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UWorld > Set 5 (Cardiovascular) > Flashcards

Set 5 (Cardiovascular) Flashcards

1
Q

Torsades de pointes always a/w?

A

Prolonged QT interval

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2
Q

QT interval prolonged in these antiarrhythmic agents

beware of Torsades

A 
Quinidine
Procainamide
Sotalol
Disopyramide
Ibutilide/dofetilide
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3
Q

Verapamil

A

CCB
Slow SA firing, AV node conduction
PROLONGS PR interval

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4
Q

Metoprolol as antiarrythmic

A

Slow SA firing, AV node conduction

PROLONGS PR interval

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5
Q

Lidocaine as antiarrythmic

A

Reduce phase 4 diastolic depol (decrease in automaticity)

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6
Q

Digoxin as antiarrythmic

A

SLOW conduction through AV node

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7
Q

Holosystolic murmur @ left mid-sternal border

A

VSD

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8
Q

Fixed S2 split

A

ASD

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9
Q

Bifid cartold pulse w/ brisk upstroke

“spike and dome”

A

Hypertrophic obstructive CM

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10
Q

Coagulase-negative staph
Synthetic valve
Endocarditis
Tx?

A

Vancomycin
+/- Rifampin or gentamycin
(WIDEspread antibiotic resistance of S. epidermidis, esp nosocomial)

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11
Q

Paradoximal emboli: heart sound

A

= ASD

fixed S2 split

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12
Q

Suspect WPW in?

A

Sudden cardiac death in otherwise healthy young adult

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13
Q

Significantly prolong QT interval
BUT
LOW incidence of torsade

A

Amiodarone (unlike rest of class III)

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14
Q

Main purpose of binding

A

Prevent patient/researcher expectancy form interfering w/ outcome (OBSERVOR biasis)

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15
Q

Beta error

A

Claiming NO DIFFERENCE exist when truely:

THERE IS A DIFFERENCE!

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16
Q

Hepatic ethanol catabolism:

A

NADH production

Gluconeogenesis INHIBITION

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17
Q

Phosphodiesterase inhibitors: MOA

A

Maintain cAMP levels –> ionotropic in cardiac muscles

however, cAMP in vascular muscle –> vasodilation

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18
Q

cAMP in cardiac muscle

cAMP in vascular smooth muscle

A

cAMP in cardiac muscle: contraction

cAMP in vascular smooth muscle: relaxation

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19
Q

Apical displacemtn of Tricuspid
Decreased RV volume
Atrialization of RV

A

Ebstein’s anomaly

Lithium

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20
Q

Gestational diabetes a/w

A

Macrosomia, Caudal regression syndrome
HYPOglycemia, HYPOcalcemia
HYPERtrophic CM

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21
Q

Fetal alcohol syndrome

A

Midfacial anomalies

Growth and mental retardation

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22
Q

Dilated cardiomyopathy causes

A

Alcohol

Infectious myocarditis

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23
Q

Dilated cardiomyopathy: systolic or diastolic heart failure?

A

Systolic

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24
Q

m/c/c of mitral stenosis

A

Chronic rheumatic heart disease

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25
Q

PDA a/w

A

Prematurity

Congenital rubella infection

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26
Q

Lecithinase

A

C. perfringens alpha toin (phospholipase C)

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27
Q

C. diptheriae virulence factor

A

AB-exotoxin (Ribosylate EF-2 –> inhibit protein synthesis)

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28
Q

Pertussis toxin

A

AB toxin: stimulates G protein –> increase cAMP –> insuli production, lymphocyte/neutrophil dysfxn, increased sensitivity to histamine

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29
Q

ETEC and Shigella toxin

A

Inactivation of 60s ribosome

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30
Q

GAS cause rheumatic fever due to?

A

Antigenic mimicry

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31
Q

NNT

A

1/ARR

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32
Q

ARR

A

Event rate in placebo - Event rate in control

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33
Q

Coronary perfusion occurs during?

A

Diastole

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34
Q

LAD

A

Anterior 2/3 of IV-septum
Anterior wall of LV
Part of papillary m.

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35
Q

Left circumflex

A

Lateral and Posterior wall of LV

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36
Q

RCA

A

Wall of RV
Posterior IV-septum
Inferior wall of LV (diaphragmatic surface of heart)
Part of papillary m.

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37
Q 
Use dependence
(prolonging QRS to greater extent at faster HR)
A

Class 1C antiarrythmics (sodium channel blockers)

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38
Q

Reverse use dependence

slower heart rate, the more QT is prolonged

A

Class 3 antiarrythmics (block repolarizing K+ channels)

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39
Q

Type 1 error

A

Claiming there is a difference when really:

THERE IS NO DIFFERENCE.

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40
Q

Alpha

A

Maximum probability of making type 1 error a researcher is willing to accept
(= p-value)

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41
Q

Beta

A

Probability of commiting type II eror

missing an actual difference

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42
Q

1-Beta

A

POWER

probability of rejecting null when it is truely false

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43
Q

If you don’t want to miss an actual difference, what should you maximize?

A

Power

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44
Q

Coronary sinus dilation

A

Elevated right heart pressure

usually 2/2 pulmonary HTN

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45
Q

Phase 0 of cardiomyocyte vs. pacemaker cell

A

Cardiomyocyte: Na+
Pacemaker: Ca2+

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46
Q

Pacemaker cell: automaticity

A

Slow, inward sodium current occurring during phase 4

47
Q

Gram+ cocci

Synthesize dextran from glucose

A

Strep viridans

48
Q

Dental caries

A

Strep viridans

49
Q

Endocarditis of prosthetic valve: think of?

A

Staph. epidermidis

50
Q

Endocarditis of previously damaged valve: think of?

A 
Strep viridans
(subacute endocarditis)
51
Q

S-100

A

Marker for cells of neural crest origin

melanocyte, Schawann cell

52
Q

Ras

A

Codes for membrane-bound G-protein

Activates MAP kinase pathway

53
Q

c-Jun

A

DNA binding protein

via leucie zipper motif

54
Q

Lymphedema in neonate suggests?

A

Turner’s syndrome

55
Q

Turner’s syndrome a/w

A

Coarctation of aorta
Bicuspid aortic valve
Aortic dissection

56
Q

MVP a/w?

A

Marfan syndrome

57
Q

Vaginal adeonosis associated w/?

A

DES

precursor of clear cell adenocarcinoma of vagina

58
Q

Osteogenesis imperfecta

A

Collagen type 1 defect

AD

59
Q

Type 1 collagen

A

Bone, tendons, ligaments, dentin

Dermis, corena, scar tissue

60
Q

Type 2 collagen

A

Cartilage, Nucleus pulposus

Vitreous humor

61
Q

Type 3 collagen

A

Skin, lung, intestine
BV, bone marrow, lymphatics
Granulation tissue

62
Q

Losartan

A

ARB

63
Q

ARB is beneficial for?

A

Hypertension

Diabetes nephropathy

64
Q

Mid-systolic click

Mid-late systolic murmur

A

MVP

65
Q

Adrenergic receptor and GPCR

A

Alpha1: Gq
Alpha2: Gi
Beta1: Gs
Beta2:Gs

66
Q

Cholinergic receptor and GPCR

A

M1: Gq
M2: Gi
M3: Gq

67
Q

Dopaminergic receptor and GPCR

A

D1: Gs
D2: Gi

68
Q

HAV1 M&M

A

Gq

Phospholipase C, Protein Kinase C, IP3, DAG

69
Q

MAD 2s

A

Gi

Inhibit adenylate cyclase –> thus decreasing cAMP

70
Q

B1 receptor found on?

A

Heart
Renal juxtaglomerular cell
(NOT on vascular smooth muscle)

71
Q

Vascular reaction to endothelial and intimal injury

A

Intimal hyperplasia and fibrosis

mediated by REACTIVE smooth muscle cells that migrate from media to intima

72
Q

Vascular reaction to endothelial and intimal injury

A

Intimal hyperplasia and fibrosis

mediated by REACTIVE smooth muscle cells that migrate from media to intima

73
Q

Reduce rate of spontaneous depolarization in cardiac pacemaker cells

A

Adenosine
Acetylcholine
(work on phase 4: both activates K+ channel and other stuff)

74
Q

Cardiac pacemaker cell AP

A

Phase 0: upstroke (L-type Ca2+)
Phase 4: pacemaker potential (Na+)
Phase 3: repolarization (K+)

75
Q

Pericardial tamponade triad

A

Muffled heart sounds
Profound HYPOtension
Elevated JVP

76
Q

ANP is secreted by atrial myocyte in response to?

A

Atrial stretch due to:
HYPERtension
or
HYPERvolemia

77
Q

ANP: action

A

Peripheral vasodilation

Increased urinary excretion of sodium and water

78
Q

Treatment of choice for DKA

A

IV hydration w/ normal saline + Insulin
(Decrease serum glucose, osmolality, potassium)
(Increase serum bicarbonate, sodium)

79
Q

Most heavily involved artery in athersclerosis

A 
Abdominal aorta (1st)
Coronary artery (2nd)
Popliteal artery (3rd)
Internal carotid artery
Circle of Willis
80
Q

Location of catheter where it is MOST likely to be infected.

A

Femoral

81
Q

Class 1 anti-arrhythmic use dependence (in order)

A

IC > IA > IB

82
Q

Isolated systolic hypertension most likely due to?

A

Decrease in compliance of aorta and its proximal major branches.

83
Q

Can be used for MRSA

A/E: elevated CPK levels, myopathy

A

Daptomycin

84
Q

Daptomycin limitations

A

Inactivated by surfactants

NOT useful in gram-negatives

85
Q

Tetralogy of Fallot
Transposition of great vessels
Truncus arteriosus
Caused by?

A

Abnormal migration of neural crest cells through primitive truncus arteriosus and bulbus cordis

86
Q

Phentolamine

A

NON-specific alpha1 and alpha 2 BLOCKER

87
Q

Phenylephrine

A

Selective a-adrenergic agonist

88
Q

Isoproterenol

A

NON-selective B-adrenergic agonist

89
Q

Epinephrine

A

Increase systolic BP (a1 + b1)
Increase HR (b1)
Increase OR decrease diastolic BP (a1 vs. b2)

90
Q

Extended consuption of appetite suppressant (fenfluramine, phentermine)

A

Pulmonary HTN

91
Q

BB: EKG changes

A

Prolong PR interval

92
Q

QT segment =

A

Beginning of QRS to end to ST.

QRS + ST

93
Q

PR interval

A

Beginning of P to Beginning of QRS

94
Q

Long QT: drug induced (especially?)

A

Quinidine

Sotalol

95
Q

Cardiac specific CCB

A

Verapamil

Diltiazem

96
Q

CCB that can be used as anti-HTN, and helps in bradycardia

A

Nifedipine

reflex tachycardia w/ peripheral vasodilation

97
Q

Dystrophic calcification

A

Hallmark of preceding cell injury and necrosis

98
Q

Monitor warfarin w/?

A

PT

99
Q

Warfarin inhibits?

A

VitK dependent clotting factors

2,7,9, 10

100
Q

Bleeding time is to monitor?

A

Platelet function

101
Q

aPTT is used to monitor?

A

Unfractionated heparin

102
Q

Diastolic
Heart murmur best heard at LSB
Patient leaning forward and exhaling

A

Exhale = left sided
Leaning forward = bring aortic valve close to chest wall
Aortic regurgitation

103
Q

Peak intensity of aortic regurgitation?

A

When pressure gradient btwn aorta and LV is @ maximum

104
Q

Clonidine

A

Central activing
activates alpha2 adrenergic receptors in brainstem
(decrease peripheral resistance)

105
Q

Phenylephrine

A

a1>a2 agonist

106
Q

Dose dependent INCREASE in myocardial contractility

Dose dependent DECREASE in systemic vascular resistance

A

Isoproterenol
(acts on B1)
(at low dose, selectively binds to B2)

107
Q

Used for atrial fibrillation (heart selective)

Constipation, Gingival hyperplasia= A/E

A

Verapamil

NON-dihydroperidine CCB

108
Q

Chronic AV fistula: effects

A 
Increased CO (decreased total peripheral resistance)
Increased venous return
Increased mean arterial pressure
109
Q

Hypertrophic CM: a/w this murmur

A

Mitral regurgitation

110
Q

Major determinant of whether or not coronary artery plaque will cause ischemic myocardial injury

A

RATE at which it occludes involved artery.

111
Q

Gram+ cocci

Mannitol fermentation

A

S. aureus

112
Q

Valsava maneuver

A

INCREASE baroreceptor firing –> parasympathetic –> slow conduction through AV node

113
Q

Children
High fever
Palmoplantar erythema w/ periungual desquamation
Oral mucosal and conjunctival inflammation
Cervical ALD

A

Kawasaki disease

mucocutaneous lymph node syndrome

114
Q

Endocardial thickening

NON-compliant ventricular walls

A

Restrictive CM

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