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USMLE World Q Bank > Cardiovascular > Flashcards

Cardiovascular Flashcards

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USMLE® Step 1 flashcards
1
Q

What do muscarinic agonist do to endothelial cells?

A

It cause them to release NO also known as Endothelium Derived Relaxation Factor.

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2
Q

What are the signs and symptoms of Kawasaki’s disease?

A 
Seen in children and it includes:
Persistent fever
Bilateral conjunctivitis
LAD
Desquamation
Can progress to coronary aneurysm.
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3
Q

What are the three sources of energy in myocardium? Which requires the most oxygen per ATP produced?

A

Glycolysis, Glucose Oxidation and Fatty Acid Oxidation. Fatty acid oxidation requires the most oxygen.

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4
Q

What are the mechanisms of the four classes of antiarrhythmics?

A

I - Na channel blockers
II - beta blockers
III - K channel blockers
IV - Ca channel blockers

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5
Q

What is the treatment for beta-blocker overdose?

A

Glucagon (increases cAMP -> releases Ca -> increased HR and contractility). The symptoms of beta-blocker overdose are hypotension and bradycardia.

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6
Q

Name the three medium vessel vasculitis and give a quick synopsis of each.

A

POLYARTERITIS NODOSA - Hep B + young adults, renal and visceral vessels, many microanneurysms.
KAWASAKI DISEASE - Asian children with strawberry tongue, LAD, conjunctivitis, recurrent fever and desquamination.
BUERGER DISEASE - (Thromboangiitis Obliterans) Smoker <40 years old, Raynaud phenomenon

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7
Q

What are some of the typical findings in coarctation of the aorta?

A

Weak lower extremities with signs of hypertension above (nose bleeds & headaches). Large intercostal collateral circulation may lead to notching of the ribs.

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8
Q

Which antiarrhythmics show activity dependent?

A

Class I, the Na channel blocker. They work better on myocardium that is tachy or in fibrilation. QT interval prolonged at high HR.

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9
Q

Which antiarrhythmics show reverse activity dependence?

A

Class III, the K channel blockers. QT interval is prolonged at low HR.

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10
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever

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11
Q

What is the first line and second line drug therapy for hypertriglyceridemia?

A 
First = Fibrate (Gemfibrozil, clofibrate, bezafibrate, fenofibrate)
Second = Niacin (B3)
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12
Q

Where is the block in AV block? Describe what happens in complete (3rd degree) block.

A

Between the SA node and the AV Node. The SA node paces the atria and the SA node paces the ventricles leading to a completely independent cycles. Normally the SA node “paces” everything.

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13
Q

What are the side effects of hydralazine and minoxidil, the direct arteriolar vasodilators?

A

They cause a reflex sympathetic response that leads to tachycardia and sodium/fluid retention.

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14
Q

What are the two enzematic activities of ACE?

A

ATI to ATII. And breakdown of bradykinin. (ACE inhibitor can cause facial angioedema)

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15
Q

What is the most common side effect of amiodarone?

A

Hypothyroidism

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16
Q

What does a normal jugular venous pressure tracing show?

A

Two peaks (atrial contraction A, and tricuspid bulging C) a drought (atrial relaxation, X), another peak (venous filling, V), and one more draught (emptying into ventricle, Y)

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17
Q

What are the class 1A antiarrythmics?

A

Quinedine, Procainamide, Disopyramide. (the Queen Proclaims Diso’s Pyramids.)

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18
Q

What are the class 1B antiarrythmics?

A

Lidocaine, Mexiletine (Lida’s Mexican makes 1 Burrito)

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19
Q

What are the class 1C antiarrythmics?

A

Flecainide, Propafenone (Can i have Fries Please.)

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20
Q

Name the four small vessel vasculitis and give a quick synopsis of each.

A

GRANULOMATOSIS with POLYANGIITIS - Focal necrotizing vasculitis, granulomas in the lung and airway, glomerulonephritis, c-ANCA
MICROSCOPIC POLYANGIITIS - MPO-ANCA, p-ANCA, same presentation as granulomatosis but no pharyngeal involvement.
CHURG-STRAUSS SYNDROME - MPO-ANCA, p-ANCA, asthma, eosinophilia, high IgE, peripheral neuropathy
HENOCH-SCHONLEIN PURPURA - Childhood, IgA complex deposition, follows URI, arthralgia, abdominal pain, melena, GI lesions.

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21
Q

What is the difference between early and late post-MI pericarditis?

A

Early is due to inflammation caused by the necrotic tissue and it occurs day after the MI. Late is due to an autoimmune reaction caused by the necrotic tissue and it occurs one week to months after the MI (Dressler’s Syndrome)

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22
Q

What are the two most commonly used drugs for hypertensive emergencies? What are their MoA?

A

Nitroprosside (increases cGMP via direct NO release)

Fenoldopam (Selective D1 agonist that causes arterial dilation and increases renal blood flow)

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23
Q

What is cholestyramine?

A

Bile acid binding agent that causes gastric excretion of bile. This promotes bile acid synthesis in the liver and therefore, it also promotes cholesterol synthesis despite it’s net cholesterol decreasing effect.

24
Q

What is the effect of beta blockers on an ECG?

A

Prolongation of the PR interval. (Similar to block)

25
Q

What are the three most important side effects of ACE inhibitors?

A

Decrease GFR, Hyperkalemia, Cough

26
Q

Which compound can mimic the effects of Marfan’s Syndrome if ingested?

A

beta-aminopropionitrile. It inhibits Elastin fiber cross-linkage. Found in some sweet peas.

27
Q

Why is nitroglycerin useful in the setting of stable angina?

A

Vasodilation leads to decreased pre-load. (Decreased in end diastolic ventricular volume.) While they also decrease arteriolar resistance this is not the most beneficial effect.

28
Q

What are the side effects of Ca channel blockers?

A

In the heart: AV Block, CHF, and SA node depression

Outside: Constipation, Flushing and Edema

29
Q

Which ones are the cardio selective and non cardio selective Ca channel blockers?

A 
Peripheral = Amlodipine, Nimodipine, Nifedipine(which has a little cardio)
Cario = Diltiazem and Verapamil
30
Q

What can be use to treat PDA?

A

NSAIDs: Indomethacin or Ibuprofen

31
Q

What effects does chronic hypertension have on the cerebral vasculature?

A

The arteries of the basal ganglion develop Charcot-Bouchard pseudoaneurysms.

32
Q

Compare and contrast Cherry and Strawberry Hemangiomas?

A

Both are benign capilliary tumors but Strawberry is in children and Cherry is in elderly patients. Strawberry hemangiomas regress on their own, Cherry do not.

33
Q

What is a cystic hygroma?

A

Cavernous lymphangioma that presents on the neck of children. Assc. with Turner syndrome. The mass is compressible and can be transluminated.

34
Q

What are the syndromes of congenital long QT?

A

Both Romano-Ward and “Jervell and Lange-Nielsen” syndrome cause congenital long QT but only the latter (JLN) has sensorineural deafness. Ion channel defect.

35
Q

What is the separation scheme for the beta blockers?

A

B1 = (A to M) = Acebutolol, Atenolol, Betaxolol, Esmolol, Metoprolol.
B1 & B2 = (N to Z) = Nadolol, Pindolol, Propranolol, Timolol
A & B = (LC) = Carvedilol, Labetalol
B1 & B3+ = Nebivolol (which has B3 agonist activity to vasodilate)

36
Q

What is the difference between metaproterenol & metoprolol?

A

Metaproterenol is a B2>B1 agonist. Metoprolol (like all -lol) is a B1 selective blocker.

37
Q

What is the most common cardiac neoplasm?

A

Myxoma. Most often in the left atrium. They often produce IL-6 so pts present with constitutional symptoms.

38
Q

What is the classical presentation of lymphangiosarcoma?

A

Multiple nodules in an area with persistent lymphedema. (ie. post radical mastectomy) AKA Stewart-Treves Syndrome

39
Q

What are the antrhacycline chemotherapy drugs? What is the mechanism of their major side effect?

A

Daunorubicin, doxorubicin, epirubicin, iadarubicin (-rubicin)
They create free radicals in the myocardium and cause dilated cardiomyopathy months later.

40
Q

What is the most common side effect of nitrates?

A

Headaches

41
Q

What are the side effects of Niacin?

A

Cutaneous vasodilation, hyperuricemia and hyperglycemia.

Niacin is the second line treatment for high triglycerides and the first line treatment to increase HDL.

42
Q

What are the effects of thiazide diuretics? There are four hypers and three hypos.

A

HYPER-urecemia, calcemia, glycemia, lipidemia.

HYPO-kalemia, tension, natremia.

43
Q

What is the only drug that causes long QT but decreased the probability of Trosade de Pointes?

A

Amiodarone. The anti arrhythmic with activity from all classes.

44
Q

What is special about the dosing of nitrates long term?

A

Generally there is a morning dose and an afternoon dose, creating a low dose period at night. This prevents from the development of tolerance.

45
Q

Which beta blocker has both class II and class II antiarrythmics effects?

A

Sotalol, causes bradycardia and severe QT prolongation.

46
Q

What is the best sign of severity in mitral stenosis?

A

The smaller the interval from S2 to opening snap the more severe the disease is. OS occurs due to tension on the leaflets. The more the fibrosis the more tension and the earlier the snap.

47
Q

What are berry aneurysms of the circle of willis in a young adult associated with?

A

Coarctation of the aorta. Depending on location this can cause hypertension in the carotid vessels.

48
Q

What are the side effects of adenosine?

A

Facial flushing, hypotension and chest pain

49
Q

What is Kussmaul’s Sign and what can it be caused by?

A

Paradoxical increase of JVP on inspiration. Only in CHRONIC diseases. Constrictive Pericarditis, Restrictive Cardiomyopathy, RV failure, Tricuspid stenosis, and rarely tamponade.

50
Q

Formula for resistance of a vessel.

A

R = (viscosity) x Length / Radius^4

The fact that is to the 4th is very important.

51
Q

What is the highest risk factor for an aortic dissection?

A

HTN. High cholesterol does not predispose to dissection as much as it predisposes to aneurysms in the abdominal aorta.

52
Q

What are the side effects of digoxin? Which is the most serious?

A

Arrhythmia & hyperkalemia is the most serious but it can also cause changes in color perception, anorexia, vomiting, diarrhea, Long QT, ST scooping, T-wave inversion, AV block.

53
Q

What maneuvers can increase the murmur of hypertrophic cardiomyopathy?

A

Anything that decreases preload will augment obstruction by simply having a less dilated ventricle. This includes sudden standing and valsalva.

54
Q

What causes hyaline arteriolosclerosis?

A

Diabetes and NONmalignant (aka essential) hypertension.

55
Q

Which nitrate has the best oral availability?

A

Isosorbide Mononitrate. Which is a metabolite of Isosorbide Dinitrate (bad availability in contrast). Nitroglycerin is given sublingually. Nitroprusside is given IV.

56
Q

What causes the adverse effects of Nitroprusside and how can they be reversed?

A

It get broken into NO and Cyanide. Cyanide toxicity can be treated with Thiosulfate which acts as a Sulfur donor.

57
Q

Describe the mechanism of Digoxin?

A

First it blocks the Na/K ATPase leading to increased Ca and thus it has an ianotropic effects. It also increases Vagal tone and decreases conduction through the AV node. This is useful in rapid ventricular response during A-fib.

USMLE World Q Bank (14 decks)

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