Cardiac pathology Flashcards
(106 cards)
1
Q
Most probably cause of HTN: paroxysms of increased sympathetic tone -> anxiety, palpitations, diaphoresis
A
Pheochromocytoma
2
Q
Most probably cause of HTN: age of onset between 20 and 50
A
Given no other info, the most common cause is essential HTN (primary HTN)
3
Q
Most probably cause of HTN: elevated serum creatinine and abnormal urinalysis
A
renal disease or CKD
4
Q
Most probably cause of HTN: Abdominal bruit
A
Renal artery stenosis
5
Q
Most probably cause of HTN: blood pressure in arms greater than in the legs
A
Coarctation of the aorta (postductal, adult type)
6
Q
Most probably cause of HTN: family history of HTN
A
More likely to cause primary (essential) HTN
7
Q
Most probably cause of HTN: tachycardia, heat intolerance, diarrhea
A
Hyperthyroidism
8
Q
Most probably cause of HTN: hyperkalemia
A
Renal failure, renal artery stenosis
9
Q
Most probably cause of HTN: episodic sweating and tachycardia
A
Pheochromcytoma
10
Q
Most probably cause of HTN: abrupt onset in a patient younger than 20 or older than 50 and depressed serum K+ levels
A
Hyperaldosteronemia
11
Q
Most probably cause of HTN: central obesity, moon shaped face, hirsutism
A
Cushings syndrome
12
Q
Most probably cause of HTN: normal urinalysis and normal serum K+ levels
A
Primary (essential) HTN
13
Q
Most probably cause of HTN: young individual with acute onset tachycardia
A
Think stimulant abuse: cocaine or other stimulants (meth, amphetamines, etc)
14
Q
Most probably cause of HTN: hypokalemia
A
Hyperaldosteronism
15
Q
Most probably cause of HTN: proteinuria
A
Renal disease
16
Q
Which antihypertensive drug has SE of first dose orthostatic hypotension?
A
Alpha 1 blockers (zosin drugs -> prozosin, terazosin)
17
Q
Which antihypertensive drug has SE of ototoxicity (esp w/ aminoglycosides)?
A
Loop diuretics
18
Q
Which antihypertensive drug has SE of hypertrichosis?
A
Minoxidil
19
Q
Which antihypertensive drug has SE of cyanide toxicity
A
Nitroprusside
20
Q
Which antihypertensive drug has SE of dry mouth, sedation, severe rebound HTN
A
Clonidine (3x per day drug and if you skip a dose you will get severe rebound HTN)
21
Q
Which antihypertensive drug has SE of reflex tachycardia
A
Hydralazine, DHP CCB’s, Nitrates (nitroglycerine, isosorbide dinitrate) -> anything that vasodilates
22
Q
Which antihypertensive drug has SE of bradycardia, impotence, asthma exacerbation
A
Beta blockers
23
Q
Which antihypertensive drug has SE of cough
A
ACE inhibitors (ACE also breaks down bradykinin normally, excess bradykinin with ACE I’s can cause cough)
24
Q
Which antihypertensive drug needs to be avoided in patients with a sulfa allergy?
A
Loops, Thiazides
25
Which antihypertensive drug has SE of angioedema
ACE I's (bradykinin in excess increases vascular permeability) -> swelling from lips to larynx -> life threatening
26
Which antihypertensive drug has SE of drug induced lupus
Hydralazine (SHIPP)
27
Which antihypertensive drug has SE of hypercalcemia and hypokalemia
Thiazides (Loops lose calcium, thiazides dont -> thiazides will cause hypercalcemia). Both thiazides and loops cause hypokalemia
28
Which antihypertensive drug has SE of hyperkalemia
ACE I's and ARBs, potassium sparing diuretics
29
Which antihypertensives are safe to use in pregnancy?
```
A Hy woman took a kNIFE into a METH LAB
Hydralazine
Nifedipine
alpha Methlydopa
Labetalol
```
30
**While on an ACE I a patient develops a cough. What is a good replacement drug and why doesnt it have the same effects
ARB (losartan, valsartan). No cough because it is inhibiting angiotensin at the receptor level. Does not inhibit ACE and therefore there are no increased levels of bradykinin which cause the cough.
31
Which lipid lowering agent matches the following description? SE: flushing
Niacin
32
Which lipid lowering agent matches the following description? SE: elevated LFTs, mysoitis
Statins, Fibrates
33
Which lipid lowering agent matches the following description? SE: GI discomfort, bad taste
Bile acid binding resins (Cholestyramine, Colestipol, colesevelam)
34
Which lipid lowering agent matches the following description? Best effect on HDL
Niacin (Vit B3)
35
Which lipid lowering agent matches the following description? best effect on triglycerides/ VLDL
Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate). Second best is omega 3 fatty acids.
36
Which lipid lowering agent matches the following description? best effects on LDL/ cholesterol
Statins
37
Which lipid lowering agent matches the following description? Binds C. diff toxin
Cholestyramine
38
A 50 year old man starts on lipid lowering medication. Upon his first dose, he develops a rash, pruritis, and diarrhea. What drug is he taking?
Niacin
39
How can the flushing reaction of niacin be prevented?
Aspirin. Decreases with long term place. Take it before bedtime.
40
What is the mechanism of action of the cardiac glycoside?
Inhibit the Na+/K+ ATPase -> decrease sodium gradient for Na+/Ca++ transporter -> increase Ca++ in the cell. Inotropy
41
** An abdominal aortic aneurysm (AAA) is most likely a consequence of what process?
Atherosclerosis. (Thoracic aortic aneurysm and aortic dissection tend to be caused by HTN and cystic medial necrosis of marfans)
42
What are the 5 deadly causes of acute chest pain?
Aortic dissection, MI, unstable angina, PE, Tension pneumothorax
43
A patient with poorly managed HTN has acute, sharp substernal pain that radiates to the back and progresses over a few hours. Death occurs in a few hours. Diagnosis?
Aortic dissection
44
Chest pain with ST segment elevation only during brief episodes of chest pain. What is the most likely cause of the chest pain?
Prinzmetal angina
45
Patient is able to point to localize the chest pain using one finger. What is the most likely cause of the chest pain?
Musculoskeletal
46
Chest wall tenderness on palpation. What is the most likely cause of the chest pain?
Musculoskeletal
47
Rapid onset sharp chest pain that radiates to the scapula. What is the most likely cause of the chest pain?
Aortic dissection
48
Rapid onset sharp chest pain in a 20 year old a/w dyspnea. What is the most likely cause of the chest pain?
Spontaneous pneumothorax (lung collapses). Doesnt progress/ get worse and build up all that tension like in a tension pneumothorax.
49
Occurs after heavy meals and improved by antacids. What is the most likely cause of the chest pain?
GERD.
Can also be esophageal spasm. Feels very much like myocardial pain. Not always associated with meals. Can also be relieved by nitroglycerin b/c relaxes smooth muscle (part of the esophagus). Never use pain relief with nitroglycerin as a diagnostic tool for cardiac pain. Tricky to diagnose.
50
Sharp pain lasting hours-days and is somewhat relieved by sitting forward. What is the most likely cause of the chest pain?
Pericarditis
51
Pain is made worse by deep breathing and/ or motion. What is the most likely cause of the chest pain?
Musculoskeletal
52
Chest pain in a dermatomal distribution. What is the most likely cause of the chest pain?
Shingles (VZV). Can can be a prodrome.
53
Most common cause of noncardiac chest pain.
GERD. But, esophageal spasm and musculoskeletal pain is also very common.
54
Acute onset dyspnea, tachycardia, and confusion in a hospitalized patient. What is the most likely cause of the chest pain?
PE (this is the classic triad for PE in hospitalized patients -> must rule out PE)
55
Pain began the day following an intensive new exercise program. What is the most likely cause of the chest pain?
Musculoskeletal
56
During a high school football game, a young athlete collapses and dies immediately. What type of cardiac disease did he have?
Hypertrophic cardiomyopathy
57
What heart sounds are considered benign when there is no evidence of disease?
Split S1, Split S2 on inspiration, S3 heart sound in a patient younger than 40, early quiet systolic murmur
58
What defect is associated with the following type of murmur? Crescendo decrescendo systolic mumur best heard in the 2nd-3rd right interspace close to the sternum
Aortic stenosis
59
What defect is associated with the following type of murmur? Early diastolic decrescendo murmur heard best along the left side of the sternum
Pulmonic regurgitation
60
What defect is associated with the following type of murmur? Late diastolic decrescendo murmur heard best along the left side of the sternum
Tricuspid stenosis
61
What defect is associated with the following type of murmur? Pansystolic (aka holosystolic or uniform) murmur best heard at the apex and often radiates to the left axilla.
Mitral regurgitation
62
What defect is associated with the following type of murmur? Late systolic murmur usually preceded by a mid systolic click.
Mitral valve prolapse
63
What defect is associated with the following type of murmur? Crescendo-decrescendo systolic murmur best heard in the 2nd and 3rd left interspaces close to the sternum
Pulmonic stenosis
64
What defect is associated with the following type of murmur? Pansystolic (aka holosystolic or uniform) murmur best heard along the left lower sternal border and generally radiates to the right lower sternal border
Tricuspid regurgitation or VSD
65
What defect is associated with the following type of murmur? Rumbling late diastolic murmur with an opening snap
Mitral stenosis
66
What defect is associated with the following type of murmur? Pansystolic (aka holosystolic or uniform) murmur best heard along at the 4th-6th left intercostal spaces
Tricuspid regurgitation or VSD
67
What defect is associated with the following type of murmur? Continuous machine-like murmur (in systole and diastole)
PDA
68
High pitched diastolic murmur a/w a widened pulse pressure
Aortic regurgitation
69
What are the most common causes of aortic stenosis?
Congenital bicuspid valve is very common (usually not clinically apparent until after age 40), senile or degenerative calcification is common (after age 60 typically), congenital unicuspid aortic valve is not common, chronic rheumatic heart disease can also cause aortic stenosis.
70
**Know the classic descriptions of heart murmurs! Murmur heard best in left lateral decubitus position
Mitral regurgitation & Mitral stenosis are both best heard in the Mitral area (by the PMI) but will be heard even better when the patient is placed in the left lateral decubitus position.
Left S3 and S4 sounds will also be heard best in this position.
71
An 80 year old man presents with a systolic crescendo-decrescendo murmur. What is the most likely cause?
Aortic stenosis from senile calcifications of the aortic valve (if this patient was a 50 year old man it would be more likely to be a congenital bicuspid aortic valve)
72
What are the signs of right-sided heart failure? What are the signs of left sided heart failure?
Right -> increase JVP, liver congestion (nutmeg liver) -> hepatosplenomegaly, peripheral edema in the lower extremities
Left- dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, pulmonic congestion (w/ rales)
73
What medications are used to treat chronic heart failure? What medications are used for acute heart failure?
CHF- Digoxin, beta blockers, ace inhibitors/ ARBs, diuretics
```
Acute exacerbation of CHF- stop the beta blocker + LMNOP
Loops
Morphine
Nitrates
O2
Positioning
Pressers
```
74
**An IV drug user presents with chest pain, dyspnea, tachycardia, tachypnea. What is most likely the cause?
Bacterial endocarditis (may have also had heart murmur and fever associated). This could be a right sided endocarditis that sent emboli into the pulmonary arteries -> PE (lead to the pulmonary symptoms and reflex tach)
75
A patient in a MVA presents with chest pain, dyspnea, tachycardia and tachypnea. What is the most likely cause?
Tension pneumothorax
76
A post op patient presents with chest pain, dyspnea, tachycardia and tachypnea. What is the most likely cause?
PE
77
A young girl with congenital valve disease is given penicillin prophylactically. In the ER, bacterial endocarditis is diagnosed. What is the next step in her management?
IV Vancomycin (drug of choice for empiric tx of bacterial endocarditis). When culture comes back, treat based on susceptibility.
78
Under what circumstance might you see pulses paradoxus?
Cardiac tamponade >> pericarditis, asthma, croup, OSA, severe COPD
79
Which heart pathology has diffuse myocardial inflammation with necrosis and mononuclear cells?
Myocarditis
80
Which heart pathology has focal myocardial inflammation with multinucleate giant cells?
Aschoff bodies = pathognomonic for rheumatic heart disease
81
Which heart pathology has fever + IVDA + new heart murmur?
Bacterial endocarditis (now tricuspid is added to mitral and aortic as being a possible valve involved. Staph aureus, Pseudomonas, and Candida are also more likely causes).
82
Which heart pathology has chest pain and course rubbing heart sounds in a pt with Cr of 5.0?
Uremic pericarditis
83
Which heart pathology has tree-barking of the aorta
Syphilitic (tertiary) heart disease
84
Which heart pathology has child with fever, joint pain, cutaneous nodules 4 weeks after a throat infection?
Rheumatic fever
85
Which heart pathology has ST elevations in all EKG leads?
Pericarditis
86
Which heart pathology has disordered growth of myocytes?
Hypertrophic cardiomyopathy
87
Which heart pathology has an EKG that shows electrical alternans?
Cardiac tamponade
88
Which vasculitis? weak pulses in upper extremities
Takayasu's arteritis
89
Which vasculitis? Necrotizing granulomas of the lung and necrotizing glomerulonephritis
Wegener's granulomatosis
90
Which vasculitis? young male smokers
Buerger's disease (thromboangitis obliterans)
91
Which vasculitis? young Asian women
Takayasu's arteritis
92
Which vasculitis? asthmatics
Churg-Strauss syndrome
93
Which vasculitis? infants and young children involving the coronary arteries
Kawaski disease
94
Which vasculitis? most common vasculitis
Temporal (giant cell) arteritis
95
Which vasculitis? a/w hepatitis B infection
Polyarteritis nodosa
96
Which vasculitis? Occlusion of the ophthalmic artery can lead to blindness
Temporal (giant cell) arteritis
97
Which vasculitis? Perforation of the nasal septum
Wegener's granulomatosis
98
Which vasculitis? unilateral headache, jaw claudication
Temporal (giant cell) arteritis
99
Which vasculitis? necrotizing immune complex inflammation of visceral and renal vessels
Henoch-Schonlein purpura
100
Which vascular tumor? Benign raised red lesion about the size of mole in older patients
Cherry hemangioma
101
Which vascular tumor? Raised, red area present at birth, increases in size initially and then regresses over time
Strawberry hemangioma
102
Which vascular tumor? lesioned cause by lymphoangiogenic growth factors in an infected HIV patient
Kaposi's sarcoma
103
Which vascular tumor? Polypoid red lesion found in pregnancy or after trauma
Pyogenic granuloma
104
Which vascular tumor? Benign, painful, red-blue tumor under fingernails
Glomus tumor
105
Which vascular tumor? cavernous lymphangioma a/w Turner's syndrome
Cystic hygroma
106
Which vascular tumor? skin papule in AIDS patients caused by Bartonella henselae
Bacillary angiomatosis
