2/22 Flashcards Preview

Final FA review > 2/22 > Flashcards

Flashcards in 2/22 Deck (104):
1

Congenital long QT syndromes
-problem w/what?

-disorder of myocardial repolarization, typically due to ion channel defects.

2

QT interval

-mechanical contraction of ventricles.
-QRS wave til end of T wave (repol).
-long QT interval predisposes to Torsades

3

Romano-Ward syndrome

-congenital long QT
-auto dom.
-pure cardiac phenotype, no deafness

4

Jervell and Lange Neilson syndrome

-congenital long QT
-auto recessive
-sensorineural deafness

5

What is neg. feedback on renin?

-angio2, aldo.
-you can also have low renin (not just by neg feedback) but by high renal perfusion and low Cl- at the macula densa!)

6

What is the most common side effect of epleronone and spironolactone?

-gynecomastia.
-more so w/spironolactone

7

What causes type 4 renal tubular acidosis

-hypoaldosteronism.

8

1-Familial hyperchylomicronemia
-protein defect?
-whats happening?
-major manifestations?

-LPL or apoC2
-TGs can't be broken down and taken out of chylos & VLDL.
-acute pancreatitis, eruptive skin xanthomas, hepatosplenomegaly.
*lipemia retinalis = milky appearing retinal vasculature

9

2a-familial hypercholesterolemia
-protein defect?
-whats happening?
-major manifestations?

-LDL receptor, apoB100
-LDL = full of cholesterol, gets trapped in blood cuz can't be taken up by liver.
-premature CAD, corneal arcus, tendon xanthomas, xanthelasmas.
*xanthoma of achilles tendon

10

4-hypertriglyceridemia
-problem?
-manifestation?

-hepatic overprod. of VLDL.
-pancreatitis

11

Ligand for LDL receptor?

apoB-100

12

familial hyperchylomicronemia
-are they are risk for premature CAD?

-no
-their LDL and HDL levels are fine.
-CAD risk main indicator is HDL levels.

13

What types of drugs have a low volume of distribution?

-large/charged molecules
-plasma protein bound

14

Whats the average total body water?

41 liters
-plasma volume = 3 L
-interstitial = 11 L
*so about 14 L out of 41 L is extracellular fluid.

15

Lichtenburg figures

-fern-leaf pattern cutaneous marks following a lightning strike. lol.

16

U wave
-what is it?
-what can it point to?

-electrical activity of papillary muscles.
-hypokalemia, bradycardia

17

midline of EKG

-cells are depolarized
-no more current flowing

18

which interval = systole?

QT interval
-so vent repolarization is also part of systole.

19

Which drugs can slow down AV node? and how?
-can prevent atrial tachys from getting to ventricles.

-Ca channel blockers: slow phase 0 of AV node.

-beta blockers: blocking beta-1

-digialis: inc. vagal activity, inhibition conduction thru AV node.

20

Heart block
-which segment is elongated?

-AV nodal block aka junctional block.
-PR segment

21

2nd deg. heart block: Mobitz 1
*Wenckebach

Progressive elongation of PR interval until one P wave not followed by QRS, then cycle repeats.
*usually asymptomatic.

22

2nd deg. heart block: Mobitz 2

PR interval is stable, but at some point, a P wave is not followed by QRS.
*often found as 2:1 Heart Block
*often treated w/pacemaker

23

Causes of torsades de pointe
-treatment?

-drugs, dec. K, dec. Mg
-Tx: magnesium sulfate

24

Drugs that can cause torsades

Sotalol, Risperidone (antipsychotics), Macrolides
Chloroquine, Protease inhibitors (-navir), Quinidine (class Ia; also class III), Thiazides
*Some Risky Meds Can Prolong QT

25

Afib: describe tracing

-irregularly irregular
-no discrete P waves (atrial depol)
-

26

Atrial flutter: describe tracing

-A rapid succession of identical, back-to-back atrial depolarization waves.
*Sawtooth appearance.

27

Vfib: describe tracing

-no identifiable waves

28

3rd degree heart block (complete)
-what infection can result in this?

-no AV conduction. atria and ventricles independent of each other.
-atria are faster than ventricles.
-lyme diseaes can lead to complete heart block.

29

B-type (brain) natriuretic peptide
-where is it released from?

-Released from ventricular myocytes in response to inc. tension.
-longer half life than ANP.
-good negative predictive value for diagnosing heart failure.

30

recombinant form of BNP?

neseritide

31

aortic arch baroreceptor
-what does it respond to?

-only respond to increases in BP.
-inc. in BP = inc. firing of vagus to solitary nucleus = increased inhibition of sympathetics.

32

carotid sinus baroreceptor
-what does it respond to?

-responds to both increases and decreases in BP.

33

Cushing reaction triad

-increased BP, resp. depression, and dec. heart rate.

34

Periph. chemoreceptors
-stimulated by what?

-dec. pH
-inc. pCO2
-dec. pO2
*so only stimulated when you need to breath more.

35

Which organ extracts the most O2 from its blood supply?

-Heart. Extracts ~80% O2 from its blood source.
-so inc. O2 demand met by inc. coronary blood flow, not by extracting more O2.

36

Heart: local vasodilatory metabolites?

-adenosine
-CO2
-NO

37

Skeletal muscle: local vasodilatory metabolites?

-lactate
-H
-K
-adenosine
-CO2

38

Filtration constant Kf
-determined by what?

capillary permeability

39

Jv = ?

Jv = net fluid flow
Jv = Kf*Pnet

40

Whats one disease that inc. oncotic pressure of interstitum?

lymphatic blockage

41

What are the 5 right-left congenital cardiac shunts?

1-truncus artiosus
2-transposition of great vessels
3-tricuspid atresia
4-tetralogy of fallot
5-total anomalous pulm. venous return

42

Cause of truncus arteriosus?

Abnormal neural crest cell migration

43

Which maternal disease predisposed to transposition of great vessels?

maternal DM.

44

Cause of transposition of great vessels?

Abnormal neural crest cell migration leading to problems w/septation.
*heart will be dome shaped & enlarged.

45

Tricuspid atresia
-what does it require to be viable?

Both ASD and VSD.
-need a way to get to that RV.

46

Boot shaped heart on CXR

Tetralogy of fallot
-due to RV hypertrophy

47

Tet spells

In Tetralogy of fallot
-Suddenly develop deep blue skin, nails and lips after crying, feeding, having a bowel movement, or kicking his or her legs upon awakening. Caused by a rapid drop in the amount of oxygen in the blood.
-Toddlers or older children may instinctively squat when they are short of breath. Squatting increases blood flow to the lungs by inc. systemic resistance/pressure which inc pressure in RV so blood shunted thru stenotic pulm art.

48

Total anomalous pulmonary venous return (TAPVR)

-Pulm. veins drain into right heart circulation; associated with ASD and sometimes PDA to allow for right-to-left shunting to maintain CO.

49

Dilated coronary sinus, think what?

Pulm HTN.

50

Frequency of left to right shunts:

VSD > ASD > PDA.

51

Common cause of VSD?

Fetal alcohol syndrome

52

Marked distinction btwn foramen ovale and ASD.

-ASD = septum is missing tissue.
-PFO = tissue is not fused properly.

53

ASD: usually occurs in septum primum or secundum?

-secundum.

54

which L=>R shunt can result in differential cyanosis?

PDA b/c ductus is AFTER the major aortic branches, so upper extremities will not be receiving deoxy blood!

55

Common cause of PDA?

congenital rubella

56

Infantile coarctation
-proximal or distal to ductus artiosus?
-proximal or distal to aortic major branches?

-proximal to ductus arteriosus.
-distal to aortic major branches (so is adult type).

57

22q11 syndromes
-lead to which cardiac abnormalities?

-truncus arteriosus
-tetralogy of fallot

58

Turners
-leads to preductal or postductal coarctation?

-obviously preductal cuz you're born with it.

59

Mönckeberg (medial calcific sclerosis)
-calcification in which layer of artery?
-which arts are most likely to be affected?

-media.
-no intima involvement.
-seen in radial & ulnar arts.
-"pipestem" arteries on x-ray

60

Statistical power

(1 - beta)
-probability of finding a true relationship
-beta = probability of missing a relationship when one actually exists.

61

stats: beta

-probability of committing a type 2 error.
-ie. a study finding that aspirin does not impact platelet function when in fact it does.

62

type 1 error

-finding a significant difference when one doesn't actually exist.
-alpha = max probability of committing a type 1 error that a researcher is willing to accept. Usually .05.
-alpha comparable to p-value.

63

ACE inhibitors can dec. GFR and inc. creatinine.
-can precipitate acute renal failure.

-no AT2 = no constriction of efferent areriole = dec. GFR (dec. filtration fraction).
*especially in pts w/bilat renal art. stenosis.

64

Avoid ACE inhibitors in which pts?

-bilat renal art stenosis.
-they need their efferent arteriole constricted to get as much filtration fraction/GFR as possible.

65

Mnemonic for P450 inducers

Chronic alcoholic mona steals phen phen and never refuses greasy carbs.

66

Mnemonic for P450 inhibitors

MAGIC RACKS in GQ

67

Mnemonic for P450 substrates

Always Always Always Always think before starting others.
*4 always.

68

CHF
-mixed venous O2 content. Inc or Dec?

-dec.
-less arterial blood delivered to tissues (due to vasoconstriction & dec. perfusion pressure), so whatever blood is delivered, more O2 sucked out of it.

69

Pulm edema
-affect on lung compliance?

-dec lung compliance.

70

presystolic gallop

S4
-unlike S3, S4 is always pathological, even in kids.
-happens during atrial contraction into a stiff/non compliant ventricle. So late diastole, right before systole.

71

protodiastolic gallop

S3

72

Carotid sinus
-in which carotid
-proximal or distal to bifurcation?

-internal carotid, right after bifurcation of common carotid.

73

Cherry hemangioma
-in old or young people?
-does it regress?

-old people
-does NOT regress

*usually much smaller than strawberry hemangiomas.

74

Which drug can lead to ebstein's anomaly?

Lithium

75

Lysyl oxidase
-cross links collagen or elastin?
-fucked up in what disease?

-both
-ehlers danlos

76

Migratory thrombophlebitis
-should make you think what?

Cancer
-hypercoag = common paraneoplastic syndrome seen in adenocarcinomas of pancreas, colon, or lung.

77

Metalloproteinases in atheroma
-more of these = more or less risk of rupture?

-more risk of rupture
-released by macros

78

Common locations for atherosclerosis

Abdominal aorta > coronary artery > popliteal
artery > carotid artery

79

Can HTN cause cystic medial degeneration?
-what does that predispose to?

-yes.
-aneurysm, dissection.

80

Stable angina: EKG?

-ST depression or nothing.

81

Prinzmetal: EKG?

-transient ST elevation

82

Triggers of prinzmetal angina

-triptans (vasoconstrictors for migrains), cocaine, tobacco.

83

Unstable/crescendo angina: EKG?

-ST depression

84

Can you give prinzmetal pts beta-blockers?

do NOT given prinzmetal pts beta-blockers. This will block the vasodilatory effects of beta-2 and make matters worse.
-The coronary vessel dilation is a balance between alpha-1 (constriction) and beta-2 (dilation).

85

Coronary steal syndrome

Distal to coronary stenosis, vessels are maximally dilated at baseline. Administration of vasodilators (e.g., dipyridamole, regadenoson) dilates normal vessels and shunts blood toward well-perfused areas => dec. flow and ischemia in the poststenotic region. Principle behind pharmacologic stress tests.

86

How many minutes of ischemia in heart before necrosis?

-20 min

87

Most common 3 spots for occlusion of coronary.

#1 = LAD
#2 = Right coronary art
#3 = Left circumflex

88

How long after MI do neutrophils arrive?

24 hrs.

89

Is fibrinous pericarditis seen w/subendocardial infarction?

-no, only w/transmural infarct do you get fibrinous pericarditis.

90

Q waves
-seen w/STEMIs or NSTEMIs?

-seen w/STEMIs (transmural infarcts)

91

Anterior wall (LAD)
-Q waves in which leads?

V1–V4

92

Anteroseptal (LAD)
-Q waves in which leads?

V1–V2

93

Anterolateral (LAD or LCX)
-Q waves in which leads?

V4–V6

94

Lateral wall (LCX)
-Q waves in which leads?

I, aVL

95

InFerior wall (RCA)
-Q waves in which leads?

II, III, aVF

96

What type of pericarditis does Dressler syndrome lead to?

fibrinous

97

Irreversible cell damage changes

-nuclear pyknosis, karyorrhexis, karyolysis
-plasma membrane damage
-lysosomal rupture
-mito permeability/vacuolization

98

Which aortic arch is PDA from?

sixth aortic arch

99

PDA
-Sxs

-palpable thrill over left infraclavicular region due to turbulent flow thru PDA.
-wide pulse pressure (inc. volume in LV = higher systolic, and dec. diastolic cuz some fluid leaving aorta going back into pulm art).
-volume overloads LV, can lead to Sxs of heart failure like failure to thrive & respiratory distress.

100

Which calcium channel blocker is the most cardioselective?

verapamil
-can lead to gingival hyperplasia.

101

mnemonic for dilated cardiomyopathy causes:

ABCCCD
-alcohol
-(wet) beriberi
-cocaine
-coxsackie B
-chagas
-doxorubicin

-also hemochromatosis & pregnancy.

102

Which trinucleotide repeat is associated w/hypertrophic cardiomyopathy?

Friedrich ataxia (GAA)

103

Löffler syndrome

Endomyocardial fibrosis with a prominent eosinophilic infiltrate.
-causes restrictive cardiomyopathy.

104

Restrictive/infiltrative cardiomyopathy
-result in systolic or diastolic dysfunction?

-diastolic.