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4. Cardio Flashcards

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1
Q

What substances act on smooth muscle myosin light-chain kinase? (3)

How does this affect blood pressure?

A
  1. Ca2+ channel blockers
  2. Epinephrine B2
  3. Prostaglandin E2

2 and 3 act to increase cAMP, inhibiting myosin light-chain kinase, which will decrease phosphorylation of myosin

  • all the above lead to vasodilation, and decrease in BP
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2
Q

Describe the chain of events in which hypotension (vasodilators) causes reflex tachycardia

A
  • baroreceptors in the carotid sinus sense low BP
  • decrease stretch of carotid sinus
  • decreased stimulation of CN9 (which transmits to solitary nucleus of medulla)
  • decreased inhibition of sympathetic output => more sym
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3
Q

What would you most suspect the cause of HTN to be in a pt with paroxysms of increased sympathetic tone: anxiety, palpitations, diaphoresis

A

pheo

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4
Q

What would you most suspect the cause of HTN to be in a pt age of onset 20-50

A

essential HTN

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5
Q

What would you most suspect the cause of HTN to be in a pt with abdominal bruit

A

renal artery stenosis

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6
Q

What would you most suspect the cause of HTN to be in a pt with BP in arms > legs

A

coarct

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7
Q

What would you most suspect the cause of HTN to be in a pt with family hx of HTN

A

essential HTN

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8
Q

What would you most suspect the cause of HTN to be in a pt with tachycardia, heat intolerance, diarrhea

A

hyperthyroidism

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9
Q

What would you most suspect the cause of HTN to be in a pt with hyperkalemia

A

renal insufficiency

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10
Q

What would you most suspect the cause of HTN to be in a pt with hypokalemia

A

renal artery stenosis

- b/c body’s response to poor renal perfusion is to activate RAAS (=> aldo leads to potassium wasting)

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11
Q

What would you most suspect the cause of HTN to be in a pt with central obesity, moon-shaped face, hirsutism

A

Cushing

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12
Q

What would you most suspect the cause of HTN to be in a young pt with acute onset tachy

A

cocaine, amphetamine

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13
Q

What would you most suspect the cause of HTN to be in a pt with proteinuria?

A

renal disease

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14
Q

What category of BP medication is preferred in the treatment of aortic dissection?

A

b-blocker

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15
Q 
Which antihypertensive class or drug fits each of the following S/Es? 
- hypertrichosis
A

Minoxidil

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16
Q 
Which antihypertensive class or drug fits each of the following S/Es? 
- cyanide toxicity
A

sodium nitroprusside

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17
Q 
Which antihypertensive class or drug fits each of the following S/Es? 
- reflex tachycardia
A

any vasodilators

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18
Q 
Which antihypertensive class or drug fits each of the following S/Es? 
- cough
A

ACE-i

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19
Q 
Which antihypertensive class or drug fits each of the following S/Es? 
- possible development of drug-induced lupus
A

hydralazine

  • remember SHIPP
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20
Q 
Which antihypertensive class or drug fits each of the following S/Es? 
- possible angioedema
A

ACE-i and ARBs

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21
Q

Which antiHTN are particularly beneficial to heart failure pts? (4)

A
  • ACE-i or ARB
  • aldosterone antagonist
  • b-blockers (carvedilol, metoprolol, bisoprolol)
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22
Q

Which antiHTN are safe to use in pregnancy? (4)

A
  • hydralazine
  • methyldopa
  • labetolol
  • nifedipine

Hypertensive Moms Love Nifedipine

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23
Q

What is the most likely cause of chest pain in a pt who has ST segment elevation only during brief episodes of chest pain?

A

Prinzmetal angina

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24
Q

Which lipid-lowering agent matches

SE: facial flushing

A

niacin

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25
Which lipid-lowering agent matches | SE: elevated LFTs, myositis
statins, fibrates
26
Which lipid-lowering agent matches | SE: GI discomfort, bad taste
bile acid resins
27
Which lipid-lowering agent matches | - best effect on HDL
niacin
28
Which lipid-lowering agent matches | - best effect on trig/VLDL
fibrates
29
Which lipid-lowering agent matches | - best effect on LDL/cholesterol
statin (HMG-CoA reductase inhibitors)
30
Which lipid-lowering agent matches | - binds C. diff toxin
Cholestyramine (bile acid resin) | - can use in C. diff pt
31
A 50 yo man is started on lipid-lowering medication. Upon his first dose, he develops a rash, pruritus, and diarrhea. What drug is he taking?
niacin
32
How can the flushing rxn of niacin be prevented?
- take aspirin or NSAID 30 min before niacin
33
What is the most common lethal complication after an MI?
arrhythmia
34
What would cause each of the following findings after an MI? - cardiac tamponade
free wall rupture
35
What would cause each of the following findings after an MI? | - severe mitral regurg
papillary muscle rupture
36
What would cause each of the following findings after an MI? | - new VSD
rupture of intraventricular septum
37
What would cause each of the following findings after an MI? | - stroke
pseudoaneurysm --> mural thrombus --> embolus
38
Which ECG leads will show evidence of ischemia in an anterior wall MI?
V1-V4, maybe V5 this is LAD
39
What is the differences b/w acute and subacute infective endocarditis?
Acute: S. aureus - rapid onset (days) - normal valves Subacute: Viridans - insidious onset (wks to months) - affects prev damaged/congenitally abnormal valves
40
An IVDU presents with chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely cause?
Endocarditis --> bacterial embolism --> septic pulmonary emboli
41
A young girl with congenital valve disease is given penicillin ppx. In the ER, infective endocarditis is diagnosed. What is the next step in her management?
Empiric IV vanc pending culture results
42
Under what circumstances might you see pulsus paradoxus? (5)
- cardiac tamponade - asthma - croup - obstructive sleep apnea - COPD
43
What are the Jones criteria for the dx of acute rheumatic fever?
- Joints (migratory polyarthritis) - carditis (pancarditis) - Nodules (subQ) - Erythema marginatum - Sydenham chorea
44
What heart pathology cause focal myocardial inflammation with multinucleate giant cells?
Aschoff bodies
45
What heart pathology cause chest pain and course rubbing heart sounds in a pt with Cr of 5.0
Uremic pericarditis
46
What heart pathology cause tree-barking of the aorta?
Tertiary syphilis
47
What heart pathology cause child with fever, joint pain, cutaneous nodules 4 wks after a throat infection?
Acute rheumatic fever
48
What heart pathology cause ST elevation in all ECG leads
pericarditis
49
What heart pathology cause ECG showing electrical alternans
cardiac tamponade
50
Which type of vasculitis fits description - weak pulses in upper extremities
Takayasu arteritis
51
Which type of vasculitis fits description - granulomas of lung, glomerulonephritis, c-ANCA positive
GPA (granulomatosis with polyangiitis)
52
Which type of vasculitis fits description - necrotizing immune complex inflammation of visceral/renal vessels
PAN (polyarteritis nodosa) - spares the lungs, ANCA (-)
53
Which type of vasculitis fits description - 2 yo East Asian female
Kawasaki
54
Which type of vasculitis fits description - 20 yo East Asian female
Takayasu
55
Which type of vasculitis fits description - young male smokers
Thromboangiitis obliterans (Buerger disease)
56
Which type of vasculitis fits description - young asthmatics
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
57
Which type of vasculitis fits description - infants and young children; involves the coronary arteries
Kawasaki
58
Which type of vasculitis fits description - most common vasculitis
Giant cell (temporal) arteritis
59
Which type of vasculitis fits description - associated with hep B infection
PAN
60
Which type of vasculitis fits description - occlusion of ophthalmic artery can lead to blindness
Giant cell
61
Which type of vasculitis fits description - perforation of nasal septum
GPA (Wegener's)
62
Which type of vasculitis fits description - unilateral headache, jaw claudication
Giant cell
63
Which disorders are commonly discovered in pts with Raynaud phenomenon? (4)
- lupus - CREST scleroderma - Buerger disease - Mixed connective tissue disease
64
Which vascular tumor fits the following description? - benign, raised, red lesion about the size of a mole in older pts
cherry hemangioma
65
Which vascular tumor fits the following description? - raised, red area present at birth; increases in size initially then regresses over months to years
strawberry hemangioma
66
Which vascular tumor fits the following description? - lesion caused by lymphoangiogenic growth factors in an HIV pt
Kaposi Sarcoma
67
Which vascular tumor fits the following description? - polypoid red lesion found in pregnancy or after trauma
pyogenic granuloma
68
Which vascular tumor fits the following description? - benign, painful, red-blue tumor under fingernails
glomus tumor
69
Which vascular tumor fits the following description? - cavernous lymphangioma associated with Turner syndrome
cystic hygroma
70
Which vascular tumor fits the following description? - skin papule in AIDS pt caused by Bartonella spp.
Bacillary angiomatosis | remember, it causes cat scratch disease

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