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Flashcards in Cardiology_2 Deck (351):
1

Truncus arteriosus gives rise to what?

ascending aorta and pulmonary trunk

2

which congenital cardiac defect is associated with 22q11 syndromes?

truncus arteriosus • ToF

3

which congenital cardiac defects are associated with Down syndrome?

ASD • VSD • AV septal defect (endocardial cushion defect)

4

which congenital cardiac defects are associated with congential rubella?

septal defects • PDA • PA stenosis

5

which congenital cardiac defects are associated with turner syndrome?

coarctation of the aorta (preductal)

6

which congenital cardiac defects are assciated with Mafan's syndrome?

aortic insufficiency and dissection (late complication)

7

which congenital cardiac defects are associated with infants of diabetic mothers?

transposition of great vessels

8

hypertension is defined as what?

BP >= 140/90

9

what are the risk factors for hypertension?

↑ age • obesity • smoking • genetics • black>white>asian

10

90% of hypertension is what?

1° (essential) and related to ↑ CO and ↑ TPR

11

10 % of hypertension is what?

mostly 2° to renal disease

12

features of malignant hypertension?

severe • >180/120 • rapidly progressing

13

hypertension predisposes to what?

athersclerosis • LVH • stroke • CHF • renal failure • retinopathy • aortic dissection

14

what are the signs of hyperlipidemia?

atheromas • xanthomas • tendinous xanthoma • corneal arcus

15

what are atheromas?

plaques in blood vessel wall

16

what are xanthomas?

plaques or nodules composed of lipid-laden histiocytes in the skin, especially the eyelids

17

what do you call a xanthoma of the eyelid?

xanthelasma

18

what is a tendinous xanthoma?

lipid depost in the tendon, especially the achilles

19

what is corneal arcus?

lipid deposit in cornea, nonspecific (arcus senilis)

20

what are the 3 classes of arteriosclerosis?

Monckberg • arteriosclerosis • atherosclerosis

21

what is Monckberg arteriosclerosis?

calcification in the media of the arteries, especially radial or ulnar

22

severity of monckberg arteriosclerosis?

usually benign • does not obstruct blood flow • intima not involved

23

typical presentation of monckberg arteriosclerosis?

pipestem arteries

24

what are the two subtypes of arteriosclerosis?

hyaline • hyperplastic

25

what is hyaline arteriosclerosis?

thickening of small arteries in essential hypertension or DM

26

what is hyperplastic arteriosclerosis?

onion skinning in malignant hypertension

27

what is atherosclerosis?

fibrous plaques and atheromas form in intima of arteries

28

what type of disease is atherosclerosis?

disease of elastic arteries and large and medium sized muscular arteries

29

what are the modifiable risk factors for atherosclerosis?

smoking • hypertension • hyperlipidemia • diabetes

30

what are the non-modifiable risk factors for atherosclerosis?

age, gender (↑ in men and postmenopausal women), and positive family history

31

what is important in the pathogenesis of atherosclerosis?

inflammation

32

what is the progression of atherosclerosis?

endothelial cell dysfunction → macrophage and LDL accumulation → foam cell formation → fatty streaks → smooth muscle cell migration (involves PDGF and FGF), proliferation and ECM deposition → fibrous plaque → complex atheromas

33

important histological finding in atherosclerosis?

cholesterol crystals

34

what are the complications of atherosclerosis?

aneurysms • ischemia • infarcts • peripheral vascular disease • thrombus • emboli

35

what is the relative frequency of location of atherosclerosis?

abdominal aorta > coronary artery > popliteal artery > carotid artery

36

what are the symptoms of atherosclerosis?

angina • claudication • but can be asymptomatic

37

what is an aortic aneurysm?

localized pathologic dilation of the aorta

38

what are the 2 types of aortic aneurysm?

AAA • TAA

39

AAA is associated with what?

atherosclerosis

40

AAA occurs more frequently in who?

hypertensive male smokers> 50yo

41

TAA is associated with what?

hypertension, cystic medial necrosis (Marfan's) and historically 3° syphilis

42

what happens in aortic dissection?

longitudinal intraluminal tear forming a false lumen

43

aortic dissection associated with what?

hypertension • bicuspid aortic valve • cystic medial necrosis • inherited connective tissue disorders (Marfans)

44

aortic dissection presents how?

tearing chest pain radiating to the back

45

in aortic dissection, CXR shows what?

mediastinal widening

46

possibilities for the false lumen in aortic dissection?

can be limited to the ascending aorta, propagate from the ascending aorta, or propagate from the descending aorta

47

aortic dissection can result in what?

pericardial tamponade • aortic rupture • death

48

what are the ischemic heart disease manifestations?

angina • coronary steal syndrome • myocardial infarction • sudden cardiac death • chronic ischemic heart disease

49

pathology involved in angina?

CAD narrowing >75% • no myocyte necrosis

50

stable angina is mostly 2° to what?

atherosclerosis

51

presentation of stable angina?

ST depression on ECG • retrosternal chest pain with exertion

52

Prinzmental angina occurs when?

at rest 2° to coronary artery spasm

53

ECG finding in prinzmental angina?

ST elevation

54

pathology involved in unstable angina?

thrombosis with incomplete coronary artery occlusion

55

presentation of unstable/crescendo angina?

ST depression on ECG • worsening chest pain at rest or with minimal exertion

56

what happens in coronary steal syndrome?

vasodilator may aggravate ischemia by shunting blood from area of critical stenosis to an area of higher perfusion

57

myocardial is most often due to what?

acute thrombosis due to coronary artery atherosclerosis with complete occlusion of coronary artery with myocyte necrosis

58

ECG findings in MI?

ECG initially shows ST depression progressing to ST elevation with continued ischemia and transmural necrosis

59

what is sudden cardiac death?

death from cardiac causes within 1 hour of onset of symptoms, most commonly due to a lethal arrhythmia (V-fib)

60

sudden cardiac death is associated with what?

CAD up to 70% of cases

61

what is chronic ischemic heart disease?

progressive onset of CHF over many years due to chronic ischemic myocardial damage

62

relative frequency of coronary artery occlusion in MI?

LAD >RCA > circumflex

63

what are the symptoms of MI?

diaphoresis • nausea • vomiting • severe retrosternal pain • pain in left arm and or jaw • shortness of breath • fatigue

64

what are the gross findings within 0-4h of MI?

none

65

what are the LM findings within 0-4h of MI?

none

66

what are the risks within 0-4h of MI?

arrhythmia • CHF • exacerbation • cardiogenic shock

67

what are the gross findings within 4-24h of MI?

infarct and dark mottling; pale with tetrazolium stain distal to occluded artery

68

what are the LM findings within 4-12h of MI?

early coagulative necrosis • edema • hemorrhage • wavy fibers

69

what is the risk within 4-12h of MI?

arrhythmia

70

what are the LM findings within 12-24h of MI?

contraction bands from reperfusion injury • release of necrotic cell content into blood • beginning of neutrophil migration

71

what is the risk within 12-24h of MI?

arrhythmia

72

what are the gross findings within 1-3 days of MI?

hyperemia

73

what are the LM findings within 1-3days of MI?

extensive coagulative necrosis • tissue surrounding infarct shows acute inflammation • neutrophil migration

74

what is the risk within 1-3 days of MI?

fibrinous pericarditis

75

what are the gross findings within 3-14days of MI?

hyperemic border; • central yellow-brown softening • maximally yellow and soft by 10 days

76

LM findings within 3-14days of MI?

macrophage infiltration followed by granulation tissue at the margins

77

what is the risk within 3-14 days of MI?

free wall rupture leading to tamponade, papillary muscle rupture, ventricular aneurysm, interventricular septal rupture due to macrophages that have degraded important structural components

78

what are the gross findings 2weeks-months post MI?

recanalized artery • gray white

79

LM findings 2 weeks-months post MI?

contracted scar complete

80

risk 2weeks-months post MI?

dressler's syndrome

81

what is the gold standard for dx of MI in first 6h?

ECG

82

use of cardiac troponin I in diagnosis of MI?

rises after 4 hours and is elevated for 7-10 days; more specific than other protein markers

83

use of CK-MB in diagnosis of MI?

useful in diagnosing reinfarction following acute MI because levels return to normal after 48 hours

84

CK-MB predominantly found where?

in myocardium but can also be released from skeletal muscle

85

ECG changes in MI?

ST elevation (transmural infarct) • ST depression (subendocardial infarct) • Q waves (transmural infarct)

86

necrosis in transmural infarct?

↑ necrosis

87

subendocardial infarcts due to what?

ischemic necrosis of < 50% of ventricle wall

88

transmural infarct affects how much of cardiac structure?

affects entire wall

89

subendocardial infarct affect what structure?

subendocardium especially vulnerable to ischemia

90

ECG in transmural infarcts?

ST elevation • Q waves

91

ECG in subendocardial infarct?

ST depression

92

Q waves in V1-V4, where is the infarct?

Anterior wall (LAD)

93

Q waves in V1-V2, where is the infarct?

Ateroseptal (LAD)

94

Q waves in V4-V6, where is the infarct?

anterolateral (LCX)

95

Q waves in I, aVL, where is the infarct?

lateral wall (LCX)

96

Q waves in II, III, aVF, where is the infarct?

inferior wall (RCA)

97

in MI, what is an important cause of death before reaching hospital?

cardiac arrhythmia

98

cardiac arrhythmia in MI is common when?

in first few days

99

what are the complications of MI?

cardiac arrhythmia • LV failure and pulmonary edema • Cardiogenic shock • Ventricular free wall rupture • papillary muscle rupture • IVS rupture • ventricular aneurysm formation • postinfarction fibrinous pericarditis

100

what is Dressler's syndrome?

autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)

101

factors associated with cardiogenic shock in MI?

large infarct- high risk of mortality

102

in MI ventricular free wall rupture →?

cardiac tamponade

103

in MI, papillary muscle rupture→?

severe mitral regurgitation

104

in MI, IVS rupture→?

VSD

105

factors associated with ventricular aneurysm formation in MI?

↓ CO • risk of arrhythmia • embolus from mural thrombus

106

when is the greatest risk for ventricular aneurysm formation in MI?

1 week post MI

107

what is the most common cardiomyopathy?

dilated (congestive) cardiomyopathy 90%

108

dilated cardiomyopathy is usually what origin?

often idiopathic, up to 50% familial

109

specific etologies of dilated cardiomyopathy include what?

ABCCCD • Alcohol abuse • wet Beriberi • Coxsackie b virus myocarditis • chronic Cocaine use • Chaga's disease • Doxorubicin toxicity • hemochromatosis • peripartum cardiomyopathy

110

what are the findings in dilated cardiomyopathy?

S3 • dilated heart on U/S • balloon appearance on chest X ray

111

what is the treatment for dilated cardiomyopathy?

Na+ restriction • ACE inhibitors • diuretics • digoxin • heart transplant

112

what happens in hypertrophic cardiomyopathy?

hypertrophied interventricular septum is too close to mitral valve leaflet, leading to outflow tract obstruction

113

60-70% of hypertrophic cardiomyopathy are of what origin?

familial • AD • βmyosin heavy chain mutation

114

hypertrophic cardiomyopathy is associated with what?

Friedreich's ataxia

115

morphologic findings in hypertrophic cardiomyopathy?

disoriented, tangled, hypertrophied myocardial fibers

116

what is a cause of sudden death in young athletes?

hypertrophic cardiomyopathy

117

what are the findings in hypertrophic cardiomyopathy?

normal sized heart • S4 • apical impulses • systolic murmur

118

what is the treatment for hypertrophic cardiomyopathy?

β blocker or non-dihydropyridine calcium channel blocker (verapamil)

119

what ensues in hypertrophic cardiomyopathy?

diastolic dysfunction

120

gross appearance in hypertrophic cardiomyopathy?

asymmetric concentric hypertrophy (sarcomeres added in parallel)

121

pathogenesis of hypertrophic cardiomyopathy?

proximity of hypertrophied interventricular septum to mitral leaflet obstructs outflow tract, resulting in systolic murmur and syncopal episodes

122

major causes of restrictive/obliterative cardiomyopathy include what?

sarcoidosis • amyloidosis • postradiation fibrosis • endocardial fibroelastosis • Lofflers syndrome • hemochromatosis

123

what is endocardial fibroelastosis?

thick fibroelastic tissue in endocardium of young children

124

what is Loffler's syndrome?

endomyocardial fibrosis with a prominent eosinophilic infiltrate

125

what ensues in restrictive/obliterative cardiomyopathy?

diastolic dysfunction

126

what is CHF?

a clinical syndrome that occurs in patients with an inherited or acquired abnormality of cardiac structure or function, which is characterized by a constellation of clinical symptoms (dyspnea, fatigue) and signs (edema, rales)

127

in CHF RHF most often results from what?

LHF

128

isolated RHF is usually due to what?

cor pulmonale

129

which drugs reduce mortality in CHF?

ACE inhibitors • β blockers • ARBs • spironolactone

130

when do you not give β blockers in CHF?

acute decompensated HF

131

which drugs are used for symptomatic relief in CHF?

thiazides • loop diuretics

132

which drugs improve symptoms and mortality in select patients with CHF?

hydralazine with nitrate therapy

133

what are the abnormalities seen in CHF?

cardiac dilation • dyspnea on exertion • LHF • RHF

134

what is the cause of cardiac dilation in CHF?

greater ventricular EDV

135

what is the cause of DOE in CHF?

failure of cardiac output to ↑ during exercise

136

what are the manifestations of LHF in CHF?

pulmonary edema/PND • orthopnea

137

what is the cause of pulmonary edema/PND in CHF?

↑ pulmonary venous pressure→ pulmonary venous distentions and transudation of fluid

138

histological finding in LHF in CHF?

presence of hemosiderin laden macrophages (heart failure cells) in the lungs

139

what is the cause of orthopnea in CHF?

↑ venous return in supine position exacerbates pulmonary vascular congestion

140

what are the manifestations of RHF in CHF?

hepatomegaly (nutmeg liver) • peripheral edema • jugular venous distention

141

what is the cause of hepatomegaly (nutmeg liver) in CHF?

↑ central venous pressure → ↑ resistance to portal flow

142

rarely, hepatomegaly in RHF leads to what?

cardiac cirrhosis

143

what is the cause of peripheral edema in CHF?

↑ venous pressure → fluid transudation

144

what is the cause of jugular venous distention in CHF?

↑ venous pressure

145

what are the symptoms of bacterial endocarditis?

Bacteria FROM JANE: • Fever • Roth spots • Osler nodes • Murmur • Janeway lesions • Anemia • Nail-bed hemorrhage • Emboli

146

what is the most common symptom of bacterial endocarditis?

fever

147

what are roth spots?

round white spots on retina surrounded by hemorrhage

148

what are osler's nodes?

tender raised lesions on finger or toe pads

149

what are janeway lesions?

small, painless, erythematous lesions on palm or sole

150

what is necessary for diagnosis of bacterial endocarditis?

multiple blood cultures

151

organism that causes acute bacterial endocarditis?

S aureus

152

virulence of organism that causes acute bacterial endocarditis?

S aureus (high virulence)

153

presentation in acute bacterial endocarditis caused by S aureus?

large vegetations on previously normal valves

154

what is the onset of acute bacterial endocarditis caused by S aureus?

rapid onset

155

organism that causes subacute bacterial endocarditis?

viridans streptococcus

156

virulence of the organism that causes subacute bacterial endocarditis?

low virulence

157

presentation in subacute bacterial endocarditis?

smaller vegetations on congenitally abnormal or diseased valves

158

subacute bacterial endocarditis can be sequelae of what?

dental procedures

159

what is the onset of subacute bacterial endocarditis?

more insidious onset

160

endocarditis may be nonbacterial secondary to what?

malignancy • hypercoagulable state • lupus (marantic/ thrombotic endocarditis)

161

S bovis is present in which cause of endocarditis?

colon cancer

162

S epidermidis is present in which cause of endocarditis?

prosthetic valves

163

which valve is most frequently involved in bacterial endocarditis?

mitral

164

tricuspid valve endocarditis is associated with what?

IV drug use (dont TRI DRUGS)

165

tricuspid endocarditis is associated with which organisms?

S aureus • Pseudomonas • Candida

166

what are the complications of bacterial endocarditis?

chordae rupture • glomerulonephritis • suppurative pericarditis • emboli

167

rheumatic fever is a consequence of what?

pharyngeal infection with group A β hemolytic streptococci

168

early deaths in rheumatic fever due to what?

myocarditis

169

late sequelae of rheumatic fever include what?

rheumatic heart disease

170

relative frequency of valves affected by rheumatic heart disease?

mitral > aortic >> tricuspid (high pressure vavles affected most)

171

early lesion in rheumatic fever is what?

MR

172

what is the late lesion in rheumatic fever?

MS

173

Rheumatic fever is associated with what?

Aschoff bodies • Anitschkow's cells • elevated ASO titers

174

what are Aschoff bodies?

granuloma with giant cells

175

what are anitschkow's cells?

activated histiocytes

176

immunology of rheumatic fever?

Type II HSR; not a direct effect of bacteria • Ab to M protein

177

symptoms of Rheumatic fever?

FEVERSS: • Fever • Erythema marginatum • Valvular damage • ESR ↑ • Red hot joints (migratory polyarthritis) • Subcutaneous nodules • St. Vitus' dance (Sydenham's chorea)

178

acute pericarditis commonly presents with what?

sharp pain, aggravated by inspiration, and relieved by sitting up and leaning forward • friction rub

179

ECG findings in acute pericarditis?

widespread ST-segment elevation and/or PR depression

180

acute fibrinous pericarditis is caused by what?

Dressler's syndrome, • uremia • radiation

181

fibrinous pericarditis presents with what?

loud friction rub

182

what are the causes of serous pericarditis?

viral • noninfectious inflammatory diseases

183

course of viral serous pericarditis?

often resolves spontaneously

184

non infectious inflammatory diseases that cause acute serous pericarditis?

RA • SLE

185

what causes suppurative/purulent pericarditis?

bacterial infections with pneumococcus or streptococcus

186

frequency of purulent pericarditis?

rare with antibiotics

187

what happens in cardiac tamponade?

compression of heart by fluid (blood effusions) in pericardium leading to ↓ CO

188

what happens to pressures in cardiac tamponade?

equilibration of pressures in all 4 chambers

189

what are the findings in cardiac tamponade?

hypotension • ↑ venous pressure (JVD) • distant heart sounds • ↑ HR • pulsus paradoxus

190

what is pulsus paradoxus?

↓ in amplitude of systolic blood pressure by >=10mHg during inspiration

191

pulsus paradoxus seen in what?

severe cardiac tamponade • asthma • OSA • pericarditis • croup

192

what happens in syphilitic heart disease?

3° syphilis disrupts the vasa vasorum of the aorta with consequent atrophy of the vessel wall and valve ring

193

in syphilitic heart disease you may see what?

calcification of the aortic root and ascending aortic arch

194

syphilitic heart disease leads to what appearance?

tree bark appearance of the aorta

195

syphilitic heart disease can result in what?

aneurysm of the ascending aorta or aortic arch and aortic insufficiency

196

what are the most common primary cardiac tumors in adults?

myxomas

197

90% of cardiac myxomas occur where?

in the atria (mostly left atrium)

198

myxomas are usually described as what?

ball valve obstruction in LA associated with multiple syncopal episodes

199

what is the most frequent primary cardiac tumor in children?

rhabdomyomas

200

cardiac rhabdomyomas are associated with what?

tuberous sclerosis

201

most common heart tumor is what?

mets from melanoma or lymphoma

202

what is Kussmaul's sign?

↑ in JVP on inspiration instead of normal ↓

203

what happens in Kussmaul's sign?

inspiration → negative intrathoracic pressure not transmitted to the heart→ impaired filling of RV → blood backs up into the venae cavae→ JVD

204

Kussmaul's sign may be seen in what?

constrictive pericarditis • restrictive cardiomyopathies • RA or RV tumors • cardiac tamponade

205

Raynaud's phenomenon affects what type of vessels?

small vessels

206

what happens in Raynaud's phenomenon?

↓ blood flow to the skin due to arteriolar vasospasm in response to cold temperature or emotional stress

207

Raynauds phenomenon is most often seen where?

fingers • toes

208

when is it called Raynaud's disease?

when primary (idiopathic)

209

when is it called Raynaud's syndrome?

when secondary to a disease process such as mixed connective tissue disease, SLE, or CREST

210

temporal arteritis generally affects who?

elderly females

211

symptoms in temporal arteritis?

unilateral headache (temporal artery) • jaw claudication

212

temporal arteritis may lead to what?

irreversible blindness die to ophthalmic artery occlusion

213

temporal arteritis is associated with what?

polymyalgia rheumatica

214

temporal arteritis most commonly affects which vessels?

branches of carotid artery

215

pathology/labs seen in temporal arteritis?

focal granulomatous inflammation • ↑ ESR

216

what is the treatment for temporal arteritis?

high dose corticosteroids

217

Takayasu arteritis typically affects who?

asian females <40yo

218

symptoms of takayasu arteritis?

pulselessness disease: • fever • night sweats • arthritis • myalgias • skin nodules • ocular disturbances

219

pathology/labs seen in takayasu arteritis?

granulomatous thickening of aortic arch, proximal great vessels • ↑ ESR

220

what is the treatment for takayasu arteritis?

corticosteroids

221

what are the large artery vasculitis disorders?

temporal arteritis and takayasu arteritis

222

what are the medium vessel vasculitis disorders?

polyarteritis nodosa • kawasaki disease • Buerger's disease (thromboangitis obliterans)

223

polyarteritis nodosa affects who?

young adults

224

viral association with polyarteritis nodosa?

HBV seropositivity in 30% of patients

225

symptoms of polyarteritis nodosa?

fever • weight loss • malaise • headache • abdominal pain • melena • HTN • neuro dysfunction • cutaneous eruptions • renal damage

226

polyarteritis nodosa typically involves which vessels?

renal and visceral vessels, not pulmonary arteries

227

immunology of polyarteritis nodosa?

IC mediated

228

pathology/labs seen in polyarteritis nodosa?

transmural inflammation of the arterial wall with fibrinoid necrosis • lesions are of different stages • many aneurysms and constrictions on arteriogram

229

treatment for polyarteritis nodosa?

corticosteroids • cyclophosphamide

230

kawasaki disease affects who?

asian children < 4yo

231

symptoms associated with kawasaki disease?

fever cervical lymphadenitis • conjunctival injection • changes in lips/oral mucosa (strawberry tongue) • hand-foot erythema • desquamating rash

232

children with kawasaki disease may develop which complications?

coronary aneurysms → MI, rupture

233

treatment for kawasaki disease?

IV immunoglobulin and aspirin

234

Buerger's disease affects who?

heavy smokers, males <40yo

235

symptoms in Buerger's disease?

intermittent claudication may lead to gangrene, autoamputation of digits, superficial nodular phlebitis • raynauds phenomenon

236

what is the pathology seen in buerger's disease?

segmental thrombosing vasculitis

237

what is the treatment for buergers disease?

smoking cessation

238

what are the small vessel vasculitis disorders?

microscopic polyangitis • Wegener's granulomatosis (granulomatosis with polyangitis) • Churg strauss syndrome • Henoch Schonlein purpura

239

what is microscopic polyangitis?

necrotizing vasculitis commonly involving lung, kidneys, and skin with pauci immune glomerulonephritis and palpable purpura

240

pathology/labs seen in microscopic polyangitis?

no granulomas • p-ANCA

241

what is the treatment for microscopic polyangitis?

cyclophosphamide and corticosteroids

242

what are the upper respiratory tract symptoms of wegener's granulomatosis?

perforation of nasal septum, • chronic sinusitis • otitis media • mastoiditis

243

what are the lower respiratory symptoms of Wegener's granulomatosis?

hemoptysis • cough • dyspnea

244

what are the renal manifestations of wegener's granulomatosis?

hematuria • red cell casts

245

what is the triad that characterizes wegener's granulomatosis?

focal necrotizing vasculitis • necrotizing granulomas in the lung and upper airway • necrotizing glomerulonephritis

246

what are the labs seen in wegeners granulomatosis?

c-ANCA • CXR: large nodular densities

247

what is the treatment for wegeners granulomatosis?

cyclophosphamide • corticosteroids

248

what are the symptoms of Churg-strauss syndrome?

asthma • sinusitis • palpable purpura • peripheral neuropathy (wrist/foot drop) • can also involve heart, GI, pauci-immune glomerulonephritis

249

pathology/labs seen in Churg strauss syndrome?

granulomatous, necrotizing vasculitis with eosinophilia • p-ANCA, elevated IgE level

250

what is the most common childhood systemic vasculitis?

henoch-schonlein purpura

251

henoch-schonlein purpura often follows what?

URI

252

what is the classic triad of henoch schonlein purpura?

skin: palpable purpura on buttocks/legs • arthralgia • GI: abdominal pain, melena, multiple lesions of same age

253

pathology seen in henoch schonlein purpura?

vasculitis secondary to IgA complex deposition • associated with IgA nephropathy

254

what is a strawberry hemangioma?

benign hemangioma of infancy

255

strawberry hemangioma appears when?

first few weeks of life (1/200 births)

256

course of strawberry hemangioma?

grows rapidly and regresses spontaneously at 5-8 years of age

257

what is a cherry hemangioma?

benign capillary hemangioma of the elderly

258

course of cherry hemangioma?

does not regress

259

incidence of cherry hemangioma?

frequency ↑ with age

260

what is a pyogenic granuloma?

polypoid capillary hemangioma that can ulcerate and bleed

261

pyogenic granuloma is associated with what?

trauma and pregnancy

262

what is a cystic hygroma?

cavernous lymphangioma of the neck

263

cystic hygroma is associated with what?

Turner syndrome

264

what is a glomus tumor?

benign painful red-blue tumor under fingernails

265

glomus tumor arises from what?

modified smooth muscle cells of the glomus body

266

what is bacillary angiomatosis?

benign capillary skin papules found in AIDS patients

267

bacillary angiomatosis is caused by what?

Bartonella henselae infections

268

bacillary angiomatosis is frequently mistaken for what?

kaposi sarcoma

269

what is angiosarcoma?

rare blood vessel malignancy typically occuring in the head, neck, and breast areas

270

angiosarcoma is associated with what?

patients receiving radiation therapy, especially for BRCA and hodgkins lymphoma

271

course of angiosarcoma?

very aggressive and difficult to resect due to delay in diagnosis

272

what lymphangiosarcoma?

lymphatic malignancy associated with persistent lymphedema (post radical mastectomy)

273

what is kaposi sarcoma?

endothelial malignancy most commonly of the skin but also mouth, GIT, and respiratory tract

274

kaposi sarcoma is associated with what?

HHV-8 and HIV

275

kasposi sarcoma is frequently mistaken for what?

bacillary angiomatosis

276

what is sturge-weber disease?

congenital vascular disorder that affects capillary sized blood vessels.

277

Sturge-weber disease manifests how?

with port wine stain (nevus flammeus) on face • ispilateral leptomeningeal angiomatosis (intracerebral AVM) • seizures • early onset glaucoma

278

what are the antihypertensive therapies for essential hypertension?

diuretics • ACEI • ARBs • Ca channel blockers

279

what are the antihypertensive therapies used in CHF?

diuretics • ACEI/ARBs (compensated CHF) • K+ sparing diuretics

280

β blockers must be used cautiously in what?

decompensated CHF

281

β blockers are contraindicated in what?

cardiogenic shock

282

what are the antihypertensive therapies used in DM?

ACEI/ARBs • Ca channel blockers • diuretics • β blockers • α blockers

283

ACEIs are protctive against what in DM?

diabetic nephropathy

284

which drugs are Ca channel blockers?

nifedipine • verapamil • diltiazem • amlodipine

285

MOA of Ca channel blockers?

block voltage dependent L type calcium channels of cardiac and smooth muscle and thereby reduce muscle contractility

286

relative effect on smooth muscle of Ca channel blockers?

Vascular smooth muscle- amlodipine=nifedipine>diltiazem>verapamil

287

relative effect on heart of Ca channel blockers?

heart- verapamil>diltiazem>amlodipine=nifedipine • Verapamil-ventricle

288

clinical use of Ca channel blockers?

hypertension • angina • arrhythmias (not nifedipine) • prinzmental's angina • Raynauds

289

toxicity of Ca channel blockers?

cardiac depression • AV block • peripheral edema • flushing • dizziness • constipation

290

MOA of hydralazine?

↑cGMP→smooth muscle relaxation • vasodilates arterioles > veins • ↓ afterload

291

clinical use of hydralazine?

severe hypertension • CHF • first line tx for htn in pregnancy, with methyldopa • frequently coadministered with β blocker to prevent reflex tachycardia

292

toxicity of hydralazine?

compensatory tachycardia (CI in angina/CAD), fluid retention, nausea, HA, angina • Lupus like syndrome

293

commonly used drugs for malignant hypertension treatment?

nitroprusside • nicardipine • clevidipine • labetalol • fenoldopam

294

features of nitroprusside for malignant hypertension?

short acting • ↑ cGMP via direct release of NO

295

toxicity of nitroprusside?

can cause cyanide toxicity

296

MOA of fenoldopam?

dopamine D1 receptor agonist→ coronary, peripheral, renal, splanchnic vasodilation→ ↓BP and ↑ natriuresis

297

MOA of nitroglycerine, isosorbide dinitrate?

vasodilate by releasing NO in smooth muscle, causing ↑ cGMP in and smooth muscle relaxation • dilates veins>>arteries • ↓preload

298

clinical use of GTN, ISDN?

angina • pulmonary edema

299

toxicity of GTN, ISDN?

reflex tachycardia, hypotension, flushing, HA, "monday disease" in industrial exposure

300

what is monday disease in industrial GTN, ISDN exposure?

development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend results in tachycardia, dizziness, and HA upon reexposure

301

what is the goal of antianginal therapy?

reduction of myocardial O2 consumption (MVO2) by decreasing >=1 of the determinants of MVO2: EDV, BP, HR, contractility, ejection time

302

effect of nitrates on EDV?

303

effect of β blockers on EDV?

304

effect of nitrates+ β blockers on EDV?

no effect or ↓

305

effect of nitrates on BP?

306

effect of βblockers on BP?

307

effects of nitrates + βblockers on BP?

308

effect of nitrates on contractility?

↑ (reflex response)

309

effects of β blockers on contractility?

310

effect of nitrates + βblockers on contractility?

little/no effect

311

effect of nitrates on HR?

↑ (reflex)

312

effect of βblockers on HR?

313

effect of nitrates + β blockers on HR?

314

effect of nitrates on ejection time?

315

effect of β blockers on ejection time?

316

effect of nitrates + βblockers on ejection time?

little/no effect

317

effect of nitrates on MVO2?

318

effect of β blockers on MVO2?

319

effect of nitrates + βblockers on MVO2?

↓↓

320

how do Ca channel blockers compare to the effects of nitrates and beta blockers on MVO2?

nifedipine is similar to nitrates • verapamil is similar to beta blockers

321

which are the partial β agonists contraindicated in angina?

pindolol and acebutalol

322

effect of HMG-CoARI's on LDL?

↓↓↓

323

effect of HMG-CoARIs on HDL?

324

effect of HMGCoARI's on TG?

325

MOA of HMGCoARIs?

inhibit conversion of HMG-CoA to mevalonate, a cholesterol precursor

326

AE of HMGCoARIs?

hepatotoxicity (↑LFT) • rhabdomyolysis

327

effect of niacin on LDL?

↓↓

328

effect of niacin on HDL?

↑↑

329

effect of niacin on TG ?

330

MOA of niacin?

inhibits lipolysis in adipose tissue; • reduces hepatic VLDL secretion into circulation

331

AE of niacin?

red, flushed, face which is ↓ by aspirin or long term use • hyperglycemia (acanthosis nigricans) • hyperuricemia (exacerbates gout)

332

effect of bile acid resins on LDL?

↓↓

333

effect of bile acid resins on HDL?

slightly ↑

334

effect of bile acid resins on TG?

slightly ↑

335

MOA of bile acid resins?

prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more

336

AE of bile acid resins?

patients hate it- • tastes bad and causes GI discomfort • ↓ absorption of fat soluble vitamins • cholesterol gallstones

337

effect of ezetimibe on LDL?

↓↓

338

effect of ezetimibe on HDL ?

no effect

339

effect of ezetimibe on TG?

no effect

340

MOA of ezetimibe?

prevent cholesterol reabsorption at small intestinal brush border

341

AE of ezetimibe?

rare ↑ in LFTs • diarrhea

342

effects of fibrates on LDL?

343

effects of fibrates on HDL?

344

effects of fibrates on TG?

↓↓↓

345

MOA of fibrates?

upregulate LPL→↑TG clearance

346

AE of fibrates?

myositis • hepatotoxicity • cholesterol gallstones

347

PK of digoxin?

75% bioavailability • 20-40% protein bound • t1/2=40h • urinary excretion

348

MOA of digoxin?

direct inhibition of Na+/K+ ATPase leads to indirect inhibition of Na+/Ca++ exchanger/antiport • ↑[Ca++]i → positive inotropy • stimulates vagus → ↓ HR

349

clinical use of digoxin?

CHF • atrial fibrillation

350

why use digoxin in CHF?

↑ contractility

351

why use digoxin in atrial fibrillation?

↓conduction at AV node and depression of SA node