis

A

Trosseau syndrome

313
Q

Humoral hypercalcemia of malignancy, The most common cause of hypercalcemia in hospitalized patients

A

Due to production of a parathyroid hormone like substance by tumors

314
Q

Autoimmune paraneoplastic myasthenic syndrome that affects the presynaptic calcium channels

A

Lambert Eaton syndrome

315
Q

What is the result of Lambert Eaton syndrome?

A

Decreased presynaptic acetylcholine release

316
Q

With what is lambert eaton syndrome associated?

A

With oat cell carcinoma of the ling

317
Q

Laboratory findings for systemic lupus erythematosus

A

Hemolytic anemia, thrombocytopenia and leukopenia
Hypocomplementemia (c3 & c4)
ANA and Anti dsDNA & anti SM
Proteinuria and elevated creatinine

318
Q

Sensitive antibodies present in systemic lupus erythematosus

A

ANA

319
Q

Sensitive antibodies present in systemic lupus erythematosus

A

Anti dsDNA & anti SM

320
Q

Cardiovascular manifestations in SLE

A

Pericardial effusion, verrucous (Libman- Sacks) endocarditis and increased risk of coronary artery disease

321
Q

In which patients does aortic dissection occurs?

A

With long-standing hypertension and those with Marfan and Ehlers Danlos syndrome

322
Q

It presents would abrupt onset, Severe, tearing chest pain that radiates to the back

A

Aortic dissection

323
Q

Distended neck veins, hypotension, Diminished heart sounds and pulsus paradoxus

A

Cardiac tamponade

324
Q

It presents with dyspnea, Malaise, and findings associated with right ventricular failure

A

Pulmonary hypertension

325
Q

Most common cardiovascular manifestation associated with SLE

A

Pericarditis

326
Q

It presents with sharp pleuritic chest pain that is relieved by sitting up and leaning forward

A

Pericarditis

327
Q

When do we consider that an ischemic injury becomes irreversible for contractility in myocardial infarction?

A

If it last more than 30 minutes

328
Q

After MI, how long does the myocyte last in order to lose all ATP?

A

60 seconds

329
Q

In MI, who Maintains vasodilation in coronaries the first 30 minutes?

A

Adenosine

330
Q

Aschoff bodies

A

Interstitial myocardial granulomas typically found in acute rheumatic arthritis

331
Q

Plump macrophages with abundant cytoplasm and central , round to ovoid nuclei with central , slender chromatin ribbons are called…

A

Anitschkow cells (caterpillar cells)

332
Q

Characteristics of diastolic heart failure

A

Normal left ventricle her ejection fraction

End diastolic volume with increase left ventricular filling pressure

333
Q

How is left ventricular diastolic pressure determined?

A

By the blood volume in the left ventricle cavity and compliance of the left ventricle

334
Q

Cause of Diastolic dysfunction

A

Decreased in ventricular compliance

335
Q

Cause of systolic dysfunction

A

Decreased in myocardial contractility

336
Q

Characteristics of systolic heart failure

A

Reduced left ventricular ejection fraction, along with progressive chamber dilation with increased left ventricular volume and elevated left ventricular end diastolic pressure

337
Q

How is Atrial regurgitation best heard?

A

At the left sternal border, with the patient leaning forward and at end expiration

338
Q

What does jugular venous distention mean?

A

Elevation or the central venous pressure in the superior vena cava

339
Q

Acute onset central venous pressure elevation with hypotension and tachycardia

A

Cardiac tamponade

Pneumothorax

340
Q

Central venous pressure elevation

A

> 15 cm H2O

341
Q

Hypotension, distended neck veins, and distant or muffled hearts sounds on auscultation

A

Beck triad

342
Q

Beck triad + tachycardia

A

Cardiac tamponade

343
Q

In congestive heart failure, what does loss of a palpable pulse during inspiration means?

A

Is most likely due to an inspiratory fall in systolic blood pressure

344
Q

Pulsus paradoxus + acute onset hypotension + tachycardia + JVD=

A

Cardiac tamponade

345
Q

Characterized by pleuritic chest pain pain and a pericadial friction rub

A

Acute fibrinous pericarditis

346
Q

The only class 3 antiarrhythmic with beta adrenergic blocking abilities

A

Sotalol

347
Q

Class III antiarrhythmic

A

Amiodarone, ibutilide, dofelitide, sotalol

348
Q

Possible side effect of class 3 antiarrhythmics

A

QT prolongation

349
Q

How do beta blockers decrease heart rate and cardiac contractility?

A

By slowing AV nodal conduction and the phase 4 depolarization of cardiac pacemaker

350
Q

Clinical use for beta blockers

A

As myocardium protective agents following myocardial infarction or in congestive heart failure resulting from systolic dysfunction, and as anti hypertensive

351
Q

Slow the phase 0 depolarization of cardiac pacemaker cells and phase 2 of the myocyte action

A

Calcium channel blockers

352
Q

Which Viral agent cause dilated myocardiopathy?

A

Coxsackie B

353
Q

Dilation of all four chambers of the heart, systolic dysfunction, and myocardial failure

A

Dilated cardiomyopathy

354
Q

Situations when thiazide diuretics are not recommended in patients with essential hypertension as a an initial treatment

A

In patients with CHF and diabetics

355
Q

When are ACE inhibitors the recommended first line of treatment in patients with essential hypertension?

A

When the patients are diabetics or have CHF

356
Q

Eiocosanoid, arachidonic acid derived substances with paracrine properties

A

Prostacyclin

357
Q

What is the effect prostacyclin related to platelet aggregation?

A

Inhibits platelet aggregation and adhesion

And also vasodilates, increases vascular permeability and stimulates leukocyte chemotaxis

358
Q

Clinical use for prostacyclin

A

Pulmonary Hypertension, Peripheral vascular disease and Raynaud syndrome

359
Q

It’s action is to convert kininogen into bradykinin

A

Kallikrein

360
Q

Which clothing factors are in inhibited by Protein C?

A

Va and VIIIa

361
Q

Phosphodiesterase isoenzyme 3 inhibitor

A

Milrinone

362
Q

Which is the effect of cyclic AMP in the heart?

A

Increases the conductance of the calcium channel in the sarcoplasmic reticulum, and as a result re calcium can enter the cell and strengthen the force of contraction

363
Q

What is the effect of phosphodiesterase isoenzyme 3 in the heart?

A

Metabolizes cyclic AMP, so decreases calcium in the heart, with decreased contractility as a result

364
Q

Which is the effect of cAMP in vascular smooth muscle?

A

Cause vasodilation

365
Q

What is the effect of milrinone?

A

Increase contractility but induces vasodilation

366
Q

When do we see tubular obstruction with urate Crystals?

A

During tumor lysis

367
Q

Classic clinical presentation of tubular obstruction with urate Crystals

A

Acute renal failure during chemotherapy for a malignancy

368
Q

What does cystic dilation of the collecting duct make you suspect of?

A

Autosomal dominant polycystic kidney disease (ADPKD)

369
Q

Classic presentation of Autosomal dominant polycystic kidney disease (ADPKD)

A

A patient in his 40s or 50s with a family history of renal disease who presents with flank pain, hematuria and hypertension

370
Q

What should you suspect when you see signs of renal failure and toe gangrene or livedo reticularis following an invasive vascular procedure?

A

Atheroembolic renal disease

371
Q

Which vessels are affected in polyarteritis nodosa?

A

Medium to small sized arteries in any organ

372
Q

Segmental, transmural, necrotizing inflammation of medium to small sized arteries in any organ

A

Polyarteritis nodosa

373
Q

Which arteries are spare in polyarteritis nodosa?

A

Pulmonary arteries

374
Q

What does persistent lymphedema predisposes to?

A

Lymphangiosarcoma

375
Q

Typical scenario of lymphangiosarcoma

A

Approximately 10 years following radical Mastectomy for breast cancer

376
Q

With which pathology are cystic hygromas associated?

A

Turner syndrome

377
Q

In what do cystic hygromas differ to cavernous hemangiomas?

A

Only by the absence of luminal blood cells

378
Q

What causes congenital QT prolongation?

A

Due to decreased outward K+ currents

379
Q

When does dynamic left ventricular outflow obstruction happens?

A

Hypertrophic obstructive cardiomyopathy

380
Q

Alternative name for Buerger disease

A

Thromboangitis obliterans

381
Q

Which vessels are mainly affected in thrombangitis obliterans?

A

Vasculitis of medium and small sized arteries, principally tibial and radial arteries

382
Q

What can thrombosed arteries of Buerger diaseas lead to?

A

Can often extend into contiguous veins and nerves

383
Q

When is Buerger’s disease commonly seen?

A

In heavy cigarette smokers, with onset before age 35

384
Q

When can onion like concentric thickening of arteriolar walls be seen?

A

A condition that can result from malignant hypertension

385
Q

How does malignant hypertension defined?

A

Diastolic pressure >120-130 mmHg

386
Q

From which vasculitis is Granulomatous inflammation of the media characteristic?

A

Temporal (giant cell) arteritis

387
Q

Most common form of systemic vasculitis in adults

A

Temporal (giant cell) arteritis

388
Q

Which vessels are mainly affected by Temporal (giant cell) arteritis?

A

Medium to smaller branches of carotid artery, especially the temporal arteries

389
Q

Transmural inflammation of the arterial wall with fibrinoid necrosis

A

Characteristic of polyarteritis nodosa

390
Q

Heavy cigarette smoker with onset before age 35 and associated with hypersensitivity reaction to intradermal injection of tobacco extract

A

Thromboangitis obliterans (Buerger’s disease)

391
Q

When myocardial infarction occurs in the setting of normal coronary arteries, what should be suspected?

A

Hypercoagulability with acute thrombosis, or coronary vasospasm

392
Q

Differential diagnosis for mitral valve thickening with vegetations

A

Infectious endocarditis, rheumatic valvulitis, Libman Sacks endocarditis

393
Q

Pathologies associated to Libman Sacks endocarditis

A

SLE, and non bacterial thrombotic endocarditis

394
Q

How does SLE affects coronary arteries?

A

Via arteritis and/or thrombosis

395
Q

How does SLE produce thrombosis?

A

Due to hypercoagulable antiphospholipid antibody syndrome, present in 10-30%

396
Q

What does bleeding time indicates?

A

Platelet function

397
Q

What does aPTT indicate?

A

Intrinsic coagulation system

398
Q

What does PT indicates?

A

Extrinsic coagulation pathway

399
Q

What is the result of factor VIII deficiency?

A

Classic X linked hemophilia A

400
Q

Which factor is deficient in hemophilia C?

A

Factor XI

401
Q

Autosomal recessive disorder of factor XI deficiency

A

Hemophilia C

402
Q

Which factor is Hageman factor?

A

Factor XII

403
Q

Carrier molecule for factor VII and mediator of platelet adhesion to the endothelium

A

Von Willebrand factor

404
Q

Niacin’s main side effect

A

Cutaneous (flushing, warmth, itching)

405
Q

Who mediates cutaneous effects of Niacin?

A

Prostaglandins

406
Q

Which drug induces red man syndrome? And who mediates it?

A

Vancomycin by histamine release

407
Q

Reduces pain by decreasing the level of substance P in the peripheral nervous system

A

Capsaicin

408
Q

Which drug should be initiated promptly in patients with temporal arteritis?

A

Prednisone

409
Q

Which lab is altered in patients with temporal arteritis?

A

Erythrocyte sedimentation rate (ESR)

410
Q

How should patients with granulomatosis with polyangiitis be treated?

A

With cyclophosphamide and prednisone

411
Q

How should patients with Goodpasture syndrome be treated?

A

Immediate plasmapheresis, along with immunosuppressive therapy

412
Q

Granulomatosis with polyangiitis syndrome

A

Wegner’s syndrome

413
Q

Most common vasculitis associated with MI

A

Kawasaki’s disease

414
Q

Long extremities , scoliosis, pectus excavatum, ectopia lentis, and Aortic root disease

A

Marfan syndrome

415
Q

Most common cardiac abnormalities

A

Mitral valve prolapse

Cystic medial degeneration of the aorta

416
Q

In Marfan syndrome patients what is the risk of cystic medial degeneration of the aorta?

A

Aneurysm dilation

417
Q

Which is the most common cause of death in patients with Marfan syndrome?

A

Aortic dissection

418
Q

Second most common cause of death in Marfan syndrome

A

Cardiac failure secondary to mitral valve prolapse and/aortic regurgitation

419
Q

Where are beta 1 receptors found?

A

Cardiac tissue and on renal juxtaglomerular cells

420
Q

Another effect of metoprolol

A

Blocks catecholamine induced renin release by the kidney

421
Q

Which veins form brachiocephalic vein?

A

Right subclavian vein and right internal jugular vein

422
Q

What is Ortner syndrome?

A

Mitral stenosis can cause left atrial dilation sufficient to impinge on the left recurrent laryngeal nerve

423
Q

Which is the only structure of the intrinsic muscles of the larynx that isn’t innervated by left recurrent?

A

Cricothyroid

424
Q

What is the result of paresis of vocal cord muscles innervated by recurrent laryngeal?

A

Hoarness

425
Q

Cause of left recurrent laryngeal nerve impingement

A

Left atrial enlargment

426
Q

Most common cause of left ventricle diastolic dysfunction

A

Hypertensive heart disease due to chronic hypertension

427
Q

From which situations is crescendo decrescendo systolic murmur characteristic of?

A

Aortic or pulmonic stenosis

428
Q

Chronic inflammatory disease of the axial skeleton characterized by pain and stiffness of the spine, sacroiliitis and increased risk of aortic regurgitation

A

Ankylosing spondylitis

429
Q

Characteristic sound of mitral regurgitation associated to chordal rupture

A

Holosystolic decrescendo murmur

430
Q

Medications that cause Drug induced lupus erythematosus

A 
Hydralazine
Procainamide
Isoniazid
Minocycline
Quinidine
431
Q

In which percentage does procainamide cause drug induced lupus erythematosus?

A

20%

432
Q

Which antibodies are present in drug induced lupus erythematosus?

A

ANA and antihistone antibodies in >95% of cases

433
Q

Most notable side effects of amiodarone

A

Thyroid dysfunction, lung fibrosis, liver toxicity, as well as a blue or grey discoloration of the skin

434
Q

Most frequently encountered adverse effects of nonselective beta blockers

A

Negative inotropy and bronchoconstriction in patients with asthma or COPD

435
Q

Main side effects of lidocaine

A

Nonfocal neurologic signs such as tremor, drowsiness, and change in mental status, and can also lead to generalized seizures

436
Q

Which drugs have the highest risk for drug induced lupus erythematosus?

A

Procainamide and hydralazine

437
Q

Selective vasodilators of coronary vessels

A

Adenosine and dipyridamole

438
Q

Drugs used in myocardial perfusion imaging studies to stimulate the generalized coronary vasodilation caused by exercise

A

Adenosine and dipiridamole

439
Q

What is the effect adenosine and dipiridamole in myocardial ischemia due to an obstruction?

A

Cause coronary steal, may lead to hypoperfusion and potential worsening of existing ischemia

440
Q

Calcific deposits in muscular arteries in people older than 50

A

Monckeberg’s medial calcific sclerosis (medial slerosis)

441
Q

What could be the result of malignant hypertension?

A

Hyperplastic arteriolosclerosis in renal arterioles

442
Q

Onion like concentric thickening of arteriolar walls in the renal vasculature and elsewhere

A

Hyperplastic arteriolosclerosis

443
Q

The left heart diastolic volume and stroke volume are reduced, resulting in decreased systemic blood pressure during inspiration, and hence pulsus paradoxus

A

Conditions that impair expansion into the pericardial space

444
Q

Which pathologies impair expansion into the pericardial space?

A

Acute cardiac tamponade, constrictive pericarditis, severe obstructive lung disease, and restrictive cardiomyopathy

445
Q

For acute asthma exacerbation treated with beta adrenergic agonist, which type of receptor do they have? What is the effect?

A

This receptor is a Gs protein coupled receptor that activates adenylyl cyclase and increases intracellular cAMP concentrations

446
Q

This drug mechanism of action is to stabilize mast cells

A

Cromolyn

447
Q

Which hormones increase the production of cGMP?

A

Nitric oxide and atrial natriuretic peptide

448
Q

Drug that increases levels of cGMP by inhibiting its degradation

A

Sildenafil

449
Q

Half life of adenosine

A

10 seconds

450
Q

Which Is the drug used for chemical stress test?

A

Adenosine

451
Q

Fever for 5 days, cervical lymph node>1.5 c,, rash, bilateral nonexudative conjunctivitis, mucositis, coronary artery aneurysms,swelling &/or erythema of palms/soles

A

Kawasaki disease

452
Q

Clinical findings of Kawasaki disease

A

Fever for 5 days, cervical lymph node>1.5 c,, rash, bilateral nonexudative conjunctivitis, mucositis, coronary artery aneurysms,swelling &/or erythema of palms/soles

453
Q

What is Kawasaki disease?

A

Vasculitis of Medium sized arteries that affects young children(usually age

454
Q

How is Kawasaki disease diagnosis done?

A

Fever for more than 5 days plus 4:

  1. Bilateral non exudative conjuntivitis
  2. Cervical lymphadenopathy
  3. Mucositis
  4. Extremity changes
  5. Rash
455
Q

How is mucositis seen in patients with Kawasaki disease?

A

Erythema of palatine mucosa, fissured erythematous lips, “strawberry” tongue

456
Q

Characteristics of the rash in Kawasaki disease

A

Polymorphous (usually urticarial) erythematous rash on the extremities that spreads centripetally to the trunk

457
Q

A serious complication of Kawasaki disease

A

Coronary artery inflammation leading to development of coronary artery aneurysm

458
Q

What does exertional syncope, harsh systolic murmur and asymmetric septal hypertrophy in a young man suggest?

A

Hypertrophic cardiomyopathy

459
Q

Most common cause if ventricular fibrillation in individuals below age 30

A

Hypertrophic cardiomyopathy

460
Q

Episodic and transient angina, chest pain, occurring during the nighttime hours and accompanied by temporal ST segment elevations

A

Prinzmetal’s variant angina

461
Q

When does Prinzmetal angina occur?

A

Generally occurs at rest

462
Q

Which is the most sensitive provocative diagnostic test for coronary. Vasospasm?

A

Ergonovine

463
Q

Ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha adrenergic and serotoninergic receptors

A

Ergotamina

464
Q

Which drug is used to treat Prinzmetal’s angina?

A

Nitroglycerin

465
Q

Used to treat and prevent Prinzmetal’s angina

A

Calcium channel blockers

466
Q

Which is the common evolution of capillary hemangiomas?

A

First increase in size then regresses

467
Q

When do capillary hemangiomas normally completely regress?

A

By 7 years old

468
Q

Situations that can lead to concentric left ventricular hypertrophy

A

Pressure overload: chronic hypertension or aortic stenosis

469
Q

Situations that lead to eccentric ventricular hypertrophy

A

Volume overload: aortic or mitral regurgitation, myocardial infarction or dilated cardiomyopathy

470
Q

What is deposited in localized amyloidosis confined to the cardiac atria?

A

Abnormally folded atrial natriuretic peptide derived proteins

471
Q

In which patients is Amylin usually found?

A

In patients with localized pancreatic amyloidosis

472
Q

Percentage of patients with type 2 diabetes that have Amylin deposits

A

90%

473
Q

Who is responsible for primary systemic (not localized) amyloidosis?

A

Deposition of immune globulin light chains, especially delta light chains and fragments

474
Q

When does primary systemic amyloidosis arise?

A

In association with monoclonal B cell proliferation (eg. Multiple myeloma)

475
Q

Which deposit may be seen in Patients with medullary thyroid cancer?

A

Calcitonin

476
Q

Which deposit may be seen in Patients with amyloidosis of pituitary gland?

A

Prolactin

477
Q

Which is the most common cause of intermittent claudication?

A

Almost always the result of atherosclerosis larger named arteries

478
Q

What does thigh claudication is suggestive for?

A

Occlusive disease of the ipsilateral external iliac or common femoral arteries and/or both superficial femoral and profunda femoris arteries

479
Q

Seen in about 25% of patients with hypertrophic cardiomyopathy

A

Left ventricular outflow tract obstruction

480
Q

In patients with hypertrophic cardiomyopathy how is Left ventricular outflow tract obstruction heard?

A

Harsh crescendo decrescendo systolic ejection type murmur that is best heard along the lower left sternal border and apex

481
Q

On what varies the degree of Left ventricular outflow tract obstruction?

A

On Left Ventricular end diastolic volume

482
Q

Maneuvers that decrease the preload

A

Sudden standing, Valsalva or Nitroglycerin administration

483
Q

Maneuvers that increase preload and/or afterload

A

Squatting, sustained hand grip or passive leg rising

484
Q

Which maneuvers will increase murmur intensity of Left ventricular outflow tract obstruction?

A

Maneuvers that decrease preload

Sudden standing, Valsalva or Nitroglycerin administration

485
Q

Which maneuvers will decrease murmur intensity of Left ventricular outflow tract obstruction?

A

Maneuvers that increase preload and/or afterload

Squatting, sustained hand grip or passive leg rising

486
Q

Hemodynamic signs for constrictive pericarditis

A

increased jugular venous pressure
Kussmaul sign
Pulsus paradoxus
Pericardial knock

487
Q

When is a loud P2 heard?

A

In pulmonary hypertension

CARDIOVASCULAR (6 decks)

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