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AAW - CRAAB 1 > Week 5 > Flashcards

Week 5 Flashcards

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1
Q

list 3 calcium antagonists

A

Very Nice Drugs

verapamil, nifedipine, diltiazem

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2
Q

Nitrates and nitrites mech

A

decreased preload - lowers left ventricular end-diastolic pressure (causes compensatory increases in heart rate and contractility)

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3
Q

Drug interactions of nitro

A

synergistic hypotension with phosphodiesterase type 5 inhibitors (ED drugs)

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4
Q

Ca channel blockers mech on heart

A

increases coronary blood flow
decreases aortic diastolic pressure

decreases HR
decreases contractility

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5
Q

name one dihidropyradine calcium channel blocker

A

Nifedipine

also anything else that ends in pine like amlodapine

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6
Q

Name two non-dihydropyridine calcium channel blockers

A

`verapamil, dilteazem

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7
Q

What does the cardiac cell do when there is little atp in an attempt to repolarize

A

opens Katp channels to let K out.

other effects of low ATP
high Na in cell
high Ca in cell
delayed repolarization

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8
Q

how to diagnose hemochromatosis

A

order iron pannel, see

high serum iron
>45% transferrin saturation
low iron binding capacity

or see
HFE gene mutation

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9
Q

where does iron accumulate in hemochromatosis

A

as hemosiderin in heart, liver, lungs, endocrine glands, joints, skin

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10
Q

what can happen to the liver in hemochromatosis

A

hepatoma (liver cancer)

can cause diabetes (bronze diabetes)

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11
Q

What happens to the heart in hemochromatosis

A

excess hemosiderin induces myocyte toxcity

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12
Q

what does hemosiderin look like histologically

A

blue streaks

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13
Q

In the US, what is the mechanism of disease in most amyloidosis cases?

A

monoclonal plasma cell proliferation - producting light chains

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14
Q

most dangerous types of amyloidosis

A

“stand alone” aka primary anyloidosis

monoclonal protein-derived (aka cancer)

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15
Q

what does amyloidosis look like in the heart

A

amorphous substance around the myofibrils in the heart

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16
Q

cause of myocarditis in first world countries

A

mostly viral or post viral in kids

then immune mediated

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17
Q

Chagas disease

A

trypanosoma cruzi

myocarditis
infects esophogous

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18
Q

histology of myocarditis

A

a bunch of lymphocytes in myocardium,

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19
Q

histiology of hypersensitivity myocarditis

Tx

A

eosinophils

Tx with steriods

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20
Q

why are platelets down in hemochromatosis

A

cirrhosis -> portal hypertension -> splenomegaly -> spleen sucks up platelets

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21
Q

common causes of pericarditis/pericardial effusion

A

autoimmune: SLE, RA etc.

intrapericardial blood: trauma, anticoag, ruptured MI, aortic dissection

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22
Q

EKG in acute pericarditis

A

can have widespread ST elevation that makes people think it’s a STEMI (STEMI will have ST elevation in particular leads)

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23
Q

chronic/recurrent pericarditis Tx

A

pericardial surgical window

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24
Q

pearls of myxomas

A

left atrium usually
like to block the AV valves causing syncope
can break off and embolize

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25
most emboli that cause stroke come from the _______ as a result of ________
HEART AFIB
26
if someone has a stroke and you cannot find out why for the life of you, what do you look for
ASD RARE
27
leading causes of sudden cardiac death in children
myocarditis, coronary artery anomalies (like two coronary ostia)
28
when do you usually see DVTs
local inflammatory disorder post ortho surg not systemic hypercoagulability
29
Tx for PE
heparin
30
impaired vision loss jaw claudication headache old age
think temporal arteritis
31
how do you definitively diagnose vasculitis
tissue Bx (skin or deeper)
32
painful small tumors of the distal digits
glomus tumor
33
arteriovenous malformations
tangled mass of arteries and veins without intervening capillary bed, can cause high output heart failure and risk of rupture in the brain
34
AV fistula
happens from penetrating vascular injury a bundle of arteries and veins that bypass capillaries surgeons create them for purposes of hemodialysis
35
"most feared high grade malignant vascular neoplasm"
angiosarcoma tends to uccur in skin of head and neck or in places with resected lymph nodes looks like aggressive reddish/purple lesions in the skin with hematogenous metastases
36
hemolytic uremic syndrome can be caused by what bacteria?
E. Coli 0157
37
What do you auscultate for in someone with renovascular hypertension
a bruit over the abdomen
38
in what disease do you see a "string of beads" angiographic apperance on the renal and cerebral vessels
Fibromuscular dysplasia - a deposition of collagen on the arteries
39
What do you think if someone has hypertension and LOW potassium
primary aldosteronism (increased aldosterone) usually from an aldosterone secreting adrenal cortical adenoma
40
what does diabetes do to the kidney
diabetic kidney arteriolar sclerosis kidney glomerulus has multi nodular sclerosis
41
what bacteria CLASSICALLY is associated with aortic aneurism
syphilis also staph, strep
42
Risk of thoracitc aorta and abdominal aorta pearls
- thoracic aorta: 7% rupture risk/year if >6 cm diameter. - abdominal aorta: 5 year risk of rupture 20-40% if >5 cm diameter most aneurysms of aorta are abdominal
43
what do you think when you see purple toes in a guy with vasuculopathic status
cholesterol emboli shower
44
DDx for thoracic aortic aneruysm
hypertension if >40 years | familial connective tissue disorder if
45
how do you confirm aortic dissection
Trans esophogeal echo! look for root dilatation or chest angiography
46
Typical presentation of acute aortic dissection Tx?
slender tall athlete collapses on floor during exertion variable pressures and pulses between arms diastolic murmur because of aortic root dilatation Tx is image and do surgery
47
Takayasu's
arteritis, a granulomatous vasculitis affecting large/medium sized arteries like *aortic arch* and branch vessels prefers adolescent and young adult women aka aortic arch syndrome or pulesless disease downstream ischemic effects
48
polymyalgia rheumatica is linked to what vasculitis
Giant cell vasculitis (aka temporal arteritis)
49
Tx for giant cell arteritis
take out the vessel, corticosteriods
50
kawasakis pearls and TX
Autoimmune destruction of medium sized vessels mucocutaneous lymph node syndrome acute, febrile, in children associated with coronary artery vasculitis, oral mucous membrane changes, palmar/plantar rash Tx with IVIG
51
Skin pearls of small vessel vasculitis
PALPABLE purpura (Henoch-schonlein purpura)
52
What is leukocytoclastic vasculitis
cutaneous vasculitis, aka small vessels vasculitis most common vasculitis in clinical practice
53
systemic small vessels vasculitis effects
arthralgia, GI involvement with colicky abdominal pain/GI bleeding, Glomerulonephritis, IgA nephropathy
54
cryoglobulinemic vasculitis pearls and most common cause
cryoglobulins = measurable cold-recipitated immunoglobulins, usually monoclonal protein type most common cause of it is Hep C Sx: arthralgias, weakness, neuropathy, glomerulonephritis (bad)
55
Antineutrophil cytoplasmic antibody (ANCA) serology is seen in what condition
Wegener’s granulomatosis (c-ANCA) Microscopic polyangiitis (p-ANCA)
56
Rx for wegener's
corticosteroids plus CYTOXAN
57
Typical presentation of microscopic polyangiitis how to diagnose
typically acute presentation with renal failure Dx: on renal Bx can see rapidly progressive glomerulonephritis p-ANCA
58
rare systemic vasculitis associated with asthma
Churg-strauss p-ANCA
59
small vessel vasculitis is associated with what connective tissue diseases
SLE, RA
60
small vessel vasculitis is associated with what infections
rickettia baterial subacute endocarditis viruses - lots of different ones
61
mech of esophageal varicies from portal hypertension
cirrhosis causes increased portal venous pressure which opens porto-systemic shunts causing esophago-gastic varicies
62
virchow's triad
impeded venous circulation, hypercoagulability, endothelial injury/dysfunction seen in DVT
63
Dx for DVT
venous ultrasound with doppler
64
what test do you do if you suspect a PE secondary to DVT
chest CT angiography
65
non pulmonary complications of venous thrombosis
post-thrombotic/ throbophlebitic syndrome: - chronic venous insufficiency (from valve destruction) - often severe stasis dermatitis sequelae - usually due to inadequate course of anti-coagulation with inadequate clot lysis.
66
define carcinoma
cancer of epithelial origin
67
define angioma
cancer via growth of new blood vessels or dilatation of blood vessels
68
kaposi sarcoma
caused by HHV-8 seen often in immunocompromised patients
69
Polyarteritis nodosa
Medium vessel vasculitis involving renal and visceral vessels but sparing the lungs neutrophilic vasculitis with aneurysm formation - aneurisms make small beads like on a rosary 30% of patients with this have hep B
70
ARBs
anything that ends in sartan
71
Typical lab test finding is shock (5 of them)
Hyperkalemia Hyponatremia Hyperglycemia Metabolic acidosis Lactic acidosis
72
shock index
HR/systolic BP
73
vasopressor agents used in shock
NE, epi, dopamine, dobutamine
74
define distributive shock
Distributive shock includes infectious, anaphylactic, endocrine and neurogenic causes. The SIRS features typically occur in early septic shock
75
when do you use a bell for heart sounds
lower pitched sounds i.e. looking for a mitral regurgitation
76
elevated jugular venous pulse reflects:
increased central venous pressure
77
what type of murmur would you expect in congestive heart failure
mitral regurg (S1 holosystolic) because of increased left ventricular dilatation
78
Lateral leads on an EKG
I, aVF, V6
79
inferior leads on an EKG
II, III, aVF
80
anterior leads on EKG
V1,2,3,4
81
SIRS
systemic inflammatory response system

AAW - CRAAB 1 (8 decks)

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