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UWorld Missed Questions > Cardio > Flashcards

Cardio Flashcards

1
Q

50 year old man, dizzy confused. Took nitroglycerin + Tadafalil. BP is 50/20. What cellular changes are responsible?

A

Interaction between nitrates and PDE inhibitors = cGMP accumulation.

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2
Q

46 male. Starts with RIGHT sided DVT and ends up with LEFT sided cerebral stroke.

A

Paradoxical Embolism.
From Patent Foramen, ASD, VSD, AVM. Transient reversal of shunt during elevated right sided pressure (ie cough).

ASD = wide and fixed splitting, no change with respiration.

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3
Q

Fenoldopam

A

Derivative of Dopamine. Selective Dopamine-1 Agonist. increases cAMP. Results in arteriolar VASODILATION of RENAL, mesenteric, and coronary beds.

Short term management of severe HTN, especially in patient with renal insufficiency.

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4
Q

Esmolol

A

Quick acting Selective B1 antagonist = Decrease HR, Contractility, and CO

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5
Q

Diaoxide, Hydralazine

A

ATERIAL vasodilators. Relfex tachycardia. 3rd line in HTN emergency.

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6
Q

Nitroprusside

A

Very potent direct acting ARTERIAL and VENOUS Dilator. 1st line in HTM emerg.

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7
Q

Purpose of Double Blind Study

A

Prevent patient and researcher expectancy from intefering with determination of outcome = PREVENT OBSERVER BIAS.

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8
Q

Which component of CV system is most susceptible to this molecule? :

CH2-O-NO2
   |
CH2-O-NO2
   |
CH2-O-NO2
A

Nitroglycerin. Large Veins

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9
Q

Pharmacological Principles:
Permissiveness = ?
Additive/Synergistic = ?
Tachyphylaxis=?

A
  • when one hormone/drugs allows another to each if its max effect (cortisol and norepinephrine)
  • combination of 2 drugs that have SIMILAR ACTIONS. If equals SUM of the individual drugs then is ADDITIVE. If equals more than sum of both individual drugs then SYGERGISTC.
  • decreased drug responsiveness in short period of time (rapid developing tolerance)
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10
Q

Missed question because did not know the different effects of Epi, Phenylephrine, Dopamine on Syst. BP, Diast. BP, HR, Contractility, Renal Blood Flow.

A

SBP \ DBP \ HR \ Contractil \ RBF
Epi (a+B) + - + + none

Phenyl (a1) + + - none -

LowDose
Dopamine + none + + +
(B1 + D1)

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11
Q

Effects of Dopamine at Low, Higher, Highest doses

A

Low = D1 receptors. Renal Vascular DILATION. Increase RBF, Na excretion and GFR.

Higher = B1 agonist in heart. Increase contractility, SBP, HR.

Highest = a1 agonist in sys vasculature. Increase afterload, vasocostriction. Decrease CO.

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12
Q

Bohr effect

Haldane Effect

A

Bohr = In PERIPHERAL tissues. Involved in O2 off-loading. O2 release enhanced by low pH and High pCO2

Haldane = In LUNG. Rise in pO2 causes release of CO2 and H+.

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13
Q

What substances utilize JAK/STAT transmembrane receptor?

A

GH, cytokines, prolactine, IL-2

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14
Q

What substances utilize Tyrosine receptor, NO Jak/Stat pathway?

A

Growth Factors: EGF, PDGF, FGF, etc

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15
Q

Change in color of resolving Hematoma is explained by activity of what enzyme?

A

Heme Oxygenase.

Hg containing RBCs get into tissue giving intial blue/purple color.

Cells lyse and Heme Oxygenase degrades heme to BILIVERDIN leading to green/yellow color.

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16
Q

Kozak sequence. Mutation in this sequence would lead to problems with what?

A

gccRccAUGG. Serves as intiator of translation/mRNA binding to ribosome.

R = Adenine or Guanine. Therefore, mutation at this position leads to problem with translation/binding to ribosome.

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17
Q

Hereditary anemia in which point mutation in B globin gene, resulting in G to C subsitution…?

A

Beta Thalassemia Intermediate. Hypochromic, Microcytic anemia, may have target cells.

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18
Q

What is a major difference b\t daughter strands during DNA Replication/synthesis ?

A

DNA Ligase and primase will act many more times on LAGGING STRAND.

Other than that all other processes are the same.

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19
Q

Steps of Catecholamine synthesis

A

look up

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20
Q

Newborn with poor feeding, vomiting, acidosis/ketosis/anion gap, hypotonia, hypoglycemia, lethargy. Increased propionic acid.

A

Propionyl CoA carboxylase deficiency.

Isoleucine, Methionine, Valine, and Threonine are odd chain fatty acids that lead to high propionic acid.

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21
Q

Pt with previous MI 1 year ago, a histo slide from autopsy show the scar from the MI. What type of collagen make up scar?

A

TYPE 1 - most abundant in body, bones, dermis, tendons, cornea, dentin, scars

After ACUTE MI there is some granulation tissue intially (TYPE 3 collagen), but it is eventually replaced.

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22
Q

52 year old smoker with malaise, dyspnea, decreased appetite. Fever, new murmur, and elevated WBCs. Culture is positive for Streptococcus Gallolyticus (s.bovi). What is the connection?

A

Pt should be screened for colon cancer.

Strep Gall is part of normal gut flora, can cause subacute endocarditis.

Bacteremia/SAE from Strep Gall is associated with ColonCancer in 25% of cases.

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23
Q

If this comes up in a question : Reliability and Precision are the same thing.

A

remember this so you dont get confused if it shows up in a question

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24
Q

47 year old, in high speed collision while wearing seatbelt. Chest/Abd Pain. Becomes unresponsive and pulseless in ED.

A

BLUNT AORTIC INJURY. From sudden deceleration. Die from aortic rupture.

Occurs most often at AORTIC ISTHMUS, adjacent to descending aorta.

25
Q

Pt with BICUSPID VALVE. Greatest risk for developing what?

A

AORTIC STENOSIS by AGE 50

26
Q

Greatest difference in O2 content between aorta and ……what other vessel?

A

Coronary Sinus.

Myocardial O2 extraction is VERY HIGH (60%-75%). Exceeds any other tissue.

27
Q

Flecainide

A

STRONG USE DEPENDENCE.

I.e. QRS duration will be prolonged during immediate recovery period of stress test.

28
Q

What maintains CO in chronic Aortic Regurge?

A

INCREASED SV, due to eccentric hypertrophy.

In ACUTE setting, it would be HR. Dont confuse acute with chronic.

29
Q

Identify Valve dysfunction using a Hemodynamic profile/graph

A

LOOK UP for aortic stenosis, regurge, etc

30
Q

Pharyngeal/Aortic Arches…..??!!

A

1st Pharyn/Aortic Arch = Trigeminal Nerve, Muscles of Mast, Max Artery

2nd = Facial Nerve, Muscles of Facial Express, NO BLOOD VESSELS

3rd= Glossopharyngeal Nerve, Stylopharyngeus Muscle, COMMON CARTOTIDS/INTERNAL CAROTIDS

4th= Vagus nerve, Muscles of pharynx and palate, True Aortic Arch and Subclavians

6th= RECURRENT LARYNGEAL BRANCHES, Pulmonary Arteries, PDA!!

31
Q

Number needed to Treat

A

( 1 / Event rate in Controls - Event rate in Treat Group)

OR ( 1 / Absolute Risk Reduction)

32
Q

Most common cause of sudden cardiac death (V fibb) in young, healthy person…?

What would autopsy show?

A

HTCM/HOCM

Autopsy would show massive cardiac hypertrophy

Missed this question bc I chose “endocardial thickening, non compliant ventricle “ which would be Restrictive Cardiomyopathy

33
Q

What path would embolus from left side of neck take to get to RETINAL ARTERY?

A

Left Internal Carotid > Opthalmic Artery > Retinal Artery

…I though it was External Carotid. REVIEW YOUR ANATOMY!!

34
Q

Question where a guy is buttoning the neck of his shirt, and passes out….How can massaging the Carotid Sinus, lead to slowing heart rate, vasodilaton, and potential PASSING OUT?

A

CAROTID SINUS uses the GLOSSOPHARYNGEAL NERVE as the AFFERENT SIGNALER.

AORTIC ARCH uses VAGUS NERVE as AFFERENT.

BOTH terminate in the SOLITARY NUCLEUS of MEDULLA

35
Q

What is the best indicator of Mitral Stenosis Severity ?

A

Length bt S2 (A2) and Opening Snap.

As MS worsens, pressure in LA goes up, and OS gets louder, and the interval SHORTENS. SHORTER interval = Worsening MS

36
Q

CYP450 INhibitors

A 
Cimetidine
Isonaizid
Macrolide (except Az)
Grapefruit Juice
Ritonavir
Cipro
Azole Antifungals
Binge Alcohol
Sulfanomides
Omeprazole
Metronidazole 
Chloramphenicol
37
Q

CYP450 inducers

A 
Rifampicin
Griseofulvin
Phenobarbitone
Sulphonylureas
Chronic Alcohol 
Carbemazepines
Phenytoin
38
Q

Methionine created from…?

A

Homocysteine

Requires B12

39
Q

In total ischemia of cardiac tissue, when does contractility STOP?

A

Within first 60 SECONDS. Aerobic Glycolysis stops, toxins/metabolites build, contraction stops. EVEN THOUGH ATP levels may intially remain high.

40
Q

In severe Aortic Stenosis, what other cardiac arrythmia are you at higher risk for?

A

ACUTE AFIBB….can lead to ACUTE LEFT SIDED HEART FAILURE and PULMONARY EDEMA…..due to SUDDEN decrease of PRELOAD IN LEFT VENTRICLE ….which backs up to lungs

41
Q

For a coronary bypass, where is the GREAT SAPHENOUS VEIN taken from ?

A

Medial aspect of Thigh, just INFEROLATERAL to PUBIC TUBERCLE

42
Q

How do Fibrates work?

A

Activate PPAR-a, which leads to DECREASE VLDL production, and INCREASED LPL production

Fish oils also decrease VLDL

43
Q

Timeline of cardiomyocyte injury after MI ?

A

MINIMAL CHANGE IN FIRST 4 HOURS.
Then COAGUL and NECROSIS (in first 24 hours)
Then Neutrophils (1-5 days)
Then Macrophages (5 - 10 days)
Then Granulation Tissue- collagen type 3 (10-14days)
Then scar

44
Q

Describe Mitral Regurgitation Murmur?

Best indicator of severity of this murmur?

A

Holosystolic Murmus, heard best at Apex, Radiate to Axilla.

Presence of S3.

45
Q

What Embryological event/defect correlates with Tetrallogy of Falot?

A

Deviation of Interventricular Septum

46
Q

Distinguish b/t presentation of SVC syndrome, Obstructed Right Brachiocephalic Vein, Obstructed Subclavian Vein…

A

SVCS = swelling and engorgement of veins in BOTH sides of face/neck, chest, and BOTH arms

Brachiocephalic = swelling and engorgement in UNILATERAL of face/neck/arm

Subclavian= swelling and engorgement in UNILATERAL arm

47
Q

Presentation and cause of Femoral Nerve Injury/Neuropathy?

A

Defect in Flexion of thigh and Extension on Leg, Difficulty climbing stairs, “Knee buckling”, Falls

Pelvic Fracture or Mass related to Iliopsoas/psoas muscle (Abcess/Hematoma)

48
Q

Strep Viridians in SABE adhere to what ?

A

Use DEXTRAN to adhere to FIBRIN and PLATELETS

49
Q

What antibodies present in pt with Rheumatoid Arthrits? Which is more SPECIFIC?

A

IgG antibody = less specific (found in 10% of healthy people, and people with SLE)

Anti-CCP = 95-98% SPECIFICITY

50
Q

How to calculate CO, given list of pressures and O2 contents….?

A

CO = SV x HR

CO = O2 consumption / Arteriorvenous O2 difference, this is the FICK PRINCIPLE

51
Q

Pt who has SABE, caused by Enterococci Bacteria (grow in 6.5% NaCl), what procedure likely led to the illness?

A

Missed because I did not know what Cystoscopy was … which is endoscopy of urinary bladder…

Common procedure that can lead to spread of enterococci.

52
Q

Define Pulsus Parodoxus

A

GREATER than 10mmHG in BP during INSPIRATION.

To measure: inflate BP cuff, and Subtract the BP at which heart sounds are heard ONLY during Expiration from BP at which heart sounds are heard throughout Inspiration/Expiration. Should be greater than 10 mm Hg.

53
Q

How to diagnose Kawasakis Disease on clinical presentation?

A

Fever for 5 days + 4 of the following:

  • Bright Red Conjuctiva, no pus
  • Red hands/feet with edema
  • Cervical Lymphadenopathy
  • Red tonuge, and Red cracked Lips
  • Polymorphous red rash that spreads to trunk

Young Asian kids. Increased risk of coronary anuerisym. Treat with aspirin and IVIG.

54
Q

Pt presenting with skin and mucosal talengectasias and recurrent nosebleeds…..

A

Osler-Weber-Rendu syndrome, Aut. Dominant, can lead to hematuria, nosebleeds, GI bleeds

55
Q

Von Recklinghausen’s is same thing as …..

A

NFT1

56
Q

COmmon side effect of CCBs Amolodipine and Nifedipine?

A

Peripheral Edema and DIzzy/lightheadedness

57
Q

Class III antiarrythmic drugs….name and how do they work?

A

Dofetlide, Amiodarone, Sotalol

They block outward flow of K from cardiomyocyte during Phase 3 of cardiac action potential

58
Q

Long acting Isosorbide Dinitrate - metabolism, kinetics, why is it added?

A

Used for chronic nitrate therapy in someone with angina,

Have to use a HIGHER DOSE, bc of extensive FIRST PASS METABOLISM leads to LOW Bioavailability.

59
Q

Pt with sign of thromboembolic stroke, hx of Afibb with enlarged Left Atrium. Where in the heart was the embolus likely created?

A

Left Atrial Appendage.

If it was a post MI pt, then it would be left ventric. Apex

UWorld Missed Questions (10 decks)

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