UWorld Test 5/20/2014 - Cardio and general

Question 1

Major determinant of whether or not a coronary artery plaque will cause ischemic injury is?

Answer 1

Rate at which it occludes the artery. Slow developing occlusion allows for the formation for collaterals

Question 2

thin fibrous cap, rich lipid core, active inflammation increases or decreases plaque stability?

Answer 2

Decreases - more prone to rupture

Question 3

Character of pericarditis chest pain? Exacerbated by? Relieved by?

Answer 3

Sharp, friction rub. Exacerbated by swallowing. Relieved by sitting up/leaning forward

Question 4

What are the types of pericarditis that can happen after MI? When do they happen?

Answer 4

Early onset pericarditis happens in 10-20% of patients, happens 2-4 days after event. Inflammatory reaction to necrotic myocardium that happens to adjacent visceral and parietal percardium. Dresslers syndrome happens 1 week to several weeks after event. Thought to be autoimmune polyserositis

Question 5

What is myocardial hibernation?

Answer 5

Persistent or repetitive low flow state that can lead to reversible loss of contractile function. It can be reversed by reperfusion. Mycoardial stunning is a less severe form of this. Repetitive stunning can lead to hibernation.

Question 6

What is ischemic preconditioning?

Answer 6

Development of resistance to infarction by myoctes previously exposed to sub lethal ischemia.

Question 7

How does aortic stenosis affect the LV - aorta pressure gradient in “the graph”

Answer 7

Normally, aorta pressure and lv pressure are on top of each other (same) during systole but in aortic stenosis, there is a gradient such that the LV pressure is greater than the aortic pressure.

Question 8

Holosystolic murmur that increases In intensity during inspriation is?

Answer 8

Tricuspid regurgitation. Upon inspiration, there is greater venous return to the RA/RV, more volume => increases intensity of murmur. On the left side, there is increases pulmonary vein capacity, and less venous return to the left heart so there is no change in murmur sound.

Question 9

Why is the pathophysiology behind S3?

Answer 9

Occurs in early diastole during rapid ventricular filling phase. A/w increased filling pressures. For example, in mitral regurg there is increased volume due to the regurgitant volume/increased rate of filling. Also heard in LV systolic function failure. Heard when blood rushes into partially filled ventricle. Also when filling stifff ventricle. Also more common in dilated ventricles (more normal in pregnant women and children)

Question 10

What is the most reliable auscultuary finding indicating severity of mitral regurgitation

Answer 10

S3. Intensity of holosystolic murmur is not indicative since larger regurgitant volumes are also a/w larger orifices and can present with softer murmurs.

Question 11

Bell of stethoscope is best sutied for? Diaphragm is best for?

Answer 11

Bell - low frquency sounds like S3. Diaphragm - high frequency sounds.

Question 12

S4 sound is due to?

Answer 12

Low frequency sound due to decreased left ventricular compliance. A/w LVH and restrictive cardiomyopathies.

Question 13

What is the most common cardivascular syndrome associatd with Lupus

Answer 13

Pericarditis. Libman sacks endocarditis is another cardio manifestation in lupus patients.

Question 14

Golden yellow or brownish cytoplasmic granules may be? What test can be used to distinguish the two possibilities

Answer 14

Lipofuscin or hemosidern. Prussian blue stain = colorless potassium ferrocyanide is converted by iron to blue black ferrocyanide.

Question 15

What is the most effective treatment for hypertriglyceridemia

Answer 15

Niacin and Fibrates

Question 16

Stimulation of vagal nerve branches that supply the lung would result in?

Answer 16

Parasympathetic, i.e. muscarinic/Ach activity => Bronchoconstriction, increased bronchial secretions. Therefore increased work of breathing.

Question 17

What is the MOA for rifampin? What is the mechanism of resistance for Ripampin?

Answer 17

Inhibits bacterial DNA dependent RNA polymerase => inhibits transcription. Subsequent lack of mRNA leads to deficiency of these proteins necessary for mycobacterial survival. Altered rifampin binding site/altered DNA dependent RNA polymerase

Question 18

What are the four Rs of rifampin

Answer 18

RNA polymerase inhibitor, Ramps up cyt P450, red/orange body fluids (sweat, urine), rapid resistance If used alone, Rifampin ramps up P450 but rifaBUTin doesn’t

Question 19

Lung abscesses on CT can be identified by

Answer 19

Presence of air fluid levels

Question 20

Alocoholics are likely to develop pulmonary infections and abscesses involving which organisms? What tx is appropriate?

Answer 20

Combination of oral anaerobic flora (bacteroides, fusobacterium, and peptostreptococcus) and aerobic bacteria. Clindamycin covers most of these organisms and is antibiotic of choice for treating lung abscesses

Question 21

What are symptoms specific to Grave’s disease?

Answer 21

Exopthalmos and pretibial myxedema. Can be described as “lower leg skin thickening and induration.”

Question 22

Name the anticholinesterases

Answer 22

Neostigmine, pyridostigmine, physostigmine, Donepezil/Rivastigmine/galantamine, edrophonium

Question 23

What drug can counteract both peripheral and CNS effets of atropine

Answer 23

Physostigmine, an anti-cholinestarase, able to cross the blood brain barrier.

Question 24

HBA2 is elevated in?

Answer 24

Beta thalassemia minor (trait) and intermedia because of underproduction of beta globin chain.

Question 25

QRS complex that is prolonged during immediate recovery (when heart rate would still be elevated) indicates what kind of drug usage?

Answer 25

Drug used to treat afib exhbits strong use dependence. Drug like Class IC flecainimide

Question 26

What is the drug of choice for prevention of venous thrombosis in non-ambulatory patients/patients undergoing surgery?

Answer 26

Heparin. Increases the effect of naturally occuring anti-thrombin III. Binds to it which causes conformational change of antithrombin 3, which in turn increasees antithrombin III binding and neutralization of thrombin.

Question 27

Follicular lymphoma looks like what on histology. What kind of translocation is seen with this?

Answer 27

Packed follicles tht obscure l ymph node architecture. T(14;18) translocation is seen, results in overexpression of BCL-2.

Question 28

Sterile non-destructive vegetations characteristic of?

Answer 28

Non-bacterial thrombotic endocarditis (NBTE). Typically the result of a hypercoagulable state or endothelial cell injury.

Question 29

Particularly strong association between NBTE and ?

Answer 29

Mucinous adenocarcinoma of the pancreas and adenocarcinoma of the lung which may relate to procoagulant effects of mucin.

Question 30

What is trousseau syndrome

Answer 30

Migratory thrombophlebitis - induced by dissminated cancers. Pathophys is similar to NBTE

Question 31

What is the precursor protein/peptide responsible for localized amyloidosis in 1) cardiac atria 2) thryoid gland 3) pancreatic islets 4) cerebrum/blood vessels 5) pituitary gland

Answer 31

1) ANP 2) calcitonin 3) amylin (islet amyloid protein) 4) beta amyloid protein 5) prolactin

Question 32

What is used to treat DVT in pregnant women?

Answer 32

Heparin

Question 33

Loss of previously acquired motor schools is a finding in what disease?

Answer 33

Niemann-Pick disease Type A

Question 34

Describe Nieman-Pick Disease. Inheritance? Presentation?

Answer 34

A/R disorder that presents in infants of Ashkenazi jews. Deficiency of sphingomyelinase that causes sphingomyelin to accumulate within phagocytes. Resultant foamy histiocytes accumulate in the liver, spleen and skin. Gradual sphingomyelin deposition in the CNS causing neurologic degeneration. Loss of previously acquired motor skill.s Progresses to hypotonia and blindness. Cherry red macular spot (like in Tay Sachs) and hepatosplenomegaly are comon findings.

Question 35

PAH concentration is lowest where? Why?

Answer 35

Lowest in bowman’s capsule. Filtered and actuallys ome is secreted into nephron lumen by proximale tubule. It then getes concentrated as it move sthrough the system. Therefore, concentration is lowest in bowmen’s capsule.