Qbank missed questions Flashcards
MOA of digitalis/cardiac glycosides
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
Continuous machine-like murmur
PDA (patent ductus arteriosus)
What infectious disease can result in 3rd degree AV heart block
Lyme disease (B. burgdorferi)
Mental retardation, gout, self-mutliation
Lesch-Nyhan Syndrome, X-linked deficiency of HGPRT
CCCK (cough, coryza, conjunctivitis, koplik)
Measles (Rubeola, Paramyxovirus)
What action will enhance a Mitral valve prolapse
standing or valsalva (decreasing venous return)
When muscle stretched, monosynaptic reflex activation of motor neuron causes contraction to resist the stretch
Fxn of muscle spindles/intrafusal muscle fibers
“Sausage” fingers or toes (DIP joints)
Psoriatic Arthritis
Xerophthalmia, xerostomia, arthritis
Sjogren’s syndrome
Microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency caused by E.coli
Hemolytic Uremic syndrome
Progressive lengthening of PR interval until a beat is ‘dropped’
2nd degree, Mobitz I Wenckebach AV block
Which organ has the largest blood flow
Lung
Projection defense mechanism
Immature form, unacceptable or personally disagreeable impulses or drives are attributed to others around them
HLA-DR4
Rheumatoid arthritis
Rheumatic fever and infective endocarditis cause which type of heart murmurs?
Tricuspid regurgitation
2 congenital long QT syndromes
Jervell and Lange-Nielson syndrome (can present with severe congenital sensorineural deafness)
Treatment for Torsades de pointes
Magnesium Sulfate
Bamboo spine, uveitis, aortitis
Ankylosing spondyloarthritis
pulsus parvus et tardus - weak pulses with a delayed peak
Seen in Aortic stenosis (crescendo-decrescendo systolic ejection murmur with ejection click)
Acanthosis
increased thickness of stratum spinosum, seen in Psoriasis
What congenital infection is most common cause of PDA
Rubella (German measles)
Ecthyma gangrenosum
Caused by Pseudomonas in immunocompromised, virulence factors are Elastase, phospholipase C, exotoxin A (protein synth. inhibition) and pyocyanin
Uveitis, aortic regurgitation, stiff spine
Ankylosing spondyloarthritis
what can torsades de pointes progress to
Ventricular fibrillation
Concomitant withdrawal of sympathetic efferent activity with enhanced parasympathetic activity, causing bradycardia, vasodilation and orthostatic hypotension
Vasovagal syncope
Main thing to remember about CHF
Decreases cardiac output!! (decreased ability to perfuse body, afterload is increased)
What action will enhance a VSD
hand grip (increase afterload)
Yellow-green foamy vaginal discharge
Trichomonas vaginitis
Which 2 stimuli/substances act on phase 4 of the cardiac nodal cell action potential to reduce the rate of spontaneous depolarization?
Adenosine & acetylcholine
Heart failure will increase or decrease RAAS system?
Increase, leads to increased ACE II production in lungs (since heart failure causes decreased CO and subsequent inadequeate visceral perfusion
Opening snap followed by rumbling diastolic murmur heard best over apex
Mitral stenosis
Synovitis, tenosynovitis, dermatitis
STD in Infectious Arthritis
Prolonged PR interval >200msec that is asymptomatic
1st degree AV block
High-pitched “blowing” diastolic decrescendo murmur with bounding pulses and head bobbing
Aortic regurgitation
Disease in females associated with coarctation of the aorta
Turner syndrome (XO)
Lecithinase/Alpha toxin/Phospholipase C
Made by C. perfringens, causes hemolysis and tissue necrosis by destroying cellular membranes
Osteosarcoma predisposing factors
“RARE PAIN” = RAdiation, REtinoblastoma, PAget’s disease, Infarcts
Diminished femoral pulses compared to brachial pulses, sx of inadequate perfusion of lower extremities during ambulation, enlarged intercostal arteries
Coarctation of the aorta
Anemia of chronic disease w/ arthritis
Rheumatoid
Bounding femoral pulses, carotid pulsations (water-hammer pulses) w/ head-bobbing
Aortic regurgitation
Sublimation defense mechanism
Mature mechanism, redirecting emotions toward completely acceptable targets (ex: working out)
Reaction defense mechanism
Immature form, unacceptable feelings are ignored and opposite sentiment is adopted
Colchicine
Treatment of gouty arthritis; S/E nausea, abd pain, diarrhea; affects tubulin polymerization into microtubules
Amenorrhea, parotid gland hypertrophy, osteoporosis
Anorexia nervosa
Binge alcohol consumption, increased cardiac sympathetic tone, and pericarditis are precipitating factors for which cardiac event?
Isolated Atrial fibrillation episodes
Most common metastatic tumors to brain
Lung CA, breast CA, melanoma
Multi-nucleated giant cells, intranuclear inclusions, vaginal discharge
HSV2
2 most common causes of an S3 heart sound in adults
LV systolic failure or restrictive cardiomyopathy
Characteristics of mitral valve stenosis heard on auscultation
Opening snap (from fusion of leaflet tips) with low diastolic rumble -> prior rheumatic cardidits most common cause
Nitrates
Vasodilators, decrease blood pressure, decrease venous return (venodilators) = decrease preload
Crescendo-decrescendo systolic ejection murmur
Aortic stenosis
List the locations of the heart in order of speed of conduction (fastest to slowest)
“Park At Ventura Avenue” - Purkinje fibers, atrial muscle, ventricular muscle, AV node
Thymic hyperplasia with ocular disturbances
Myasthenia Gravis
HLA-DRB1
Rheumatoid arthritis
Displacement defense mechanism
Redirection of emotions from a person/object causing the emotions, to a more acceptable, but still inappropriate, person or object
Dupuytren’s contracture
slowly progressive fibroproliferative disease of palmar fascia, nodules form and fingers lose flexibility
Immunodeficiency, albinism, neurologic defects (such as nystagmus)
Chediak-Higashi syndrome - defect in phagosome lysosome fusion (will also have recurrent pyogenic infections)
Rapid succession of identical, back-to-back atrial depolarization waves
“Sawtooth appearance” of Atrial flutter
Rate-limiting step in steroid hormone synthesis
Transport of cholesterol to the inner mitochondrial membrane so that it can be converted to pregnenolone
Sx of hypovolemic shock
Low BP, tachycardia (increased heart contractility), cool extremities (caused by increased TPR to shunt blood toward vital organs)
Nitroprusside action
Balanced venous and arterial vasodilator that decreases BOTH preload and afterload
Secondary causes of gout
Leukemia/myoproliferative disorders, Lesch-Nyhan syndrome, Renal insufficiency
Fxn of golgi tendon organs
Cause sudden muscle relaxation as part of a feedback inhibitory mechanism to prevent damage to muscles when sense contraction against heavy object
Which organ has the largest arteriovenous O2 difference
Heart (high O2 demand, extraction of O2 is high)
Phenylephrine action
Alpha-agonist, increases sympathetic tone resulting in vasoconstriction
Supine hypotension syndrome
Also known as Aortocaval compression syndrome, when a pregnant woman lies supine and the gravid uterus compresses IVC, decreasing venous return/preload
C5-C9 complement deficiency
Results in inability to form Membrane Attack Complex, predisposes to recurrent infetions by Neisseria species
Urethritis, uveitis, arthritis
Reiter’s syndrome (Reactive arthritis) -> “can’t see, pee, or climb a tree”
HLA-B27
Seronegative spondyloarthropathies
Ring fibers on muscle biopsy (NADH)
Myotonic dystrophy
Curd-like discharge
Candida albicans vaginitis
Pneumocystis infections
T-cell deficiency
Anti-histone antibodies positive
Drug-Induced SLE (lupus)
Clue cells
Gardnerella vaginalis causing bacterial vaginosis
Leukocyte adhesion deficiency (kids)
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
Hydralazine activity on heart
Vasodilator, decreases afterload
Holosystolic harsh sounding murmur
VSD
Poor feeding, macroglossia, constipation, umbilical hernia, w/ HYPOTONIA
Congenital Hypothyroidism (necessary for normal brain development)
Secondary amyloidosis w/ arthritis
Rheumatoid
What action will enhance a mitral regurg
squatting, hand grip (increasing total peripheral resistance/afterload)
Anti-CCP antibodies
Rheumatoid arthritis
completely erratic ECG rhythm with no identifiable waves, fatal
Ventricular fibrillation
What maneuver enhances Mitral stenosis
expiration (increase LA return)
Furosemide
Loop diuretic, causing decreased ESV
Splitting defense mechanism
Immature form, events or actions are either all good or all bad
NSAID that is associated with Stevens-Johnson syndrome (Enolic Acid class)
Piroxicam
Holosystolic high-pitched “blowing” murmur
Mitral, Tricuspid regurgitation
An AV shunt will cause what kind of change in CO and venous return curves?
Decreases TPR (as in exercise), so equilibrium point will be higher at same level of R.atrial pressure/EDV = increase preload, decrease afterload
Expanded trinucleotide repeat muscular disorder
Myotonic dystrophy (CTG repeats)
Kartagener syndrome
Immotile cilia due to microtubular dynein arm defect (associated with situs inversus)
Telomere lengths for stem cells vs. differentiated cells
SC: long telomeres, active telomerase w/ shortening (vs.) DC: low telomerase activity
small cell carcinoma of lung can cause muscle manifestations
Lambert-Eaton syndrome
2 most important mediators of vasodilation in controlling coronary autoregulation
NO and Adenosine
Pulmonary-Renal syndromes
Lupus, Wegener’s granulomatosis, Goodpasture’s syndrome
Triad of hypertension, respiratory depression, BRADYCARDIA
Cushing reaction (cerebral ischemia due to increased intracranial pressure constricting cerebral arterioles)
Are steroid hormones all made from one single substance? And if so, what is it?
Yes, cholesterol
Serum sickness
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!
Left lateral decubitus position enhances which heart sound
Pathologic S3, by decreasing volume of lungs and bringing heart closer to chest wall
Most of blood supply to heart occurs during systole or diastole? Why?
Diastole (duration is important factor in determining coronary blood flow); Because during systole, the contracting myocardium compress the coronary arteries
Atria and ventricles beat independently of e/o
Complete, 3rd degree AV block
