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A_First Aid Random Memorizing > Cards UWORLD > Flashcards

Cards UWORLD Flashcards

1
Q

access point for 3 vessel CABG

A

needs to access great seaphenous vein which
originates medial side of foot and courses anterior to medial malleolus and then travels up the medial aspect of leg and thigh…surgeons access just inferolateral to pubic tubercle

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2
Q

most common site of truamatic deceleration aortic injury

A

aortic isthmus just before ligamentum arteriosum (just right past initial downsloping of aortic arch)

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3
Q

in chronic aortic regurg from infection, what physiologic change to heart structure maintains cardiac output?

A

increased LV stroke volume (eccentric hypertrophy in LV from aortic regurg helps with this)

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4
Q

MOA fibrates

A

upregulate lipoprotein lipase by avtivating PPAR-alpha which leads to decreased hepatic VLDL and increaed LPL (lowers triglycerides)

omega 3 fatty acids also help with this

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5
Q

MOA nitrates

A

relaxes vascular smooth muscle causing peripheral vasodilation (venodilation) which will DECREASE PRELOAD/LVEDV, modest reduction in afterload and mild coronary artery dilation

this all decreases myocardial o2 demand

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6
Q

Hx of depression, tachycardia, prolonged QRS/QT

dx and rx

A 
TCA overdose (too much blockade of fast sodium channels) causing prlonged QT
treat with sodium bicarb to increase pH and favors extracellular Na which will alleviate blockade
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7
Q

How does embolus travel in retinal artery occlusion

A

internal carotid -> opthalmic -> retinal artery

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8
Q

biochemical MOA nitrates

A

increase NO -> increase cGMP -> decreases intracellular Ca -> myosin light chain DEPHOSPHORYLATION -> smooth muscle relaxation and vasodilation

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9
Q

MOA class III antiarrythmics and what are they?

A

block potassium channels which will prolong ventricular repolarization…prolongs QT and may lead to torsades

AIDS
amiodarine
ibulitide
dofetilidude
solatol
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10
Q

pathogenesis of pulmonary arterial hypertension

A

2 hit hypotehsis
AD mutation of BMPR2 gene….second insult (drugs, infection) activates disease process which involves increased endotheilin (vasconstrictor) and decreased NO and prostacyclin levels….smooth muscle proliferation

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11
Q

Karotkoff sounds heard first only during expiration at certain pressure….then at a lower pressure heard at all phases of respiration indicate what?

A

peridcardial dx…like tamponade, severe asthma, or constrictive pericarditis
this is PULSUS PARADOXUS

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12
Q

MOA beta agonists

A

bronchial smooth muscle relaxation via increased intracellular cAMP

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13
Q

10 year old immigrant with limited vaccine status presents with exertional dyspnea, easy fatigability, and toe cyanosis and clubbing but no finger or upper extremity abnormalities

A

patent ductus arteriosus

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14
Q

ACUTE pericarditis in otherwise healthy person associated with what physical exam finding

A

friction rub

NOT PULSUS (this is seen in more severe conditions like COPD, cardiac tamponade or severe asthma)

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15
Q

How to calculate number needed to treat/harm?

A

first calculate absolute risk reduction (ARR)
control rate - treatment rate

NNT = 1/ARR

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16
Q

How do AV shunts affect preload and afterload?

A

decrease afterload (blood can bypass arteriole resistance and just go stragiht into veins)….but increase preload

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17
Q

What does posterior descending supply?

A

posterior 1/3 of intraventricular septum, inferior wall of left ventricle, posterior wall of ventricle, posteriormedial part of papillary muscle

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18
Q

Adverse effect of statins and what can exacerbate theM?

A

rhabdo
cytochrome p 450 INHIBITORS can exacerbate them

SICKFACES.com
Sodium valproate, isoniazid, cimetidine, ketoconzaole, fluconazole, acute alcohol abuse, chloramphenicol, erythromycin, sulfonamides, ciprofloxacin, ondansetron, metronidazole

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19
Q

histologic color/hallmark of aging cells

A

lipofuscin (product of lipid peroxidation and free radical injury that chronically accumulates)

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20
Q

What at low doses can stimulate contractility in the heart and increase renal blood flow?

A

dopamine

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21
Q

infant born ok presents with new blowing holosystolic murmur a few days after birth

A

small vsd

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22
Q

combo of what two anginal drugs can cause severe bradycardia and hypotension

A

non-dihydropyridine Ca channel blockers (verapamil, diltiazem) and beta blockers

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23
Q

why does infusion of selective a1 adrenergic agonist (phenylephrine, methoxamine) eventually lead to decreased heart rate?

A

these drugs lead to vasoconstriction and increased systemic BP which will stimulate baroreceptors in carotid sinus and aortic arch to increase efferent firing which will increase VAGAL TONE on heart to inhibit pacemaker SA activity and slow conduction through AV node

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24
Q

patient comes in with hypertensive crisis…what’s a good medication that will cause arteriolar dilation, improve renal perfusion, and increase natriuersis

A

fenoldopam (selective D1 recepter agonist)

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25
Q

MOA sildenafil

A

phosphodiesterase5 inhibitor that decreases degradation of cGMP which will cause vasodilation of arteries….simiilar to action of nitrates and BNP

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26
Q

Which antiarrythmic has flushing, hypotension, chest pain, bronchospasm as adverse effects?

A

adenosine

useful in certain SVT, works by pushing K out of cells and hyperpolarizing cell, decreasing Ica and AV node conduction

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27
Q

cardiac side effect of doxorubicin

A

dilated cardiomyopathy

28
Q

contraindications to OCPs

A

1 - previous history of thromboembolism or stroke
2 -hx of estrogen dependent tumor
3 - women over age 35 who smoke (increases CV risk)
4 - hypertriglyceridemia
5 - decompensated or activ eliver disease
6 - pregnancy

29
Q

nondihydropyridine vs dihydropyridine

A

BOTH OF THESE WORK ON L-TYPE CA CHANNELS
nondiyhydropyridine - affect MYOCARDIUM slowing heart rate (negative chronotropy) and reduce contractility (negative inotropy)
dihydropyridine - affect ARTERIAL SMOOTH MUSCLE, no effect on cardiac conduction/contractility…causes arterial vasodilation

30
Q

GI, neurologic, and cardiac effects of digoxin toxicity

A

GI - pain, n/v, anorexia
neurologic - COLOR VISION CHANGES, fatigue, confusion
cardiac - ARRYTHMIA
can be assocaited with hyper or hypokalemia

31
Q

continuous murmur heard best in the ifnraclavlcular/left sternal border, more intense S2 with some splitting

A

PDA

32
Q

what section of heart does coronary sinus communicate with?

A

right atria (so if right atria enlarges, so does coronary sinus)

33
Q

Why do heart muscles respond to verapamil and skeletal muscles do not?

A

skeletal muscles don’t need extracellular Ca influx through L type calclium channels (target of nondihydropyrmidine Ca channel blockers)…instead skeletal muscles release Ca into sarcoplasmic reticulum by mechanical interaction between L type and RyR ca channels

34
Q

prophylaxis for hemhoraggic cystitis from cyclophosphamide

A

mesna

35
Q

What should be given to prevent vitamin deficiency with methotrexate

A

folinic acid (folate)

36
Q

What can trigger prinzmental angina

A

cigarette smoking, cocain/amphetamines, dihydroergotamine/triptans

37
Q

What to give and what to avoid in HOCM?

A

avoid anything that will decrease LV volume (decreased preload/afterload) or reduced systemic vascular resistance such as vasodilators (nitrates, aceinhibitors, or diureteics)

GIVE negative inotropic agents like beta blockers and nondihydropyridine Ca channel blockers and disopyramide

38
Q

most common site in heart for thrmbus formation

A

left atrial appendage

39
Q

What determines whether or not a plaque will cause ischemic myocardial injury

A

the RATE that it grows/occludes the artery

slow growing plaques allow for the mormation of collaterals that would slow necrosis

40
Q

why does rapid squatting help in tetrology?

A

rapid squatting increases SVR which will shunt more blood from VSD into pulmonary circulation (remember increased resistance from pulmonary circuit will lead to right to left shunting of deoxygenated blood into systemic circulation)…by increasing pulmonary flow this improve oxygenation

41
Q

What is the most posterior section of the heart

A

left atrium (when enlarged, can compress on esophagus…esp seen in mitral regurg secondary to rheumatic fever)

42
Q

why does isosorbide dinatrate have to be adminstered at high dose for it to work effectively

A

it has low bioavailability due to extensive first pass hepatic metabolism prior to release into systemic circulation (MOST OF IT GETS USED UP BEFORE IT CAN WORK)

43
Q

small masses are seen at the edge of mitral valve leaflet, composed of platelet rich thrombi but no bacterial growth…dx and associations

A

nonbacterial thrombotic endocarditis (marantic endocard) associated with ADVANCED MALIGNANCY, SLE, DIC, and antiphospholipid syndrome…

not with systemic sclerosis

44
Q

common cardinal vein becomes

A

SVC

45
Q

agent that increases peripheral vascular resistance, increases systolic bp, decreases pulse pressure, and decreases HR

A

phenylephrine (selective a1 agonist)…arterial vasoconstriction which will trigger baroreeptor mediated increas in vagal tone which will decrease stroke volume and HR

46
Q

hypotension, JVD, diminished heart sounds, and decreased sounds during inspiration

A

tamponade

can occur after viral pericarditis

47
Q

exposure to arsenic/pesticides, thorotrast, and polyvinyl chloride predospies higher risk to

A

liver hemangiosarcoma

48
Q

how to monitor effects of warfarin

A

PT (extrinsic pathway)

49
Q

where are b1 receptors found

A

cardiac myocytes and renal juxtaglomerular cells
(not in skeletal muscle)

agonists will increase camp and antagonists will do opposite

50
Q

pathophys behind mitral valve prolapse

A

mxomatous degenearation of connective tissue affecting valve leaftlets and chordae tendiane

51
Q

why do pregnant women become dizzy and hypotensive when lying supine

A

IVC is compressed which will decrease preload and lower cardiac output causing hypotension

52
Q

how to determine severity of mitral tenosis

A

a2-opening snap interval (shorter) = more severe

53
Q

what layer of gastric lining are parietal cells found?

A

superficial region of gastric glands (under top layer, which secretes mucus)

54
Q

fever, fatigue, joing pain, urticarial rash, tender hepatosplenomegaly…dx

A

acute hep b

55
Q

progressive back pain worse at night, not relieved by rest or position changes

A

spinal metastasis

56
Q

RNA polymerase I, II, III products

A

1 - ribosomal RNA
2- mRNA
3- tRNA

57
Q

trypsinogen -> trypsin active form acivates proenzymes where?

A

pancreas…uninhibited trypsin wil cause pancreatitis (SPINK1) mutation causes herditary pancreatitis

58
Q

sensory innervation of anus below dentate line

A

inferior rectal nerve (branch of pudendal nerve)

59
Q

following splenic artery blockage, tissue supplied by which artery is vulnerable to ischemic injury

A

short gastrics

60
Q

target of medicines useful for treatment of visceral nausea due to GI insult

A

use a 5ht3 receptor antagonist like ondansetron

61
Q

marker for monocyte macrophage complex in granulomas

A

CD14

62
Q

microcytic anemia, constipation, and mental status change, construction worker

A

lead poisoning

63
Q

which polymerase is found only in the nucleolus (basophilic region of nucleus)

A

RNA polymerase I (making pre-rRNA which codes for rRNA)

64
Q

target of etoposie and teniposide

A

inhibits topiosomerase II (makes nicks in double stranded DNA)

topiosmoerase I involves single stranded DNA

65
Q

how to differentiate t-cell ALL and b0cell ALL

A

b cell ALL most common, but T cell ALL presents with mediastinal mass that can cause respiratory symptoms, dysphagia, SVC syndrome

b cell can be fever, malalise, bleeding , bone, pain hepatosplenomegaly

66
Q

replication sequence of HBV

A

double stranded DNA (partially double stranded) -> +RNA template, uses reverse transcriptase -> double stranded DNA progency

A_First Aid Random Memorizing (17 decks)

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