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STEP Review > Qbank missed questions > Flashcards

Qbank missed questions Flashcards

1
Q

MOA of digitalis/cardiac glycosides

A

Increase the force of cardiac muscle contraction by inhibiting the Na+/K+-ATPase in the myocardial cell membrane; intracellular Na+ increases (decreasing Na+ gradient across membrane), causing inhibition of Na+/Ca+ exchange so Ca+2 stays intracellularly -> more contraction

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1
Q

Continuous machine-like murmur

A

PDA (patent ductus arteriosus)

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1
Q

What infectious disease can result in 3rd degree AV heart block

A

Lyme disease (B. burgdorferi)

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2
Q

Mental retardation, gout, self-mutliation

A

Lesch-Nyhan Syndrome, X-linked deficiency of HGPRT

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2
Q

CCCK (cough, coryza, conjunctivitis, koplik)

A

Measles (Rubeola, Paramyxovirus)

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2
Q

What action will enhance a Mitral valve prolapse

A

standing or valsalva (decreasing venous return)

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3
Q

When muscle stretched, monosynaptic reflex activation of motor neuron causes contraction to resist the stretch

A

Fxn of muscle spindles/intrafusal muscle fibers

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4
Q

“Sausage” fingers or toes (DIP joints)

A

Psoriatic Arthritis

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4
Q

Xerophthalmia, xerostomia, arthritis

A

Sjogren’s syndrome

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5
Q

Microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency caused by E.coli

A

Hemolytic Uremic syndrome

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5
Q

Progressive lengthening of PR interval until a beat is ‘dropped’

A

2nd degree, Mobitz I Wenckebach AV block

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5
Q

Which organ has the largest blood flow

A

Lung

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6
Q

Projection defense mechanism

A

Immature form, unacceptable or personally disagreeable impulses or drives are attributed to others around them

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6
Q

HLA-DR4

A

Rheumatoid arthritis

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6
Q

Rheumatic fever and infective endocarditis cause which type of heart murmurs?

A

Tricuspid regurgitation

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6
Q

2 congenital long QT syndromes

A

Jervell and Lange-Nielson syndrome (can present with severe congenital sensorineural deafness)

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7
Q

Treatment for Torsades de pointes

A

Magnesium Sulfate

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8
Q

Bamboo spine, uveitis, aortitis

A

Ankylosing spondyloarthritis

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9
Q

pulsus parvus et tardus - weak pulses with a delayed peak

A

Seen in Aortic stenosis (crescendo-decrescendo systolic ejection murmur with ejection click)

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10
Q

Acanthosis

A

increased thickness of stratum spinosum, seen in Psoriasis

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10
Q

What congenital infection is most common cause of PDA

A

Rubella (German measles)

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11
Q

Ecthyma gangrenosum

A

Caused by Pseudomonas in immunocompromised, virulence factors are Elastase, phospholipase C, exotoxin A (protein synth. inhibition) and pyocyanin

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11
Q

Uveitis, aortic regurgitation, stiff spine

A

Ankylosing spondyloarthritis

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12
Q

what can torsades de pointes progress to

A

Ventricular fibrillation

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12
Q

Concomitant withdrawal of sympathetic efferent activity with enhanced parasympathetic activity, causing bradycardia, vasodilation and orthostatic hypotension

A

Vasovagal syncope

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12
Q

Main thing to remember about CHF

A

Decreases cardiac output!! (decreased ability to perfuse body, afterload is increased)

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13
Q

What action will enhance a VSD

A

hand grip (increase afterload)

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15
Q

Yellow-green foamy vaginal discharge

A

Trichomonas vaginitis

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15
Q

Which 2 stimuli/substances act on phase 4 of the cardiac nodal cell action potential to reduce the rate of spontaneous depolarization?

A

Adenosine & acetylcholine

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16
Q

Heart failure will increase or decrease RAAS system?

A

Increase, leads to increased ACE II production in lungs (since heart failure causes decreased CO and subsequent inadequeate visceral perfusion

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16
Q

Opening snap followed by rumbling diastolic murmur heard best over apex

A

Mitral stenosis

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17
Q

Synovitis, tenosynovitis, dermatitis

A

STD in Infectious Arthritis

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17
Q

Prolonged PR interval >200msec that is asymptomatic

A

1st degree AV block

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18
Q

High-pitched “blowing” diastolic decrescendo murmur with bounding pulses and head bobbing

A

Aortic regurgitation

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19
Q

Disease in females associated with coarctation of the aorta

A

Turner syndrome (XO)

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20
Q

Lecithinase/Alpha toxin/Phospholipase C

A

Made by C. perfringens, causes hemolysis and tissue necrosis by destroying cellular membranes

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21
Q

Osteosarcoma predisposing factors

A

“RARE PAIN” = RAdiation, REtinoblastoma, PAget’s disease, Infarcts

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22
Q

Diminished femoral pulses compared to brachial pulses, sx of inadequate perfusion of lower extremities during ambulation, enlarged intercostal arteries

A

Coarctation of the aorta

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24
Q

Anemia of chronic disease w/ arthritis

A

Rheumatoid

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24
Q

Bounding femoral pulses, carotid pulsations (water-hammer pulses) w/ head-bobbing

A

Aortic regurgitation

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26
Q

Sublimation defense mechanism

A

Mature mechanism, redirecting emotions toward completely acceptable targets (ex: working out)

26
Q

Reaction defense mechanism

A

Immature form, unacceptable feelings are ignored and opposite sentiment is adopted

26
Q

Colchicine

A

Treatment of gouty arthritis; S/E nausea, abd pain, diarrhea; affects tubulin polymerization into microtubules

28
Q

Amenorrhea, parotid gland hypertrophy, osteoporosis

A

Anorexia nervosa

29
Q

Binge alcohol consumption, increased cardiac sympathetic tone, and pericarditis are precipitating factors for which cardiac event?

A

Isolated Atrial fibrillation episodes

31
Q

Most common metastatic tumors to brain

A

Lung CA, breast CA, melanoma

33
Q

Multi-nucleated giant cells, intranuclear inclusions, vaginal discharge

A

HSV2

33
Q

2 most common causes of an S3 heart sound in adults

A

LV systolic failure or restrictive cardiomyopathy

33
Q

Characteristics of mitral valve stenosis heard on auscultation

A

Opening snap (from fusion of leaflet tips) with low diastolic rumble -> prior rheumatic cardidits most common cause

34
Q

Nitrates

A

Vasodilators, decrease blood pressure, decrease venous return (venodilators) = decrease preload

35
Q

Crescendo-decrescendo systolic ejection murmur

A

Aortic stenosis

36
Q

List the locations of the heart in order of speed of conduction (fastest to slowest)

A

“Park At Ventura Avenue” - Purkinje fibers, atrial muscle, ventricular muscle, AV node

38
Q

Thymic hyperplasia with ocular disturbances

A

Myasthenia Gravis

40
Q

HLA-DRB1

A

Rheumatoid arthritis

41
Q

Displacement defense mechanism

A

Redirection of emotions from a person/object causing the emotions, to a more acceptable, but still inappropriate, person or object

41
Q

Dupuytren’s contracture

A

slowly progressive fibroproliferative disease of palmar fascia, nodules form and fingers lose flexibility

42
Q

Immunodeficiency, albinism, neurologic defects (such as nystagmus)

A

Chediak-Higashi syndrome - defect in phagosome lysosome fusion (will also have recurrent pyogenic infections)

42
Q

Rapid succession of identical, back-to-back atrial depolarization waves

A

“Sawtooth appearance” of Atrial flutter

44
Q

Rate-limiting step in steroid hormone synthesis

A

Transport of cholesterol to the inner mitochondrial membrane so that it can be converted to pregnenolone

45
Q

Sx of hypovolemic shock

A

Low BP, tachycardia (increased heart contractility), cool extremities (caused by increased TPR to shunt blood toward vital organs)

46
Q

Nitroprusside action

A

Balanced venous and arterial vasodilator that decreases BOTH preload and afterload

48
Q

Secondary causes of gout

A

Leukemia/myoproliferative disorders, Lesch-Nyhan syndrome, Renal insufficiency

49
Q

Fxn of golgi tendon organs

A

Cause sudden muscle relaxation as part of a feedback inhibitory mechanism to prevent damage to muscles when sense contraction against heavy object

50
Q

Which organ has the largest arteriovenous O2 difference

A

Heart (high O2 demand, extraction of O2 is high)

51
Q

Phenylephrine action

A

Alpha-agonist, increases sympathetic tone resulting in vasoconstriction

52
Q

Supine hypotension syndrome

A

Also known as Aortocaval compression syndrome, when a pregnant woman lies supine and the gravid uterus compresses IVC, decreasing venous return/preload

54
Q

C5-C9 complement deficiency

A

Results in inability to form Membrane Attack Complex, predisposes to recurrent infetions by Neisseria species

56
Q

Urethritis, uveitis, arthritis

A

Reiter’s syndrome (Reactive arthritis) -> “can’t see, pee, or climb a tree”

58
Q

HLA-B27

A

Seronegative spondyloarthropathies

60
Q

Ring fibers on muscle biopsy (NADH)

A

Myotonic dystrophy

62
Q

Curd-like discharge

A

Candida albicans vaginitis

64
Q

Pneumocystis infections

A

T-cell deficiency

66
Q

Anti-histone antibodies positive

A

Drug-Induced SLE (lupus)

67
Q

Clue cells

A

Gardnerella vaginalis causing bacterial vaginosis

68
Q

Leukocyte adhesion deficiency (kids)

A

late separation of umbilical cord, poor wound healing, recurrent skin infections w/o pus, gingivitis/periodontitis; genetic absence of CD18 antigen necessary for iNTEGRINS formation

69
Q

Hydralazine activity on heart

A

Vasodilator, decreases afterload

70
Q

Holosystolic harsh sounding murmur

A

VSD

72
Q

Poor feeding, macroglossia, constipation, umbilical hernia, w/ HYPOTONIA

A

Congenital Hypothyroidism (necessary for normal brain development)

74
Q

Secondary amyloidosis w/ arthritis

A

Rheumatoid

75
Q
A
76
Q

What action will enhance a mitral regurg

A

squatting, hand grip (increasing total peripheral resistance/afterload)

78
Q

Anti-CCP antibodies

A

Rheumatoid arthritis

79
Q

completely erratic ECG rhythm with no identifiable waves, fatal

A

Ventricular fibrillation

80
Q

What maneuver enhances Mitral stenosis

A

expiration (increase LA return)

81
Q

Furosemide

A

Loop diuretic, causing decreased ESV

83
Q

Splitting defense mechanism

A

Immature form, events or actions are either all good or all bad

84
Q

NSAID that is associated with Stevens-Johnson syndrome (Enolic Acid class)

A

Piroxicam

85
Q

Holosystolic high-pitched “blowing” murmur

A

Mitral, Tricuspid regurgitation

86
Q

An AV shunt will cause what kind of change in CO and venous return curves?

A

Decreases TPR (as in exercise), so equilibrium point will be higher at same level of R.atrial pressure/EDV = increase preload, decrease afterload

87
Q

Expanded trinucleotide repeat muscular disorder

A

Myotonic dystrophy (CTG repeats)

88
Q

Kartagener syndrome

A

Immotile cilia due to microtubular dynein arm defect (associated with situs inversus)

90
Q

Telomere lengths for stem cells vs. differentiated cells

A

SC: long telomeres, active telomerase w/ shortening (vs.) DC: low telomerase activity

92
Q

small cell carcinoma of lung can cause muscle manifestations

A

Lambert-Eaton syndrome

93
Q

2 most important mediators of vasodilation in controlling coronary autoregulation

A

NO and Adenosine

94
Q

Pulmonary-Renal syndromes

A

Lupus, Wegener’s granulomatosis, Goodpasture’s syndrome

95
Q

Triad of hypertension, respiratory depression, BRADYCARDIA

A

Cushing reaction (cerebral ischemia due to increased intracranial pressure constricting cerebral arterioles)

96
Q

Are steroid hormones all made from one single substance? And if so, what is it?

A

Yes, cholesterol

98
Q

Serum sickness

A

Type III hypersensitivity reaction (Antigen-Antibody-Complement) w/ fever, urticaria, arthralgias, gloerulonephritis, lymphadenopathy 5-10 days after exposure to antigen (can have systemic deposition of circulating immune complexes in arteries/arterioles) = Sulfonamides!

99
Q

Left lateral decubitus position enhances which heart sound

A

Pathologic S3, by decreasing volume of lungs and bringing heart closer to chest wall

100
Q

Most of blood supply to heart occurs during systole or diastole? Why?

A

Diastole (duration is important factor in determining coronary blood flow); Because during systole, the contracting myocardium compress the coronary arteries

101
Q

Atria and ventricles beat independently of e/o

A

Complete, 3rd degree AV block

STEP Review (2 decks)

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