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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
Pt with BICUSPID VALVE. Greatest risk for developing what?
AORTIC STENOSIS by AGE 50
26
Greatest difference in O2 content between aorta and ......what other vessel?
Coronary Sinus. Myocardial O2 extraction is VERY HIGH (60%-75%). Exceeds any other tissue.
27
Flecainide
STRONG USE DEPENDENCE. I.e. QRS duration will be prolonged during immediate recovery period of stress test.
28
What maintains CO in chronic Aortic Regurge?
INCREASED SV, due to eccentric hypertrophy. In ACUTE setting, it would be HR. Dont confuse acute with chronic.
29
Identify Valve dysfunction using a Hemodynamic profile/graph
LOOK UP for aortic stenosis, regurge, etc
30
Pharyngeal/Aortic Arches.....??!!
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
Number needed to Treat
( 1 / Event rate in Controls - Event rate in Treat Group) OR ( 1 / Absolute Risk Reduction)
32
Most common cause of sudden cardiac death (V fibb) in young, healthy person...? What would autopsy show?
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
What path would embolus from left side of neck take to get to RETINAL ARTERY?
Left Internal Carotid > Opthalmic Artery > Retinal Artery ...I though it was External Carotid. REVIEW YOUR ANATOMY!!
34
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?
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
What is the best indicator of Mitral Stenosis Severity ?
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
CYP450 INhibitors
``` Cimetidine Isonaizid Macrolide (except Az) Grapefruit Juice Ritonavir Cipro Azole Antifungals Binge Alcohol Sulfanomides Omeprazole Metronidazole Chloramphenicol ```
37
CYP450 inducers
``` Rifampicin Griseofulvin Phenobarbitone Sulphonylureas Chronic Alcohol Carbemazepines Phenytoin ```
38
Methionine created from...?
Homocysteine Requires B12
39
In total ischemia of cardiac tissue, when does contractility STOP?
Within first 60 SECONDS. Aerobic Glycolysis stops, toxins/metabolites build, contraction stops. EVEN THOUGH ATP levels may intially remain high.
40
In severe Aortic Stenosis, what other cardiac arrythmia are you at higher risk for?
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
For a coronary bypass, where is the GREAT SAPHENOUS VEIN taken from ?
Medial aspect of Thigh, just INFEROLATERAL to PUBIC TUBERCLE
42
How do Fibrates work?
Activate PPAR-a, which leads to DECREASE VLDL production, and INCREASED LPL production Fish oils also decrease VLDL
43
Timeline of cardiomyocyte injury after MI ?
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
Describe Mitral Regurgitation Murmur? | Best indicator of severity of this murmur?
Holosystolic Murmus, heard best at Apex, Radiate to Axilla. Presence of S3.
45
What Embryological event/defect correlates with Tetrallogy of Falot?
Deviation of Interventricular Septum
46
Distinguish b/t presentation of SVC syndrome, Obstructed Right Brachiocephalic Vein, Obstructed Subclavian Vein...
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
Presentation and cause of Femoral Nerve Injury/Neuropathy?
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
Strep Viridians in SABE adhere to what ?
Use DEXTRAN to adhere to FIBRIN and PLATELETS
49
What antibodies present in pt with Rheumatoid Arthrits? Which is more SPECIFIC?
IgG antibody = less specific (found in 10% of healthy people, and people with SLE) Anti-CCP = 95-98% SPECIFICITY
50
How to calculate CO, given list of pressures and O2 contents....?
CO = SV x HR CO = O2 consumption / Arteriorvenous O2 difference, this is the FICK PRINCIPLE
51
Pt who has SABE, caused by Enterococci Bacteria (grow in 6.5% NaCl), what procedure likely led to the illness?
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
Define Pulsus Parodoxus
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
How to diagnose Kawasakis Disease on clinical presentation?
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
Pt presenting with skin and mucosal talengectasias and recurrent nosebleeds.....
Osler-Weber-Rendu syndrome, Aut. Dominant, can lead to hematuria, nosebleeds, GI bleeds
55
Von Recklinghausen's is same thing as .....
NFT1
56
COmmon side effect of CCBs Amolodipine and Nifedipine?
Peripheral Edema and DIzzy/lightheadedness
57
Class III antiarrythmic drugs....name and how do they work?
Dofetlide, Amiodarone, Sotalol They block outward flow of K from cardiomyocyte during Phase 3 of cardiac action potential
58
Long acting Isosorbide Dinitrate - metabolism, kinetics, why is it added?
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
Pt with sign of thromboembolic stroke, hx of Afibb with enlarged Left Atrium. Where in the heart was the embolus likely created?
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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