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Step 1 Questions > Cardio > Flashcards

Cardio Flashcards

1
Q

Streptocuccus Bovis endocarditis

A

Associated with colon cancer. Causes subacute bacterial endocarditis. Occurs in patient with NO preexisting valvular abnormality.

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2
Q

Holosystolic murmur at the apex that radiates to the axilla. What is the best indicator of severity of the problem?

A

Presence of S3: indicates high volume of regurgitant flow (mitral regurgitation)

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3
Q

pt dies in motor accident n biopsy shows heavy calcification of the ortic valve. What most likely preceded this?

A

Cell necrosis

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4
Q

Stages of Dystrophic calcificaiton

A

Initiation: within the mitochondria of dying cells and Propagation: can perforate the membrane.

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5
Q

Pt with tetralogy of Fallot squats to relieve cyanosis. The posture helps to?

A

Increase systemic vascular resistance

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6
Q

A drug dilates arterioles and veins and promotes diuresis. What is its endogenous analog?

A

Brain natriuretic peptide/atrial natriuretic peptide

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7
Q

A drug that dilates arterioles and veins and promotes diuresis

A

Nesiritide.

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8
Q

MOA of Atrial natriuretic peptide

A

activate guanylate cyclase which increases intracellular cyclic GMP causing vasodilation and diuresis.

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9
Q

In systolic heart failure which is increased blood volume within the heart causing stretch of atria and ventricles, which hormones are released?

A

Atrial natriuretic peptide and brain (ventricular) natriuretic peptide

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10
Q

Risk factor for infective endocarditis

A

Prosthetic heart valves, prior valvular inflammation and scarring

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11
Q

Pathogenesis of vegetations caused by S.Aureus

A

S.aureus can bind to normal valves due to expression of multiple surface adhesins. Then tissue factor expression results in platelet and fibrin deposition and formation of vegetation. It can then embolize and cause sepsis.

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12
Q

S.Aureus vegetations in endocarditis have?

A

Fibrin and platelets deposition.

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13
Q

Mitras stenosis Murmur

A

opening snap early in diastole due to tensing of the leaflets after they have already opened.

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14
Q

Stable angina

A

chest pain with exertion, relieved by rest or nitroglycerin

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15
Q

Stable angina pathophysiology

A

Fixed atheromatous obstruction of coronary occluding at least 75% of the luminal cross sectional area.

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16
Q

Unstable angina pathophysiology

A

Ulcerated atherosclerotic plaque with a partially obstructive thrombus.

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17
Q

Drug that can cause Prinzmetal’s angina

A

Ergonovine

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18
Q

MOA of ergonovine

A

ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha-adrenergic and serotonergic receptors. Can induce coronary spams

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19
Q

Pathophys of Prinzmetal’s angina (variant)

A

Caused by coronary artery vasospam that may occur near sites of atherosclerosis and can result in transient transmural ischemia with ST-segment Elevation

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20
Q

Prinzmetal’s angina

A

episodic angina that occurs at REST due to coronary vasospasm.

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21
Q

Mitral regurgitation

A

Blowing, holosystolic murmur heard best over the apex with radiation to the axilla.

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22
Q

Valve most affected by rheumatic heart disease

A

MITRAL, acute: regurgitaiton and chronic:stenosis

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23
Q

Congenital malformation that is normal in some adults

A

Foramen ovale: abnormalities increasing the right atrial pressure can produce a right to left shunt across the patent foramen ovale.

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24
Q

Rheumatic fever criteria

A

JONES, Joint, O is heart, Nodules, Erythema marginatum, Sydenham chorea

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25
Q

Theumatic fever

A

autoimmune reaction that occur following untreated Streptococcus pyogenes pharyngitis due to molecular mimicry.

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26
Q

Organism that causes subacute bacterial endocarditis

A

Viridians streptococci: colonizes valves with preexisting defects after dental manipulation

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27
Q

Bacteria that causes dental caries

A

Viridians streptococci (mutans)

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28
Q

gram-positive cocci in blood of patient with bactermia able to synthezise dextrans from glucose

A

Viridians streptococci

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29
Q

Aortic stenosis murmur

A

systolic crescendo-decrescendo following an ejection click

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30
Q

Kaussmaul’s sign

A

paradoxical rise in the height of the jugular venous pressure during inspiration

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31
Q

dense, thick fibrous tissue in the pericardial space between the visceral and parietal pericardium.

A

Constrictive pericarditis

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32
Q

Findings on constrictive pericarditis

A

Restricted ventricular filling, low cardiac output and right-sided heart failure resistant to medications

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33
Q

bilateral basilar lung crackels, left ventricular hypertrophy. Pulmonary arterial hypertension. The most likely mechanism for this pt pulmonary HTN?

A

Reactive vasoconstriction due to venous congestion

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34
Q

Most common cause of Right sided heart failure

A

Left sided heart failure

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35
Q

most common cause of left sided heart failure

A

Chronic hypertension

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36
Q

What does left ventricular dysfunction lead to?

A

Increased pulmonary arterial pressure due to reactive vasoconstriction secondary to pulmonary venous congestion

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37
Q

Fibromuscular dysplasia

A

irregular thickenning of large and medium sized arteries especially the renal artery, disease affecting women 20-30 years old

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38
Q

Renal artery stenosis treatment

A

be careful with ACE inhibitors because Angiotensin II is necessary to keep a GFR.

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39
Q

Gross finding in Renal artery stenosis

A

one sided kidney atrophy

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40
Q

which population does renal artery stenosis affect

A

elderly individuals due to atherosclerothic changes in intima and women in chilbearing age (fibromuscular dysplasia)

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41
Q

cherry hemangioma

A

affects adults, do not regress spontaneously yet number increase.

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42
Q

histology of cherry hemangioma

A

sharply circumscribed areas of congested capillaries and post-capillary venules in the papillary dermis

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43
Q

small red cutaneous papules common n aging adults that do not regress spontaneously

A

cherry hemangiomas

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44
Q

abnormal prominent left atrial v wave present in which murmur?

A

mitral regurgitation

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45
Q

Adult onset asthma and eosinophilia. P-ACNA

A

Churg-Strauss syndrome

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46
Q

fixed wide splitting of the second heart sound

A

ASD

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47
Q

complication of ASD

A

chronic pulmonary hypertension as a result of the left-to-right shunt. Aka increased blood flow through the pulmonary artery

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48
Q

Eisenmenger syndrome

A

late-onset reversal of a left-to-right shunt due to pulmonary vascular sclerosis resulting from pulmonary hypertension.

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49
Q

extreme myofiber disarray with interstitial fibrosis on cardiac histology

A

hypertrophic cardiomyopathy

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50
Q

mutation in genes coding for sarcomere proteins, Beta-myosin heavy chain

A

Hypertrophic cardiomyopathy

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51
Q

pt with extended consumption of appetite supressant, progressive dyspnea and dizzines on exertion. What pathologic findings would you have?

A

Right ventricular hypertrophy

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52
Q

side effects of appetite supressants

A

secondary pulmonary hypertension, leading to right ventricular hypertrophy and cor pulmonale

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53
Q

appetite supressant

A

Fenfluramine, Dexfenfluramine and phentermine

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54
Q

familial hypercholesterolemia

A

autosomal dominant mutation of the LDL receptor gene in the liver. Causes fast progression of atherosclerosis and early coronary artery disease

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55
Q

Only Right heart fibrosis. Which substance will appear high in urine?

A

5 hydroxyindoleacetic acid (serotonin metabolite)

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56
Q

skin flushing, abdominal cramping, nausea, vomit, diarhea and endocardial fibrosis of right heart

A

Carcinoid syndrome

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57
Q

What is abnormaly produced by carcinoid tumors?

A

serotonin, kallikrein, bradykinin, histamine, prostaglandins and or tachikinins.

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58
Q

eicosanoid that inhibits platelet aggregation and adhesion to the vascular endothelium, vasodilates, increases vascular permeability and stimulates leukocyte chemotaxis

A

Prostacyclin

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59
Q

artery most likely to be affected by atherosclerosis

A

Abdominal aorta

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60
Q

arteries most likely to affected by atherosclerosis in order

A

abdominal aorta, coronary arteries, popliteal, internal carotid, circle of willis.

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61
Q

Down syndrome

A

endocardial cushion defects: ASD and regurgitant AV valves

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62
Q

DiGeorge syndrome

A

tetralogy of fallot and aortic arch abnormalities

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63
Q

turners syndrome

A

coarctation of the aorta

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64
Q

marfan’s syndrome

A

Cystic medial necrosis of aorta: aortic insufficiency and dissection

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65
Q

tuberous sclerosis

A

valvular obstruction due to cardiac rhabdomyomas

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66
Q

friedreich ataxia

A

hypertrophic cardiomyopathy

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67
Q

infant of diabetic mother

A

transposition of great vessels

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68
Q

pt in ER cuz of chest pain, diaphoresis and lightheadedness. Symptoms started 1 hour ago. ST segment elevations. Which type of cell injury will most likely present?

A

Coagulative necrosis

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69
Q

small bluish lesion under the nail. Lesion is tender to touch. Which cells does it originate from?

A

Glomus bodies which regulate thermoregulation

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70
Q

small numerous encapsulated neurovascular organs found in the dermis of the nail bed. Role is to shunt blood away from the skin surface in cold temperatures in order to prevent heat loss and to direct blood flow to the skin surface in hot environments to fascilitate dissipation of heat.

A

Glomus bodies

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71
Q

cause of death in acute rheumatic fever

A

Severe myocarditis

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72
Q

Causes of death in lightning injuries

A

fatal arrhytmias and respiratory failure

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73
Q

pt with long extremities, long tapering fingers, spinal scoliosis and kyphosis. Lens discoloration and aortic dissection and/ormitral valve prolapse

A

Marfan’s syndrome

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74
Q

Mutation in marfan’s syndrome

A

autosomal dominant defect in connective tissue glycoprotein fibrillin-1

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75
Q

most common cause of death in Marfan’s

A

aortic dissection

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76
Q

most common cause of aortic stenosis in a pt 70 years old

A

degenerative calcification of aortic valve

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77
Q

aortic stenosis murmur

A

systolic ejection murmur heard at the cardiac base that radiates to the carotids arteries

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78
Q

presenttion of aortic stenosis

A

SAD syncope, angina and dyspnea

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79
Q

pt with severe headache and oliguria. BP 240/150. There is papilledema. What is the most likely pathologic process in this condition?

A

Onion-like concentric thickening of arteriolar walls. Malignant hypertension.

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80
Q

murmur present in hypertrophic cardiomyopathy

A

ejection type systolic murmur. Augmented by decreasing the LV end diastolic volume with maneuvers such as sudden standing and valsalva

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81
Q

tetralogy of fallot findings

A

pulmonic stenosis, ventricular septal defect, right ventricular hypertrophy and overriding of the aorta

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82
Q

Findings in bacterial endocarditis

A

FROM JANE, Fever, Roth’s spots, Osler’s nodules, Murmur, Janeway lesions, Anemia, Nailbed hemorrhages, Emboli

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83
Q

skin biopsy of kid has vascular lesions with IgA and C3 deposition. What other presenttions will you find?

A

Sking rash and adbominal pain. (henoch-shonlein purpura)

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84
Q

Finding in Henoch-schonlein purpura

A

skin, Arthralgia and GI. Palpable purpura, abdminal pain. Hematuria.

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85
Q

how to keep a patent ductus arteriosus open

A

protaglandins

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86
Q

how to close a patent ductus arteriosus

A

Indomethacin and ibuprofen by inhibiting PGE1 synthesis

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87
Q

Patent ductus arteriosus associations

A

Prematurity, perinatal distress, congenital rubella and fetal alcohol syndrome.

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88
Q

SLE cardiac findings

A

pleuritis and pericarditis

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89
Q

pt with proteinuria, malar facial rash, photosensitivity, arthralgias, chest pain relieved by leaning forwards and worse on inspiration

A

Systemic Lupus erythematosus findings

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90
Q

sundromes associated with mitral valve prolapse

A

Marfans and Ehlers-Danlos syndromes

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91
Q

Mid systolic click which is followed by a short late systolic murmur. Murmur disappears on squatting

A

Mitral valve prolapse

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92
Q

Atrial Septal defect sounds

A

pulmonary flow murmur because of increased flow through pulmonary valve and a diastolic rumble because of increased flow across tricuspid

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93
Q

jervell and lange-nielsen syndrome

A

Congenital long QT due to defects in cariac sodium or potassium channels. Presents with severe congenital sensrineural deafness.

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94
Q

Disease that leads to a 3rd degree block

A

Lyme disease

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95
Q

Pulsus paradoxus

A

decrease in systolic blod pressure of greater than 10 mmHg with inspiration.

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96
Q

Diseases that present with pulsus paradoxus

A

cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy, sevre obstructive pulmonary disease

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97
Q

How is pulsus paradoxis detected?

A

inflating a blood pressure cuff aboce systolic pressure and then slowly releasing it. Korotkoff sounds become audible during expiration.

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98
Q

Pt is tachypneic, expiration is prolonged and prominent bilateral wheezes. Which agent would bring immediate relief?

A

Beta-adrenergic agonist: relaxes bronchial smooth muscle by stimulation of beta 2 adrenergic receptor.

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99
Q

MOA beta 2 adrenergic agonist

A

bind to Gs protein coupled receptor and activates adenylyl cyclase and ncreases intracellular cAMP cncentrations.

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100
Q

most important factors involved in coronary blod flow

A

Adenosine and nitric oxide

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101
Q

MOA nitric oxide

A

causes vascular smooth muscle relaxation by a guanylate cyclase-mediated cGMP second messenger system. Increases cyclic GMP

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102
Q

repetitive ischemia of cardiac myocytes can result in chronicle reversible loss of contractile function called?

A

Hibernation

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103
Q

Myocardial stunning

A

less sevre form of ischemia induced reversible loss of contractile function. Repetitive stunning leads to hibernation

104
Q

major determinant of the ratio of forwards to regurgitant left ventricular output in mitral regurgitation

A

Left ventricular AFTERLOAD

105
Q

Where is Antiotensin converting enzyme produced

A

Pulmonary endothelium

106
Q

Whre is angiotensinogen produced

A

liver

107
Q

diffuse atherosclerotic vascular disease charachterized by intimal thickenning and collagen deposition is mediated by?

A

Smooth muscle cells

108
Q

most common cause of death in a young athlete?

A

hypertrophic cardiomyopathy

109
Q

Triad of wolff parkinson white syndrome

A

short PR interval, delta wave at the start of the QRS complex, wide QRS interval

110
Q

how does wolff parkinson white syndrome manifest

A

Accessory AV conduction pathway: recurrent paroxysmal supraventricular tachycardia

111
Q

what is the intiating process of an aortic dissection

A

intimal tear

112
Q

severe retrosternal pain that radiates to the back

A

aortic dissection

113
Q

carotid sinus massage

A

increases baroreceptor firing, increasing parasympathetic influence on the heart and vessels and prolongs the AV node refreactory period

114
Q

Re entrant impulse traveling through slowly and rapidly conducting segments of the AV node

A

paroxysmal supraventricular tachycardia

115
Q

treatment for paroxysmal supraventricual tachycardia

A

cartoid sinus massage and valsalva maneuver, increase cardiac parasympathetic tone, slows AV node conduction and abolishes the re entrant circuit.

116
Q

holosystolic murmur loudest over the left mid sternal border

A

Ventricular septal defect

117
Q

valvular vegetation on both sides of the valve

A

Lupus

118
Q

Lupus valvular involvement

A

limbman-sacks endocarditis

119
Q

blood flow through the coronary arteries is highest during

A

Diastole when blood vessesl are not compressed

120
Q

pt with vascular tumor that expresses positive CD31. associated with past arsenic or PVC exposure

A

Liver angiosarcoma

121
Q

major limitant factor for coronary blood flow during exercise

A

duration of diastole

122
Q

what is the most common cardiac abnormality predisposing for native valve bacterial endocarditis

A

Mitral valve prolapse

123
Q

murmur that increases pulse pressure

A

aortic regurgitation

124
Q

diastolic decrescendo murmur heard loudest in early diastole. It is heard best at the left sternal border.

A

aortic regurgitation

125
Q

cardiac function curve: decreased cardiac output without a change on venos return

A

indicated decreased contractility: due to negative inotropic drug or myocardial infarction

126
Q

low pitched holosystolic murmur heard best at the left sternal border with accentuation during handgrip exercise

A

Ventricular septal defect

127
Q

major determinant of the deegre of right-to-left intracardiac shunting in Tetralogy of fallot

A

pulmonic stenosis

128
Q

interstitial myocardial granulomas or Aschoff bodies with anitschkiw cells

A

Therumatic carditis

129
Q

Cardiac myocyte action potential

A

phase 0: rapid depolarization, Phase 1: initial rapid repolarization, Phase 2: plateau, Phase 3:late rapid repolarization, Phase 4: resting potential

130
Q

pt does 12 days after MI, what do you find on biopsy?

A

Fibrovascular granulation tissue with neovascularization

131
Q

Chronic arteriovenous fistula

A

decreased in TPR and increase in venour return

132
Q

jaw claudication, headache, facial pain, vision loss, granulomatous inflammation of the media. Pt older than 50

A

Giant cell arteritis (temporal arteritis)

133
Q

female, less than 40, medial granulomas, affects the aortic arch, lower blood pressure and pulses in the upper extremities and compared with lower extremities, cold and numb finger.

A

Takayasu arteritis

134
Q

widened, descending thoracic aorta with a double barrel

A

aortic dissection

135
Q

single most important risk factor for development of intimal tears leading to aortic dissection

A

hypertension

136
Q

67 year old male with persistent headache and difficulty chewing, arterial biopsy shows giant cells and internal elastic membrane fragmentation. Immediate prednisone therapy is initiatied to prevent

A

Blindness (ophthalmic artery occlusion)

137
Q

Giant cell arteritis initial treatment to prevent blindness

A

steroid

138
Q

triad of muffle heart sounds, elevated jugular venous pressure and profound hypotension

A

Pericardial tamponade

139
Q

most serious complication of kawasaki disease

A

coronary involvement leading to the development of coronary artery aneurysms

140
Q

persistent fever, bilateral conjuctivitis, lymphadenopathy and cutaneous involvement (strawberry tongue, desquamation of the fingertips, polymorphous erythematous rash)

A

Kawasaki disease

141
Q

murmur with bounding femoral pulses and carotid pulsations that are accompanied by head-bobbing

A

aortic regurgitation

142
Q

ANP effects

A

kidney: dilates afferent arterioles and inhibits renin secretion, Adrenal gland: restricts aldosterone secretion, blood vessels: relaxes vascular smooth muscleproducing vasodilation.

143
Q

rapid decrease in cytoplasmic calcium level immediately preceding relaxation is mediated by?

A

Na/Ca exchange mechanism

144
Q

teartment of hypovolemic shock

A

intravenous fluid infusion

145
Q

what does intravenous venous infusion cause in pt with hypovolemic shock

A

increases intravascular volume and ventricular preload. The preload increases the end diastolic sarcomere length in the ventricular myocardium, increases stroke volume and cardiact output.

146
Q

which anatominal site have a blood oxygen content that differs the most with the O2 content from the aorta?

A

Coronary sinus: drains coronary venous blood

147
Q

Features that distinguish heart circulation from other circulations

A

Cardiac muscle is perfused during diastole and consumes 5 percent of caardiac output, myocardial O2 requirement is higher than othe rorgans and Coronary flow is regulated by local metabolic factors such as nitirc oxide and adenosine

148
Q

holosystolic murmur that increases intensity on inspiration

A

tricuspid regurgitation

149
Q

opening snap followed by a diastolic rumbling murmur that is heard best over the apex of the heart

A

mitral stenosis

150
Q

coronary steal phenomenon

A

blood flow in ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas. Worsens hypoperfusion of existing ischemia

151
Q

continuous murmur heard best in the left infraclavicular region with maximal intensity at S2

A

Patent ductus arteriosus

152
Q

congenital long QT interval, autosomal recessive and congenital neurosensory deafness

A

Jervell and Lange Nielsen syndrome

153
Q

Jervel and lange Nielsen syndrome mutation

A

autosomal recessive mutation of genes coding for cardiac cell potassium or sodium channels.

154
Q

Beck’s triad: hypotension, distended neck veins and distand muffled heart sounds on auscultation AND pulsus paradoxus

A

Cardiac tamponade

155
Q

organ thaa is least vulnerable to infarction in case of arterial oclusion

A

Liver

156
Q

increased CK level is synonym of

A

Cell membrane damage

157
Q

fast and irregular pulse. Tachycardia and irregular rhythm. Irregular QRS complexes and absent p waves

A

Atrial fibrilation

158
Q

Precipitating factors of isolated episodes of Atrial fibrilation

A

binge alcohol, increased cardiac sympathetic tone and pericarditis

159
Q

harash, crescendo-decrescendo systolic ejection murmur heard best at the right sternal border with radiation to the carotids

A

Aortic stenosis

160
Q

Causes of aortic stenosis

A

Bicuspid valve, calcified normal valve and rheumatic heart disease

161
Q

how to determine the severity of mitral stenosis

A

S2 to opening snap time internal: length of the interval between A2 and opening snap. The shorter the interval, the more severe the stenosis. The more thickened and fibrotic the valve, the earlier the tensing occurs.

162
Q

hypersensitivity to intradermal injections of tobacco extracts (vasvulitis)

A

Buerger’s diease

163
Q

segmental vasculitis extending into contiguous veins and nerves

A

Buerger’s diease

164
Q

72 year old male with headaches, recent vision deterioraiton treated with prednisone and improves significantly. What is the pathologic process

A

granulomatous inflammaiton of the media

165
Q

pt with heavy smoking hx, moderate dilatation of the right ventricle and increased central venous pressure. No edema. Absence of edema is best explained by which compensatory mechanism

A

increased tissue lymphatic drainage

166
Q

man loses conciousness when buttoning his shirt collar. Stimulation of which afferent is most liekly responsible?

A

Glossopharyngeal

167
Q

course of IVC through abd and inferior thorax

A

located anterior and to the right of the vertebral bodies

168
Q

inferior vena cava filter

A

designed to prevent travel of deep vein thrombosis form the legs to the lung vasculature.

169
Q

artery that supplies the inferior wall of the left ventricle which forms the diaphragmatic surface of the heart and the SA and AV node

A

Posterior descending which arises form the right coronary artery

170
Q

provides the major proliferative stimuli for the cellular components of atherosclerotic plaques

A

platelets

171
Q

embryonic veins from systemic circulation (superior vena cava)

A

common cardinal veins

172
Q

embryonic veins of portal system

A

vitelline veins

173
Q

embryonic ascending aorta

A

truncus arteriosus

174
Q

embryonic pulmonary trunk

A

truncus arteriosus

175
Q

presystolic sound that immediately precedes S1

A

S4

176
Q

rapid emptying of atrial blood into a ventricle with reduced compliance (stiff ventricle)

A

S4

177
Q

Moa of nitrates

A

converted to nitric oxide which increased intracellular cGMP causing smooth mucle relaxation

178
Q

prevention of reflex tachycardia after treatment with nitrates

A

Beta blocker: OLOL, nitrates vasodilate and cause decrease blood pressure which the body responds to by releasing catecholamines which cause reflex tachycardia.

179
Q

drugs that relaxes smooth muscle of arterioles but does not affect veins. Name a side effect

A

Reflex tachycardia and sodium and fluid retention

180
Q

Side effects of verapamil

A

constipation, gingival hyperplasia, second and third degree AV nodal block.

181
Q

contraindication for the use of verapamil

A

CHF due to the potent negative inotropic effect

182
Q

Selectivity of verapamil

A

non-dihydropyridine Ca channel block heart

183
Q

selectivity of nifedipine

A

dihydropyridine: peripheral vasculature

184
Q

pt with irregularly irregular rhythm. Treatment with IV digoxin drop his heart rate but the rhythm remains irregular, what is the cause of this effect?

A

Increased parasympathetic tone

185
Q

first line treatment for Atrial fibrilation

A

calcium channel blocker such as diltiazema and cardioselective beta blocker

186
Q

second line treatment for atrial fibrilation

A

Digoxin

187
Q

MOA milrinone

A

phosphodiesterase isoenzyme 3 inhibitor: increases concentration of cAMP which increases conductance of Ca channel in sarcoplasmic reticulum and increases force of contraction. Also causes vascular smooth mucle vasodilation.

188
Q

Metoprolo MOA

A

selective B1 adrenergic antagonist. B1 is found on cardiac and renal juxtaglomerular cells . So it inhibits the production and release of renin, leading to decreased vasoconstriction and decreased renal sodium and water retention.

189
Q

Class III antiarrythmics

A

Amiodarone, Sotalol, Ibutilide, Dofetilide

190
Q

MOA of class III antiarrhytmics

A

slow K efflux from the ventricular myocyte, prolong repolarization and prolong refractory period.

191
Q

during inflammation, high levels of an enzyme are detected in inflammatory cells, including macrophages. This enzyme is undetectable in most normal tissues. Which of the following directly binds to this enzyme?

A

Aspirin: binds irreversibly and modifies COX1 and COX2. COX2 is undetectable In most tissues except in cases where inflammatory cells are activated.

192
Q

embryologic structure that gives rise to the pulmonary arteries and the ductus arteriosus

A

Sixth aortic arch

193
Q

important recommendation for prevention of central venous catheter infections

A

hand washing with antibacterial soap prior to catheter insertion, maximal barrier during insertion, chlorhexidine for skin disinfection, avoid femoral insertion site, remove catheter when no longer needed.

194
Q

Mid-diastolic rumbling murmur heard best at the apex, positional dyspnea, large pedunculated mass in the left atrium

A

atrial myxoma

195
Q

histo of atrial myxoma

A

scattered cells within a mucopolysaccharide stroma. Abnormal blood vessels and hemorrhaging.

196
Q

homocystinuria

A

defect in cystathione beta symthase which converts homocystine to cystathione. Cysteine is essential in the diet for these pt.

197
Q

homocystinuria presentation

A

pt with premature atherosclerotic disease, ectopia lentis, osteoporosis and mental retardation.

198
Q

kid with acute MI and with increased serum methionine level, which amino acid is essential?

A

Cysteine

199
Q

Relationship between flow, resistance and radius

A

Resistance is inverse proportional to radius to the fourth power and flow is inveser proportional to resistance

200
Q

fron and back of transesophageal echocardiograph

A

front: left atrium and back:descending aorta

201
Q

course of descending aorta

A

left anterior surface of vertebral column

202
Q

causes of dilated cardiomyopathy

A

Acohol, Beriberi(thiamine deficiency), Coxsackie(viral myocarditis), Chagas, Cocaine, Doxorubicin, Peripartum

203
Q

acute onset heart failure in the setting of a recent viral infection

A

Dilated cardiomyopathy: coxachie

204
Q

diagnosis of Polyarteritis nodosa which artery is spared

A

Pulmonary

205
Q

Pt with PSVT, rapid IV injection results in instant resolution accompanied by flushing, burning in the chest and shortness of breath. Name the drug

A

Adenosine

206
Q

drug of choice of paroxysmal supraventricula tachycardia

A

adenosine

207
Q

first step in pathogenesis of atherosclerosis

A

endothelial cell injury

208
Q

cause of hyperthrophic cardiomyopathy

A

autosomal dominant mutation in cardiac sarcomere proteins, Beta myosin heavy chain

209
Q

third pharyngeal arch

A

common carotid artery and proximal internal carotid. Glossopharyngeal n. CN IX

210
Q

pt with chest pain, difficulty catching his breath. Ventilation perfusion V/Q reveals a large perfusion defect that does not match a ventilation defect in the lungs. What is the cause?

A

Deep Vein Thrombosis causing a pulmonary thromboembolism.

211
Q

early systolic murmur best heard over the left sternal border that is accentuated by inspiration

A

tricuspid regurgitation

212
Q

Right sided endocarditis involving the tricuspid valve

A

IV drug users due to staph

213
Q

congenital association of a berry aneurysm of the circle of willis

A

coarctation of the aorta

214
Q

Causes of Spontaneous Intracranial Hemorrhage

A

arterovenous malformations, ruptured cerebral anurysms and abuse of sympathomimetic drugs such as cocaine.

215
Q

aortic regurgitation murmur

A

blowing diastolic decrescendo. Augmented with hand grip

216
Q

drug for atrial fib that causes mild bradycardia and significatng QT interval prolongation.

A

Sotalol: beta blocker and class III antiarrhythmic properties (K channel block)

217
Q

the pulmonary capillary wedge pressure measures

A

left atrial end diastolic pressure

218
Q

mitral stenosis PCWP

A

elevated PCWP which represents elevated left atrial end diastolic pressure compared to the left ventricular end diastolic pressure

219
Q

antiarrhythmics that cause torsades de pointes

A

quinidine, procainamide, disopyramide, ibutilide, dofetilide and sotalol because they cause QT prolongation.

220
Q

torsades de pointes

A

polymorphic QRS complexes of varying amplitude and cycle length with underlying QT nterval prolongation.

221
Q

deletions involving the long arm of choromosome 22 associated with

A

Digeorge syndrome

222
Q

Digeorge syndrome

A

thymic aplasia and failure of parathyroid formation, defective embryonic development of the third and fourth pharyngea pouches. Hypocalcemic tetany and recurrent viral and fungal infections due to T-cell deficiency

223
Q

strawberry hemangioma

A

present at birth, grow in proportion to the child and regress spontaneously at or before puberty. Unencapsulated aggregates of closely packed, thin walled capillaries.

224
Q

low serum potessium, depressed plasma renin, right sided adrenal mass and hypertension. How do you treat it?

A

It is an aldosetrone secreting tumor: aldosterone antagonist, spironolactone or eplerenone; or surgical resection

225
Q

Conn’s syndrome

A

aldosterone secreting tumor causing hypokalemia, low renin, hypertension and metabolic alkalosis.

226
Q

eplerenone

A

aldosterone antagonist

227
Q

transmural inflammaiton of the arteries with fibrinoid necrosis. Some arteries show fibrous wall thickening. Disease?

A

Polyarteritis nodosa

228
Q

What is Polyarteritis nodosa associated with

A

Liver infection: hepatitis B

229
Q

Jervell and Lange Nielsen and Romano ward syndrome

A

Mutations in the K channel causing QT elongation. First is autosomal recessive and the other is autosomal dominant.

230
Q

intrinsic ability of a drug to elicit an effect, such as receptor activation. Maximum pharmacodynamic effect

A

Eficacy

231
Q

the dose of drug that is required to produce a given effect. Affected by afinity of the drug for its receptor or how the drug is able to bind tissues

A

Potency

232
Q

ED50

A

dose of drug that is required to produce one half of the max biological response. Lower ED50 more potent

233
Q

causes of isolated systolic hypertension

A

age related decrease in compliance due to aortic stiffness.

234
Q

statins side effects

A

heatotoxicity and rhabdomyolysis(muscle pain)

235
Q

statin of choice with agents that inhibit cytp450

A

pravastatin

236
Q

where r statins metabolized

A

liver cytp450

237
Q

side effects of ACE inhibitors

A

Dry, nonproductive persistent cough

238
Q

side effecst of niacin

A

warmth, flushing and itchy skin. Insulin resistance (hyperglycemia/acanthosis nigricans) and hyperuricemia. Can also potentiate anti-hypertensives because they vasodilate.

239
Q

apical displacement of the tricuspic valve, decreased right ventricular volume and atrialization of the right ventricle

A

Abstein’s anomality caused by lithium

240
Q

treatment of bipolar disorder

A

lithium in manic phase and concurrent antidepressant in depressive phase

241
Q

side effects of fibrates

A

gallstones, myopathy

242
Q

side effects of bile acid-binding resins

A

GI upset, hyperglycemia, malabsorption

243
Q

Beta blocker overdose treatment

A

Glucagon

244
Q

Moa of glucagon

A

acts on G protein coupled receptors causing activation of adenylate cyclase, increasing intracellular cAMP and increasing the release of Ca.

245
Q

MOA of beta blockers

A

decrease cAMP and decrease Ca, so decrease slope of phase 4

246
Q

monitoring of warfarin

A

Prothrombin time

247
Q

monitoring of heparin

A

PTT

248
Q

pt with persistent right arm swelling following radiation. Increased risk of

A

Lymphangiosarcoma: rare malignant neoplasm due to chronic dilatation of lymphatic channels

249
Q

the most likely complication of varicose veins

A

skin ulcerations. They are too superficial to cause a pulmonary embolism

250
Q

side effects of Hydralazine and Procainamide

A

Drug induced lupus erythematous

251
Q

80 year old myocardial cells show prominent intracytoplasmic granules that are tinged yellowish-brown. what is it?

A

Lipofuscin: product of lipid peroxidation, accumulating in aging cells, especially in pt with malnutrition and cachexia

252
Q

side effects of Hydralazine and Procainamide

A

Drug induced lupus erythematous

253
Q

80 year old myocardial cells show prominent intracytoplasmic granules that are tinged yellowish-brown. what is it?

A

Lipofuscin: product of lipid peroxidation, accumulating in aging cells, especially in pt with malnutrition and cachexia

254
Q

Anaphylactic shock

A

Vasodilation, increased vascular permeability and bronchoconstriction

255
Q

Drug of choice for anaphylactic shock

A

Epinephrine, counteracts vasodilation by acting on alpha 1 and increasing BP, beta 1 action increases cardiac out and beta 2 action causes bronchodilation.

Step 1 Questions (5 decks)

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