Cardiology_2 Flashcards
1
Q
Truncus arteriosus gives rise to what?
A
ascending aorta and pulmonary trunk
2
Q
which congenital cardiac defect is associated with 22q11 syndromes?
A
truncus arteriosus • ToF
3
Q
which congenital cardiac defects are associated with Down syndrome?
A
ASD • VSD • AV septal defect (endocardial cushion defect)
4
Q
which congenital cardiac defects are associated with congential rubella?
A
septal defects • PDA • PA stenosis
5
Q
which congenital cardiac defects are associated with turner syndrome?
A
coarctation of the aorta (preductal)
6
Q
which congenital cardiac defects are assciated with Mafan’s syndrome?
A
aortic insufficiency and dissection (late complication)
7
Q
which congenital cardiac defects are associated with infants of diabetic mothers?
A
transposition of great vessels
8
Q
hypertension is defined as what?
A
BP >= 140/90
9
Q
what are the risk factors for hypertension?
A
↑ age • obesity • smoking • genetics • black>white>asian
10
Q
90% of hypertension is what?
A
1° (essential) and related to ↑ CO and ↑ TPR
11
Q
10 % of hypertension is what?
A
mostly 2° to renal disease
12
Q
features of malignant hypertension?
A
severe • >180/120 • rapidly progressing
13
Q
hypertension predisposes to what?
A
athersclerosis • LVH • stroke • CHF • renal failure • retinopathy • aortic dissection
14
Q
what are the signs of hyperlipidemia?
A
atheromas • xanthomas • tendinous xanthoma • corneal arcus
15
Q
what are atheromas?
A
plaques in blood vessel wall
16
Q
what are xanthomas?
A
plaques or nodules composed of lipid-laden histiocytes in the skin, especially the eyelids
17
Q
what do you call a xanthoma of the eyelid?
A
xanthelasma
18
Q
what is a tendinous xanthoma?
A
lipid depost in the tendon, especially the achilles
19
Q
what is corneal arcus?
A
lipid deposit in cornea, nonspecific (arcus senilis)
20
Q
what are the 3 classes of arteriosclerosis?
A
Monckberg • arteriosclerosis • atherosclerosis
21
Q
what is Monckberg arteriosclerosis?
A
calcification in the media of the arteries, especially radial or ulnar
22
Q
severity of monckberg arteriosclerosis?
A
usually benign • does not obstruct blood flow • intima not involved
23
Q
typical presentation of monckberg arteriosclerosis?
A
pipestem arteries
24
Q
what are the two subtypes of arteriosclerosis?
A
hyaline • hyperplastic
25
what is hyaline arteriosclerosis?
thickening of small arteries in essential hypertension or DM
26
what is hyperplastic arteriosclerosis?
onion skinning in malignant hypertension
27
what is atherosclerosis?
fibrous plaques and atheromas form in intima of arteries
28
what type of disease is atherosclerosis?
disease of elastic arteries and large and medium sized muscular arteries
29
what are the modifiable risk factors for atherosclerosis?
smoking • hypertension • hyperlipidemia • diabetes
30
what are the non-modifiable risk factors for atherosclerosis?
age, gender (↑ in men and postmenopausal women), and positive family history
31
what is important in the pathogenesis of atherosclerosis?
inflammation
32
what is the progression of atherosclerosis?
endothelial cell dysfunction → macrophage and LDL accumulation → foam cell formation → fatty streaks → smooth muscle cell migration (involves PDGF and FGF), proliferation and ECM deposition → fibrous plaque → complex atheromas
33
important histological finding in atherosclerosis?
cholesterol crystals
34
what are the complications of atherosclerosis?
aneurysms • ischemia • infarcts • peripheral vascular disease • thrombus • emboli
35
what is the relative frequency of location of atherosclerosis?
abdominal aorta > coronary artery > popliteal artery > carotid artery
36
what are the symptoms of atherosclerosis?
angina • claudication • but can be asymptomatic
37
what is an aortic aneurysm?
localized pathologic dilation of the aorta
38
what are the 2 types of aortic aneurysm?
AAA • TAA
39
AAA is associated with what?
atherosclerosis
40
AAA occurs more frequently in who?
hypertensive male smokers> 50yo
41
TAA is associated with what?
hypertension, cystic medial necrosis (Marfan's) and historically 3° syphilis
42
what happens in aortic dissection?
longitudinal intraluminal tear forming a false lumen
43
aortic dissection associated with what?
hypertension • bicuspid aortic valve • cystic medial necrosis • inherited connective tissue disorders (Marfans)
44
aortic dissection presents how?
tearing chest pain radiating to the back
45
in aortic dissection, CXR shows what?
mediastinal widening
46
possibilities for the false lumen in aortic dissection?
can be limited to the ascending aorta, propagate from the ascending aorta, or propagate from the descending aorta
47
aortic dissection can result in what?
pericardial tamponade • aortic rupture • death
48
what are the ischemic heart disease manifestations?
angina • coronary steal syndrome • myocardial infarction • sudden cardiac death • chronic ischemic heart disease
49
pathology involved in angina?
CAD narrowing >75% • no myocyte necrosis
50
stable angina is mostly 2° to what?
atherosclerosis
51
presentation of stable angina?
ST depression on ECG • retrosternal chest pain with exertion
52
Prinzmental angina occurs when?
at rest 2° to coronary artery spasm
53
ECG finding in prinzmental angina?
ST elevation
54
pathology involved in unstable angina?
thrombosis with incomplete coronary artery occlusion
55
presentation of unstable/crescendo angina?
ST depression on ECG • worsening chest pain at rest or with minimal exertion
56
what happens in coronary steal syndrome?
vasodilator may aggravate ischemia by shunting blood from area of critical stenosis to an area of higher perfusion
57
myocardial is most often due to what?
acute thrombosis due to coronary artery atherosclerosis with complete occlusion of coronary artery with myocyte necrosis
58
ECG findings in MI?
ECG initially shows ST depression progressing to ST elevation with continued ischemia and transmural necrosis
59
what is sudden cardiac death?
death from cardiac causes within 1 hour of onset of symptoms, most commonly due to a lethal arrhythmia (V-fib)
60
sudden cardiac death is associated with what?
CAD up to 70% of cases
61
what is chronic ischemic heart disease?
progressive onset of CHF over many years due to chronic ischemic myocardial damage
62
relative frequency of coronary artery occlusion in MI?
LAD >RCA > circumflex
63
what are the symptoms of MI?
diaphoresis • nausea • vomiting • severe retrosternal pain • pain in left arm and or jaw • shortness of breath • fatigue
64
what are the gross findings within 0-4h of MI?
none
65
what are the LM findings within 0-4h of MI?
none
66
what are the risks within 0-4h of MI?
arrhythmia • CHF • exacerbation • cardiogenic shock
67
what are the gross findings within 4-24h of MI?
infarct and dark mottling; pale with tetrazolium stain distal to occluded artery
68
what are the LM findings within 4-12h of MI?
early coagulative necrosis • edema • hemorrhage • wavy fibers
69
what is the risk within 4-12h of MI?
arrhythmia
70
what are the LM findings within 12-24h of MI?
contraction bands from reperfusion injury • release of necrotic cell content into blood • beginning of neutrophil migration
71
what is the risk within 12-24h of MI?
arrhythmia
72
what are the gross findings within 1-3 days of MI?
hyperemia
73
what are the LM findings within 1-3days of MI?
extensive coagulative necrosis • tissue surrounding infarct shows acute inflammation • neutrophil migration
74
what is the risk within 1-3 days of MI?
fibrinous pericarditis
75
what are the gross findings within 3-14days of MI?
hyperemic border; • central yellow-brown softening • maximally yellow and soft by 10 days
76
LM findings within 3-14days of MI?
macrophage infiltration followed by granulation tissue at the margins
77
what is the risk within 3-14 days of MI?
free wall rupture leading to tamponade, papillary muscle rupture, ventricular aneurysm, interventricular septal rupture due to macrophages that have degraded important structural components
78
what are the gross findings 2weeks-months post MI?
recanalized artery • gray white
79
LM findings 2 weeks-months post MI?
contracted scar complete
80
risk 2weeks-months post MI?
dressler's syndrome
81
what is the gold standard for dx of MI in first 6h?
ECG
82
use of cardiac troponin I in diagnosis of MI?
rises after 4 hours and is elevated for 7-10 days; more specific than other protein markers
83
use of CK-MB in diagnosis of MI?
useful in diagnosing reinfarction following acute MI because levels return to normal after 48 hours
84
CK-MB predominantly found where?
in myocardium but can also be released from skeletal muscle
85
ECG changes in MI?
ST elevation (transmural infarct) • ST depression (subendocardial infarct) • Q waves (transmural infarct)
86
necrosis in transmural infarct?
↑ necrosis
87
subendocardial infarcts due to what?
ischemic necrosis of < 50% of ventricle wall
88
transmural infarct affects how much of cardiac structure?
affects entire wall
89
subendocardial infarct affect what structure?
subendocardium especially vulnerable to ischemia
90
ECG in transmural infarcts?
ST elevation • Q waves
91
ECG in subendocardial infarct?
ST depression
92
Q waves in V1-V4, where is the infarct?
Anterior wall (LAD)
93
Q waves in V1-V2, where is the infarct?
Ateroseptal (LAD)
94
Q waves in V4-V6, where is the infarct?
anterolateral (LCX)
95
Q waves in I, aVL, where is the infarct?
lateral wall (LCX)
96
Q waves in II, III, aVF, where is the infarct?
inferior wall (RCA)
97
in MI, what is an important cause of death before reaching hospital?
cardiac arrhythmia
98
cardiac arrhythmia in MI is common when?
in first few days
99
what are the complications of MI?
cardiac arrhythmia • LV failure and pulmonary edema • Cardiogenic shock • Ventricular free wall rupture • papillary muscle rupture • IVS rupture • ventricular aneurysm formation • postinfarction fibrinous pericarditis
100
what is Dressler's syndrome?
autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)
101
factors associated with cardiogenic shock in MI?
large infarct- high risk of mortality
102
in MI ventricular free wall rupture →?
cardiac tamponade
103
in MI, papillary muscle rupture→?
severe mitral regurgitation
104
in MI, IVS rupture→?
VSD
105
factors associated with ventricular aneurysm formation in MI?
↓ CO • risk of arrhythmia • embolus from mural thrombus
106
when is the greatest risk for ventricular aneurysm formation in MI?
1 week post MI
107
what is the most common cardiomyopathy?
dilated (congestive) cardiomyopathy 90%
108
dilated cardiomyopathy is usually what origin?
often idiopathic, up to 50% familial
109
specific etologies of dilated cardiomyopathy include what?
ABCCCD • Alcohol abuse • wet Beriberi • Coxsackie b virus myocarditis • chronic Cocaine use • Chaga's disease • Doxorubicin toxicity • hemochromatosis • peripartum cardiomyopathy
110
what are the findings in dilated cardiomyopathy?
S3 • dilated heart on U/S • balloon appearance on chest X ray
111
what is the treatment for dilated cardiomyopathy?
Na+ restriction • ACE inhibitors • diuretics • digoxin • heart transplant
112
what happens in hypertrophic cardiomyopathy?
hypertrophied interventricular septum is too close to mitral valve leaflet, leading to outflow tract obstruction
113
60-70% of hypertrophic cardiomyopathy are of what origin?
familial • AD • βmyosin heavy chain mutation
114
hypertrophic cardiomyopathy is associated with what?
Friedreich's ataxia
115
morphologic findings in hypertrophic cardiomyopathy?
disoriented, tangled, hypertrophied myocardial fibers
116
what is a cause of sudden death in young athletes?
hypertrophic cardiomyopathy
117
what are the findings in hypertrophic cardiomyopathy?
normal sized heart • S4 • apical impulses • systolic murmur
118
what is the treatment for hypertrophic cardiomyopathy?
β blocker or non-dihydropyridine calcium channel blocker (verapamil)
119
what ensues in hypertrophic cardiomyopathy?
diastolic dysfunction
120
gross appearance in hypertrophic cardiomyopathy?
asymmetric concentric hypertrophy (sarcomeres added in parallel)
121
pathogenesis of hypertrophic cardiomyopathy?
proximity of hypertrophied interventricular septum to mitral leaflet obstructs outflow tract, resulting in systolic murmur and syncopal episodes
122
major causes of restrictive/obliterative cardiomyopathy include what?
sarcoidosis • amyloidosis • postradiation fibrosis • endocardial fibroelastosis • Lofflers syndrome • hemochromatosis
123
what is endocardial fibroelastosis?
thick fibroelastic tissue in endocardium of young children
124
what is Loffler's syndrome?
endomyocardial fibrosis with a prominent eosinophilic infiltrate
125
what ensues in restrictive/obliterative cardiomyopathy?
diastolic dysfunction
126
what is CHF?
a clinical syndrome that occurs in patients with an inherited or acquired abnormality of cardiac structure or function, which is characterized by a constellation of clinical symptoms (dyspnea, fatigue) and signs (edema, rales)
127
in CHF RHF most often results from what?
LHF
128
isolated RHF is usually due to what?
cor pulmonale
129
which drugs reduce mortality in CHF?
ACE inhibitors • β blockers • ARBs • spironolactone
130
when do you not give β blockers in CHF?
acute decompensated HF
131
which drugs are used for symptomatic relief in CHF?
thiazides • loop diuretics
132
which drugs improve symptoms and mortality in select patients with CHF?
hydralazine with nitrate therapy
133
what are the abnormalities seen in CHF?
cardiac dilation • dyspnea on exertion • LHF • RHF
134
what is the cause of cardiac dilation in CHF?
greater ventricular EDV
135
what is the cause of DOE in CHF?
failure of cardiac output to ↑ during exercise
136
what are the manifestations of LHF in CHF?
pulmonary edema/PND • orthopnea
137
what is the cause of pulmonary edema/PND in CHF?
↑ pulmonary venous pressure→ pulmonary venous distentions and transudation of fluid
138
histological finding in LHF in CHF?
presence of hemosiderin laden macrophages (heart failure cells) in the lungs
139
what is the cause of orthopnea in CHF?
↑ venous return in supine position exacerbates pulmonary vascular congestion
140
what are the manifestations of RHF in CHF?
hepatomegaly (nutmeg liver) • peripheral edema • jugular venous distention
141
what is the cause of hepatomegaly (nutmeg liver) in CHF?
↑ central venous pressure → ↑ resistance to portal flow
142
rarely, hepatomegaly in RHF leads to what?
cardiac cirrhosis
143
what is the cause of peripheral edema in CHF?
↑ venous pressure → fluid transudation
144
what is the cause of jugular venous distention in CHF?
↑ venous pressure
145
what are the symptoms of bacterial endocarditis?
Bacteria FROM JANE: • Fever • Roth spots • Osler nodes • Murmur • Janeway lesions • Anemia • Nail-bed hemorrhage • Emboli
146
what is the most common symptom of bacterial endocarditis?
fever
147
what are roth spots?
round white spots on retina surrounded by hemorrhage
148
what are osler's nodes?
tender raised lesions on finger or toe pads
149
what are janeway lesions?
small, painless, erythematous lesions on palm or sole
150
what is necessary for diagnosis of bacterial endocarditis?
multiple blood cultures
151
organism that causes acute bacterial endocarditis?
S aureus
152
virulence of organism that causes acute bacterial endocarditis?
S aureus (high virulence)
153
presentation in acute bacterial endocarditis caused by S aureus?
large vegetations on previously normal valves
154
what is the onset of acute bacterial endocarditis caused by S aureus?
rapid onset
155
organism that causes subacute bacterial endocarditis?
viridans streptococcus
156
virulence of the organism that causes subacute bacterial endocarditis?
low virulence
157
presentation in subacute bacterial endocarditis?
smaller vegetations on congenitally abnormal or diseased valves
158
subacute bacterial endocarditis can be sequelae of what?
dental procedures
159
what is the onset of subacute bacterial endocarditis?
more insidious onset
160
endocarditis may be nonbacterial secondary to what?
malignancy • hypercoagulable state • lupus (marantic/ thrombotic endocarditis)
161
S bovis is present in which cause of endocarditis?
colon cancer
162
S epidermidis is present in which cause of endocarditis?
prosthetic valves
163
which valve is most frequently involved in bacterial endocarditis?
mitral
164
tricuspid valve endocarditis is associated with what?
IV drug use (dont TRI DRUGS)
165
tricuspid endocarditis is associated with which organisms?
S aureus • Pseudomonas • Candida
166
what are the complications of bacterial endocarditis?
chordae rupture • glomerulonephritis • suppurative pericarditis • emboli
167
rheumatic fever is a consequence of what?
pharyngeal infection with group A β hemolytic streptococci
168
early deaths in rheumatic fever due to what?
myocarditis
169
late sequelae of rheumatic fever include what?
rheumatic heart disease
170
relative frequency of valves affected by rheumatic heart disease?
mitral > aortic >> tricuspid (high pressure vavles affected most)
171
early lesion in rheumatic fever is what?
MR
172
what is the late lesion in rheumatic fever?
MS
173
Rheumatic fever is associated with what?
Aschoff bodies • Anitschkow's cells • elevated ASO titers
174
what are Aschoff bodies?
granuloma with giant cells
175
what are anitschkow's cells?
activated histiocytes
176
immunology of rheumatic fever?
Type II HSR; not a direct effect of bacteria • Ab to M protein
177
symptoms of Rheumatic fever?
FEVERSS: • Fever • Erythema marginatum • Valvular damage • ESR ↑ • Red hot joints (migratory polyarthritis) • Subcutaneous nodules • St. Vitus' dance (Sydenham's chorea)
178
acute pericarditis commonly presents with what?
sharp pain, aggravated by inspiration, and relieved by sitting up and leaning forward • friction rub
179
ECG findings in acute pericarditis?
widespread ST-segment elevation and/or PR depression
180
acute fibrinous pericarditis is caused by what?
Dressler's syndrome, • uremia • radiation
181
fibrinous pericarditis presents with what?
loud friction rub
182
what are the causes of serous pericarditis?
viral • noninfectious inflammatory diseases
183
course of viral serous pericarditis?
often resolves spontaneously
184
non infectious inflammatory diseases that cause acute serous pericarditis?
RA • SLE
185
what causes suppurative/purulent pericarditis?
bacterial infections with pneumococcus or streptococcus
186
frequency of purulent pericarditis?
rare with antibiotics
187
what happens in cardiac tamponade?
compression of heart by fluid (blood effusions) in pericardium leading to ↓ CO
188
what happens to pressures in cardiac tamponade?
equilibration of pressures in all 4 chambers
189
what are the findings in cardiac tamponade?
hypotension • ↑ venous pressure (JVD) • distant heart sounds • ↑ HR • pulsus paradoxus
190
what is pulsus paradoxus?
↓ in amplitude of systolic blood pressure by >=10mHg during inspiration
191
pulsus paradoxus seen in what?
severe cardiac tamponade • asthma • OSA • pericarditis • croup
192
what happens in syphilitic heart disease?
3° syphilis disrupts the vasa vasorum of the aorta with consequent atrophy of the vessel wall and valve ring
193
in syphilitic heart disease you may see what?
calcification of the aortic root and ascending aortic arch
194
syphilitic heart disease leads to what appearance?
tree bark appearance of the aorta
195
syphilitic heart disease can result in what?
aneurysm of the ascending aorta or aortic arch and aortic insufficiency
196
what are the most common primary cardiac tumors in adults?
myxomas
197
90% of cardiac myxomas occur where?
in the atria (mostly left atrium)
198
myxomas are usually described as what?
ball valve obstruction in LA associated with multiple syncopal episodes
199
what is the most frequent primary cardiac tumor in children?
rhabdomyomas
200
cardiac rhabdomyomas are associated with what?
tuberous sclerosis
201
most common heart tumor is what?
mets from melanoma or lymphoma
202
what is Kussmaul's sign?
↑ in JVP on inspiration instead of normal ↓
203
what happens in Kussmaul's sign?
inspiration → negative intrathoracic pressure not transmitted to the heart→ impaired filling of RV → blood backs up into the venae cavae→ JVD
204
Kussmaul's sign may be seen in what?
constrictive pericarditis • restrictive cardiomyopathies • RA or RV tumors • cardiac tamponade
205
Raynaud's phenomenon affects what type of vessels?
small vessels
206
what happens in Raynaud's phenomenon?
↓ blood flow to the skin due to arteriolar vasospasm in response to cold temperature or emotional stress
207
Raynauds phenomenon is most often seen where?
fingers • toes
208
when is it called Raynaud's disease?
when primary (idiopathic)
209
when is it called Raynaud's syndrome?
when secondary to a disease process such as mixed connective tissue disease, SLE, or CREST
210
temporal arteritis generally affects who?
elderly females
211
symptoms in temporal arteritis?
unilateral headache (temporal artery) • jaw claudication
212
temporal arteritis may lead to what?
irreversible blindness die to ophthalmic artery occlusion
213
temporal arteritis is associated with what?
polymyalgia rheumatica
214
temporal arteritis most commonly affects which vessels?
branches of carotid artery
215
pathology/labs seen in temporal arteritis?
focal granulomatous inflammation • ↑ ESR
216
what is the treatment for temporal arteritis?
high dose corticosteroids
217
Takayasu arteritis typically affects who?
asian females <40yo
218
symptoms of takayasu arteritis?
pulselessness disease: • fever • night sweats • arthritis • myalgias • skin nodules • ocular disturbances
219
pathology/labs seen in takayasu arteritis?
granulomatous thickening of aortic arch, proximal great vessels • ↑ ESR
220
what is the treatment for takayasu arteritis?
corticosteroids
221
what are the large artery vasculitis disorders?
temporal arteritis and takayasu arteritis
222
what are the medium vessel vasculitis disorders?
polyarteritis nodosa • kawasaki disease • Buerger's disease (thromboangitis obliterans)
223
polyarteritis nodosa affects who?
young adults
224
viral association with polyarteritis nodosa?
HBV seropositivity in 30% of patients
225
symptoms of polyarteritis nodosa?
fever • weight loss • malaise • headache • abdominal pain • melena • HTN • neuro dysfunction • cutaneous eruptions • renal damage
226
polyarteritis nodosa typically involves which vessels?
renal and visceral vessels, not pulmonary arteries
227
immunology of polyarteritis nodosa?
IC mediated
228
pathology/labs seen in polyarteritis nodosa?
transmural inflammation of the arterial wall with fibrinoid necrosis • lesions are of different stages • many aneurysms and constrictions on arteriogram
229
treatment for polyarteritis nodosa?
corticosteroids • cyclophosphamide
230
kawasaki disease affects who?
asian children < 4yo
231
symptoms associated with kawasaki disease?
fever cervical lymphadenitis • conjunctival injection • changes in lips/oral mucosa (strawberry tongue) • hand-foot erythema • desquamating rash
232
children with kawasaki disease may develop which complications?
coronary aneurysms → MI, rupture
233
treatment for kawasaki disease?
IV immunoglobulin and aspirin
234
Buerger's disease affects who?
heavy smokers, males <40yo
235
symptoms in Buerger's disease?
intermittent claudication may lead to gangrene, autoamputation of digits, superficial nodular phlebitis • raynauds phenomenon
236
what is the pathology seen in buerger's disease?
segmental thrombosing vasculitis
237
what is the treatment for buergers disease?
smoking cessation
238
what are the small vessel vasculitis disorders?
microscopic polyangitis • Wegener's granulomatosis (granulomatosis with polyangitis) • Churg strauss syndrome • Henoch Schonlein purpura
239
what is microscopic polyangitis?
necrotizing vasculitis commonly involving lung, kidneys, and skin with pauci immune glomerulonephritis and palpable purpura
240
pathology/labs seen in microscopic polyangitis?
no granulomas • p-ANCA
241
what is the treatment for microscopic polyangitis?
cyclophosphamide and corticosteroids
242
what are the upper respiratory tract symptoms of wegener's granulomatosis?
perforation of nasal septum, • chronic sinusitis • otitis media • mastoiditis
243
what are the lower respiratory symptoms of Wegener's granulomatosis?
hemoptysis • cough • dyspnea
244
what are the renal manifestations of wegener's granulomatosis?
hematuria • red cell casts
245
what is the triad that characterizes wegener's granulomatosis?
focal necrotizing vasculitis • necrotizing granulomas in the lung and upper airway • necrotizing glomerulonephritis
246
what are the labs seen in wegeners granulomatosis?
c-ANCA • CXR: large nodular densities
247
what is the treatment for wegeners granulomatosis?
cyclophosphamide • corticosteroids
248
what are the symptoms of Churg-strauss syndrome?
asthma • sinusitis • palpable purpura • peripheral neuropathy (wrist/foot drop) • can also involve heart, GI, pauci-immune glomerulonephritis
249
pathology/labs seen in Churg strauss syndrome?
granulomatous, necrotizing vasculitis with eosinophilia • p-ANCA, elevated IgE level
250
what is the most common childhood systemic vasculitis?
henoch-schonlein purpura
251
henoch-schonlein purpura often follows what?
URI
252
what is the classic triad of henoch schonlein purpura?
skin: palpable purpura on buttocks/legs • arthralgia • GI: abdominal pain, melena, multiple lesions of same age
253
pathology seen in henoch schonlein purpura?
vasculitis secondary to IgA complex deposition • associated with IgA nephropathy
254
what is a strawberry hemangioma?
benign hemangioma of infancy
255
strawberry hemangioma appears when?
first few weeks of life (1/200 births)
256
course of strawberry hemangioma?
grows rapidly and regresses spontaneously at 5-8 years of age
257
what is a cherry hemangioma?
benign capillary hemangioma of the elderly
258
course of cherry hemangioma?
does not regress
259
incidence of cherry hemangioma?
frequency ↑ with age
260
what is a pyogenic granuloma?
polypoid capillary hemangioma that can ulcerate and bleed
261
pyogenic granuloma is associated with what?
trauma and pregnancy
262
what is a cystic hygroma?
cavernous lymphangioma of the neck
263
cystic hygroma is associated with what?
Turner syndrome
264
what is a glomus tumor?
benign painful red-blue tumor under fingernails
265
glomus tumor arises from what?
modified smooth muscle cells of the glomus body
266
what is bacillary angiomatosis?
benign capillary skin papules found in AIDS patients
267
bacillary angiomatosis is caused by what?
Bartonella henselae infections
268
bacillary angiomatosis is frequently mistaken for what?
kaposi sarcoma
269
what is angiosarcoma?
rare blood vessel malignancy typically occuring in the head, neck, and breast areas
270
angiosarcoma is associated with what?
patients receiving radiation therapy, especially for BRCA and hodgkins lymphoma
271
course of angiosarcoma?
very aggressive and difficult to resect due to delay in diagnosis
272
what lymphangiosarcoma?
lymphatic malignancy associated with persistent lymphedema (post radical mastectomy)
273
what is kaposi sarcoma?
endothelial malignancy most commonly of the skin but also mouth, GIT, and respiratory tract
274
kaposi sarcoma is associated with what?
HHV-8 and HIV
275
kasposi sarcoma is frequently mistaken for what?
bacillary angiomatosis
276
what is sturge-weber disease?
congenital vascular disorder that affects capillary sized blood vessels.
277
Sturge-weber disease manifests how?
with port wine stain (nevus flammeus) on face • ispilateral leptomeningeal angiomatosis (intracerebral AVM) • seizures • early onset glaucoma
278
what are the antihypertensive therapies for essential hypertension?
diuretics • ACEI • ARBs • Ca channel blockers
279
what are the antihypertensive therapies used in CHF?
diuretics • ACEI/ARBs (compensated CHF) • K+ sparing diuretics
280
β blockers must be used cautiously in what?
decompensated CHF
281
β blockers are contraindicated in what?
cardiogenic shock
282
what are the antihypertensive therapies used in DM?
ACEI/ARBs • Ca channel blockers • diuretics • β blockers • α blockers
283
ACEIs are protctive against what in DM?
diabetic nephropathy
284
which drugs are Ca channel blockers?
nifedipine • verapamil • diltiazem • amlodipine
285
MOA of Ca channel blockers?
block voltage dependent L type calcium channels of cardiac and smooth muscle and thereby reduce muscle contractility
286
relative effect on smooth muscle of Ca channel blockers?
Vascular smooth muscle- amlodipine=nifedipine>diltiazem>verapamil
287
relative effect on heart of Ca channel blockers?
heart- verapamil>diltiazem>amlodipine=nifedipine • Verapamil-ventricle
288
clinical use of Ca channel blockers?
hypertension • angina • arrhythmias (not nifedipine) • prinzmental's angina • Raynauds
289
toxicity of Ca channel blockers?
cardiac depression • AV block • peripheral edema • flushing • dizziness • constipation
290
MOA of hydralazine?
↑cGMP→smooth muscle relaxation • vasodilates arterioles > veins • ↓ afterload
291
clinical use of hydralazine?
severe hypertension • CHF • first line tx for htn in pregnancy, with methyldopa • frequently coadministered with β blocker to prevent reflex tachycardia
292
toxicity of hydralazine?
compensatory tachycardia (CI in angina/CAD), fluid retention, nausea, HA, angina • Lupus like syndrome
293
commonly used drugs for malignant hypertension treatment?
nitroprusside • nicardipine • clevidipine • labetalol • fenoldopam
294
features of nitroprusside for malignant hypertension?
short acting • ↑ cGMP via direct release of NO
295
toxicity of nitroprusside?
can cause cyanide toxicity
296
MOA of fenoldopam?
dopamine D1 receptor agonist→ coronary, peripheral, renal, splanchnic vasodilation→ ↓BP and ↑ natriuresis
297
MOA of nitroglycerine, isosorbide dinitrate?
vasodilate by releasing NO in smooth muscle, causing ↑ cGMP in and smooth muscle relaxation • dilates veins>>arteries • ↓preload
298
clinical use of GTN, ISDN?
angina • pulmonary edema
299
toxicity of GTN, ISDN?
reflex tachycardia, hypotension, flushing, HA, "monday disease" in industrial exposure
300
what is monday disease in industrial GTN, ISDN exposure?
development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend results in tachycardia, dizziness, and HA upon reexposure
301
what is the goal of antianginal therapy?
reduction of myocardial O2 consumption (MVO2) by decreasing >=1 of the determinants of MVO2: EDV, BP, HR, contractility, ejection time
302
effect of nitrates on EDV?
↓
303
effect of β blockers on EDV?
↑
304
effect of nitrates+ β blockers on EDV?
no effect or ↓
305
effect of nitrates on BP?
↓
306
effect of βblockers on BP?
↓
307
effects of nitrates + βblockers on BP?
↓
308
effect of nitrates on contractility?
↑ (reflex response)
309
effects of β blockers on contractility?
↓
310
effect of nitrates + βblockers on contractility?
little/no effect
311
effect of nitrates on HR?
↑ (reflex)
312
effect of βblockers on HR?
↓
313
effect of nitrates + β blockers on HR?
↓
314
effect of nitrates on ejection time?
↓
315
effect of β blockers on ejection time?
↑
316
effect of nitrates + βblockers on ejection time?
little/no effect
317
effect of nitrates on MVO2?
↓
318
effect of β blockers on MVO2?
↓
319
effect of nitrates + βblockers on MVO2?
↓↓
320
how do Ca channel blockers compare to the effects of nitrates and beta blockers on MVO2?
nifedipine is similar to nitrates • verapamil is similar to beta blockers
321
which are the partial β agonists contraindicated in angina?
pindolol and acebutalol
322
effect of HMG-CoARI's on LDL?
↓↓↓
323
effect of HMG-CoARIs on HDL?
↑
324
effect of HMGCoARI's on TG?
↓
325
MOA of HMGCoARIs?
inhibit conversion of HMG-CoA to mevalonate, a cholesterol precursor
326
AE of HMGCoARIs?
hepatotoxicity (↑LFT) • rhabdomyolysis
327
effect of niacin on LDL?
↓↓
328
effect of niacin on HDL?
↑↑
329
effect of niacin on TG ?
↓
330
MOA of niacin?
inhibits lipolysis in adipose tissue; • reduces hepatic VLDL secretion into circulation
331
AE of niacin?
red, flushed, face which is ↓ by aspirin or long term use • hyperglycemia (acanthosis nigricans) • hyperuricemia (exacerbates gout)
332
effect of bile acid resins on LDL?
↓↓
333
effect of bile acid resins on HDL?
slightly ↑
334
effect of bile acid resins on TG?
slightly ↑
335
MOA of bile acid resins?
prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more
336
AE of bile acid resins?
patients hate it- • tastes bad and causes GI discomfort • ↓ absorption of fat soluble vitamins • cholesterol gallstones
337
effect of ezetimibe on LDL?
↓↓
338
effect of ezetimibe on HDL ?
no effect
339
effect of ezetimibe on TG?
no effect
340
MOA of ezetimibe?
prevent cholesterol reabsorption at small intestinal brush border
341
AE of ezetimibe?
rare ↑ in LFTs • diarrhea
342
effects of fibrates on LDL?
↓
343
effects of fibrates on HDL?
↑
344
effects of fibrates on TG?
↓↓↓
345
MOA of fibrates?
upregulate LPL→↑TG clearance
346
AE of fibrates?
myositis • hepatotoxicity • cholesterol gallstones
347
PK of digoxin?
75% bioavailability • 20-40% protein bound • t1/2=40h • urinary excretion
348
MOA of digoxin?
direct inhibition of Na+/K+ ATPase leads to indirect inhibition of Na+/Ca++ exchanger/antiport • ↑[Ca++]i → positive inotropy • stimulates vagus → ↓ HR
349
clinical use of digoxin?
CHF • atrial fibrillation
350
why use digoxin in CHF?
↑ contractility
351
why use digoxin in atrial fibrillation?
↓conduction at AV node and depression of SA node
