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Flashcards in 4. Cardio Deck (70):
1

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

How does this affect blood pressure?

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

2

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

- 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

3

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

pheo

4

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

essential HTN

5

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

renal artery stenosis

6

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

coarct

7

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

essential HTN

8

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

hyperthyroidism

9

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

renal insufficiency

10

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

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

11

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

Cushing

12

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

cocaine, amphetamine

13

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

renal disease

14

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

b-blocker

15

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

Minoxidil

16

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

sodium nitroprusside

17

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

any vasodilators

18

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

ACE-i

19

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

hydralazine

- remember SHIPP

20

Which antihypertensive class or drug fits each of the following S/Es?
- possible angioedema

ACE-i and ARBs

21

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

- ACE-i or ARB
- aldosterone antagonist
- b-blockers (carvedilol, metoprolol, bisoprolol)

22

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

- hydralazine
- methyldopa
- labetolol
- nifedipine

Hypertensive Moms Love Nifedipine

23

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

Prinzmetal angina

24

Which lipid-lowering agent matches
SE: facial flushing

niacin

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)