Cardio

Question 1

Cushing’s Reflex

Answer 1

Respiratory depression, HTN, and bradycardia due to increased ICP Increased ICP = medullary compression = respiratory depression - cerebral arteriole constriction - increase sympathetic outflow to improve cerebral perfusion = HTN - increased baroreceptor outflow = bradycardia

Question 2

Congenital heart defect associated with Fetal Alcohol Syndrome

Answer 2

VSD

Question 3

Congenital heart defect associated with Down Syndrome

Answer 3

Endocardial cushion defects (ASD ostium primum type, VSD)

Question 4

Congenital heart defect associated with Turner Syndrome

Answer 4

Coarctation of the aorta, bicuspid aortic valve

Question 5

Congenital heart defect associated with maternal pre gestational DM

Answer 5

Transposition of the great vessels

Question 6

Congenital heart defect associated with lower extremity cyanosis (differential cyanosis)

Answer 6

Coarctation of the aorta (infantile type - distal to PDA), PDA (late - following development of Eisenmenger Syndrome)

Question 7

Evolution of MI (process, complication)
X 1 day X 1 wk X 1 mo X

Answer 7

Coagulative necrosis. Arrythmia, cardiogenic shock
-1 day-

Inflammation (PMN, M0). Papillary muscle rupture (esp RCA to posterior m), ventricular wall rupture

-1 wk-

Granulation tissue. Papillary muscle rupture (esp RCA to posterior m), ventricular wall rupture

-1 mo-

Fibsosis. Dressler syndrome, CHF.

Question 8

Treatment for Acute MI

Answer 8

ABCs

MONA (morphine, O2, nitroglycerin, aspirin)

Anticoagulation (clopidogrel + heparin)

Beta blocker

Statin

Question 9

Dilated Cardiomyopathy Causes

(ABCCCD)

Answer 9

Alcohol, wet beriberi (thiamine deficiency, vitB1), Coxsackie B, cocaine, Chagas disease, Daunorubicin/doxorubicin toxicity

Question 10

Restrictive Cardiomyopathy Causes

(LEASH restricts your dog)

Answer 10

Loffler syndrome (eosinophilic myocardial fibrosis), Endocardial fibroelastosis (fibroelastic endocardium in African children), amyloidosis, sarcoidosis, hemachromatosis

Question 11

What medications improve survival in chronic CHF?

Answer 11

ACEI/ARBs

Alsoderone antagonist (spironolactone, eplerenone)

B blockers (Metoprolol, carvediolo)

In AAs with moderate-severe symptoms - Nitrates + hydralazine

Question 12

How do you treat acute CHF exacerbation?

(NO LIP)

Answer 12

Nitrates (nitroglycerin)

O2 - only if hypoxic

Loop diuretics

Inotropes (Dobutamine)

Positioning

Question 13

Pathogens in bacterial endocarditis

Acute, subacute, culture negative, IV drugs

Answer 13

Acute - Staph aureus

Subacute - Viridans Strep

Culture negative - Coxiella burnetti (Q fever), Bartonella (Cat scratch fever)

IV drugs - Staph aureus, Pseudomonas, Candida

Question 14

Causes of acute pericarditis:

Fibrinous, serous, hemorrhagic

Answer 14

Fibrinous - Dressler Syndrome, uremia, radiation

Serous - viral, inflammatory disease (SLE, RA)

Hemorrhagic - TB, melanoma

Question 15

Kussmaul sign vs pulsus peridoxus

Answer 15

Kussmal sign - JVD with inspiration = RV insufficiency. Pericarditis

Pulsus peridoxus - BP drop > 10 mmHg with inspiration - LV insufficiency. Cardiac tamponade

Question 16

HTN Treatment

Primary, + CHF, + BPH

Answer 16

Primary - HCTZ, ACEI/ARB

+ CHF - add BB, aldosterone antagonist

+ BPH - use a blocker instead of HCTZ

Question 17

What CCB is used for subarachnoid hemorrhage?

Answer 17

Nimodipine (prevents ischemia-induced vasodilation of ruptured cerebral arteries)

Question 18

What HTN drugs are safe in pregnancy?

(Hypertensive Moms Love Nifedipine)

Answer 18

Hydralazine

Methyldopa

Labetalol

Nifedipine

Question 19

What medication class is used for aortic dissection?

Answer 19

B blockers (decreases slope of BP rise)

Question 20

What is Fenoldopam and when is it used?

Answer 20

D1R agonist = vasodilation

Used in HTN emergency, maintains renal perfusion (renal a dilation) to promote natriuresis

Question 21

How does Nitroglycerin improve symptoms of angina?

Answer 21

CANT directly vasodilate coronary arteries becuase theyre already maximally dilated.

Causes systemic venodilation - decreased preload - decreased myocardial O2 demand

Question 22

What is a side effect specific to Nitroprusside? How would you treat it?

Answer 22

CN toxicity

Thiosulfate + vitamin B12 (sequesters CN)

Nitrate (causes metHb that CN cannot bind) + Methylene Blue (rescues the metHb)

Question 23

What are the classes of antiarrhythmics?

(No BadBoy Keeps Clean)

Question 24

What drugs are Class 1A, 1B, and 1C antiarrhytmics?

Answer 24

Class 1A (Double Quarter Pounder) - Disopyramide, Qunidine, Procainamide

Class 1B (Mayo, Lettuce, Tomato) - Mexiletine, Lidocaine, Tocainide

Class 1C (Fries, Please) - Flecanide, Propafenone

Question 25

What is the clinical use for Procainamide? What side effect is specific to it?

Question 26

What is Cinchonism? What drugs cause it?

Answer 26

Headache, dizziness, tinnitus Quinidine (class 1A antiarrhythmic), Quinine (antimalarial)

Question 27

What is the clinical use of Lidocaine? Why?

Answer 27

Tachyarrhytmias after an MI. It preferentially blocks Na channels in ischemic myocardial tissue.

Question 28

How do you treat B blocker overdose?

Answer 28

Glucagon

Question 29

What is the clinical use for Amiodarone? What are the side effects?

Answer 29

WPW Check PFTs, LFTs, TFTs (pulmonary fibrosis, hepatotoxicity, dysthroid because high I content), photosensitivity Less specific - neurological, constipation

Question 30

How does Adenosine work? When is it used clinically? What drug can block it's effect?

Answer 30

MOA: Increases K effluc, hyperpolarizing cardiomyocytes Used to restart the heart in SVT at a slower rate Blocked by Theophylline (COPD PDE inhibitor that causes bronchodilation)

Question 31

What two ions can most strongly trigger dangerous arrhythmias if not optimized?

Answer 31

K and Mg

Question 32

What drugs can be used to lower LDL?

Answer 32

Statins Less effective - bile acid resins, ezetimibe (inhibits cholesterol uptake at the brush boarder)

Question 33

What are the side effects of statins?

Answer 33

Hepatotoxicity, rhabdomyolysis (esecially + fibrates or niacin)

Question 34

What lipid lowering agent can be given to bind C diff toxin?

Question 35

What drug can be used to increase HDL? What are the side effects?

Answer 35

Niacin Facial flushing, rhabdomyolysis if used with statins

Question 36

What drug can be used to decrease TGs? What are the side effects?

Answer 36

Fibrates Myositis (increased with concurrent statins), hepatotoxicity, cholesterol gallstones

Question 37

Which lipid lowering drugs increase the risk of cholesterol gallstones?

Answer 37

Bile acid resins and fibrates

Question 38

What are the side effects of Digoxin? What puts you at higher risk for toxicity? What is the antidote?

Answer 38

Bradycardia/AV block, blurry yellow vision, hyperkalemia Higher risk of OD with renal failure, hypoK (increased Na/K ATPase binding) Antidote = anti-digoxin Fab fragments

Question 39

What is Sturge-Weber Syndrome?

Answer 39

Non-inherited mutation in GNAQ gene resulting in anomolies of neural crest derivatives (specifically, blood vessels) Port-wine stain in CV V1 dermatome (non-neoplastic capillary overgrowth), leptomeningeal angioma (seizures, intellectual disability), and episcleral hemangioma (increases intra-ocular P = glaucoma)

Question 40

What is Romano-Ward syndrome?

Question 41

What is Jervell and Lange-Nielsen Syndrome?

Answer 41

Congenital long QT + sensorineural deafness

Question 42

Pt with AF and CHF with bradycardia and hyperK - what is the cause?

Answer 42

Digoxin toxicity

Question 43

What is the treatment for TdP?

Answer 43

IV Mg