PATHOLOGY Flashcards
1
Q
What is the arterial structure? and how is it made off?
A
2
Q
Type of arteries?
A
3
Q
What are the most affected arteries by atherosclerosis
A
4
Q
Name the 3 key concept for atherosclerosis formation
A
- Endothelial damage
a. HTA
b. tabaco
c. LDL
d. turbulent flow - Chronic inflammation
Macrophages release cytokines - Smooth muscle proliferation
5
Q
What is the key growth factor that make smooth mm proliferate?
A
6
Q
Types oh hemorrhagic isquemia
A
7
Q
Pathogenesis of atherosclerosis
A
8
Q
Name the 5 organs and their regions more affected by isquemia
A
9
Q
Which section is the most prone to produce isquemia?
A
B. Fibrous cap
Thin fibrous cap with weak connective tissue are prone to produce isquemia.
10
Q
What are the cells we can find here?
A
Dark blue: fibrous cap
Pale area: Macrophages filled with lipid
11
Q
% of obstruction of coronary lumen to produce estable angina
A
12
Q
Why people with coronary aa disease sudden deaths?
A
Arrrythmias
Develop Ventricular taqycardias or AF
13
Q
Risk factors for developing coronary aa disease?
A
Hypertension
hyperlipidemia
Family history (1 relative, F lees 60 and male less 50)
Smoking
Obesity
14
Q
What is the extent of the coronary ischemia?
A
15
Q
Ischemic changes in EKG in NSTEMI
A
T inversions
ST Depressions
16
Q
What are the gross changes expected in myocardial infarction?
A
17
Q
What are the acute complications myocardial infarction?
A
18
Q
What valve is affected in inferior infarcts?
A
Mitral valve because it attaches to the inferior wall if the left ventricle
19
Q
Complications of stent colocation¨:
A
20
Q
What are the coronary arteries territories?
A
21
Q
What are the 2 hallmarks of right ventricular infarction?
A
- Elevated jugular venous pressure
- Hypotension: decreased preload
22
Q
What is a special complication of MI infarctions?
A
23
Q
What does an elevated AVR means?
A
24
Q
What is the difference between a posterior and a inferior infarction?
A
Posterior: It just affects the Posterior descending artery
Inferior: Affects the dominant artery
25
Explain the 2 special types of infarctions:
26
Treatment for STEMI
Thrombotic problem:
1. Aspirin: reduce platelet agreggation
2. Heparin: inhibit clots
Ischemic problem
1. BB: reduce oxygen demand
2. Nitrates
27
28
29
30
Type of angina:
31
Describe the type of pain, biomarkers, ecg changes and infarction:
32
Causes of sudden cardiac death?
33
Diagnosis of miocardial infarction:
34
ECG locations of STEMI
35
What are NSTEMI ECG changes observed?
36
Name the biomarkers in cardiac ischemia and hrs
37
Types of CK? Where we can find them
38
What is a rare myocardial biomarker found?
39
What is the treatment of NSTEMI?
40
What is unstable angina?
41
What is the tx of unstable angina?
42
Complications of myocardial infarction
43
How can we diagnose stable angina?
44
Whats a key feature of stable angina.
45
46
Mechanism of action of nitrates
47
Explain the relationship of nitrates and stable angina
Nitrates vasodilate specially vv that helps lower the preload (benefits)
Lesser degree is vasodilate aa supplying more blood to the myocardium.
In complex CAD....
48
What are the forms of nitrates (4)
49
Adverse effect of nitrates:
50
What is the nitrate withdrawal syndrome?
51
BB and stable angina
52
Name 2 B1 cardioselective drugs
Atenolol
Metoprolol
DIOSA ATENEA (MEDUSA) LE METEMOS UN CORAZON!
53
Types of calcium channel blockers
54
55
56
57
What is ranolazine?
58
What is the fear effect of ranolazine?
59
Diagnosis of prinzmetal angina
60
Treatment of prinzmetal angina
61
What do we mean by coronary steal?
62
Name the nitrates and onset of effect
63
What is the mechanism of action of nitrates?
Mechanism of action: nitrates and phosphodiesterase-5 inhibitors
Exogenous nitrous oxide (NO) activates guanylyl cyclase, resulting in activation of protein kinase G. There is a reduction in intracellular calcium as a result of increased sarcoplasmic reticulum calcium ATPase (SERCA) and an increase in myosin-light-chain-phosphatase (MLCP) activity, resulting in smooth muscle relaxation. The net result of both pathways is vasodilation
64
Adverse effects of nitrates?
1. Vasodilation
a. headache
b. flushing
c. Reflex tachycardia
2. Tolerance. To avoid need a min 8 hrs free intervals
3. Cyanide poisoning. Sodium nitroprusside
65
What time most it elapses to take PDE 5 inhibitor and nitrates?
24 hrs
Cyclic GMP causes smooth muscle relaxation and subsequent vasodilation. Nitrates increase cGMP via increased intracellular NO. PDE-5 inhibitors decrease the metabolism of cGMP to GMP. Taking both medications together leads to significantly increased cGMP-induced vasodilation.
66
Name 4 cardioselective BB
1. Atenolol
2. Metoprolol
3. Bisoprolol
4. Esmolol
Diosa atenea (medusa) le meten un corazon y luego las servientes se vuelven viejitas y le sale una E en la cabeza.
67
Name 3 BB no cardioselectives and its adverse effects
TIMMY CON UN COHETE EN EL FUNDIO Y LUEGOOO CAE EN EL MAR Y NADA!! SOLO NADA!!
68
Name 3 uses of propanolol and 1 for timolol
69
Name 2 BB no selective with alpha effect
70
What are the effect B receptor blockage?
71
Classification of calcium channel blockers and agents:
Dihidropiridinicos: Ricardo con la esposa y amor rojooooooos
72
Mechanism of action of calcium channel antagonism
CCBs bind to and block L-type calcium channels in cardiac and vascular smooth muscle cells; → decreased frequency of Ca2+ channel opening in response to cell membrane depolarization; → decreased transmembrane Ca2+ current
73
Verapamil mainly act on ____________
VENTRICLES
74
Adverse effects of calcium channel antagonism
75
In what phase of the myocadiac cells act BB
76
A postural tremor that improves with alcohol consumption is characteristic of _________________.
Essential tremor
77
GLUCAGON
In patients with beta-blocker overdose, intravenous glucagon should be administered when blood pressure and heart rate do not respond sufficiently to IV fluids and atropine alone. Glucagon increases intracellular cAMP by activating adenylate cyclase, which improves cardiac contractility and heart rate while bypassing the beta receptors. It also improves hypoglycemia.
78
Nicardipine belongs to ________________ family.
Calcium channel blockage dyhidropyridinicos.
79
What are the rates of the pacemakers?
80
What is the normal QRS complex?
81
How to read axis in ecg
82
What does a right or left axis deviation means?
83
What causes short PR intervals?
Wolf parkinson white?
84
What causes short and prolonged QT intervals?
85
What is torsade de pointes and causes?
86
What causes the long QT syndrome?
87
Ways to acquire prolonged QT syndrome?
88
When we found T waves?
hyperkalemia
89
90
Explain the myocyte action potential
91
Explain phase 4 myocyte action potential
92
Explain phase 0 myocyte action potential
93
Explain phase 1 myocyte action potential
94
Explain phase 2 myocyte action potential
95
Explain phase 3 myocyte action potential
96
What is the refractory period?
97
Explain the pacemaker action potential
98
What are the 2 family drugs that affect the pacemaker action potential?
1. Calcium channel blocker
2. BB
99
Flecainide belongs to ___________________ family
Sodium channels blocks.... first antiarrhythmyc class
100
What gives the property of automaticity in pacemakers action potential?
Funny current
101
Family of epinephrine and mechanism of action?
like epinephrine stimulate beta 1 adrenergic receptors in the heart, thereby increasing Ca2+ influx through the sequential opening of T-type calcium channels and L-type calcium channels in the sinoatrial node and atrioventricular node in the late part of phase 4 of the pacemaker action potential (AP). Catecholamines also increase the flow of Na+ through pacemaker channels (funny channels; If). These effects lead to more rapid depolarization, which increases heart rate. Other effects of epinephrine are mediated through beta 2 adrenergic receptors (bronchial relaxation) and alpha 1 adrenergic receptors (vasoconstriction), which ease breathing and stabilize blood pressure in anaphylactic shock, respectively.
102
Pnemotecnia for pacemakers action potential phase
403
103
Mechanism of action of adrenaline and norepinephrine
104
Uses of BB antiarrhythmics
105
Adverse effects of BB
106
What is the antidote of BB overdose?
107
108
What is the effect of K channel blockers in ecg?
109
Family and mechanism of action of amiodarone
110
Side effects of amiodarone
111
Family and mechanism of action of dromeradone?
112
Family and mechanism of action of sotalol
113
114
What is the ecg effect of class 4 antiarrhytmics
115
Indications of verapamil
116
Side effects of calcium channel antagonism
117
Name the miscellaneous antiarrhythmics
1. Adenosine
2. Digoxin
3. Magnessium
118
What is the mechanism of action of adenosine?
119
Indications of magnessium?
120
Why there is a straight line in the PR
The signal must past throught all the conduction system
AV node, HIZ, bunddle branches and purkinje
121
What are the causes of AV blocks?
AV node: disease
HIZ-Purkinje disease
122
Explain the types of AV blocks
123
Explain 1st degree AV block
124
Explain 2nd degree Mobitz1 AV block
125
Explain 2nd degree Mobitz 2 AV block
126
Explain 3erd degree block
127
Explain AV blocks and lyme disease
128
129
Causes of AV blocks
aging=fibrosis/sclerosis
130
Treatment for AV blocks
131
132
133
134
135
What determines the heart rate in tachycardias?
136
___________ (disease) is associated with FA?
Hyperthyroidism
137
Triggers for FA?
138
What is the basics in treatment of FA?
139
140
Talk about cardioversion
80% resolves with electrical cardioversion. Quimical cardioversion has too much adverse effects.
141
142
Explain the CHADSVASC score
Equal or more than 2: anticoagulant
less: aspirin
143
Explain the pulmonary vein isolation procedure, when we do it? and why?
144
What is the treatment of atrial flutter?
145
Explain the atrial flutter ablation
burn
146
Explain the pathways of coagulation cascade
JESUS CON SU CORONA DE ESPINAS SANGRANDO MORADO LE OTORGA A MI ABUELO KUBALA EL NUMERO 7 ESTE CON SU RODILLA RASPADA CON LA LETRA *E* PATEA UNA PELOTA DE SOCCER Y GOLPEA EL 10
147
Why thrombin is said to be like an accelerator?
148
Function of antithrombin and where it is produced?
149
Types of heparins?
150
What is the difference in function of heparins? LMWH and HMWH
151
What are the PROS of LMWH?
152
Whay is fondaparinux?
153
Uses of heparin?
154
What is the exam that RUTH was fucked up by in internal medicine? What does it valorates? and what is normal values?
aTTP
Activated partial thromboplastin time.
NO SOY KUBALITA! Intrinsic and common pathway!!
less 1 but expected in treatment 1.5 to 2.5
155
_________________ is the antidote for heparin induced bleeding
Sulfate protamine
156
Why heparin induce thrombocytopenia?
157
When should I expect HIT? (TIME)
158
What factors does warfarin affect?
159
Hemostasis is classified as?
160
161
162
TP is obtained by adding ____________ to the px plasma
163
What is and why does INR exist?
164
Indications of warfarin? (3)
1. Deep vein thrombosis
2. Arrhythmias
3. Prosthetic valve disease
165
Toxicity of warfarin and what medication increases its leves?
166
Can we give warfarin during pregnancy?
167
Why can warfarin trigger skin necrolisis?
168
What is the heparin bridge?
169
What to do with a warfarin overdose with and without bleeding?
170
Mnemotechnic for warfarin inducers and inhibitors
Inhibitors: Sing this like a cheer ("2, 4, 6, 8 who do
we appreciate..." ) that kind of melody....
"-Navir, -Azole, Erythro,- and Cipro
- Inhibit! Inhibit! They all Inhibit!
Cimitidine, Class Four And Grape-Fruit Juice. Inhibit! Inhibit! They all Inhibit!"
(The P450 inhibitors: All the HIV
Protease inhibitors
(end with suffix- navir), all the "azole" antifungals, Erythromycin
(but none of the other macrolides
), Ciprofloxacin
and all the other fluoroquinolones, Cimitidine, Class IV Anti-arrhythmatics (use-dependent Ca channel blockers
)= Diltiazem
, Verapamil
, and grapefruit juice)
And for the inducers: .. this is a rhyme, like a nursery rhyme...
"Treat TB
and the mind, Induce the P450 enzyme
"
Inducers of P450:TB
drugs: Rifampin
and Isoniazid
"Mind" drugs (really barbiturates
, antiseizure drugs, and herbal antidepressants
): Phenobarbital
, Phenytoin
, Carbamazepine
, and St. John's Wort (herbal antidepressant
)
171
Effect of TP and TPT of direct thrombin and factor X inhibitors
172
Name the Direct Thrombin inh meds:
RUDY (ART ATTACK) HAS FRIENDS DESIRE AND VALE TIMES 2 CAUSE SHE IS DOPPED BUT BECAUSE OF THAT BUILDSHIT FRIENDSHIP HE HAS LEPRA.
173
Why does HIT forms?
174
Adverse effects of direct thrombin inhibitors
175
__________________ Is the only direct thrombin inhibitor that has a reversal agent known as _____________________
1. Dabigatran
2. IDARUCIZUMAB
176
Name the direct Xa inhibitors
1. Apixaban
2. Rivaroxaban
3. Edoxaban
177
_____________________ is the reversal agent of Factor Xa direct inhibitors
ANDEXANET
178
179
What is the mechanism of action of statins?
Harry potter and eMa Guatson are COstArs in LIPIDS secrets.
180
181
Function of the 3 types of cholesterol
182
How are triglycerides composed?
183
Function of lipoprotein lipase?
184
Mechanism of action of fibrates?
3 simposon ariels with pepe
185
Name the 3 acid bile resines
1. Colestyramine
2. Colesevelam
3. Colestipol
186
What is the mechanism of action of acid bile resins
Preventing its absorbtion
187
188
189
190
What is the Paroxysmal supraventricular tachycardia? What is the most common cause?
Sudden onset of tachycardia originated in the atrium
AVNRT
Atrioventricular nodal reentrant tachycardia
191
What is the retrogrades P waves and where we can find them?
AVNRT
192
Treatment of AVNRT
1. Carotid massage
2. Vagal maneuvers
3. Adenosine
4. BB or ant calcium
5. Surgical ablation
193
What characteristics we find in WPW syndrome in ECG?
1. Delta wave
2. Short PR syndrome
DELTA WAVE: PREEXITATION OF THE VENTRICLES
194
What is the bunddle of kent?
195
196
Explain atrial fibrillation and WPW syndrome
197
WHY IS IT IMPORTANT TO KNOW WHY IN WPW RAPID FA YOU CANNOT SLOW THE AV NODE CONDUCTION?
198
Antiarrhythmic drug that preferably binds to ischemic tissue
LIDOCAINE
199
What does USE DEPENDANT means with flecainamide?
Flecainide is a class Ic antiarrhythmic that blocks cardiac sodium channels. This drug exhibits “use dependence” meaning drug binding to sodium channels increases at fast heart rates as explained in the video. For this reason, flecainide toxicity is most likely to occur during exercise.
Through blockade of sodium channels, flecainide may prolong the QRS interval. Significant QRS prolongation is an indication to stop the drug due to high risk of toxicity. Patients started on flecainide are usually referred for a cardiac stress test to evaluate the QRS interval during exercise. If the QRS interval prolongs with exercise, the patient is at increased risk for flecainide toxicity.
200
With what 2 class 3 antiarrhytmic drugs we do hospital QT surveillance?
1. Dofetilide
2. Sotalol
201
_______________ has a class I indication for all patients after myocardial infarction to reduce the risk of sudden death
BB
202
Which antiarrhythmic drugs display the ¨reverse use dependence¨ characteristic?
SOTALOL
203
What can block adenosine response ?
Methylxanthines have a similar chemical structure and can block
(cafeine and theophyline)
204
What is atropine?
Is a muscarinic receptor blocker
205
What are the antimuscarinic effect?
206
Name the 2 arrhythmias in which we almost everytime use antiarrhythmics
207
208
Phase 0 in myocyte cells equals ______________________
QRS
Depolarization
209
The depolarization and repolarization of ventricles is demostrated in the myocyte action potential by phase __________________ and in the ecg by ________________
0, 1, 2 and the end phase 3
ECG: QT interval
210
Explain why K channel blockers prolong QT interval
Prolongs phase 1, 2 and 3
211
212
213
214
_______________ is the drug of election in WPW FA
PROCAINAMIDE
IV
215
Why class 1B antiarrhythmic drugs prefer ischemic tissue?
216
What is the drug of choice in ventricular ischemic tachycardias and why?
217
Why lidocaine helps in re-entry arrhythmias?
218
In what patients we can use class 3 antiarrhythmic drugs?
Arrhythmias with structural normal hearts
219
What antiarrhythmic drugs are use dependance ?
All class 1 but mainly Class 1C
220
Mechanism of action of amiodarone and effects in ecg
221
Why amiodarone causes adverse effect?
222
Classification of murmurs
223
224
What is the point of maximum impulse in the heart?
225
226
Causes of diastolic murmurs?
227
Causes of systolic murmurs
228
Diastolic murmurs are always pathologic and systolic murmurs not always.
229
230
How can we distinguish a murmur of a stenotic aortic valve from hypertrophic myocardiopathy ?
231
How is a aortic regurgitation murmur heard?
232
Mitral regurgitation murmur?
233
How do we hear a mitral stenosis murmur?
234
What is carvallos sign?
235
What causes holosystolic murmurs?
236
Type of murmur in PDA
237
What manuevers can we use to increase or decrease preload?
238
Most manuevers increase with preload except:
1. hypertrophic myocardiopathy
2. mitral valve prolapse
239
What manuever increase or decrease the afterload?
240
241
242
243
What 2 pathologies cause a crescendo and decrescendo murmur?
1. Aortic stenosis
2. Hypertrophic myocardiopathy
244
What clinical manifestations are present in severe aortic stenosis?
1. S2 silent
2. peak late murmur
3. Weak carotid upstrokes
245
What is persistent S2 splitting and what pathologies cause it?
246
What is fixed S2 splitting and what patologies cause it?
247
Explain the types of S2 splitting? 3
Corazon con jeanes PEPE
P. PERSISTENT: Inhalation
E. FIXED
P PARADOXYCAL : Exhalation
248
249
What is the S2 loud sound ? What causes it?
250
Where we found S3 sounds?
251
KENTUCKY
S3
252
TENESSE
S4
253
Bicuspid aortic valve predispose to _______________________
Aortic disection
254
What auscultation findings are found during pregnancy? (2)
Upper left sternal murmur: Corresponds to pulmonic valve and increase blood flow and volume
S3.
255
Explain physiological splitting?
256
What does a persistent splitting means?
Splitting during exhalation and inhalation
257
What does splitting means? And a paradoxical splitting?
That the pulmonic valve closes latter than the aortic valve.
Aortic valve closes first
258
What is the hallmark of left ventricular failure?
Left ventricular end diastolic pressure is elevated
259
What are the heart failure cells in lung biopsy?
260
____________________ mmhg is the normal jugular venous pressure
6-8
261
What is the hepatojugular reflux and how to obtain it?
262
What are the abnormal heart sounds in heart failure?
263
What is the opposite of the RAAS
Natriuretic peptide
264
Explain the relationship of heart failure and ADH?
