Card Set Information

2010-12-04 23:50:41

CV usmle 2
Show Answers:

  1. What two conditions cause turbulent blood flow?
    • Decreased blood viscosity
    • Increased blood velocity.
  2. What is Wolff-Parkinson-White syndrome, what is seen in the ECG?
    • An alternative conduction from the atria to the ventricle, resulting in early partial depolarization of the ventricles
    • Delta wave is seen right before the R wave
    • This may result in reentry current, leading to supraventricular tachycardia.
  3. What are the two types of escape beats?
    • Junctional: usually AV node, produce normal QRS complexes
    • Ventricular: ectopic ventricular focus (often purkinje fibers), abnormal QRS complex.
  4. Torsades de pointes is a type of?
    Ventricular tachycardia.
  5. What is the most common cause of atrial fibrillation (in the US)?
  6. What is hypertension defined as?
    Sustained systole >140 mmHg and/or diastole >90 mmHg.
  7. What are some risk factors for HTN?
    • Black
    • Obesity
    • Oral contraceptives
    • Smoking
    • Excessive EtOH intake
    • Family history
    • advanced age.
  8. The CV disease risk doubles for each __ increase in pressure?
    • 10 mmHg systolic
    • 5 mmHg diastolic.
  9. Pheochromocytoma presents with triad of?
    • Hypertension
    • Diaphoresis
    • Tachycardia.
  10. What is Monckeberg's arteriosclerosis?
    • Benign
    • Medial calcification of Medium sized Muscular arteries.
  11. What are the two types of arteriolosclerosis?
    • Hyaline: essential HTN, deposits of proteins in tunica intima - increased thickness of intima
    • Hyperplastic: malignant HTN, hyperplasia of basement membrane and smooth muscle - onion skinning.
  12. What is the most common cause of myocarditis?
    Viral: Coxsackie B, Rubella, Cytomegalovirus.
  13. What is the gold standard for diagnosing myocarditis?
    Biopsy showing lymphocytic infiltrates with edematous myocardial interstitium.
  14. Acute endocarditis usually infects, is caused by?
    • Normal heart valves
    • S. Aureus of IV drug abuse.
  15. Subacute endocarditis usually infects, is caused by?
    • Previously damaged heart valves
    • Streptococcus viridans.
  16. What are some clinical features seen in infective endocarditis?
    • Janeway's lesions: non-painful hemorrhages on palms and soles
    • Osler's nodes: painful nodules on fingers and toes
    • Roth's spots: retinal seeding
    • Splinter hemorrhages: beneath fingernails
    • Valvular involvement: mitral>aortic>tricuspid.
  17. What is marantic endocarditis?
    • Also known as: Non-bacterial thrombotic endocarditis (NBTE)
    • Paraneoplastic syndrome from mucin secreting tumor
    • Complication: Sterile peripheral emboli
    • Poor prognosis.
  18. What is Libman-Sacks Endocarditis (LSE), caused by?
    • Autoantibody damage to valves
    • Systemic Lupus Erythematosus (SLE)
    • Usually asymptomatic.
  19. How does carcinoid syndrome affect the heart?
    Increased serotonin levels cause thickening, contraction, and decreased mobility of right-sided valves.
  20. What is the most common cause of non-ischemic cardiomyopathies?
    Dilated cardiomyopathy: 90%.
  21. What are the etiologies of cardiomyopathy?
    • Most common: idiopathic
    • Coxsackie B virus, alcohol, thiamine deficiency, Chagas, etc.
  22. What is the clinical presentation of dilated cardiomyopathy?
    • Decreased Ejection Fraction (EF)
    • JVD
    • edema.
  23. What is the most common cause of sudden cardiac death in young athletes?
    Hypertrophic cardiomyopathy.
  24. What is the presentation for hypertrophic cardiomyopathy?
    • Dyspnea
    • Syncope
    • S4 cardiac gallop
    • May have cardiomegaly.
  25. Diagnosis of hypertrophic cardiomyopathy?
    • Xray: dilated LA
    • Echocardiography: asymmetric hypertrophy, Mitral valve regurgitation, and diastolic dysfunction.
  26. What are three causes of restrictive cardiomyopathy?
    Amyloidosis, sarcoidosis, Loeffler's endomyocarditis (most common worldwide).
  27. What are the two major causes of Left-sided heart failure?
    • Systolic dysfunction: Increased afterload, impaired contractility
    • Diastolic dysfunction: Impaired filling, compliance, or relaxation.
  28. Atherosclerotic aneurysms are associated with, found in?
    • Hypertension (atherosclerotic disease, CAD)
    • Abdominal aorta (less vasa vasorum infrarenally).
  29. Syphilitic (aortitis) anuerysms are characterized by?
    • Medial necrosis and obliterative endarteritis of the vasa vasorum
    • Usuall involves ascending aorta and aortic root.
  30. Rheumatic fever is caused by, usually affects?
    • Group A B-hemolytic streptococci
    • Children age 5-10
    • Multisystem inflammatory disease.
  31. What are the Jones major criteria for diagnosing rheumatic fever?
    • STREP
    • S: Sydenham's chorea
    • T: Transient migratory arthritis
    • R: Rheumatic subcutaneous nodules
    • E: Erythema marginatum
    • P: Pancarditis.
  32. The most serious complication of rheumatic fever is?
    Acute rheumatic heart disease.
  33. Acute rheumatic heart disease can be divided into what three conditions?
    • Fibrinous pericarditis
    • Myocarditis: Aschoff's bodies (fibrinoid and collagen material) surrounded by macrophages (anitschkow's cells) and multinucleated giant cells (aschoff cells)
    • Endocarditis: may lead to mitral or aortic insufficiency or stenosis.
  34. What are the most common hemodynamic changes in the heart (leading to murmurs)?
    • Increased flow
    • Decreased valvular area
    • Regurgitation
    • Dilated chambers
    • shunting.
  35. What are three complications of aortic stenosis?
    • Aortic Stenosis Complications
    • A: angina
    • S: syncope
    • C: CHF (dyspnea).
  36. A widened pulse pressure is seen in what condition?
    Aortic regurgitation.
  37. What is the most common primary cardiac tumor in adults?
    • Cardiac myxoma
    • Usually benign.
  38. What is the most common primary cardiac tumor in children?
    • Cardiac rhabdomyoma
    • Associated with tuberous sclerosis.
  39. What is Virchow's triad of risk factors for DVT?
    • Stasis of blood flow
    • Hypercoagulability
    • Vasuclar damage.
  40. What are the 5 causes of shock?
    • Hypovolemic
    • Cardiogenic
    • Septic
    • Anaphylactic
    • Neurogenic.
  41. What are the three presentations of IHD?
    • Angina pectoris
    • Chronic IHD
    • MI.
  42. What three drug classes are used to treat angina pectoris?
    • Nitrates
    • B-blockers
    • Ca channel blockers.
  43. What is prinzmetal's angina?
    • Aka variant angina
    • intermittent angina at rest, not related to exercise, stress, BP
    • can be induced with ergoline (method of dx)
    • Due to coronary artery vasospasm.
  44. What is the presentation of MI?
    Prolonged (>30-45 min), crushing chest pain not relieved by nitroglycerin or rest.
  45. What are the two types of MI?
    • Nontransmural: NSTEMI, St depression seen ECG, partial occlusion of coronaries
    • Transmural: STEMI, full thickness wall necrosis, complete occlusion of coronaries.
  46. When is an infarcted area of the myocardium at its softest, what risk does it present?
    • 7-10 days
    • Aneurysm, rupture of papillary wall.
  47. When to troponin levels rise after an MI?
    4-6 hours after pain begins, lasts for 7-10 days.
  48. When do levels of CK-MB rise, why is it the test of choice in the first 24 hours post MI?
    • 4-6 hours after pain, lasts for three days
    • Because if the levels rise again, it signals a new MI.
  49. Mnemonic to remember when enzymes peak?
    • 1/2 T-CAL 123
    • Troponin: day .5
    • CK-MB: day 1
    • AST: day 2
    • LDH: day 3.
  50. What are the classes and MOAs of diuretics?
    • Osmotic: goes into tubule, cannot be reabsorbed, increases osmotic pressure
    • Carbonic-anydrase inhibitors: inhibit conversion of HCO3- to CO2, inhibiting HCO3- reabsorption
    • Loop: inhibits Na-K-2Cl channel
    • Thiazide: inhibits Na-Cl symporter
    • Potassium sparing: Spironolactone: competitive inhibitor of aldosterone receptor - Amiloride and Triamterene: Direct inhibitors of Na+ channels in collecting duct.
  51. Example of Osmotic diuretic?
  52. Example and side effect of CAI?
    • Acetazolamide
    • Acidosis (acidazolamide).
  53. Example and side effect of loop diuretics?
    • Furosemide (lasix), ethacrynic acid
    • OH DANG
    • O: ototoxicity
    • H: hypokalemia, hypercalciuria
    • D: dehydration
    • A: allergy to sulfa
    • N: Nephritis
    • G: gout.
  54. Example and side effects of thiazide diuretics?
    • Hydrochlorothiazide
    • HyperGLUC
    • G: hyperglycemia
    • L: hyperlipidemia
    • U: hyperuricemia
    • C: hypercalcemia.
  55. What are two centrally acting sympathoplegics, MOA?
    • Methyldopa: BP med during pregnancy
    • Clonidine: Rebound HTN
    • alpha-2 agonists: decrease central sympathetic outflow (brain stem).
  56. Drugs that end in -zosin are?
    • Alpha-1 antagonists (mainly at arterioles)
    • Block vasoconstriction and decrease SVR.
  57. What are the two types of Ca channel blockers, MOA?
    • Vasoselective: dihydropyridines: Nifedipine, amlodipine
    • Nonselective: also decrease contractility - diltiazem, verapamil
    • Block L-type Ca channels, inhibiting intake of Ca into arteriolar SMC, inhibiting contraction.
  58. What is nitroprusside?
    Spontaneous releaser of NO, used IV in hypertensive emergencies.
  59. What causes drug-induced lupus?
  60. How does Minoxidil work?
    Opens K+ channels in arteriolar SMC, hyperpolarizing and preventing contraction.
  61. What are the drugs of choice for prinzmetals (variant) angina?
    Ca channel blockers.
  62. What is streptokinase, how does it work?
    • Fibrinolytic
    • Indirectly activates plasminogen
    • (non fibrin specific).