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DIT Flashcards

1
Q

pathogenesis of atherosclerosis

A
  1. endothelial damage
  2. Lipoprotein accumulation (LDL) in vessel wall
  3. Adhesion of monocytes and foam cells (macrophages)
  4. Factor release (puts, macrophages, inflammatory mediators, cytokines)
  5. Smooth muscle infiltration
  6. Lipid accumulation
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2
Q

How to dx PAD?

A

ABI < 0.9

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3
Q

Meds associated with HLD

A
  • thiazide diuretics
  • bblockers
  • atypical antipsychotics
  • protease inhibitors
  • oral estrogens
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4
Q

Who needs statin therapy?

A
  • clinical ASCVD (ACS, MI, Stroke/TIA, PAD, revascularizaiton)
  • anyone LDL>190
  • DM 40-75
  • 10 year risk >7.5% age 40-75
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5
Q

MOA and target of statins

A

HMG-Coa reductase inhibitor

BEST drug to lower LDL

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6
Q

side effects and what labs to get before starting statin

A

myopathy/inhibits coenzyme q10 (increased CK, myalgia, cramping)
hepatic dysfunction

get LFTs before starting but not routinely

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7
Q

MOA and target ezetimibe

A

impairs dietary and biliary cholesterol at brush border

primarily lowers LDL

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8
Q

Side effects ezetimibe

A

myalgia and increased LFTs (like statin)

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9
Q

MOA and target of fibrates

A

decrease hepatic secretion of VLDL
primary effect on TRIGLYCERIDES

VLDL = triglycerides

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10
Q

side effects fibrates

A

same as statins and ezetimibe (myalgia LFT elevation)

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11
Q

Name some bile acid sequestrants

A

cholestyramine, colestipol, colesevelam

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12
Q

bile acid sequestrates target what?

A

LDL (but only lower 10%…statins more effective)

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13
Q

side effects bile acid sequestrants

A

GI side effects (bloating, cramping), LFT elevaiton

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14
Q

Which cholesterol med is best for increasing HDL

A

niacin

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15
Q

side effect niacin and how to rx

A

facial flushing

improves with ASA or NSAID, and time

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16
Q

target of omega 3 fatty acids (fish oil)

A

TGs

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17
Q

which cholesterol med can be used as an adjunct treatment of cdiff?

A

cholestyramine

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18
Q

what new heart sounds can you get during MI?

A

new systolic murmur
S3
S4

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19
Q

What additional finding besides ST changes can indicate STEMI?

A

new LBBB

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20
Q

After MI when does troponin elevate

A

elevates in 1-4 hours

stays elevated up to 1-2 weeks

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21
Q

When do Q waves (dipping before R wave) appear during MI?

A

appears within hours, deepens over 1-2 days and persists until weeks later

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22
Q

How doe ST segment and T waves change during MI

A

ST elevates hours after MI but is normal days after

T wave inverts after Day 1-2 returns to normal weeks later

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23
Q

ST changes in V2,3,4,5

A

anterior MI

LAD

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24
Q

ST changes V1, V2, V3

A

septal wall MI

LAD

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25
Q

ST changes II, III, avF

A

inferior wall MI

PDA

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26
Q

ST changes I, aVL, V5, V6

A

lateral wall MI

LAD/circumflex

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27
Q

MOA dobutamine

A

primary B1 agonist - increases HR and contractility

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28
Q

best pressor for cardiogenic shock

A

dobutamine

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29
Q

MOA epinephrine

A

ALL AROUND AGONIST (a1,a2,b1,b2)
low dose - b1 increases CO
high dose - a1 vasoconstriction

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30
Q

best pressor for septic shock

A

norepi

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31
Q

best pressor for anaphylactic shock

A

epi

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32
Q

MOA norepi

A

a1 agonist - vasoconstriction

b1 agonist

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33
Q

if norepinephrine doesn’t work for septic shock, what are 2 ok 2nd line drugs

A

epi
phenylephrine
vasopressin

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34
Q

complications of using pressor like norepinephrine for extended period of time

A

finger/toe ischemia and necrosis
mesenteric ischemia
renal insufficiency

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35
Q

if dobutamine doesn’t work for cardiogenic shock, what’s a good 2nd line

A

dopamine

also good adjuvant pressor

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36
Q

MOA phenylephrine

A

a1 agonist (vasoconstriction)

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37
Q

MOA dopamine

A

low dose - b1

high dose - a1

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38
Q

when does Dressler syndrome occur?

A

2-4 weeks post MI

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39
Q

bacterial infection most commonly associated with acute pericarditis

A

TB

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40
Q

what drugs can cause pericarditis

A

isoniazid, procainamide, hydralazine

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41
Q

Which viral infection can cause pericarditis

A

HIV

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42
Q

Patient with CKD presents with pleuritic chest pain and friction rub with diffuse ST elevation…?

A

uremic pericarditis

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43
Q

rx acute pericarditis

A

usually NSAIDs and colchicine

also treat underlying cause if you can find one

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44
Q

Echo finding in acute pericarditis

A

pericardial effusion

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45
Q

physical exam findings tamponade

A

Beck’s triad (hypotension, JVD, muffled heart sounds)

pulses paradoxus

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46
Q

what is pulsus paradoxus

A

SBP decreases >10 mmhg during inspiration

usually due to poor LV capacitance

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47
Q

pulsus paradoxus vs kussmaul sign

A

pulsus - poor LV capacitance

kussmaul - poor RV capcitance

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48
Q

what is kussmaul sign and what conditions is it usually found in?

A

anything that restricts RV filling

  • chronic constrictive pericarditis
  • RV infarction
  • massive PE
  • R CHF
  • tricuspid stenosis
  • restrictive cardiomyopathy
49
Q

What is kussmaul sign (not breathing)?

A

JVD with inspiration

50
Q

Physical exam finding left atrial myxoma

A

early DIASTOLIC sound (“tumor plop”)…rare finding

51
Q

what are the classes of antiarrythmics

A

1 - Na channel blockers
2 - beta blockers
3- potassium channel blockers
4 - Ca channel blockers

“No BadBoys Keep Clean”

52
Q

Name class 1a antiarrhythmics

A

“the Queen Proclaims Diso’s pyramid”
Quinidine
Procainamide
Disopyramide

53
Q

Name the class 1c antiarrhythmics

A

“can I have Fries Please?”
Flecanide
Propafenone

54
Q

Name the class 1b antiarrhytmics

A

“Liddy’s Mexican Tacos”
Lidocaine
Mexiletine
Tocanide

also phenytoin

55
Q

Which antiarrhythmics widen QRS?

A

Class 1

56
Q

Which anti arrhythmic is associated with drug induced lupus?

A

procainamide

57
Q

Which class of antiarrhythmics are best post MI?

A

class Ib (since they lower AP, lower ERP, and shorten QT) unlike other class 1 drugs which prolong QRS and QT

58
Q

Name the class III antiarrhythmics

A 
"AIDS"
Amiodarone
Ibulitide
Dofelitide
Sotaolol (sounds like beta blocker but it aint)
59
Q

Which class of antiarrhythmics prolong QT?

A

class III K channel blockers

watch out for torsades!

60
Q

Adverse effects of amiodarone

A

pulmonary fibrosis (check PFTs, c/I lung dx)
hepatotoxicity (check LFTs)
hypo/hyperthyroidism (check TSH)
blue/gray skin deposits, corneal deposits

61
Q

PVCs are wide or narrow QRS complexes?

A

wide

62
Q

Cardiac index, SVR, and LVEDV in systolic CHF?

A

Cardiac index - decreased
SVR - increased (activation of RAAS system)
LVEDV - increased (secondary to RAAS system to increase preload, even if there is a mitral regurg)

63
Q

MCC cause secondary HTN

A

renal artery stenosis

atherosclerosis/fibromuscular dysplasia

64
Q

What med to avoid if bilateral renal artery stenosis?

A

ACEI/ARB (constricts efferent arteriole -> rapidly fucks up GFR)

65
Q

HTN, hypokalemia, metabolic alkalosis

A

Conn syndrome (primary hyperaldosteronism)

66
Q

How to dx primary hyperaldosteronism

A

plasma aldosterone:plasma renin activity

aldosterone to renin ratio

67
Q

How to manage BP in hypertensive urgency

A

reduce BP to 160/100 initially

don’t decrease MAP more than 25%

68
Q

Name some fast acting and titratable meds appropriate for hypertensive urgency

A 
nitroprusside
enalapril
captopril
clonidine
labetalol
nicardipine
69
Q

3 ways to calculate MAP

A
  1. CO x TPR
  2. 1/3SBP + 2/3DBP
  3. DBP + 1/3PP (pulse pressure = SBP-DBP)
70
Q

HTN med causes hyperkalemia and renal insufficiency

A

ACEI/ARBs

(even though these are renal protective) , they will dilate efferent arteriole which will decrease GFR and increase BUN and Cr)

71
Q

HTN meds associated with reflex tachycardia cardia

A

arterial vasodilators (hydrazine, minoxidil)

72
Q

HTN med that can cause inappropriate hair growth/treat baldness

A

minoxidil

73
Q

HTN med that causes hypokalemia, hyponatremia, and hypercalcemia

A

thiazides

74
Q

which HTN to avoid in asthma or COPD

A

non selective beta blockers (M-P +labetolol, carvedilol)

75
Q

HTN med that can cause headache, constipation, GERD,

A

CCBs

76
Q

HTN med that can cause peripheral edema

A

CCB

77
Q

HTN med that can cause bradycardia

A

nondihydropyridines (diltiazem, verapamil)

78
Q

metabolic side effects beta blockers

A

reduce HDL, increase TGLs

79
Q

which HTN med can mask symptoms of hypoglycemia

A

Beta blockers

80
Q

Which HTN med is associated with positive antihistone abs?

A

drug induced lupus
HYDRALAZINE

also watch out for in class 1a antiarrythmic procainamide

81
Q

Which HTN meds safe in pregnancy?

A

“Hypertensive mothers love nifedipine”

  • hydralazine
  • methyldopa
  • labetolol
  • nifedipine
82
Q

Which HTN meds c/I pregnancy

A

ACEI
ARBs
direct renin inhibitors

83
Q

HTN med with rebound HTN, dry mouth, sedation

A

clonidine

84
Q

HTN med associated with orthostatic hypotension

A

a1 blockers (prazosin, doxazosin)

85
Q

name 2 thiazides

A
  • hctz

- chlorthalidone

86
Q

indication for surgical repair of aortic dissecction

A

stanford type A (ascending aorta dissection)

type B (descending) only needs medical management

87
Q

first line BP med for aortic dissection

A

BB

88
Q

indications for AAA repair

A
  • AAA>5.5 cm in men and 5 cm in women
  • symptomatic (tenderness, abdominal pain)
  • increase in diameter more than 0.5 cm in 6 month interval
89
Q

Best management for PAD

A 
conservative!
-smoking cessation
- daily exercises
-glucose BP control
aspirin/statin
90
Q

pharmacologic treatment for leg claudication

A

cilostazol - improves blood flow to LE and decreases claudication

91
Q

Best rx for varicose veins

A

lifestyle modification (weight reduction, avoid prolonged standing, leg elevation)

92
Q

meds that reduce morbidity and mortality in patients with known CAD

A
  • bb
  • statin
  • DUAL anti platelet (asa + p2y12 receptor blocker like clopidogrel, ticragrelor)
  • aldosterone antag (spiriniolactone, eplenerone)
  • ACEI/ARB
93
Q

patient with pacemaker presents with right sided heart failure, JVD, hepatomegaly, abdominal dissension, lower extremity edema

A

Tricuspid regurg (adverse effect of implantable pacemaker/defib) since it can damage tricuspid leaflets

94
Q

GCA associated with what other rheum disease

A

PMR (polymyalgia reumatica)

95
Q

Physical exam finding takayasu

A

poor pulses in UE (“pulseless dx”)

96
Q

What specific vessel does takayasu tend to effect

A

aorta (specifically the arch)

97
Q

Kawasaki criteria

A

CRASH and burn
4/5 (Conjunctivitis, rash, adenopathy cervical, strawberry tongue, hand/feet changes/desquamation)

+

fever >104 for more than 5 days

98
Q

treatment Kawasaki

A

IVIG

high dose ASA

99
Q

Which vasculitis is ANCA negative?

A

polyarteritis nodosa

100
Q

What organs does PAN affect?

A

usually, kidneys, GI, SPARES lungs

101
Q

asthma patient with skin findings, lung and upper airway dx with positive p-ANCA

A

eosinophilic granulomatosis polyangitis

102
Q

Lung involvement, upper airway, kidney, c-ANCA positive

A

granulomatosis with polyangitis (Wegner’s)

103
Q

How to differentiate Wegner’s (gran with polyangitis) and Churg Strauss (eosinophilic gran)

A

Wegner - c-ANCA

Churg strauss - p-ANCA

104
Q

HCV patient comes in with palpable purport, weakness, and joint pain) with some renal involvement

A

mixed cryoglobulinemia

105
Q

treatment for thromboangitis obliterans

A

smoking cessation (prevents autoamputation of digits)

106
Q

Rx HSP

A

supportive therapy

107
Q

rx AML

A

m3 variant
vit a
all trans retinoic acid

if not m3, chemo

108
Q

rx CML

A

imantinib

109
Q

how to dx AML/ALL

A

bone marrow biopsy

>20% blasts

110
Q

blast cell with auer rods

A

AML

rx with vit A if m3 variant

111
Q

age of ALL

A

kids, age 7

112
Q

+Tdt

A

ALL

113
Q

t 9;22

A

phiadelphia chromosome
BCR-ABL
CML!!!!!!

tyrosine kinase causing overactivity and expressing cancer

114
Q

BCR ABL

rx

A

t 9;22
CML
tyrosine kinase inhibitor (imantinib)

115
Q

CML + blast crisis

A

AML

116
Q

complication CLL

A

hyperviscosity syndrome from so many cells

117
Q

myeloperoxidase

A

AML

118
Q

CML can turn into…?

A

AML

119
Q

4 year old, bone pain, pancytopenia (bleeding/pallor/infections)

A

ALL

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