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Step Rx incorrect answers > Heme 1 > Flashcards

Heme 1 Flashcards

1
Q

pulseless dz- weak pulses in upper extremities

A

Takayasu’s arteritis

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2
Q

Takayasu’s arteritis- labs?

A

ESR is elevated

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3
Q

Takayasu’s arteritis- biopsy?

A

granulomatous changes in walls of affected large vessels

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4
Q

Anti- IgG seen in? AKA?

A

AJKA rheumatoid factors. associated with RA

morning stiffness, rheumatoid nodules, etc.

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5
Q

cytoplasmic? -antineutrophil cytoplasmic antibody seen in?

A

Wegner’s granulomatosis

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6
Q

Wegner’s granulomatosis- characterization

A

pulmonary and renal focal necrotizing granuloomatois vasculitis

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7
Q

P-ANCA seen in?

A

polyangitis and churg-strauss

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8
Q

hypertrophic obstructive cardiomyopathy- mode of inheritance?

A

auto dom in 50% otherwise idiopathic

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9
Q

hypertrophic obstructive cardiomyopathy- micro?

A

myofiber hypertorphy and disarray

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10
Q

See extensive neutrophilic infiltrate in necrotic myofibers

A

3-4 days after MI

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11
Q

Lymphocytic infiltration in heart

A

Viral myocarditis

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12
Q

Aschoff bodies

A

are collections of lymphocytes, macrophages, and occasionally giant cells in myocardium surrounded by fibrinoid degeneration. pathomneumonic for rheumatic heart disease

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13
Q

Aschoff bodies

A

are collections of lymphocytes, macrophages, and occasionally giant cells in myocardium surrounded by fibrinoid degeneration. pathomneumonic for rheumatic heart disease

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14
Q

amyloidosis causes what kind of cardiomyopathy?

A

restrictive.==> leads to ventricular stiffening and imparied cardiac filling during diastole

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15
Q

what is idiopathic hypertrophic subaortic stenosis?

A

AKA hypertrophic cardiomyopathy

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16
Q

pathophys of microscopic polyangiitis

A

activation of neutrophils and monocytes by P-ANCA leads to inflammation and etc…

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17
Q

Pregnant woman comes in with norm BO sitting, but super low BP when lying supine…explain.

A

IVC compression during third trimester of pregnancy because of large uterus. decr. venous return to heart, and hypotension when lying supine. tell them to lay on left side (take uterus off IVC)

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18
Q

How do fibrates work?

A

Incr HDL levels by increasing PPAR- alpha activity

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19
Q

How do statins work?

A

inhibit HMG-CoA reductase (which is the rate limiting step in cholesterol synthesis)

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20
Q

Side effects of amiodarone?

A

hyperthyroidism (which causes weight loss, hyperreflexia, and palpatations) hepatotoxicity, and pulmonary fibrosis

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21
Q

What happens 4 hours after an MI?

A

coagulative necrosis

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22
Q

When does neutrophilic infiltration happen after an MI?

A

24 hours after

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23
Q

When does neutrophilic infiltration happen after an MI?

A

24 hours after

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24
Q

When do mononuclear cells appear after an MI?

A

7-10 days after

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25
Q

When do fibroblasts deposit collagen after an MI?

A

2-3 weeks after!

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26
Q

What are the 5 Ts of neonatal cyanosis?

A 
tetralogy of fallot
transposition of great vessels
truncus arterious
tricuspid atresia
total anomalous pulmonary venous return
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27
Q

neonatal cyanosis. diabetic mother.

A

transposition of great vessels

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28
Q

newborn with hypotenstion, tachypnea, single S2, prominent systolic ejection murmur at upper sternal border, and mid-diastolic rumble at left lower sternal border?

A

pulmonary atresia (presents with early cyanosis as patent ductus arteriosus closes)

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29
Q

newborn with hyperactive right ventricular impulse, quadruple rhythm, fixed and split S2, prominent systolic ejection murmer at left upper sternal border, and mid-diastolic rumble at left lower sternal border

A

anomalous venous return

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30
Q

what happens in anomalous venous return?

A

pulmonary veins don’t drain into left atrium, may drain into superior vena cava instead

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31
Q

what is prazosin and what is it used to treat?

A

alpha 1 blocker, used to treat HTN and BPH

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32
Q

what is prazosin and what is it used to treat?

A

alpha 1 blocker, used to treat HTN and BPH

33
Q

what is clonidine and what is it used to treat?

A

centrally acting alpha agonist use dot treat HTN, especially in renal disease

34
Q

What is dobutamine? used for?

A

Beta agonist. used to treat shock and heart fail

35
Q

what is Mirtazapine and used for?

A

selective alpha 2 blocker. used for depression. adverse effects include sedation and inreased appetite

36
Q

what is phenoxybenzamine and used for?

A

irreversible alpha blocker. used for pheochromocytomas

37
Q

what is phenylephrine? and used for?

A

alpha agonist (1 >2) used as nasal decongestant and pupillary dilator

38
Q

what is intermittent claudication?

A

painful ischemic condition caused by peripheral atherosclerosis of arteries

39
Q

what is intermittent claudication?

A

painful ischemic condition caused by peripheral atherosclerosis of arteries

40
Q

physio of smooth muscle contraction?

A
  1. membrane depolarizes and VG Ca channels open
  2. calcium binds to calmodulin.
  3. ca+calmodulin complex activates myosin light chain kinase
  4. kinase phosphorylates myosin light chains
  5. the light chains facilitate cross bridge formation and SM contraction
41
Q

What is Diltiazem and used for?

A

class 4 antiarrhythmic. prolongs PR interval. esp in AV nodal cells.. useful in preventing nodal arrhythmias

42
Q

How do Ca++ channel blockers work and what are they used for?

A

useful for HTN becasue they inhibit Ca++ influx into vascular SM cells. decr. vascular tone

43
Q

Amiodarone is first line med for what?

A

V fib after an MI

44
Q

Would you give a class 1C antiarrhythmic to a post MI?

A

NOOO! associaed with mortality. it works at phase 3 of action potential and has no effect in AP duration. They’re used in v tachy, or intractable supraventricular tachy

45
Q

What do you use Procainamide to treat?

A

it is a type 1A antiarrhythmic. used for V fib. increases AP duration and QT interval. often used for re-enterant and ectopic supraventricular and ventricular tachy.

46
Q

common side effect of procainamide?

A

drug induced lupus

47
Q

digoxin tox?

A

yellow-green vision, nausea, vomiting, diarrhea, arrythmias.

48
Q

Digoxin use?

A

chronic heart failure. control a fib (NOT v fib)

49
Q

Digoxin mechanism?

A

inhibits Na/K ATPase. leading to indirect inhibition of na/ca exchanger. incr in intracellular ca. positive inotrophy

50
Q

familial hyercholesterolemia- inheritance

A

auto. dom

51
Q

xanthomas in achilles tendom, arcus lipoides, and very high LDL level…what i it?!

A

familial hypercholesterolemia or type IIa dyslipidema

52
Q

xanthomas in achilles tendom, arcus lipoides, and very high LDL level…what i it?!

A

familial hypercholesterolemia or type IIa dyslipidema

53
Q

familial dyslipdemia- type 1- hyper chylomicronemia

A 
auto recessive.
lipoprotein lipase deficiency
altered APO C-II.
causes pancreatitis, hepatosplenomegal, eruptive/ ruritic xanthomas
no increased risk for atherosclerosis.
creamy layer in supernatant
54
Q

familial dyslipdemia- type 2a- familial hyper cholesterolemia

A 
auto dom.
absent/defective LDL receptors
accelerated atherlo. (MI before 20)
tendon xanthomas
corneal arcus
55
Q

familial dyslipdemia- type 4-hyper triglyceridemia

A

auto dom
hepatic overproduction of VLDL
may cause acute pancreatitis

56
Q

Hep B associated with which vasculitis

A

polyarteritis nodosa.

57
Q

what type of hypersensitivity is polyarteritis nodosa?

A

type 3. complex deposition in medium sized vessels ANCA negative

58
Q

statin + fibrate what side effect?

A

rhabdomyolysis

59
Q

pt has high BUN and creatinine, recent oliguria, what do you see on ECG?

A

acute renal failure, can’t secrete potassium. leads to hyperkalemia. see peaked T waves

60
Q

bilateral renal artery stenosis….what do you see on ECG?

A

=> incr in RAS=> incr in aldo => incr in secretion of K=> extreme hypoK => U waves

61
Q

systolic flow murmur because of high

fixed split S2

A

ASD, most likely from a patent foramen ovale.

62
Q

first choice antihypertensive in diabetic

A

ACE inhibitors! because renal protective

63
Q

What can a thiazide toxicity cause?

A

mech: inhibits Na resorption in early DT. Can cause high lipids, uric acid, calcium

64
Q

What can gitelman syndrome cause?

A

mimics thiazide tox.
mutation in thiazide sensitive nacl co transporter in DCT.
Hyper GLUC
(glycemia, lipidemia, uric acid, calcium)

65
Q

Side effect of spironolactone (K sparing diuretic)

A

gynecomastia. inhibition of androgen receptor signaling

66
Q

what is libman- sacks endocarditis (LSE)?

A

associated with SLE. deposition of small sterile vegetations made of fibrin and inflamm cells. may rarely embolize.

67
Q

what is libman- sacks endocarditis (LSE)?

A

associated with SLE. deposition of small sterile vegetations made of fibrin and inflamm cells. may rarely embolize.

68
Q

how does nitroglycerin work?

A

reduce O2 use by heart and incr O2 supply to heart. (systemic venodilation, dilate coronary vessels

69
Q

would you give digoxin to pt with acute coronary syndrome?

A

NO! digoxin is a cardiac glycoside that increases cardiac ionotropy. it will increase O2 demands

70
Q

what would a carotid sinus massage do?

A

stim carotid baroreceptors. incr para, and slow HR (decr SA and AV firing rate)

71
Q

Tx for septic shock

A

Norepi (priority is to stabalize BP)

72
Q

Wernike’s aphasia. where is the stroke?

A

MCA (because Wernike’s is in left superior temporal gyrus)

73
Q

Wernike’s aphasia. where is the stroke?

A

MCA (because Wernike’s is in left superior temporal gyrus)

74
Q

valvular damage, chorea, fever, polyarthritis

A

rheumatic fever!

75
Q

How do beta blockers decrease O2 demand of heart?

A

decr HR, decr contractility, decr afterload, secondary to decreased cardiac output and BP.
Decreased symp tone will decrease inward Na current, slow phase 4 depol, and prolong diastole. the coronary arteries are filled in this phase.

76
Q

what do alpha receptors do?

A

vasoconstriction of arteries, increases BP

77
Q

What do Beta 1 receptors do?

A

incr contractile force and HR

78
Q

what unintended side effect does Norepi have and why?

A

norepi will increase venous return to heart (mostly stimulate alpha 1) by vasoconstriction and increased heart contractility, incr in stroke valume. So there will be reflex bradycardia

Step Rx incorrect answers (10 decks)

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