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1
Q

fetal erythropoiesis

A

Young Liver Synthesizes Blood: Yolk sac (3-8wks), Liver (6wks-birth), Spleen (10-28wks), Bone marrow (18wks-adult)

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2
Q

allantois ->

A

urachus -> median umbilical ligament. urachus = part of allantoic duct between bladder and umbilicus

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3
Q

ductus arteriosus ->

A

ligamentum arteriosum

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4
Q

ductus venosus ->

A

ligamentum venosum

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5
Q

foramen ovale ->

A

fossa ovale

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6
Q

notochord ->

A

nucleus pulposus

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7
Q

umbilical arteries ->

A

medial umbilical ligaments

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8
Q

umbilical vein ->

A

ligamentum teres hepatis (contained in falciform ligament)

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9
Q

SA and AV nodes supplied by

A

RCA (usually)

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10
Q

LCX supplies

A

posterolateral LV, anterolateral papillary muscle

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11
Q

LAD supplies

A

anterior 2/3 of interventricular septum, anterolateral papillary muscle, anterior LV

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12
Q

PDA supplies

A

posterior 1/3 of interventricular septum, posterior walls of ventricles, posteromedial papillary muscle

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13
Q

right marginal artery supplies

A

RV

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14
Q

in 85%, PDA arises from

A

RCA

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15
Q

inc. pulse pressure in

A

hyperthyroid, AR, aortic stiffening, OSA, exercise

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16
Q

dec. pulse pressure in

A

AS, cardiogenic shock, cardiac tamponade, advanced HF

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17
Q

normal splitting

A

inspiration -> dec. intrathoracic P -> inc. venous return -> inc. RV filling -> inc. RV stroke volume -> inc. RV ejection time -> delayed pulmonic closure. pulm circulation also has inc. capacity during inspiration.

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18
Q

wide splitting

A

in conditions that delay RV emptying: PS, RBBB. = exaggeration of normal splitting

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19
Q

fixed splitting

A

in ASD! -> L-R shunt -> inc. RA + RV volumes -> inc. flow through pulmonic valve so that closure is always greatly delayed, regardless of breath

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20
Q

paradoxical splitting

A

in conditions that delay aortic valve closure: AS, LBBB. normal order is reversed, P2 sound is before A2, so when P2 is pushed back by inspiration, split is eliminated.

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21
Q

murmurs: inspiration

A

inc. venous return to RA -> louder R heart sounds

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22
Q

murmurs: hand grip

A

inc. afterload -> louder MR, AR, VSD; quieter hypertrophic cardiomyopathy murmur; later click in MVP.

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23
Q

murmurs: valsalva, standing up

A

dec. preload. most murmurs, including AS, get quieter. hypertrophic cardiomyopathy murmur gets louder. earlier click in MVP.

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24
Q

murmurs: rapid squatting

A

inc. venous return, inc. preload -> quieter hypertrophic cardiomyopathy murmur, louder AS murmur, later click in MVP

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25
Q

phase 0 - myocardial AP

A

rapid upstroke and depolarization - V-gated Na channels open

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26
Q

phase 1 - myocardial AP

A

initial repolarization - inactivation of V-gated Na channels. V-gated K channels start opening.

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27
Q

phase 2 - myocardial AP

A

plateau - Ca influx through V-gated Ca channels balances K efflux. Ca influx triggers Ca release from SR and myocyte contraction

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28
Q

phase 3 - myocardial AP

A

rapid repolarization - massive K efflux due to opening of V-gated slow K channels and closure of V-gated Ca channels

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29
Q

phase 4 - myocardial AP

A

resting potential - high K permeability through K channels

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30
Q

myocardial AP differences from skeletal AP

A

has a plateau, contraction is due to Ca-induced Ca release from SR.

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31
Q

funny current

A

responsible for automaticity. slow, mixed Na-K inward current

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32
Q

phase 0 - pacemaker AP

A

upstroke - opening of V-gated Ca channels. fast B-gated Na channels are permanently inactivated b/c of less neg resting V of these cells -> slow conduction v that is used by AV node to prolong transmission from atria to ventricles

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33
Q

phase 1, 2 - pacemaker AP

A

absent

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34
Q

phase 3 - pacemaker AP

A

inactivation of Ca channels and inc. activation of K channels -> K efflux

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35
Q

phase 4 - pacemaker AP

A

slow spontaneous diastolic depolarization as Na conductance increases (Ifunny). the slope of phase 4 determines HR. ACh/adenosine dec. diastolic depolarization rate and HR, catecholamines inc. depolarization and HR. sympathetic stimulation increases Ifunny.

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36
Q

J point

A

junction between end of QRS complex and start of ST seg

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37
Q

U wave

A

caused by hypokalemia, bradycardia.

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38
Q

drug-induced long QT mnemonic

A

ABCDE: antiArrhythmics (class IA, III), antiBiotics (e.g. macrolides), anti”C”ychotics (e.g. haldol), antiDepressants (e.g. TCAs), antiEmetics (e.g. ondansetron)

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39
Q

torsades de pointes

A

causes: long WT, drugs, dec. K, dec. Mg. Tx: mag sulfate

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40
Q

romano-ward syndrome

A

AD cause of congenital long QT. pure cardiac phenotype (no deafness)

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41
Q

jervell, lange-nielsen syndromes

A

AR causes of congenital long QT, sensorineural deafness

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42
Q

brugada syndrome

A

AD, often asian males. peudo-RBBB, ST elevations in V1-V3. inc. risk of V tach + SCD. Tx: ICD

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43
Q

WPW

A

most common type of ventricular pre-excitation. abnormal fast accessory pathway (bundle of Kent) bypasses rate-slowing AV node -> early depolarization -> delta wave, widened QRS, short PR interval. can -> SVT (reentry circuit)

44
Q

ANP

A

released from atrial myocytes in response to inc. blood V and atrial P. acts via cGMP -> vasodilation and dec. NA reabsorption at renal collecting tubule. dilates afferent renal arterioles, constricts efferent arterioles -> diuresis. part of aldosterone escape mechanism.

45
Q

BNP

A

released from ventricular myocytes in response to inc. T. similar physiologic action to ANP but longer 1/2 life. can be used to Dx and Tx HF.

46
Q

aortic receptors

A

transmitted via vagus to solitary nucleus of medulla. respond to dec. and inc. in BP

47
Q

carotid sinus receptors

A

trasmitted via glossopharyngeal nerve to solitary nucleus of medulla. respond to dec. and inc. in BP

48
Q

carotid massage

A

inc. P on carotid sinus -> inc. stretch -> inc. afferent baroreceptor firing -> inc. AV node refractory period -> dec. HR

49
Q

peripheral chemoreceptors

A

carotid and aortic bodies = stimulated by dec. PO2 (<60mmHg), inc. PCO2, and dec. blood pH.

50
Q

central chemoreceptors

A

stimulated by changes in pH and PCO2 of brain interstitial fluid (influenced by arterial CO2). not directly related to PO2.

51
Q

V1-V3 ST elevations/Q waves

A

anteroseptal (LAD)

52
Q

V3-V4 ST elevations/Q waves

A

anteroapical (distal LAD)

53
Q

V5-V6 ST elevations/Q waves

A

anterolateral (LAD or LCX)

54
Q

I, aVL ST elevations/Q waves

A

lateral (LCX)

55
Q

II, III, aVF ST elevations/Q waves

A

inferior (RCA) (can -> papillary muscle rupture)

56
Q

myxoma

A

most common adult primary cardiac tumor. 90% in atria L>R). ball-valve obstruction associated w/syncope. can -> “tumor plop” sound.

57
Q

rhabdomyoma

A

most common child primary cardiac tumor. associated w/tuberous sclerosis. usually in ventricle.

58
Q

angiosarcoma

A

rare blood vessel malignancy. head, neck, breast. usually elderly, sun-exposed. radiation and chronic post-mastectomy lymphedema inc. risk. hepatic ones associated w/vinyl chloride (PVC pipe) and arsenic. aggressive

59
Q

bacillary angiomatosis

A

benign capillary skin papules in AIDS pts. cause by bartonella henselae. looks like kaposi but w/neutrophilic infiltrate

60
Q

cherry hemangioma

A

benign capillary hemangioma of elderly. does not regress. inc. frequency w/age.

61
Q

cystic hygroma

A

cavernous lymphangioma of neck. associated w/turners

62
Q

glomus tumor

A

benign, painful, re-blue tumor under fingernails. arises from modified smooth muscle cells of thermoregulatory glomus body

63
Q

kaposi sarcoma

A

endothelial malignancy most commonly of skin, but can be mouth, GI, respiratory. associated w/HHV-8. looks like bacillary angiomatosis but w/lymphocytic infiltrate.

64
Q

pyogenic granuloma

A

pollypoid capillary hemangioma that can ulcerate and bleed. associated w/trauma and pregnancy

65
Q

strawberry hemangioma

A

benign capillary hemangioma of infancy. appears early in life. grows rapidly, regresses spontaneously by 5-8yrs.

66
Q

takayasu arteritis

A

usually asian females weak UE pulses, fever, night sweats, arthritis, myalgias, skin nodules, ocular disturbances. granulomatous thickening and narrowing of aortic arch and proximal great vessels. Tx: steroids

67
Q

polyarteritis nodosa

A

young adults. hep B seropositivity in 30%. Sx: fever, wt. loss, malaise, h/a, abd. pain, melena, HTN, neuro Sx, cutaneous eruptions, renal damage. LUNG = SPARED. IC-mediated. fibrinoid necrosis. string-of-pearls. Tx: steroids, cyclophosphamide

68
Q

buerger dz (thromboangiitis obliterans)

A

heavy smokers. males gangrene, autoamputation of digits, superficial nodular phlebitis. raynauds. segmental thrombosing vasculitis. Tx: smoking cessation.

69
Q

granulomatosis w/polyangiitis

A

we”c”ener: upper respiratory tract: perf. nasal septum, chronic sinusitis, otitis media, mastoiditis. lower respiratory tract: hemoptysis, cough, dyspnea. renal: hematuria, RBC casts. triad: focal necrotizing vasculitis, necrotizing granulomas in lung/upper airway, necrotizing glomerulonephritis. “c”-ANCA. Tx: “c”yclophosphamide, “c”orticosteroids.

70
Q

microscopic polyangiitis

A

necrotizing vasculitis involving lung, kidneys, skin. pauci-immune glomerulonephritis and palpable purpura. looks like wegeners but w/o nasopharyngeal involvement. no granulomas, no eosinophilia. p-ANCA. Tx: cyclophosphamide, steroids.

71
Q

churg-strauss

A

asthma, sinusitis, skin nodules/purpura, neripheral neuropathy (wrist/foot drop). can also involve heart, GI, kidneys (pauci-immune glomerulonephritis), lungs. granulomatous, necrotizing vasculitis w/eosinophilia. p-ANCA, inc. IgE.

72
Q

HSP

A

most common childhood systemic vasculitis. often follows URI. triad: palpable purpura, arthralgia, abd. pain. 2/2 IgA immune complex deposition. associated w/IgA nephropathy (Berger dz).

73
Q

hydralazine

A

MoA: inc. cGMP -> smooth muscle relaxation -> arteriolar vasodilation -> dec. afterload. often used w/BB to prevent reflex tachycardia. side effects: tachycardia, fluid retention, h/a, angina, lupus-like syndrome

74
Q

nitroprusside

A

short acting, inc. cGMP via direct release of NO. can cause cyanide toxicity

75
Q

fenoldopam

A

DA D1 receptor agonist: coronary, peripheral, renal, and splanchnic vasodilation. dec. BP, inc. natriuresis.

76
Q

nitrates

A

vasodilate by inc. NO in vascular smooth muscle -> inc. in cGMP -> smooth muscle relaxation. dilate veins&raquo_space; aterires. dec. preload. toxicity: reflex tachycardia, hypotension, flushing, h/a. “monday dz” in industrial exposure: tolerance during work week, then tachycardia, dizzines, h/a on monday.

77
Q

bile acid resins (e.g. cholestyramine)

A

dec. LDL, slightly inc. HDL and TGs. MoA: prevent intestinal reabsorption of bila acids; liver must use cholesterol to make more. side effects: GI upset, dec. fat-soluble absorption.

78
Q

ezetimibe

A

dec. LDL, no effect on HDL, TG. MoA: prevent cholesterol absorption at small intestine brush border. side effects: rare inc. LFTs, diarrhea.

79
Q

fibrates

A

dec. TGs, slightly dec. LDL, inc. HDL. MoA: upregulate LDL -> inc. TG clearance. activates PPAR-alpha to induce HDL synthesis. side effects: myopathy (inc. risk w/statins), cholesterol gallstones

80
Q

niacin

A

dec. LDL, inc. HDL, slight dec. TGs. MoA: inhibits lipolysis (hormone-sensitive lipase) in adipose tissue; reduces hepatic VLDL synthesis. side effects: red, flushed face (dec. w/NSAIDs or long-term use). hyderglycemia, hyperuricemia.

81
Q

class IA antiarrhythmics

A

quinidine, procainamide, disopyramide

82
Q

class IA MoA

A

inc. AP duration, inc. effective refratory period in ventricular AP, inc. QT interval. dec. slope of phase 0 (Na current)

83
Q

class IA use

A

both atrial and ventricular arrhythmias, esp. re-entrant and ectopic SVT and VT

84
Q

class IA toxicity

A

cinchonism (h/a, tinnitis w/quinidine), reversible SLE-like Sx (procainamide), HF (disopyramide), thrombocytopenia, torsades de pointes due to inc. QT

85
Q

class IB antiarrhythmics

A

lidocaine, mexiletine, (+ phenytoin sortof)

86
Q

class IB MoA

A

dec. AP duration. preferentially affect ischemic or depolarized purkinje and ventricular tissue. dec. slope of phase 0.

87
Q

class IB use

A

acute ventricular arrythmias (esp. post-MI). dig-induced arrhythmias

88
Q

class IB toxicity

A

CNS stimulation/depression, CV depression

89
Q

class IC antiarrhythmics

A

flecainide, propafenone

90
Q

class IC MoA

A

sig. prolongs ERP in AV node and accessory bypass tracts. no effect on ERP in purkinje and ventricular tissue. minimal effect on AP duration. dec. slope of phase 0.

91
Q

class IC use

A

SVTs, inc. a fib. last resort in refractory VT

92
Q

class IC toxicity

A

proarrhythmic, esp. post-MI.

93
Q

class II antiarrhythmics

A

beta-blockers!

94
Q

class II MoA

A

dec. SA and AV node activity by dec. cAMP, dec. Ca currents. suppress abnormal pacemakers by dec. slope of phase 4.

95
Q

class II use

A

SVT, ventricular rate control for atrial fibrillation and atrial flutter

96
Q

class II toxicity

A

impotence, exacerbation of COPD/asthma, CV effects *bradycardia, AV block, HF), CNS effects (sedation, sleep alterations). may mask hypoglycemia signs. Tx overdose w/saline, atropine, glucagon.

97
Q

class III antiarrhythmics

A

K channel blockers: amiodarone, ibutilide, dofetilide, sotalol.

98
Q

class III MoA

A

inc. AP duration. inc. ERP, inc. QT. markedly prolonged repolarization (K current)

99
Q

class III use

A

a fib, a flutter, VT (amio, sotalol).

100
Q

class III toxicity

A

sotalol: torsades, excessive beta-blockade. ibutilide: torsades. amio: pulm. fibrosis, hepatotoxicity, thyroid issues, acts as hapten (deposits in skin/cornea), neuro effects, constipation, CV effects (bradycardia, heart block, HF). amio: check PFTs, LDTs, TFTs. it is also lipophilic and has class I, II, III, and IV effects

101
Q

class IV antiarrhythmics

A

Ca channel blockers: verapamil, dilt

102
Q

class IV MoA

A

dec. conduction velocity, inc. ERP, inc. PR interval. slow rise of AP, prolonged repolarization.

103
Q

class IV use

A

prevention of nodal arrhythmias (e.g. SVT), rate control in a fib

104
Q

class IV toxicity

A

constipation. flushing, edema, CV effects (HF, AV block, SA node depression.

105
Q

adenosine

A

inc. K out of cells -> hyperpolarizing the cell and dec. Ca current. drug of choice in Dx/Tx of SVT. very short action (~15sec). effects blunted by theophylline and caffeine (adenosine receptor antagonists). adverse effects: flushing, hypotension, CP, sense of doom, bronchospasm)

106
Q

Mg

A

effective in torsades and dig. toxicity

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