Quick Review

Question 1

Nitrates for IHD

Answer 1

• nitroglycerin
• isosorbide mononitrate
• isosorbide dinitrate

Question 2

Calcium channel blockers: non - cardio for IHD

Answer 2

• Amlodipine
• Nifedipine
• Nicardipine

*best at vasodilation

Question 3

Calcium channel blockers: cardio for IHD

Answer 3

• Verapamil
• Diltiazem

*best at decreased contractility, SA node, AV node

Question 4

Beta blockers for IHD

Answer 4

• Propanolol (antagonist)
• Metoprolol (inverse)
• Nadolol (antagonist)
• Atenolol (antagonist)

Question 5

Classic v. Variant angina

Answer 5

a. due to occlusion

b. due to vasospasm (prinzmetal)

Question 6

What drug causes coronary steal syndrome?

Answer 6

Dipyridamole

Question 7

What drug class are contraindicated in those with elevated intracranial pressure?

Answer 7

nitrates

Question 8

Pt. presents with severe unstable angina. They have a hx of type 1 diabetes, but it is well controlled with insulin. They also have a history of HTN, but are negative for all respiratory complaints. What beta blocker would you prescribe?

Answer 8

none - type 1 diabetics on insulin is a contraindication

Question 9

Women presents 24 weeks pregnant to neonatal surgery. What condition is being corrected?

Answer 9

CPAM –> they can get get so big that you get pulmonary hypoplasia

Question 10

mediastinum shift with the following atelectasis:

a. respiration
b. compression
c. contration

Answer 10

a. toward resorption
b. away
c. idk

Question 11

what four ways do we get pulmonary edema?

Answer 11

a. increased hydrostatic P (LHF, inc volume, pulmonary v. obstruction)
b. decrease oncotic pressure (liver or renal problem)
c. unknown (altitude, neuo)
d. injury to alveolar wall (bac pneumonia, sepsis, smoke, aspiration)

Question 12

Stages of ARDS

Answer 12

1. Exudative (hyaline, neutrophils, edema)
2. Proliferative (fibroblast, early fibrosis)
3. Resolution (normal tissue) or Fibrotic (extensive fibrosis)

Question 13

List of Obstructive Diseases

Answer 13

• asthma
• chronic bronchitis
• emphysema
• bronchiectasis
• pneumoconiosis

Question 14

List of Restrictive Diseases

Answer 14

• pneumoconiosis
• idiopathic pulmonary fibrosis
• sarcoidosis
• HS pneumonitis

Question 15

What cells do we see in asthma?

Answer 15

a. atopic: mast, eosinophils, lymphocytes

b. non-atopic: neutrophils, T cells

Question 16

Why is the hypertrophied heart at risk of ischemia?

Answer 16

the myocytes getting bigger doesn’t mean they’re getting more O2/blood

Question 17

What causes LV hypertrophy?

Answer 17

• HTN
• ischemic HD
• aortic/mitral valvular diseases
• primary myocardial diseases

Question 18

When do we see nutmeg liver?

Answer 18

• Right sided HF

Question 19

NOTCH pathway is associated with what congenital defects?

Answer 19

NOTCH1 –> bicuspid aortic valve

NOTCH 2 and JAG 1 –> Tetralogy of Fallot

Question 20

What type of coarctation is symptomatic at birth?

Answer 20

• one with a PDA (cyanosis in lower half of body)

* one without isn’t seen until adulthood where you may get leg claudication, hypotension in LE, hypertension in UE

Question 21

When do we see myocyte hypereosiniphilia?

Answer 21

12-24 hrs after an MI

Question 22

Where are phase I enzymes located?

Answer 22

lipophilic ER membranes of liver (and other tissues)

Question 23

Succinycholine and inhalation anesthetics can cause what?

Answer 23

malignant hyperthermia in pts with ryanodine receptor mutations

Question 24

Individuals with genetic defects in pseudocholinesterase can metabolize _____ at 50% the rate as normal individuals

Answer 24

Succinycholine

Question 25

CYP inducers

Answer 25

- phenytoin (anticonvulsant) - ethanol (CYP2E1) - aromatic hydrocarbons such as benzo[a]pyrene (tobacco smoke), - rifampin - phenobarbital and other barbiturates

Question 26

rasburicase not be used in patients with deficiency.

Answer 26

G6PD

Question 27

the common variant, rs4149056 in SLCO1B1, increases systemic exposure of _______ and was identified to have the single strongest association with _____________

Answer 27

simvastatin | simvastatin-induced myopathy

Question 28

Choline esters have what charge? alkaloids?

Answer 28

a. + | b. -

Question 29

The net cardiovascular effects of moderate doses of AChE inhibitors is modest Brady/tachycardia, a ____ in cardiac output, and a modest ____ in blood pressure

Answer 29

a. Brady b. fall c. increase

Question 30

a. The tertiary amines are used for their effects on the ___ or ____ (___, ___, ___) b. The quaternary amines are ___ and elicit their antimuscarinic effects in the ___ (___, ___)

Answer 30

a. eye, CNS, atropine, tropicamide, benztropine | b. charged, periphery, ipratropium, glycopyrrolate

Question 31

____ is the first drug of choice for symptomatic bradycardia in an advanced cardiac life support (ACLS) setting

Answer 31

atropine

Question 32

Surgical excision is not recommended in small cell carcinoma when what has happened?

Answer 32

it has spread to the LNs

Question 33

Apex of lung can cause what problem?

Answer 33

Horner Syndrome --> ptsosis, miosis, anhidrosis

Question 34

Atypical Carcinoid tumor vs. Carcinoid Tumor

Answer 34

- increased rte of metastasis - necrosis - increased mitotic activity - disordered growth

Question 35

a. Calretinin distinguishes what two types of cancers? | b. CD34+ and keratin - distinguishes what type of cancer from another?

Answer 35

a. mesothelioma from adencocarcinoma | b. Solitary fibrous tumor from mesothioloma

Question 36

What causes the following: a. pigeon breeder's lung b. Farmer's Lung c. Hot tub Lung

Answer 36

all are HS pneumonitis a. protein in pigeon poop b. actinomycetic spores in hay c. reaction to Mycobacterium avium complex (MAC)

Question 37

Desquamative Interstitial Pneumonia

Answer 37

tons of macrophages | 5-6th decade smokers

Question 38

Respiratory Bronchiolitis-ILD

Answer 38

- 3-4th decade smokers | - "peribronchiolar" metaplasia

Question 39

gelatinous material

Answer 39

protein alveolar proteinosis

Question 40

plexiform lesion, medial hypertrophy

Answer 40

pulmonary HTN

Question 41

human Metapneumovirus

Answer 41

- affects young, old, and immunocompromised - causes bronchiolitis, pneumonia - a paramyxovirus

Question 42

pumpkin seed

Answer 42

histoplasmosis capsulatum* *granulomatous response; coin lesions on CXR

Question 43

ACE Inhibitors should be given to all people with what? unless they are what?

Answer 43

a. LV systolic failure or LV dysfunction without HF | b. not tolerated (try ARB), pregnant, hypotensive, serum creatine >3, hyperkalemic

Question 44

Unless contraindiateced, carvedilol should be give to what pts? in addition to what?

Answer 44

a. LV systolic dysfunction caused by MI | b. ACE inhibitors

Question 45

What should you use in a patient with low GFR: | Hydrochlorothiazide or furosemide

Answer 45

furosemide (other doesn't work in pts with low GFR)

Question 46

What drug combo works to tx chronic HF in African Americans but not whites?

Answer 46

isosorbide denigrate + hydralazine* *can cause drug induced lupus