Cardio

Question 1

What causes Hypospadias?

Answer 1

Failure of the urethral folds to fuse. Same underlying embryological process responsible for PFO.

Question 2

Fenoldopam MOA?

Answer 2

Dopa agonist -> Increases cAMP -> activates Protein Kinase A -> inhibits myosin light chain kinase activity -> decreased m. contraction.

Question 3

Congestive HF can lea to?

What medication does this resulting condition contrindicate?

Answer 3

Lactic Acidosis.

Metformin.

Question 4

Bosentan MOA?

Answer 4

Endothelin 1 receptor antagonist. Endothelin promotes vasoconstriction.

Question 5

What is Kartagener Syndrome?

Answer 5

Dynien arm defects that lead to cilia dysfunction. Results in inability to properly clear mucus, dextrocardia, infertility in women (ciliary defects in the fallopian tube or immotile sperm).

Question 6

First line investigation in patients with features suggestive of chronic venous insufficiency?

Answer 6

Duplex Ultrasound. Can help identify incompetent valves.

Question 7

Wallenberg Syndrome/?

Answer 7

Neuro condition caused by lateral medullary infarction. Which results from occlusion of either the PICA or vertebral artery. Sx: Ipsi horner syndrome, hoarseness, dysphonia), vestibulocerebellar sx; nystagmus, vertigo, ataxia). Contra sensory disturbances (pain and tem) in trunk and limbs.

Question 8

Difference between infarction in lateral medulla and lateral pons?

Answer 8

Lateral medulla infarction manifests with features of CNIX and CNX. While lateral pontine syndrome manifests with features of cochlear nucleus infarction and VII palsy.

Question 9

What should be administered immediately following an anaphylactic T1HS reaction?

Answer 9

Epinephrine (both a b-adrenergic receptor and alpha -adrenergic to help increase bp, broncho-dilation, reduce mucosal edema in upper airways and reduce release of inflammatory mediators from mast cells.

Question 10

What is the first line treatment for vasospastic angina?

Answer 10

1st line tx: CCB

Others: nitrates and smoking cessation

Question 11

Causes of vasospastic angina?

Answer 11

RF: smokin
Triggers: cocaine, alcohol, triptans.

Question 12

the region of the anal canal above the dentate line drains into the portal venous system via the following pathway?

Answer 12

Superior rectal vein -> inferior mesenteric vein -> splenic vein -> hepatcic portal vein.

Question 13

The region of the anal canal below the dentate lube drains into systemic venous circulation via the following pathway?

Answer 13

Inferior rectal vein -> internal pudendal vein -> internal iliac vein -> inferior vena cava.

Question 14

Why is it important to know the lower anal canal venous drainage?

Answer 14

• Predicting most likely route or hematogenous spread of malignancies
• Understanding first pass metabolism

Question 15

In CHF, what is accumulated?

Answer 15

NADH. Due to hypoxia. Hypoxia impairs oxidative phosphorylation and causes lactic acidosis.
W/o oxidative phospho -> the body increases glycolysis to generate ATP anaerobically which produces excess pyruvate and NADH. Hypoxia also results in underutilization of pyruvate and NADH in the CCA and ETC.

Question 16

Depending on the shape of the QRS, the site of escape ventricular rhythms can be identified. Normal narrow QRS complexes start with impulses where?

Answer 16

SA node up to the bundle of His.

Question 17

The superior thyroid artery is a branch of ?

What does it supply?

Answer 17

External carotid artery

Supplies the cranial half of the thyroid gland.

Question 18

Classic triad of congenital rubella infection?

Answer 18

Bilateral cataracts, sensorineural hearing loss and heart defect.
Other findings: Blue-berry muffin rash.

Question 19

What symptoms can be suggestive of diphtheria?

Answer 19

Pharyngitis and pseudomembranous formation and cervical lymphadenopathy.

Question 20

What is indicated for the immediate control fo symptoms in patients with hyperthyroidism?

Answer 20

Propranolol.

Question 21

What can high doses of propanolol do for hypertyroidism?

Answer 21

Decrease the peripheral conversion of T4 - T3 by inhibiting 5-monodeiodinase.

Question 22

Cystic media degeneration occurs in what circumstances?

Answer 22

Occurs with aging, bicuspid valve, Marfans.

Question 23

PDGF function?

Answer 23

STimulates the transition of cells form the G1 phase to the S phase. STimulates proliferation and migration of smooth m. cells in the tunica intima. Also mediates the differentiation of fibroblasts into myofibroblast -> fibrous cap formation.

Question 24

Sudden onset of urinary incontinence in conjunction with sensory and motor loss predominantly affecting the lower extremity should raise concern for?

Answer 24

Cortical injury, especially in the region of the ACA.

ACA occlusion causes loss of contralateral motor function, particularly of LE and contralateral sensory loss.

Question 25

What are some of the complications of chronic venous insufficiency?

Answer 25

Results in stasis dermatitis, lipodermatosclerosis and ulcer formation. Often occur over the shin and medial malleolus.

Question 26

What are some of the conditions that you find in chronic venous insufficiency?

Answer 26

Superficial thrombophlebitis and thrombosis. NOT DVT.

Question 27

MOA of Sotalol?

Answer 27

Antiarrhythmic drug that has both class II (B-blocker) and class III (K= blocker) effects.

Question 28

What does the posterior cerebral artery supply?

Answer 28

Parts of the thalamus (contralateral hemisensory loss) and the visual cortex within the occipital lobe (contralateral homonymous hemianopia). Central vision is not spared.