EXAM 3 Flashcards
(141 cards)
1
Q
fibromuscular dyplasia will appear how?
A
can occur anywhere, but tends to look like beads on a string - tends to occur in the kidney
2
Q
wht is conn syndrome
A
when you have a tumor in the zona glomerulosa that releases excess aldosterone –> Na+ retention and SVR increase
3
Q
explain DOC hypersecretion
A
increased ACTH from the anterior pituitary for any reason leads to hypersecretion of deoxycortisone, an aldoserone precurosor –> retention of Na+
4
Q
explain GRA: Glucocortocoid remediable aldosteronism
A
genes encoding aldosterone synthase and 11b hydroxylase are linked during embryogenesis
- get hypersecretion of glucocortocoids and aldsterone
- have very severe HTN that starts early in life
5
Q
how to treat GRA
A
glucocortocois
6
Q
three adrenal gland disorders
A
Con syndrome, DOC hypersecretion, glucocortocoid remediable aldosteronism
7
Q
cushing’s syndrome
A
incidence of HTN is greater in cushing’s - excess glucocortocoid. this increases angiotensinogen
8
Q
most common risk of cushings
A
oral corticosteroids
9
Q
symptoms of cushings
A
buffalo hump, broomstick arm+ legs,
10
Q
pheochromacytoma
A
increased NE from the adrenal medulla leading to an increase in systolic and diastolic pressure
11
Q
symptoms of pheo
A
palpittions, hypertension, glycosuria and extree systolic HTN
12
Q
how do natriuretic hormones work
A
they dump Na+ into the urine, but cause Ca to accumulate –> vascular smooth muscle contraction
13
Q
2x more likely to develop ____ than ____ in smoking
A
PAD
14
Q
explain the ankle-brachial index
A
on the arms and ankles the BP should be the same, but in peripheral artery disease, sometimes it is not
15
Q
in PAD, a drop of ____ as you go down the leg is significant
A
20mmHg
16
Q
how do you treat PAD
A
- smoking cessation, HTN control, statin,
- antiplatelet therapy: ASA
- exercise
17
Q
the timing of surgical repair of an aortic aneurysm is related to
A
the diameter and the rate of increase
18
Q
pulsatile abdominal mass is a
A
abdominal aortic aneurysm
19
Q
what will you find in a thoracic abdominal aneurysm
A
cystic medial necrosis - a mucoid material accumulation in the media of the aorta
20
Q
risk factors of AAA
A
smoking, male, atherosclerosis
21
Q
descending thoracic AA due to
A
atherosclerosis
22
Q
ascending thoracic AA due to
A
bicuspid aortic valve, connective tissue disease, syphillis
23
Q
genetic factors leading to an ascending thoracic AA
A
Marfan, ehlers danlos and loeys deitz
24
Q
defect in marfan
A
FBN1
25
defect in ehlers danlos
type III collagen
26
defect in loeys deitz
TGFBR
27
ideal size to operate on an aortic aneurysm
5cm
28
what is the genetic inheritance pattern of marfan
autosomal dominant
29
what tears in an aortic dissection
intimina
30
where is the blood located in an aortic dissection
in the media
31
what structures can a debakey typeI/ ascending Aortic dissection damage
the aortic annulus and RCA
32
abrupt onset of severe chest pain radiating to the back
aortic dissection
33
what does a negative D-dimer test tell you about aortic dissection
rules out dissection
34
how does one treat an aortic dissetion
1) lower BP + HR with IV labetolol and nitroprusside, BB if the BP is already low to decrease HR
35
what do we want to AVOID in aotic dissections
pure venous dillators such a nitroglycerin
36
treating type A dissection
surgical emergency
37
mutation leading to vascular ehlers danlos
COL3A
38
best way to diagnose aortic dissecction
Computer thomography angiography
39
how to diagnose PAD
non-invasive flow studies
40
type of arteriolar disease seen in diabetes
hyaline arteriosclerosis
41
what cases the hyerplastic appearance of arteriosclerosis
smooth muscle proliferation
42
acute renal failure from which type of arteriosclerosis
hyperplastic
43
lipo proteins that are pro-atherogenic
cylomicrons/ VLDL
| LDL - apo B (90% of apo B is LDL)
44
anti atherogenic lipoproteins
HDL
| Apo A
45
what parameter of HDL so i care about
how many of the particles you have, not how much cholesterol is in the body
46
higher LDL leads to an increased risk of
coronary artery disease
47
what does HDL take from the VLDL and LDL
cholesterol
| and takes it from the periphery and back to the liver.
48
most genetic causes of dyslipidemia are due to a
LDL receptor defect
49
if LDL> ______ you are likely to have a heterozygrous LDL R problem
LDL>190
50
when Triglycerides are mre than 1000 you suspect ____ and worry about what condition
genetic defect and pancreatitis
51
drugs that can make your cholesterol very high
protease inhibitors for HIV
| corticosteroids and immunosupressant like rapamycin
52
major statins
atrovastatin and rosuvastatin
53
what do statins do
they block the production of cholesterol by the liver
54
statin side effects
transaminitis - increase in ASL and ALT,
| Rhabdomyalasis
55
rhabdomyalasis high risk population
advaced age, women, frailty, alcohol abuse
56
statin drug interaction that can put at risk for rhabdomyalysis
fibrates
57
what does ezetamide fo
blocks uptake fo bile acids back into the circulation
58
PCSK9 acts how
is a cofactor for the LDL receptor, which marks it for degredation. so the more PCSK9 you have the less LDL receptor and higher cholesterol
59
how do PCSK9 inhibitors work
if not PCSK9, LDL receptors stay on the liver all the time and are never broken down, so very low cholesterol in the circulation
60
golden standard for cholesterol treatments?
statins - most effective for reducing cardiovascular risk - and ezetamide
61
dyslipidemia is driven by _____ containing proteins
apo b on LDL and VLDL
62
what do fibrates decrease the most?
TAGs
63
what causes hyaline arteriolosclerosis
diabetes and HTN
64
most predicitive inflammatory marker of MI risk
CRP + Total cholesterol:HDL - markers of the acute phase repsonse
65
prostacyclin is a
vasodillator
66
Platelet aggrivating factor is a
vasoconstrictor
67
what do statins do to eNOS and what does eNOS do
statins inrease
68
where are nicotinic Ach receptors found
preganglionic synapse of PNS, SNS and at skeletal muscle post ganlgionic
69
post mi, cardiac arrhthmias occur
within 1st few days after Mi
70
post MI, fibrinous pericarditis occurs
1-3 days after MI
71
post Mi, papillary muscle rupture occurs
2-7 days
72
IC setpum rupture after an MI will occur
3-5 post Mi
73
aneurysm formation after an Mi will occur
5-14 days post MI
74
dressler syndrome occurs how long after an Mi
weeks-months
75
probability of death from CVD
47%
76
normal response of a vessel to acetycholine is to
dillate
77
what drugs promote eNOS function
statins
78
EXCESS NO CAN predispose to
shock
79
too little NO leads to
atherosclerosis
80
what molecue to chemokines use to attract an activate monocytes
monocyte chemoattractant protein-1 MCP-1
81
smooth muscle cels in atheroscelerosis secrete
collagen and elastin
82
what moleculae to platelets make that results in vasconstriction and anginal pain
TXA2
83
what is the singel most important determinany of stenosis for any given level of flow
the minimum cross sectional area within the stenosis
84
low ATP, due to MI, and inability to relax the LV leads to
diastolic dysfuntion
85
transient sarcomeric dyskinesis due to low O2 leads to
systolic sydfunction
86
what releases TPA
endothelial cells
87
what activates tpa
thrombin
88
what does tpa do
it converts plasmin to plasminogen, which breaks down fibrin
89
what is an inhibitor of thombolysis
plaminogen activator inhibitor, PAI-1
90
elevation in cardiac biomarkers in untable angina?
no
91
describe prinzmetal agina
episodic chest pain that occurs at rest, that is secondary to vasospasm
92
does prinzmetal angina respond to vasodillators?
yes, responds promtly to nitroglycerin
93
ST segment requirements for dianogsis of a STEMi
- St elevation in 2 contiguous leads or new LBBB
| - St elevation = 1mm limb, and 2mm in precordial
94
which leads indicate an ateroseptal infarct
V1-V4
95
what artery would be occluded in an ateroseptal infarct
LAD
96
what leads indicate a lateral infarct
I, AVL, V5 and V6
97
what arteries supply the lateral heart
L circumflex and the LAD diagonal
98
what leads indicate an inferior infarct
II, III and Avf
99
what arteries supply the inferior part of the heart
RCA if right dominant
Lcx if left cominant
and mid LAd
100
see yellowing alone, how old is the Mi?
1-3 days
101
see yellow with rd borders, how old si the Mi
2-4 day range
102
no red or yellow, jsut mushy or necrotic, how old is the infarct
7-10 days old
103
red-grey infarct with red rim is how old?
more than 10 days
104
previous myocarditis pointsyou towards a diagnosis of
dilated cardiomyopathy
105
an s3 sound makes you think that the heart is
dilated
106
s4 heart sound makes you think the heart is
hypertrophic
107
hypertrophic cardioyopathy due to what mutation
b-myosin heavy chain
108
what disease is caused by defects in adhesion proteins such a desmosomes
arrhythmogenic right ventricular cardiomyopathy
109
describe arrhythmogenic right ventricular cardiomyopathy
the RV wall is thinned with fatty ifnilatrates and fobrosis
110
most common reason for a restrictive cardiomyopathy
amyloidosis
111
what is seen on histo in restricitive cardiomyopathies
eosinophilic protein deposited btw cardiac myositis
112
key sign in sarcoid cardiomyopathy
non caseating granulomas leading to a thick and stiffened paricardium
113
how to diagnose sarcoid cardiomyopathy
MRI
114
viral infections leading to myocarditis
group b coxackie and chagas disease
115
fibrinous/serofibrinous pricarditis is usally associated with what findings or conditions
pericardial rub and dresslers syndrome
116
myofilbrillar disarray seen in
hypertrophic idiopathic subaortic stenosis
117
organiss that infect vascular endothelial cells
Rickettsia, Orientsia
118
organisms that infect circulating granuocytes
Ehrlichia, Anaplasma
119
intrcellular pathogen that ifnects erythrocytes
Bartonella bacilliformis
120
most bacterial spread is via
lymphatic capillaries through the lymph nodes into the thoracic duct.
121
Prototype parasitic bloodstream pathology
malaria `
122
homes of a malria virus
in the misuito, in the RBC and in the liver hepatocyte
123
requirement to be on the blod borne pathoge list
characterized by a phase in which the microbes causing the disease may circulate in the blood for a prolonged period. They are therefore capable of being transmitted through blood or other potentially infectious materials.
124
histo findings in rheumatic fever
ashoff bodies and antischow cells
125
syptoms of aortic stenosis
Syndope
Angina
Dyspnea
pulsus parvus et tardus
126
pulsus parvus et tardus means
weak pulses w a delayed
127
murmur of aortic stenosis
crescendo-decrescndo murur radiating to the corotids
128
a late aortic stenosis murmur means
more severe
129
drugs to avoid in aortic stenosis
preload reducers such a diuretics and nitroglycerin
130
most coomon cause of aortic regurg
aortic root dilation
131
a wide pulse pressure points you towards which valve deformity
aortic insufficiency
132
in aortic regurg you want to to treat by
lowering the afterload
133
describe sound of aortic insufficiency
high pitched diasotlic
134
widely split S2 think
pulmonic stenosis
135
notched alongated sick looking p wave think
mitral stenosis
136
opening snap wiht loud first heart sound heard in
mitral stenosis
137
does a short or longer time between S2 and the opening snap worse?
shorter time btw OS and S2 is worse
138
main reason for mitral insufficiency
myxamatous degenertion
139
for mitral stenosis, what mediation should you NOT use
b blockers or negative inotropes
140
kleinfelters assocaited with
mitral valve prolapse
141
opening click heard btw S1 and S1 think
mitral valve prolapse
