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HDS > Cardio > Flashcards

Cardio Flashcards

1
Q

alpha-granules

A

FVIII, vWF, FV, FI, PF4, fibronectin, mitogens

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2
Q

Dense granules

A

ADP, Ca2+, Mg2+, histamine, epinephrine, 5-HT

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3
Q

DVT

A 
M > W 
Lower extremity (calf) 
PE risk proximal > distal 
Virchows triad predisposes 
Pain, swelling, erythema (distal) 
Palpabale cord 
Low grade fever 
Treat w anticoagulation
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4
Q

Virchows Triad

A

Hypercoaguability
Stasis
Endothelial injury

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5
Q

Homan’s sign

A

DVT
Calf pain w foot dorsiflexion
Low sensitivity/specificity

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6
Q

D dimer

A

DVT test
Fibrin degradation
Non specific
High sensitivity

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7
Q

DVT diagnosis

A

D dimer
Duplex US
Contrast Venography (gold standard)

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8
Q

Thrombophlebitis

A

Superficial inflammation and pain involving a vein (DVT differential)
Virchows
Trousseau’s syndrome
Treat w anti-inflammatories and local heat

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9
Q

Aspirin

A 
Anti TXA2 => Antiplatelet aggregation
Irreversible COX1 inhibitor 
Low dose prophylactic 
High dose after MI 
Anti PGE2, low mucus, GI irritation
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10
Q

P2Y12 inhibitors

A

Clopidogrel, ticlopidine, prasugrel
Irreversible ADP inhibitor
CYP2C19 metabolism

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11
Q

GpIIb/IIIa inhibitors

A 
Target platelet integrin etc Rs 
IV + aspirin + anticoagulants 
Abciximab: anti IIb/IIIa Ab 
Eptifibatide/tripfiban: inhibits fibrin binding 
High risk ACS and PCI
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12
Q

Heparin

A 
Anticoagulant
Binds ATIII & Factor X 
Toxicity: bleeding, HIT, long term osteoporosis
IV/SC 
Test aPTT throughout 
Use: DVT, MI, preg
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13
Q

LMW Heparin

A

Anticoagulant
Inhibits FXa
SC, less bleeding
Prevent DVT post surgery

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14
Q

Warfarin/coumarin

A 
Vit K analogs 
Prevent reduction (activation) of Vit K 
Prevents y-carboxylation of glut residues on FII, VII, IX, X 
8-12hr onset, 1-3day peak 
Oral 
Measure PT 
Use: AF, prosthetic heart valve
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15
Q

Factor X inhibitors

A

Fondaparinux: indirect, SC, DVT/PE
Apixaban: oral, VTE (knee/hip surgery), nonvalvular AF (pre stroke)
rivaroxiban: nonvalvular AF

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16
Q

Thrombin inhibitors (direct)

A

Desirudin: SC, post-op VTE
Bivalirudin: IV, PCI
Argatroban: IV, HIT thrombosis/PCI
Dabigatran etexiliate: prodrug CYP450, like warfarin w/o monitoring, AF, Preg C

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17
Q

Streptokinase and APSAC (anistreplase)

A

Converts plasminogen to plasmin

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18
Q

tPA

A

Activated plasminogen bound to fibrin
IV bolus
PE, DVT, acute MI (golden hour)
Not for unstable angina/NSTEMI

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19
Q

Acetylcholine/analog effects

A 
D: diarrhoea, dec BP
U: urination
M: mitosis 
B: bronchoconstriction, bradychardia
E: excitation of skeletal muscle (N) 
L: lacrimation 
S: salivation, sweating (SNS)
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20
Q

Bethanechol

A

ACh Agonist at GI M-Rs
AChE resistant
Postop/partum for bladder, promote salivation (xerostemia)

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21
Q

Methacholine

A

M ACh agonist
CH3 inc M specificity
Bronchial hyperreactivity/asthma test

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22
Q

Carbachol

A

All AChRs
Amine group
Highly AChE resistant
Wide angle glaucoma - use only when other drugs ineffective

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23
Q

Pilocarpine

A 
Agonist (partial) at M AChRs 
Wide angle glaucoma (not preferred) 
Acute closed angle glaucoma (low P) 
Salivation 
3
Tert amine (CNS effects)
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24
Q

Physostigmine

A

Reversible AChE inhibitor
Wide angle glaucoma
Tert amine (CNS) - reverse atropine effects (antiM)
Cataracts

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25
Q

Edrophonium

A

Competitive/reversible AChE inhibitor
Quat amine
MG test
Attracted to an ionic site

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26
Q

Neostigmine

A 
Reversible AChE inhibitor 
Quat amine 
Short action
Paralytic loss of tone (GI, bladder) 
MG
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27
Q

Pyridostigmine

A

Like neostigmine
Quat amine
MG- longer acting

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28
Q

Echothiophate

A

Organophosphate
AChEI
Glaucoma (not preferred)
Only one clinically used

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29
Q

Malathion/Parathion

A

Pro-drug insecticide
Detoxed in mammals via plasma esterases or metabolised by oxygenases
Farm poisoning (most common)

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30
Q

Sarin/Soman

A

Nerve gas

Volatile, toxic synthetic agent

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31
Q

Organophosphate poisoning

A 
S: sweating, salivation 
L: lacrimation
U: urination
D: defacation 
G: GI upset
E: emesis 
B: bradycardia/bonchoconstriction
A: abdominal cramps, anorexia
M: miosis
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32
Q

Organophosphate treatment

A

Atropine + pralidoxime (PAM)
Support resp distress
Diazepam (convulsions)

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33
Q

Atropine

A

Anti-M (all)

Use: muscarine poison, AChE inhibitor poison, diarrhea, long-lasting pupil dilation

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34
Q

Scopolamine

A

Atropine-like

Motion sickness

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35
Q

Tropicamide/Homatropine

A

M-R antagonist
Short acting
Pupil dilation

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36
Q

Ipratropium/Tiotropium

A

M-R antagonist
Quat amine
COPD

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37
Q

Tolterodine/Oxybutynin/Solifenacin

A

Bladder M-R antagonist

Treat overactive bladder

38
Q

Dicyclomine/Hyocyamine

A

GI M-R antagonist

IBS

39
Q

Glycopyrrolate

A

M-R antagonist

Use for secretion, sweating, M overshoot after AChE inhibition

40
Q

Benztropine

A

Lipid soluble M-R antagonist

Treats Extrapyramidal effects

41
Q

Mecamylamine

A

N-R ganglion antagonist
Improve GI absorption
Tourette’s

42
Q

Hexamethonium

A

N-R ganglion antagonist

Prevent barroreceptor reflex

43
Q

P Falciparum life cycle

A 
10-14d incubation 
No exoerythrocytic 
All RBC stages infected 
48hr erythrocytic cycle 
High RBC parasitemia (60%)
44
Q

P vivax

A 
12-15d incubation 
Yes exoerythrocytic 
Reticulocyte stage 
48hr RBC cycle 
Low parasitemia (2%)
45
Q

P ovale

A 
12-15d incubation
Yes exoerythrocytic 
Reticulocyte stage 
48hr cycle 
Low parasitemia
46
Q

P malariae

A 
18-30d incubation
No exoerythrocytic 
Senescent 
72hr cycle 
Low RBC parasitemia
47
Q

Cardiac endocarditis complications

A 
Valve destruction
CHF
Myocardial/valve ring abscess 
Superlative pericarditis 
Emboli
48
Q

Embolic endocarditis complications

A

L side: brain, Roth spots, heart, spleen, kidney

R side: lung, septic emboli, infarct, pneumonia

49
Q

Janeway lesions

A

Septic emboli
Hemorrhagic non-painful macules
Palms/soles

50
Q

Osler nodes

A

Painful nodules
SC
Distal pads of fingers/toes

51
Q

Roth spot

A

Retinal hemorrhage
Small central clearing
L sided IE

52
Q

IE lab findings

A 
Anemia 
High ESR, CRP
Leukocytosis 
RF 
Ag-Ab complexes 
Histocytes 
Hematuria 
\+ blood culture
53
Q

IE diagnostic tests

A 
Blood cultures (mult over time) 
Echocardiogram (all)
54
Q

IE prophylaxis

A

B-lactam agent
Amoxicillin, ampicillin, cefazolin
Single dose 30-60min before procedure

55
Q

Bacterial resistance mechanisms

A
  1. B-lactamase antibiotic inactivation (constitutive or induced): staph to penicillin G
  2. Reduced PBP affinity for antibiotic: staph to methicillin
  3. Dec drug entry via porins: Gram(-) to B-lactams
56
Q

P wave

A

Atrial depolarisation

57
Q

PR interval

A

AV delay

.12-.20

58
Q

QRS

A

Ventricular depolarisation

59
Q

ST segment

A

Ventricular depolarisation ending to repolarization beginning
No length

60
Q

T wave

A

Ventricular repolarization

No length

61
Q

QT interval

A

Vent depol/repol

62
Q

U wave

A

Vent afterpotentials
Purkinje repol
No length

63
Q

Low voltage EKG causes

A

QRS amp <10mm (precordial) and <5mm (limb)

  1. COPD
  2. Pericardial effusion
  3. Restrictive/infiltrative cardiomyopathies (amyloidosis)
64
Q

Atherosclerotic plaque distribution

A 
Ostia and branch points :
Abdominal aorta 
Coronary a
Popliteal a 
Circle of Willis 
Internal carotid a
65
Q

LAD

A 
Anterior ventricles 
Ant 2/3 septum
Ant papillary
Diagonal branch: LV surface
MI in V1-V4 (anterior)
66
Q

Circumflex

A

L atrium
Post/lateral L vent
MI in V5, V6, I, aVL (anterolateral)

67
Q

RCA

A 
R atrium 
R vent 
SA/AV (nodal arteries) 
R marginal: RV 
PDA: Post 1/3 septum
MI in II, III, aVF (inferior)
68
Q

LDL eqn

A

LDL = total cholesterol - HDL - TG/5

69
Q

Metabolic syndrome

A 
Abdominal obesity 
TG 
BP 
Fasting glucose high 
Low HDL
70
Q

Ischemia

A

Demand > supply of blood/O2 to myocardium

Usually bc of atherosclerotic coronary

71
Q

Angina

A

Pain due to myocardial ischemia
70% dec in lumen w inc O2 demand (exercise)
90% dec in lumen w/o inc O2 demand

72
Q

Stable angina

A

Transient angina
Activity/emotional upset
Relieved by rest (mins)
No myocardial damage

73
Q

Silent ischemia

A

Asymptomatic
ECG
Seen in DM, elderly

74
Q

Variant angina

A

Coronary a spasm at rest
No plaques
Prinzmetals

75
Q

Unstable angina

A

Inc angina freq w less exertion

Progress to MI

76
Q

MI

A

Myocardial necrosis from blood supply loss

Thrombus

77
Q

Dressier Syndrome

A 
Uncommon pericarditis weeks post MI 
Immune against heart tissue 
Fever, sharp pain 
Pericardial effusion 
Aspirin/NSAIDs
78
Q

Lambl excrescences

A

Filiform processes on aortic/mitral valve closure lines

Small thrombi organization

79
Q

Heart Disease Principal Mechanisms

A
  1. Pump failure
  2. Flow obstruction
  3. Regurgitant flow
  4. Shunted flow
  5. Conduction abnormalities
  6. Heart/major vessel Rupture
80
Q

Trisomy 21 cardiac defects

A

VSD, ASD, PDA (AV septal)

81
Q

Trisomy 18 cardiac defects

A

VSD, double outlet RV, PDA

82
Q

Trisomy 13 cardiac defects

A

VSD, ASD, PDA

83
Q

Turners XO cardiac defect

A

Aortic coarctation

84
Q

Marfans (connective tissue) cardiac defects

A

Mitral valve prolapse

Aortic root dilation

85
Q

DiGeorge cardiac defects (cardiofacial)

A

Conotruncal (truncus arteriosus)

86
Q

TAR (upper limb) cardiac defects

A

Tetralogy of Fallot

87
Q

Williams syndrome cardiac defects

A

Supravalvular aprtic/pulmonary stenosis

88
Q

Cyanotic CHD

A

Fixed R —> L shunt

Tetralogy of Fallot

89
Q

Acyanotic CHD

A

No shunt

Aorta Coarctation

90
Q

Cyanosis Tardive

A

Initial L —> R shunt and later R —> L shunt
VSD
Pulmonary hypertension reverses flow
Eisenmenger’s Complex

HDS (1 decks)

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