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PPS - From Nelson's > Cardio > Flashcards

Cardio Flashcards

1
Q

wide pulse pressure seen in

A 
pda
truncus arteriosus
avm
aortic insufficiency
anemia
sepsis
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2
Q

narrow pulse pressure seen in

A

pericardial tamponade
aortic stenosis
heart failure

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3
Q

cardiac in hunter hurler

A

valvular insufficiency, heart failure, hypertension

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4
Q

cardiac in duchenne dystrophy

A

cardiomyopathy, heart failure

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5
Q

cardiac in pompe

A

short PR interval
cardiomegaly
heart failure
arrhythmia

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6
Q

cardiac in kawasaki

A

coronary artery aneurysm
thrombosis
myocardial infarction
myocarditis

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7
Q

cardiac in marfan

A

aortic and mitral insufficiency

dissecting aortic aneurysm

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8
Q

cardiac in juvenile rheumatoid arthritis

A

pericarditis

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9
Q

cardiac in sle

A

pericarditis
libman sacks endocarditis
congenital AV block

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10
Q

cardiac in lyme

A

arrhythmias
myocarditis
heart failure

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11
Q

cardiac in graves

A

tachycardia
arrhythmias
heart failure

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12
Q

cardiac in tuberous sclerosis

A

cardiac rhabdomyoma

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13
Q

cardiac in neurofibromatosis

A

pulmonic stenosis

coA

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14
Q

cardiac in trisomy 21

A

endocardial cushion defect
vsd
asd
pda

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15
Q

cardiac in trisomy 18

A

vsd
asd
pda
ps

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16
Q

cardiac in trisomy 13

A

vsd
asd
pda
dextrocardia

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17
Q

cardiac turner

A

coA

aortic stenosis

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18
Q

cardiac in CHARGE (coloboma, heart, atresia choanae, retardation, genital and ear abnormalities)

A

tof

aortic arch and conotruncal anomalies

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19
Q

cardiac in digeorge

A

aortic arch anomalies

conotruncal anomalies

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20
Q

cardiac in vacterl

A

vas

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21
Q

cardiac in william syndrome

A

supravalvular aortic stenosis

peripheral pulmonary stenosis

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22
Q

cardiac of infant of diabetic mother

A

hypertrophic cardiomyopathy
vsd
conotruncal anomalies

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23
Q

cardiac of asplenia syndrome

A 
complex cyanotic heart
anomalous pulmonary venous return
dextrocardia
single ventricle
single AV valve
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24
Q

cardiac in polysplenia syndrome

A

azygos continuation of inferior vena cava
pulmonary atresia
dextrocardia
single ventricle

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25
Q

cardiac in fetal alcohol syndrome

A

vsd

asd

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26
Q

cardiac in fetal hydantoin syndrome

exposure to teratogenic effects of phenytoin or carbamazepine

A

tga
vsd
tof

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27
Q

s1 associated with closing of

A

mitral and tricuspid valves

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28
Q

s2 associated with closing of

A

aortic and pulmonic valves

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29
Q

s2 should normally split in

A

inhalation

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30
Q

s4 indicates

A

diastolic failure

lvh

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31
Q

s3 indicates

A

cardiomyopathy

failure

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32
Q

pulmonary ejection murmur radiates to

A

back and axilla

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33
Q

aortic ejection murmur radiates to

A

neck

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34
Q

class I antiarrhythmic drug

A

Depression of phase of depolarization (velocity of upstroke of action potential); sodium channel blockade

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35
Q

class Ia antiarrhythmic drug

A

Prolongation of QRS complex and QT interval

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36
Q

class Ia antiarrhythmic drug ex.

A

Quinidine, procainamide, disopyramide

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37
Q

class Ib antiarrhythmic drug

A

Significant effect on abnormal conduction

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38
Q

class Ib antiarrhythmic drug ex.

A

Lidocaine, mexiletine, phenytoin, tocainide

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39
Q

class Ic antiarrhythmic drug

A

Prolongation of QRS complex and PR interval

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40
Q

class Ic antiarrhythmic drug ex.

A

Flecainide, propafenone, moricizine?

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41
Q

class II antiarrhythmic drug

A

β blockade; slowing of sinus rate; prolongation of PR interval

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42
Q

class II antiarrhythmic drug ex.

A

Propranolol, atenolol, acebutolol

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43
Q

class III antiarrhythmic drug

A

Prolongation of action potential; prolongation of PR, QT intervals, QRS complex; sodium and calcium channel blockade

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44
Q

class III antiarrhythmic drug ex.

A

Bretylium, amiodarone, sotalol

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45
Q

class IV antiarrhythmic drug

A

Calcium channel blockade; reduction in sinus and AV node pacemaker activity and conduction; prolongation of PR interval

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46
Q

class IV antiarrhythmic drug ex.

A

Verapamil and other calcium channel blocking agents

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47
Q

physio and anatomic problem:

Cyanosis with respiratory distress

A

Increased pulmonary blood flow

Transposition

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48
Q

physio and anatomic problem:

Cyanosis without respiratory distress

A

Decreased pulmonary blood flow

Right heart obstruction

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49
Q

physio and anatomic problem:

hypoperfusion

A

EITHER:
Poor cardiac output
Left heart obstruction

OR

Poor cardiac function
Normal anatomy

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50
Q

physio and anatomic problem:

Respiratory distress with desaturation (not visible cyanosis)

A

Bidirectional shunting

Complete mixing

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51
Q

physio and anatomic problem:

Respiratory distress with normal saturation

A

Left-to-right shunting

Simple intracardiac shunt

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52
Q

surgery for tricuspid atresia

A

Surgery is staged with an initial subclavian artery-to-pulmonary shunt (Blalock­Taussig procedure) typically followed by
a two-stage procedure: bidirectional cavopulmonary shunt (bidirectional Glenn) and Fontan procedure

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53
Q

surgery for hypoplastic left heart

A

surgical repair is staged with the first surgery (Norwood procedure) done in the newborn period.

Subsequent procedures create a systemic source for the pulmonary circulation (bidirectional Glenn and Fontan procedures), leaving the right ventricle to supply systemic circulation

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54
Q

factors affecting PRELOAD

A 
Total blood volume
Venous tone (sympathetic tone)
Body position
Intrathoracic and intrapericardial pressure
Atrial contraction
Pumping action of skeletal muscle
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55
Q

factors affecting AFTERLOAD

A

Peripheral vascular resistance
Left ventricular volume (preload, wall tension)
Physical characteristics of the arterial tree (elasticity of vessels or presence of outflow obstruction)

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56
Q

factors affecting contractility

A 
Sympathetic nerve impulses*
Circulating catecholamines*
Digitalis, calcium, other inotropic agents*
Increased heart rate or postextrasystolic augmentation*
Anoxia, acidosis†
Pharmacologic depression†
Loss of myocardium†
Intrinsic depression†
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57
Q

etiology in dilated cardiomyopathy

A

Infectious
Metabolic
Toxic
Idiopathic

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58
Q

hemodynamics in dilated cardiomyopathy

A

Decreased systolic function

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59
Q

tx in in dilated cardiomyopathy

A 
Positive inotropes 
Diuretics
Afterload reduction 
β-Blockers 
Antiarrhythmics 
Anticoagulants
Cardiac transplantation
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60
Q

etiology in hypertrophic cardiomyopathy

A 
Sporadic
Inherited (autosomal dominant)
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61
Q

hemodynamics in hypertrophic cardiomyopathy

A

Diastolic dysfunction (impaired ventricular filling)

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62
Q

tx in in hypertrophic cardiomyopathy

A

β-Blockers

Calcium channel blockers

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63
Q

etiology in restrictive cardiomyopathy

A 
Infiltrative (amyloidosis, sarcoidosis) 
Noninfilltrative (idiopathic, familial) 
Storage disease (hemochromatosis, Fabry disease)
Endomyocardial disease
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64
Q

hemodynamics in restrictive cardiomyopathy

A

Diastolic dysfunction (impaired ventricular filling)

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65
Q

tx in in restrictive cardiomyopathy

A

Diuretics
Anticoagulants
Cardiac transplantation

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66
Q

signs nonconstrictive pericarditis

A

Fever
Tachycardia
Friction rub (accentuated by inspiration, body position)
Enlarged heart by percussion and x-ray examination
Distant heart sounds

67
Q

signs in tamponade

A 
Distended neck veins
Hepatomegaly
Pulsus paradoxus (>10 mm Hg with inspiration)
Narrow pulse pressure
Weak pulse, poor peripheral perfusion
68
Q

signs in constrictive pericarditis

A 
Distended neck veins
Kussmaul sign (inspiratory increase in jugular venous pressure)
Distant heart sounds
Pericardial knock
Hepatomegaly
Ascites
Edema
Tachycardia
69
Q

Wide splitting is noted in

A

atrial septal defect, pulmonary stenosis, Ebstein anomaly, total anomalous pulmonary venous return, and right bundle branch block

70
Q

A single 2nd sound occurs in

A

pulmonary or aortic atresia or severe stenosis, truncus arteriosus, transposition of the great arteries.

71
Q

midsystolic click

A

mvp

72
Q

total fetal cardiac output—the combined output of both the left and right ventricles—is

A

≈450 mL/kg/min

73
Q

in transition of fetus to neonate, the LV will need to do 200% increase cardiac output of

A

≈350 mL/kg/min

74
Q

normal adult cardiac output of approximately

A

75 mL/kg/min

75
Q

foramen ovale is usually functionally closed by the

A

3rd mo of life

76
Q

Functional closure of the ductus arteriosus is usually complete by

A

10-15 hr

77
Q

When the Po2 of the blood passing through the ductus reaches about __ mm Hg, the ductal wall begins to constrict

A

50 mm Hg

78
Q

Cyanosis, the visible sign of this shunt, occurs when approximately ___ of reduced hemoglobin is present in systemic blood

A

5 g/100 mL

79
Q

balloon atrial septostomy

A

rashkind procedure

80
Q

___ remains leading cause of death in kids with anomalies

A

congenital heart disease

81
Q

qp:qs 2:1 implies

A

twice the normal pulmo blod flow

82
Q

hypoplastic or absent radii
1st degree AV block
ASD
autosomal dominant

A

holt oram syndrome

83
Q

VSD pressure is restrictive meaningn

A

RV pressure is normal

84
Q

indications for surgical correction vsd

A

any age large defects with symptoms that can’t be controlled medically
infant 6-12mo old with large defects assoc with pulmo hypertension even if controlled
patient >24mo with qp:qs > 2:1
supracristal VSD of any size

85
Q

pulmonary stenosis is a common finding in

A

noonan and alagille

86
Q 
suprevalvular aortic stenosis with pulmonary branch stenosis
idiopathic hypercalcemia of infancy
elfin facies
mental retardation
deletion in chrosome 7 (maternal)
A

williams

87
Q

subvalvar aortic stenosis
mitral stenosis
coarctation of aorta

A

shone syndrome

88
Q

most coarctation of the aorta occur

A

just below origin of the left subclavian artery at the origin of the ductus arteriosus
juxtaductal coarctation

89
Q 
posterior brain fossa abnormalities
facial hemangiomas
arterial anomalies
cardiac anomalies like coarctation of aorta
eye anomalies
A

PHACE syndrome

90
Q

interrupted aortic arch type b associated wtih

A

digeorge 22q11

91
Q

stenosis of common pulmonary vein

A

cor triatriatum

92
Q

mitral valve prolapse

A

Marfan syndrome, straight back syndrome, pectus excavatum, scoliosis, Ehlers-Danlos syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum.

93
Q

prolapse is defined as

A

> 2mm movement from long axis

valve thickening >5mm is “classic”

94
Q

tx for taussig bing malformation

A

rastelli

95
Q

normally the aorta is. ___ to the pulmonary artery

A

posterior and right

96
Q

position d tga

A

aorta is anterior and to the right of pulmonary artery

97
Q

d tga more common in

A

males of diabetic moms

98
Q

successful rashkind procedure for TGA will cause paO2 to rise

A

35-50mmhg

99
Q

surgical treatment of choice TGA

A 
arterial switch (Jatene) procedure
performed in 2wks
100
Q

atrial switch

A

mustard or senning operation

101
Q

disadvantage of atrial switch TGA

A

right ventricle as systemic pumping chamber

102
Q

L TGA

A

ventricular inversion

103
Q

t or f

prostaglandin effective for TAPVR

A

false

104
Q

cxray finding of TAPVR in neonate

A

perihilar pulmonary edema with small heart

105
Q

hypoplastic left heart associated with

A

turner syndrome
trisomy 13 and 18
holt oram syndrome
rubinstein taybi syndrome

106
Q

tx for hypoplastic left heart

A

norwood

sano

107
Q

anomalous venous return from lung

A

scimitar syndrome

108
Q

blood flow from the left coronary artery is reversed (empties to pulmonary artery) in ALCAPA

A

myocardial steal

109
Q

angiomas of nasal and buccal mucus membrane, GI tract, liver
mutation in endoglin gene
communication between pulmonary artery and vein thus bypassing lungs
no cardiomegaly

A

osler weber rendu syndrome

hereditary hemorrhagic telangiectasia type I

110
Q 
ectopia cordis
midline supraumbilical ab defect
anterior diaphragm deficiency
defect in lower sternum
intracardiac defect (VSD, TOF, or diverticulum of the left ventricle)
A

pentalogy of cantrell

111
Q

heath edwards classification of patho changes in eisenmengerization

A

Grade I changes involve medial hypertrophy alone
grade II consists of medial hypertrophy and intimal hyperplasia
grade III involves near obliteration of the vessel lumen
grade IV includes arterial dilation
grades V and VI include plexiform lesions, angiomatoid formation, and fibbrinoid necrosis

112
Q

which grades indicate irreversible pulmo vascular obstructive disease

A

grade IV to VI

113
Q

eisenmenger physio defined as pulmo arterial resistance to greater than

A

12 wood units or

ratio of pulmo to systemic resistance of > or = to 1

114
Q

endocarditis prophylaxis needed for

A

patients with previous endocarditis
unrepaired cyanotic CHD
completely repaired congenital heart defects with prosthetic material or device during the 1st 6 mo after the procedure
repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

115
Q

seen wolff parkinson white syndrome
atrial -> ventricle conduction bundle of kent
normal qrs

A

orthodromic conduction

116
Q

seen wolff parkinson white syndrome
ventricle -> atrial conduction retrograde reentry
wide qrs

A

antidromic conduction

117
Q

treatment of choice for AVNRT AV nodal re entrant tachycardia

A

adenosine

118
Q

in WPW what drugs are contraindicated

A

digoxin and ca channel blockers

119
Q

non WPW DOC for arrhythmia control

A

b blockers

or digoxin

120
Q

DOC for WPW

A

b blockers

121
Q

DOC for junctional ectopic tachycardia JET

A

amiodaron

sotalol

122
Q

tx for atrial flutter

A

synchronized DC cardioversion

123
Q

tx for atrial fibrillation

A

ca channel blockers

124
Q

DOC for stable vtach

A

amiodarone
lidocaine
procainamide

125
Q

LQT1 events are

A

stress induced

126
Q

LQT3 events

A

occur during sleep

127
Q

drugs assoc with prolonged QT

A 
erythromycin
clarithromycin
azithromycin
cotrimoxazole
cipro
fluconazole
amitriptylline
haloperidol
risperidone
128
Q

tx for long QT syndrome

A

b blockers

129
Q

abnormality in conduction pathway esp after surgery

sometimes with tachy-brady syndrome

A

sick sinus syndrome

130
Q

maternally derived antibodies that cause congenital heart block

A

anti SSA/Ro

anti SSB/La

131
Q

fainting spell due to heart block

A

stoke adams attacks

132
Q

likelihood that heart block post open heart surgery is low if it persists more than __days

A

10-14 days

133
Q

vfib after blunt nonpenetrating trauma to chest

A

commotio cordis

134
Q

leading causes of endocarditis in kids

A

viridans type streptococci (alpha hemolytic strep)

staph aureaus

135
Q

pathogen in endocarditis

more common in patients with heart disease

A

staph

136
Q

pathogen in endocarditis

common after dental procedures

A

viridans group strep

137
Q

pathogen in endocarditis

after lower bowel or genitourinary manipulation

A

group D enterococci

138
Q

pathogen in endocarditis

seen in IV drug users

A

pseudomonas

serratia marcescens

139
Q

pathogen in endocarditis

seen after open heart surgery

A

fungal

140
Q

pathogen in endocarditis

in presence of indwelling central venous catheter

A

coagulase negative staph

141
Q

childen at highest risk for endocarditis

A

prosthetic cardiac valves or other prosthetic material used for cardiac valve repair

unrepaired cyanotic congenital heart disease (including those palliated with shunts and conduits)

completely repaired defects with prosthetic material or device during the 1st 6 mo after repair

repaired congenital heart disease with residual defects at or adjacent to the site of a prosthetic patch or device

valve stenosis or insuffciency occurring after heart transplantation

permanent valve disease from rheumatic fever (mitral stenosis, aortic regurgitation)

previous infective endocarditis

142
Q

greatest risk of embolization in endocarditis if

A

> 1cm mass

fungating

143
Q

diagnosis of endocarditis

Duke criteria

A

Major criteria include

(1) positive blood cultures (2 separate cultures for a usual pathogen, 2 or more for less-typical pathogens)
(2) evidence of endocarditis on echocardiography (intracardiac mass on a valve or other site, regurgitant flow near a prosthesis, abscess, partial dehis- cence of prosthetic valves, or new valve regurgitant flow)

Minor criteria include
predisposing conditions,
fever,
embolic-vascular signs, i
mmune complex phenomena (glomerulonephritis, arthritis, rheuma- toid factor, Osler nodes, Roth spots),
a single, positive blood culture or serologic evidence of infection,
echocardiographic signs not meeting the major criteria.

Two major criteria, 1 major and 3 minor, or 5 minor criteria

144
Q

empiric therapy before pathogen identified in endocarditis

A

vancomycin

gentamicin

145
Q

apical presystolic murmur similar to mitral stenosis in RHD heard as result of regurgitant aortic flow preventing mitral valve to open fully

A

austin flint murmur

aortic insufficiency

146
Q

murmur in RHD simmilar to aortic insufficiency but without bounding pulses

A

graham steell murmur

147
Q

most common form of cardiomyopathy

A

dilated cardiomyopathy

148
Q

dilated cardiomyopathy

A

left ventricular dilatation

systolic dysfxn

149
Q

hypertrophic cardiomyopathy

A

diastolic dysfxn

increased ventricular wall thickness

150
Q

restrictive cardiomyopathy

A

nearly normal wall and chamber size
preserved systolic fxn
diastolic dysfxn

151
Q

associated with dilated cardiomyopathy

A 
duchenne
emery dreifuss
fatty acid oxidation disorders
carnitine abnormalities
organic acidemias
mitochondrial (kearns sayre syndrome)
alstrom syndrome
barth syndrome
152
Q

associated with hypertrophic cardiomyopathy

A

mitochondiral (friedreich ataxia)
stoarge disorders (pompe, fabry, mucopolysaccharidoses, hemochromatosis, danon disease)
noonan syndrome

153
Q

associated with restrictive cardiomyopathy

A

myofibrillar myopathies
storage disorders
familial restrictive cardiomyopathy

154
Q

autosomal recessive
chronic progressive external ophthalmoplegia
cerebellar ataxia, proximal muscle weakness, deafness, diabetes mellitus, growth hormone deficiency, hypoparathyroidism
dilated cardiomyopathy

A

Kearns–Sayre syndrome

155
Q 
x linked disorder
dilated (or sometime hypertrophic) cardiomyopathy
neutropenia
growth delay
cardiolipin abnormalities
phospholipid disorder
A

barth syndrome

156
Q

autosomal recessive
childhood obesity, blindness due to congenital retinal dystrophy, and sensorineural hearing loss
hyperinsulinemia, early-onset type 2 diabetes, and hypertriglyceridemia
dilated cardiomyopathy

A

Alström syndrome

157
Q

autosomal recessive
progressive damage to the nervous system
hypertrophic cardiomyopathy
reeduced expression of mitochondiral protein FRATAXIN

A

friedreich ataxia

158
Q 
autosomal receessive
glycogen storage disease typeII
deficiency lysosomal acid alpha-glucosidase enzyme
progressive muscle weakness (myopathy) 
hypertrophic cardiomyopathy
A

pompe disease

159
Q 
x linked
lysosomal storage disease
kidney failure
pain
hypertrophic cardiomyopathy
angiokeratomas
neuropathy
A

fabry disease

160
Q

glycogen storage type IIB
X-linked lysosomal and glycogen storage disorder
hypertrophic cardiomyopathy
skeletal muscle weakness, and intellectual disability

A

danon disease

161
Q 
post cardiac surgery 7-14 days ago
fever
lethargy
anorexia
irritability
chest/ab discomfort
A

postpericardieotomy syndrome

162
Q

DOC for hypertensive diabetics with proteinuria

A

ACE inhibitors or ARBs

163
Q

DOC for hypertensive with headache or migraine

A

b blocker

ca channel blocker

164
Q

in hypertensive emergency, reduction of BP should be

A

10% in first hour

15% more in next 3-12 hours

PPS - From Nelson's (24 decks)

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