Randomized List of Smith Cardio PVD and Oncology Flashcards
Of the two types of vascular remodeling (positive and negative), which is more likely to cause acute coronary syndrome?
Positive.
What is dysplasia?
Dysplasia is a change from a mature cell type to an immature cell type.
Besides chemotherapy, what other options exist to treat cancer?
Biologic/targeted therapy (rituximab, traztuzumab, bevacizumab), targeted therapy with tyrosine kinase inhibitors, gene therapy, hormonal therapy (tamoxifen), steroids.
What are some of the risk factors for uterine cancer?
Estrogen, tamoxifen, early menarche and later menopause, fewer pregnancies/older age at first pregnancy, polycystic ovarian syndrome. (These are pretty much the same risk factors for ovarian cancer.)
How is liver cancer diagnoised?
Ultrasound or CT/MRI, alpha-fetoprotein (AFP), biopsy
Of the two types of vascular remodeling (positive and negative), which is associated with stable angina?
Negative.
What are the clinical manifestations of hypertrophic cardiomyopathy?
Exertional dyspnea, angina at rest, syncope after exercise. Sudden cardiac death is possible after exercise.
What is metaplasia? Give an example of when this happens.
Metaplasia is change from one type of mature cell type to another mature cell type. Example: change in the lungs of a smoker from ciliated columnar to stratified squamous. Something similar can also happen with gastric reflux.
Which brain tumor is the most common ocular tumor in adults?
Meningioma
What are the two most common symptoms of heart failure?
Progressive breathlessness (dyspnea with ordinary exertion –> dyspnea at rest –> orthopnea (shortness of breath while lying down) –> paroxysmal nocturnal dyspnea (SOB during sleep that causes patient to wake up) and fatigue. Note that reduced renal perfusion –> increased blood volume is another common sign of heart failure.
Atherosclerosis involves damage to the endothelium. What sort of trauma might cause endothelial damage?
Elevated shear stress (especially at bifurcations and curved areas, and with high BP), biochemical abnormalities (such as high LDL, which inhibits the release of NO thus resulting in vasoconstriction, which increases damage from shear stress; also in diabetes, the AGEs can damage the endothelium), inflammation (increased platelet adhesion), smoking (toxic damage to BVs), advanced age.
What breast cancer screening protocol is recommended for women?
Mammogram every two years after age 50.
What are the clinical features of acute pericarditis?
Left chest pain on deep breath, friction rub during systole and diastole (sounds like a washing machine).
Which is more severe, NSTEMI or STEMI?
STEMI is more severe, and involves total inclusion of a coronary artery. (NSTEMI only partially occludes.)
Lower limb ischemia is a type of peripheral vascular disease that involves the arteries. It can be caused by atherosclerosis, thrombosis, or embolism. What are some of the presenting symptoms?
Pain and limping while walking, pallor, paralysis, pulselessness, hair loss
There are a few different classes of drugs used for the treatment of atheroscleroma. Which class(es) help lower LDL?
Statins, bile acid binders, niacin
What are the three most common types of cancer in women?
In order of decreasing prevalence: breast, lung, colorectal
What are the three most common types of cancer in men?
In order of decreasing prevalence: prostate, lung, colorectal
True or false: the hypertrophy of hypertrophic cardiomyopathy usually occurs mainly in the septum.
True.
Ischemic heart disease (IHD) is also known as coronary artery disease (CAD) and coronary heart disease (CHD). What is the major cause of ischemic heart disease?
Coronary atherosclerosis
What surgical options are available for a patient with hypertrophic cardiomyopathy?
Myomectomy (reduces septal thickness), pacemaker and defibrillator, intentional septal infarction, cardiac transplant.
What are some of the signs and symptoms of aortic regurgitation?
Palpitations, LV failure (and resulting progressive dyspnea), syncope, angina, increased LV size, Quincke’s sign (capillary pulsation in nail beds) and De Musset’s sign (head bobbing with heartbeat.
You can use enzyme tests and EKG to differentiate between unstable angina, NSTEMI, and STEMI. What would these tests show in a patient with NSTEMI?
Enzymes (troponin, etc) would be elevated, but there would be no ST elevation.
What virus is present in nearly every case of cervical cancer?
HPV
Surgical management of angina can be considered when medications aren’t working. Coronary-artery bypass grafting (CABG) is one of the procedures discussed in class. Briefly outline this surgery. When might CABG be preferred over PCI (the other procedure)?
Transplanted vessel (internal thoracic arteries, usually) are used to bypass the area of blockage. CABG would be preferred when the disease is complex, involving more than one vessel.
Constrictive pericarditis is when the pericardium becomes thickened in response to previous inflammation. What are the features of this condition?
Dyapnea on exertion, orthopnea, edema, ascites, hepatic tenderness with jaundice
What are some causes of mitral regurgitation?
Mitral valve prolapse (due to redundant chordae tendinae), rheumatic heart disease, coronary artery disease (can damage papillary muscles), ventricular enlargement.
Is the 5-year survival rate for lung cancer with treatment high or low?
Low: 30-50% for NSCLC, 5-10% for SCLC
What is the treatment for constrictive pericarditis?
Pericardiectomy (removal of pericardium); symptoms may persist for up to 6 weeks
Briefly outline the ACh challenge test (diagnostic tool for IHC, especially in women).
ACh by itself causes vasoconstriction in the coronary arteries, but it also causes a release of NO. The end result is vasodilation, since the vasodilative effect of NO is greater than the vasoconstrictive effect of ACh. In a patient with IHD, NO release is impaired so administration of ACh will cause vasoconstriction instead of the expected vasodilation.
What are the two types of lung cancers we need to remember from class? Which is more prevalent overall? Which is more common for non smokers to get?
Non small cell carcinoma (most common) and small cell carcinoma. Non small cell is the most common for non smokers.
What sort of laboratory testing can be done for atherosclerosis?
Fasting total cholesterol (want total ~50 mg/dL, want LDL
Drugs used for the treatment of atheroscleroma may have an impact on the patient’s ocular health. What ocular implications do bile acid binders have?
They could interfere with the absorption of other drugs (beta blockers, tetracycline, oral contraceptives, etc.)
What causes varicose veins?
Inherited defects of the valves or vein walls. Increased venous pressure from prolonged standing or lifting can also play a role.
If angina is not relieved by 2-3 NTG tablets given five minutes apart, this indicates a medical emergency.
Free card.
There are two mechanisms of thrombosis due to atherosclerosis. Briefly describe them. Which is usually more serious?
Supericial endothelium breaks down, and platelets adhere to the underlying collagen, and a thrombus forms. The other form is a deep endothelial fissure tears the atheroma cap. Blood then enters the plaque and starts to form a large thrombus. The deep thrombus is usually the more serious.
What is the heart’s response to aortic stenosis?
The left ventricle undergoes hypertrophy in order to push against the increased pressure; this can lead to relative ischemia with angina and left ventricle failure.
In addition to general therapies of heart failure, what would you include for a patient in stage D?
Inotropes to increase the strength of contraction (beta agonists such as dobutamine; dopamine has been used); biventricular pacemaker if patient has a conduction defect or is not responding to therapy; implantable defibrillator; parachute device if infarction has induced left ventricle dilation; left ventricular assist device to pump blood while waiting for transplant; transplant.
There are a few different classes of drugs used for the treatment of atheroscleroma. Which class(es) help lower TGs and increase HDL?
Fibrates and niacin
What are the four stages of heart failure, according to the ACA/AHA? What determines each stage?
Stages A-D. Stage A = no structural disease or symptoms, but risk factors. Stage B = structural disease present, but no signs or symptoms. Stage C = current or past symptoms of heart failure (SOB). Stage D = patients with heart failure that is difficult to treat with just meds, need to consider transplantation.
Which cancers were mentioned as being more prevalent in African Americans?
Prostate, pancreatic, osteosarcoma
What are some of the potential complications of myocardial infarction?
Acute arrhythmias and conduction defects (potentially life-threatening), heart failure (if more than 30% of heart tissue infarcted), chamber wall defects (ventricular septal defect/thinning, ventricular aneurysm, cardiac rupture)
S1 and S2 are normal heart sounds associated with the closing of valves. Which valve closures cause S1? S2? Which sound is associated with the pulse?
S1 is caused by the mitral and tricuspid valves closing, S2 is caused by the aortic and pulmonary valves closing. S1 is the sound associated with the pulse.
What colorectal cancer screening protocol is recommended?
Colonoscopy every 10 years starting at age 50
Is the 5-year survival rate for colorectal cancer with treatment high or low?
High (75-90%), but low (6-10%) if there has been metastasis
Right ventricular systolic dysfunction (RVSD) is a type of heart failure in which the right heart blood ejection fails. What are the common causes of RVSD?
It most common occurs due to LVSD, but can also arise from pulmonary disease or tricuspid valve disease.
What are some tumor suppressor genes and their related cancers? (The ones bolded in the lecture.)
RB1 (retinoblastoma), BRCA1/BRCA2 (breast)
How would you treat acute pericarditis?
Treat the underlying disorder, use meds (NSAIDs, steroids, colchicine)
Stable (typical) angina is the result of what type of remodeling in the coronary arteries?
Negative.
Stable angina is usually provoked by exercise or emotional stress and usually doesn’t last very long. What relieves stable angina?
Rest, or sublingual nitroglycerin (NTG).
What adjunct therapy can be used for a patient with a myocardial infarction?
Beta-blockers (for arrhythmias and to reduce reinfarction risk), ACEi to reduce fibrosis, statins to stabilize plaques, anticoagulants (heparin), possibly antiplatelets (aspirin and clopidogrel or prasugrel)
What are some of the causes of aortic stenosis? Which cause is the most common?
Senile calcific stenosis (most common; an inflammatory process causes the valve to be too stiff); congenital stenosis/bicuspid aortic valve (defect causes aortic valve to only have two leaflets rather than three as is normal; calcification then occurs prematurely by the 4th or 5th decade; more common in men); rheumatic heart disease (not common in industrialized nations since it follows an untreated strep pharyngitis).
Surgical management of angina can be considered when medications aren’t working. Percutaneous coronary intervention (PCI) is one of the procedures discussed in class. Briefly outline this surgery. When might PCI be preferred over CABG (the other procedure)?
A stent is put in place to open the clogged artery. Glycoprotein IIB/IIIA inhibitors are put in palce to inhibit platelet aggregation during the procedure. Overall, this is a simpler and less invasive procedure, preferred when the disease is single-vessel and relatively straight-forward.
Atherosclerosis is a very common cause of death in the US. It is the most common cause of heart disease (ischemic heart disease and myocardial infarction); it can also cause stroke and possibly increase the risk of dementia.
Free card.
How is infective endocarditis diagnosed?
Blood culture (at least three draws, seprated by 12 hours), echocardiography showing valve dysfunction or abscess. The following can support a diagnosis: fever, elevated CRP, emboli, hemorrhage, Janeway lesions (little red nontender macular lesions on palms of hands and soles of feet)
What medical therapy is used for patients with hypertrophic cardiomyopathy?
Beta-blockers. Digitalis can be used in the end stage after dilation has occurred.
True or false: Roth spots in and of themselves are diagnostic of infective endocarditis.
False.
What are some of the symptoms of advanced atherosclerosis?
PVD, MI, kidney disease, aneurysm, angina, sudden death, stroke.
When does prinzmetal’s angina tend to occur?
Night or early morning.
Which cancers tend to occur in younger (i.e., below 50 years) people? [By “tend” I mean either the average or the median, according to Dr. Ooley’s lecture.]
Cervical, testicular, bone
What are some of the risk factors for heart failure?
Ischemic cardiomyopathy (#1 risk factor), age, smoking, alcohol abuse, obesity (lack of exercise, poor diet), DM, HTN, high-sensitivity C-reactive protein, dyslipidemia, poor dental health.
True or false: pancreatic cancer is a very common type of cancer.
False; it only accounts for 3% of cancers
What therapy should you advise for a patient with lower limb ischemia?
Patient education (avoid trauma, foot and toe hygiene, stop smoking, be careful with exercise), treat any underlying HTN and diabetes, anticoagulants (aspirin, clopidogrel), angioplasty with stent, or bypass surgery
What are the signs of aortic stenosis?
Carotid pulse is small volume/slow-rising (since blood has a hard time getting past the stenotic valve); systolic ejection murmur (due to turbulence as blood passes the stenotic valve); soft S2 sound (since aortic valve is contributing less to the sound); S4 development (due to hypertrophy)
Infective endocarditis is infection of the endocardial surface and valves. What are some of the common causes?
Staph aureus is the most common overall cause, and the most common bacterial cause; Candida albicans is the most common fungal cause.
There are a few different classes of drugs used for the treatment of atheroscleroma. Which class(es) help harden the cap of the lesion?
Statins
Drugs used for the treatment of atheroscleroma may have an impact on the patient’s ocular health. What ocular implications do statins have?
They increase retinal blood circulation, may decrease diabetic neuropathy and retinopathy. (Note: antibiotics like erythromycin and clarithromycin interfere with the breakdown of statins, prolonging their effect.)
What would be recommended as general therapy for a patient in any stage of HF?
Patient education, correct underlying risk factors, flu and pneumococcal vaccines, dietary salt restriction, get enough rest and avoid overexertion, but do get some exercise.
