Cardiology

Question 1

Temporal arteritis

Answer 1

Giant cell
Elderly female
Affect branches of carotid artery
Unilateral headache, jaw claudication
Treat w/ steroids

Question 2

Takayasu arteritis

Answer 2

Asian females < 4o yrs old
Pulseless disease (weak upper extremity)
Fever, night sweats, myalgias
Thickening and narrowing of aortic arch and proximal great vessels
Treat w/ steroids

Question 3

Polyarteritis nodosa

Answer 3

Young adults
Fever, weight loss, malaise, headache
Involves renal and visceral vessels, not pulmonary
Immune complex mediated w/ innumberable microaneurysms
Treat w/ steroids

Question 4

Kawasaki disease

Answer 4

Kids < 4 yrs old
Fever, cervical lymphadenopathy, conjunctival injection, changes in lip/oral mucosa (strawberry tongue), hand-foot erythema, rash
Treat w/ IV immunoglobulin and aspirin

Question 5

Bueger disease (thromboangitis obliterans)

Answer 5

Heavy smokers
Segmental thrombosing vasculitis
Intermittent claudication leading to gangrene, autoamputation of digits
Quit smoking

Question 6

Granulomatosis with polyangiitis (Wegner)

Answer 6

Triad: focal necrotizing vasculitis, necrotizing granulomas in the lung and upper airway (otitis media, chronic sinusitis), necrotizing glomerulonephritis
PR3-ANCA/c-ANCa
Treat w/ steroids

Question 7

Microscopic polyangiitis

Answer 7

No granulomas
Necrotizing vasculitis involving lung, kidney, and skin w/ palpable purpura
MPO-ANCA/p-ANCA
Treat w/ steroids

Question 8

Churg Strauss

Answer 8

Asthma, sinusitis, palpable purpura, granulomatous, necortizing vasculitis with eosinophilia
MPO-ANCA/p-ANCA
Increased IgE

Question 9

Henoch-Schonlein purpura

Answer 9

Triad: palpable purpura on buttocks, arthralgia, abdominal pain
Follow URI
Secondary to IgA complex deposition

Question 10

Dilated cardiomyopathy

Answer 10

Idiopathic or congenital
Other causes include: alcohol abuse, Coxasckie virus
Heart failure, S3, dilated heart
Eccentric hypertrophy, systolic dysfunction
Treat w/ Na restriction, ACE inhibitors, beta blockers

Question 11

Hypertrophic cardiomyopathy

Answer 11

Familial
Sudden death in young athletes
S4, systolic murmur
Diastolic dysfunction, ventricular hypertrophy w/ setpal dominance
Treat w/ cessation of high intensity activity, beta blockers

Question 12

Restrictive/infiltrative cardiomyopathy

Answer 12

Sarcoidosis, amyloidosis, hemochormatosis
Diastolic dysfunction
Low voltage ECG despite thick myocardium

Question 13

Digoxin

Answer 13

75% bioavailability
T1/2 = 40 hours
Direct inhibition of Na+/K+ ATPase leads to indirect inhibition of Na+/Ca2+ exchanger leading to increased Ca concentration –> inotropy
CHF (increase contractility)
Afib (decrease conduction at AV)
Tox: increased PR interval, T wave inversion, arrhythmia, hyperkalemia
Antidote: slowly normalize K, anti digoxin Fab fragments

Question 14

Anti-arrhthymic class I

Answer 14

Na+ channel blockers (phase 0)
Slow or block conduction, increase threshold for firing in abnormal pacemaker cells
Cause hyperkalemia

IA: quinidine, increase effective refractory period, treat SVT and VT

IB: lidocaine, decrease action potential duration, treat acute ventricular arrhythmias

IC: flecainide, prolongs refractory period in AV, treat SVT especially afib

Question 15

Anti-arrhythmic class II

Answer 15

Beta blockers (phase 4)
Metoprolol, propanolol
Decrease SA and AV nodal activity by decreasing cAMP and Ca2+ currents and suppressing abnormal pacemaker currents
Treat SVT

Question 16

Anti-arrhythmic Class III

Answer 16

K+ channel blockers (phase 3)
Amiodarone
Increase effective refractory period
Treat afib, aflutter, vtach

Question 17

Anti-arrhythmic Class IV

Answer 17

Ca channel blockers (phase 2)
Verapamil, diltiazem
Decrease conduction velocity
Treat nodal arrhythmias, rate control for afib

Question 18

Adenosine

Answer 18

Increase K+ out of cells to hyperpolarize cells
Abolish SVT
Very short acting