Set 5 (Cardiovascular) Flashcards
1
Q
Torsades de pointes always a/w?
A
Prolonged QT interval
2
Q
QT interval prolonged in these antiarrhythmic agents
beware of Torsades
A
Quinidine Procainamide Sotalol Disopyramide Ibutilide/dofetilide
3
Q
Verapamil
A
CCB
Slow SA firing, AV node conduction
PROLONGS PR interval
4
Q
Metoprolol as antiarrythmic
A
Slow SA firing, AV node conduction
PROLONGS PR interval
5
Q
Lidocaine as antiarrythmic
A
Reduce phase 4 diastolic depol (decrease in automaticity)
6
Q
Digoxin as antiarrythmic
A
SLOW conduction through AV node
7
Q
Holosystolic murmur @ left mid-sternal border
A
VSD
8
Q
Fixed S2 split
A
ASD
9
Q
Bifid cartold pulse w/ brisk upstroke
“spike and dome”
A
Hypertrophic obstructive CM
10
Q
Coagulase-negative staph
Synthetic valve
Endocarditis
Tx?
A
Vancomycin
+/- Rifampin or gentamycin
(WIDEspread antibiotic resistance of S. epidermidis, esp nosocomial)
11
Q
Paradoximal emboli: heart sound
A
= ASD
fixed S2 split
12
Q
Suspect WPW in?
A
Sudden cardiac death in otherwise healthy young adult
13
Q
Significantly prolong QT interval
BUT
LOW incidence of torsade
A
Amiodarone (unlike rest of class III)
14
Q
Main purpose of binding
A
Prevent patient/researcher expectancy form interfering w/ outcome (OBSERVOR biasis)
15
Q
Beta error
A
Claiming NO DIFFERENCE exist when truely:
THERE IS A DIFFERENCE!
16
Q
Hepatic ethanol catabolism:
A
NADH production
Gluconeogenesis INHIBITION
17
Q
Phosphodiesterase inhibitors: MOA
A
Maintain cAMP levels –> ionotropic in cardiac muscles
however, cAMP in vascular muscle –> vasodilation
18
Q
cAMP in cardiac muscle
cAMP in vascular smooth muscle
A
cAMP in cardiac muscle: contraction
cAMP in vascular smooth muscle: relaxation
19
Q
Apical displacemtn of Tricuspid
Decreased RV volume
Atrialization of RV
A
Ebstein’s anomaly
Lithium
20
Q
Gestational diabetes a/w
A
Macrosomia, Caudal regression syndrome
HYPOglycemia, HYPOcalcemia
HYPERtrophic CM
21
Q
Fetal alcohol syndrome
A
Midfacial anomalies
Growth and mental retardation
22
Q
Dilated cardiomyopathy causes
A
Alcohol
Infectious myocarditis
23
Q
Dilated cardiomyopathy: systolic or diastolic heart failure?
A
Systolic
24
Q
m/c/c of mitral stenosis
A
Chronic rheumatic heart disease
25
PDA a/w
Prematurity
| Congenital rubella infection
26
Lecithinase
C. perfringens alpha toin (phospholipase C)
27
C. diptheriae virulence factor
AB-exotoxin (Ribosylate EF-2 --> inhibit protein synthesis)
28
Pertussis toxin
AB toxin: stimulates G protein --> increase cAMP --> insuli production, lymphocyte/neutrophil dysfxn, increased sensitivity to histamine
29
ETEC and Shigella toxin
Inactivation of 60s ribosome
30
GAS cause rheumatic fever due to?
Antigenic mimicry
31
NNT
1/ARR
32
ARR
Event rate in placebo - Event rate in control
33
Coronary perfusion occurs during?
Diastole
34
LAD
Anterior 2/3 of IV-septum
Anterior wall of LV
Part of papillary m.
35
Left circumflex
Lateral and Posterior wall of LV
36
RCA
Wall of RV
Posterior IV-septum
Inferior wall of LV (diaphragmatic surface of heart)
Part of papillary m.
37
```
Use dependence
(prolonging QRS to greater extent at faster HR)
```
Class 1C antiarrythmics (sodium channel blockers)
38
Reverse use dependence
| slower heart rate, the more QT is prolonged
Class 3 antiarrythmics (block repolarizing K+ channels)
39
Type 1 error
Claiming there is a difference when really:
| THERE IS NO DIFFERENCE.
40
Alpha
Maximum probability of making type 1 error a researcher is willing to accept
(= p-value)
41
Beta
Probability of commiting type II eror
| missing an actual difference
42
1-Beta
POWER
| probability of rejecting null when it is truely false
43
If you don't want to miss an actual difference, what should you maximize?
Power
44
Coronary sinus dilation
Elevated right heart pressure
| usually 2/2 pulmonary HTN
45
Phase 0 of cardiomyocyte vs. pacemaker cell
Cardiomyocyte: Na+
Pacemaker: Ca2+
46
Pacemaker cell: automaticity
Slow, inward sodium current occurring during phase 4
47
Gram+ cocci
| Synthesize dextran from glucose
Strep viridans
48
Dental caries
Strep viridans
49
Endocarditis of prosthetic valve: think of?
Staph. epidermidis
50
Endocarditis of previously damaged valve: think of?
```
Strep viridans
(subacute endocarditis)
```
51
S-100
Marker for cells of neural crest origin
| melanocyte, Schawann cell
52
Ras
Codes for membrane-bound G-protein
| Activates MAP kinase pathway
53
c-Jun
DNA binding protein
| via leucie zipper motif
54
Lymphedema in neonate suggests?
Turner's syndrome
55
Turner's syndrome a/w
Coarctation of aorta
Bicuspid aortic valve
Aortic dissection
56
MVP a/w?
Marfan syndrome
57
Vaginal adeonosis associated w/?
DES
| precursor of clear cell adenocarcinoma of vagina
58
Osteogenesis imperfecta
Collagen type 1 defect
| AD
59
Type 1 collagen
Bone, tendons, ligaments, dentin
| Dermis, corena, scar tissue
60
Type 2 collagen
Cartilage, Nucleus pulposus
| Vitreous humor
61
Type 3 collagen
Skin, lung, intestine
BV, bone marrow, lymphatics
Granulation tissue
62
Losartan
ARB
63
ARB is beneficial for?
Hypertension
| Diabetes nephropathy
64
Mid-systolic click
| Mid-late systolic murmur
MVP
65
Adrenergic receptor and GPCR
Alpha1: Gq
Alpha2: Gi
Beta1: Gs
Beta2:Gs
66
Cholinergic receptor and GPCR
M1: Gq
M2: Gi
M3: Gq
67
Dopaminergic receptor and GPCR
D1: Gs
D2: Gi
68
HAV1 M&M
Gq
| Phospholipase C, Protein Kinase C, IP3, DAG
69
MAD 2s
Gi
| Inhibit adenylate cyclase --> thus decreasing cAMP
70
B1 receptor found on?
Heart
Renal juxtaglomerular cell
(NOT on vascular smooth muscle)
71
Vascular reaction to endothelial and intimal injury
Intimal hyperplasia and fibrosis
| mediated by REACTIVE smooth muscle cells that migrate from media to intima
72
Vascular reaction to endothelial and intimal injury
Intimal hyperplasia and fibrosis
| mediated by REACTIVE smooth muscle cells that migrate from media to intima
73
Reduce rate of spontaneous depolarization in cardiac pacemaker cells
Adenosine
Acetylcholine
(work on phase 4: both activates K+ channel and other stuff)
74
Cardiac pacemaker cell AP
Phase 0: upstroke (L-type Ca2+)
Phase 4: pacemaker potential (Na+)
Phase 3: repolarization (K+)
75
Pericardial tamponade triad
Muffled heart sounds
Profound HYPOtension
Elevated JVP
76
ANP is secreted by atrial myocyte in response to?
Atrial stretch due to:
HYPERtension
or
HYPERvolemia
77
ANP: action
Peripheral vasodilation
| Increased urinary excretion of sodium and water
78
Treatment of choice for DKA
IV hydration w/ normal saline + Insulin
(Decrease serum glucose, osmolality, potassium)
(Increase serum bicarbonate, sodium)
79
Most heavily involved artery in athersclerosis
```
Abdominal aorta (1st)
Coronary artery (2nd)
Popliteal artery (3rd)
Internal carotid artery
Circle of Willis
```
80
Location of catheter where it is MOST likely to be infected.
Femoral
81
Class 1 anti-arrhythmic use dependence (in order)
IC > IA > IB
82
Isolated systolic hypertension most likely due to?
Decrease in compliance of aorta and its proximal major branches.
83
Can be used for MRSA
| A/E: elevated CPK levels, myopathy
Daptomycin
84
Daptomycin limitations
Inactivated by surfactants
| NOT useful in gram-negatives
85
Tetralogy of Fallot
Transposition of great vessels
Truncus arteriosus
Caused by?
Abnormal migration of neural crest cells through primitive truncus arteriosus and bulbus cordis
86
Phentolamine
NON-specific alpha1 and alpha 2 BLOCKER
87
Phenylephrine
Selective a-adrenergic agonist
88
Isoproterenol
NON-selective B-adrenergic agonist
89
Epinephrine
Increase systolic BP (a1 + b1)
Increase HR (b1)
Increase OR decrease diastolic BP (a1 vs. b2)
90
Extended consuption of appetite suppressant (fenfluramine, phentermine)
Pulmonary HTN
91
BB: EKG changes
Prolong PR interval
92
QT segment =
Beginning of QRS to end to ST.
| QRS + ST
93
PR interval
Beginning of P to Beginning of QRS
94
Long QT: drug induced (especially?)
Quinidine
| Sotalol
95
Cardiac specific CCB
Verapamil
| Diltiazem
96
CCB that can be used as anti-HTN, and helps in bradycardia
Nifedipine
| reflex tachycardia w/ peripheral vasodilation
97
Dystrophic calcification
Hallmark of preceding cell injury and necrosis
98
Monitor warfarin w/?
PT
99
Warfarin inhibits?
VitK dependent clotting factors
| 2,7,9, 10
100
Bleeding time is to monitor?
Platelet function
101
aPTT is used to monitor?
Unfractionated heparin
102
Diastolic
Heart murmur best heard at LSB
Patient leaning forward and exhaling
Exhale = left sided
Leaning forward = bring aortic valve close to chest wall
Aortic regurgitation
103
Peak intensity of aortic regurgitation?
When pressure gradient btwn aorta and LV is @ maximum
104
Clonidine
Central activing
activates alpha2 adrenergic receptors in brainstem
(decrease peripheral resistance)
105
Phenylephrine
a1>a2 agonist
106
Dose dependent INCREASE in myocardial contractility
| Dose dependent DECREASE in systemic vascular resistance
Isoproterenol
(acts on B1)
(at low dose, selectively binds to B2)
107
Used for atrial fibrillation (heart selective)
| Constipation, Gingival hyperplasia= A/E
Verapamil
| NON-dihydroperidine CCB
108
Chronic AV fistula: effects
```
Increased CO (decreased total peripheral resistance)
Increased venous return
Increased mean arterial pressure
```
109
Hypertrophic CM: a/w this murmur
Mitral regurgitation
110
Major determinant of whether or not coronary artery plaque will cause ischemic myocardial injury
RATE at which it occludes involved artery.
111
Gram+ cocci
| Mannitol fermentation
S. aureus
112
Valsava maneuver
INCREASE baroreceptor firing --> parasympathetic --> slow conduction through AV node
113
Children
High fever
Palmoplantar erythema w/ periungual desquamation
Oral mucosal and conjunctival inflammation
Cervical ALD
Kawasaki disease
| mucocutaneous lymph node syndrome
114
Endocardial thickening
| NON-compliant ventricular walls
Restrictive CM
