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658 Cards in this Set
- Front
- Back
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What are the three structures located inside the carotid sheath?
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The internal jugular Vein, the common carotid Artery, and the vagus Nerve (remember the Mnemonic VAN)
2010-250 |
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What is the spatial relationship among the three structures located inside the carotid sheath?
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The internal jugular vein is lateral, the common carotid artery is medial, and the vagus nerve is posterior
2010-250 |
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What is the most posterior part of the heart?
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The left atrium
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In most cases, the sinoatrial and atrioventricular nodes are supplied by which coronary artery?
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The right coronary artery
2010-250 |
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An enlarged left atrium can cause which noncardiac symptoms?
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Dysphagia due to compression of the esophageal nerve and hoarseness due to compression of the recurrent laryngeal nerve
2010-250 |
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In what part of the cardiac cycle do the coronary arteries fill?
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Diastole
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A patient has a myocardial infarction that damages the anterior interventricular septum and the apex. Which coronary artery was occluded?
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The left anterior descending artery
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If the right coronary artery supplies the inferior portion of the left ventricle via the posterior descending artery is the heart right or left dominant?
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Right dominant
2010-250 |
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Which coronary artery supplies the posterior left ventricle?
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Circumflex artery
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Which coronary artery supplies the right ventricle?
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Acute marginal artery (from the right coronary artery)
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The right coronary artery supplies the posterior septum via which coronary artery?
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The posterior descending artery
2010-250 |
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The posterior descending artery that supplies the posterior septum arises from the circumflex artery in _____ (20%/50%/80%) of cases.
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20%; this is a left-dominant heart
2010-250 |
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Which coronary artery is most commonly occluded?
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The left anterior descending artery, which supplies the interventricular septum
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What accounts for the increase in cardiac output in the first stages of exercise?
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An increase in stroke volume is responsible for the increase in cardiac output in the first stages of exercise
2010-250 |
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What are the two equations for mean arterial pressure?
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Mean atrial pressure = cardiac output x total peripheral resistance; mean atrial pressure = (1/3) systolic pressure + (2/3) diastolic pressure
2010-250 |
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Stroke volume = end-diastolic volume - _____ _____.
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End-systolic volume
2010-250 |
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What is Fick's principle?
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Cardiac output = rate of oxygen consumption / (arterial oxygen content - venous oxygen content)
2010-250 |
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What accounts for the increase in cardiac output after prolonged exercise?
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An increase in heart rate is responsible for the increase in cardiac output after prolonged exercise
2010-250 |
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Cardiac output = stroke volume x _____ _____.
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Heart rate
2010-250 |
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Pulse pressure is proportional to what other cardiac parameter?
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Stroke volume
2010-250 |
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What accounts for the decrease in cardiac output at very high heart rates?
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At very high heart rates, the ventricles are unable to fill completely during diastole; therefore, the cardiac output decreases
2010-250 |
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How does increasing intracellular calcium affect contractility (and thus stroke volume)?
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An increase in intracellular calcium increases contractility; this is the mechanism of digitalis
2010-251 |
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By what mechanism do catecholamines cause an increase in contractility?
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By increasing the activity of the calcium pump in the sarcoplasmic reticulum
2010-251 |
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Does pregnancy increase or decrease stroke volume?
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Increase
2010-251 |
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How does decreasing extracellular sodium affect contractility (and thus stroke volume)?
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A decrease in extracellular sodium increases contractility by decreasing the activity of the sodium/calcium ion exchanger
2010-251 |
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Would a patient with hypertrophic cardiomyopathy have an increase or decrease in myocardial oxygen demand?
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Increase
2010-251 |
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How does digitalis affect contractility (and thus stroke volume)?
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Digitalis increases contractility by causing an increase in intracellular sodium, which results in an increase in intracellular calcium, which strengthens contractions
2010-251 |
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How do catecholamines affect contractility (and thus stroke volume)?
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Catecholamines increase contractility
2010-251 |
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Does increasing contractility increase or decrease myocardial oxygen demand?
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Increase
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By what mechanism does increasing heart size increase myocardial oxygen demand?
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By causing an increase in wall tension
2010-251 |
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What are the three variables that affect stroke volume?
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Contractility, Afterload, and Preload (remember the mnemonic SV CAP)
2010-251 |
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With an increase in stroke volume, one would expect the heart to have a(n) _____ (decrease/increase) in preload, a(n) _____ (decrease/increase) in afterload, and/or a(n) _____ (decrease/increase) in contractility.
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Increase; decrease; increase
2010-251 |
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How does β1 blockade affect contractility and stroke volume?
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β1 blockade decreases contractility and stroke volume
2010-251 |
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How does hypoxia affect contractility?
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Hypoxia causes a decrease in contractility and in stroke volume
2010-251 |
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How does acidosis affect contractility?
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Acidosis decreases contractility
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How do calcium channel blockers affect contractility and stroke volume?
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Calcium channel blockers decrease contractility and stroke volume by decreasing intracellular calcium
2010-251 |
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Would chronic hypertension increase or decrease myocardial oxygen demand? By what mechanism?
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Chronic hypertension would cause an increase in myocardial oxygen demand by causing an increase in afterload
2010-251 |
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An increase in peripheral resistance will cause an _____ (increase/decrease) in afterload.
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Increase
2010-251 |
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Would you expect nitroglycerin to decrease preload or afterload? By what mechanism?
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Nitroglycerin decreases preload by causing venodilation
2010-251 |
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A 60-year-old male patient mistakenly receives triple the maintenance level of intravenous fluids for 24 hours. Do you expect his preload to increase or decrease?
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Increase
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________ (Preload/Afterload) = ventricular end-diastolic volume.
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Preload
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Would you expect hydralazine to decrease preload or afterload? By what mechanism?
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Hydralazine decreases afterload by causing arterial dilation
2010-251 |
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_____ (Preload/Afterload) = mean arterial pressure.
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Afterload
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Does digitalis increase or decrease contractile strength?
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Increase
2010-251 |
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Do circulating catecholamines increase or decrease contractility of the heart?
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Increase
2010-251 |
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The Starling curve shows that the force of contraction is proportional to what?
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The preload or the initial length of the cardiac muscle fiber
2010-251 |
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Do β-blockers and calcium channel blockers increase or decrease contractile strength?
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Decrease
2010-251 |
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Does sympathetic stimulation increase or decrease contractility of the heart?
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Increase
2010-251 |
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The Starling curve represents the relationship between which two cardiac parameters?
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Preload and cardiac output
2010-251 |
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Would an increase in end-diastolic volume be indicative of an increase or decrease in the ejection fraction?
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Decrease
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Ejection fraction is used as an indication of which cardiac parameter?
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Contractility
2010-251 |
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The cardiac ejection fraction is normally greater than what percentage of the total end-diastolic volume?
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55%
2010-251 |
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Ejection fraction = _____ _____ / end-diastolic volume.
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Stroke volume
2010-251 |
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What is the equation for ejection fraction?
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Ejection fraction = (end-diastolic volume - end-systolic volume) ÷ end-diastolic volume
2010-251 |
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Which equation in cardiology, relating the variables of resistance, pressure, and flow, is a restatement of Ohm's law?
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Change in pressure (P1 - P2) = flow (Q) x resistance (R)
2010-252 |
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Which blood vessels account for most of total peripheral resistance?
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Arterioles
2010-252 |
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What is the equation for the total resistance of blood vessels in parallel?
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1/(Total resistance) = 1 / R1 + 1 / R2 + 1 / R3...
2010-252 |
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What is the equation for blood vessel resistance that incorporates variables of viscosity, length, and radius?
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Resistance = (8 x viscosity x length) / (π x [r4])
2010-252 |
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Which parameter does the viscosity of blood mostly depend on?
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Hematocrit
2010-252 |
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What is Ohm's law?
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Change in voltage (V1 - V2) = current (I) x resistance (R)
2010-252 |
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Name three hematologic disease states in which the viscosity of blood increases.
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Polycythemia, multiple myeloma (or other hyperproteinemic states), hereditary spherocytosis
2010-252 |
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What is the equation for the total resistance of blood vessels in series?
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Total resistance = R1 + R2 + R3...
2010-252 |
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In cardiology, by what factor does resistance increase in a vessel whose size is reduced by one half?
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16 times; resistance is inversely proportional to the radius to the fourth power
2010-252 |
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Pressure gradient drives flow from _____ (high/low) pressure to _____ (high/low) pressure.
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High; low
2010-252 |
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An increase in blood volume leads to a(n) _____ (increase/decrease) in right atrial pressure and a(n) _____ (increase/decrease) in cardiac output.
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Increase; increase
2010-252 |
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What does the x-intercept of the venous return curve signify?
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The value of the mean systemic pressure
2010-252 |
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What is the name for the point at which cardiac output is equal to venous return?
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The operating point of the heart
2010-252 |
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A 23-year-old man has significant blood loss following a motor vehicle accident. A decrease in blood volume leads to a(n) _____ (increase/decrease) in right atrial pressure and a(n) _____ (increase/decrease) in cardiac output.
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Decrease; decrease
2010-252 |
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A 76-year-old man with congestive heart failure is given digoxin as a positive inotrope. An increase in inotropy leads to a(n) _____ (increase/decrease) in cardiac output and a(n) _____ (increase/decrease) in right atrial pressure.
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Increase; increase
2010-252 |
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A 10-year-old boy presents with dehydration following acute diarrhea. He receives 2 liters of normal saline. An increase in blood volume leads to a(n) _____ (increase/decrease) in right atrial pressure and a(n) _____ (increase/decrease) in cardiac output.
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Increase; increase
2010-252 |
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What is the name of the phenomenon that occurs when P2 (pulmonic valve) precedes A2 (aortic valve) in the heart sound S2?
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Paradoxic splitting
2010-253 |
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In relation to the cardiac cycle, the "C wave" of the jugular venous pulse is associated with what contraction?
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Right ventricle contraction (ie, the tricuspid valve bulging into the atrium)
2010-253 |
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When listening to a normal heart, which valve closes first during S2: the aortic valve or the pulmonic valve?
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The aortic valve
2010-253 |
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What phase of the cardiac cycle corresponds with the period just before mitral valve closure?
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Reduced filling
2010-253 |
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What phase of the cardiac cycle corresponds with the period between the opening and closing of the aortic valve?
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Systolic ejection
2010-253 |
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Which abnormal heart sound is associated with dilated congestive heart failure?
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S3
2010-253 |
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What causes the S4 heart sound or "atrial kick"?
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The left atrium pushing against a stiff left ventricular wall in a patient with ventricular hypertrophy
2010-253 |
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What phase of the cardiac cycle corresponds with the period between the closing of the aortic valve and the opening of the mitral valve?
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Isovolumetric relaxation
2010-253 |
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Which abnormal heart sound occurs during rapid ventricular filling?
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S3
2010-253 |
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In relation to the cardiac cycle, the "V wave" of the jugular venous pulse is associated with what?
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Increased atrial pressure as a result of filling against the closed tricuspid valve
2010-253 |
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What is the name of the finding on auscultation that occurs when the aortic valve closes before the pulmonic valve?
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S2 splitting
2010-253 |
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On auscultation of a patient with an atrial septal defect during inspiration, does the time period between pulmonic and aortic valvular closure increase, decrease, or stay the same?
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Stays the same; because pressures can equalize across the atrial wall, there is no change in splitting during inspiration
2010-253 |
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During auscultation of a patient with aortic stenosis during inspiration, does the time period between pulmonic and aortic valvular closure increase or decrease?
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Decrease; this is known as paradoxical splitting
2010-253 |
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During which phase is ventricular volume lowest?
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During isovolumetric relaxation
2010-253 |
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In which disorder is the paradoxical splitting of the S2 heart sound seen?
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Aortic stenosis
2010-253 |
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During which phase is ventricular volume highest?
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During atrial systole
2010-253 |
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Which heart sound is also referred to as the "atrial kick"?
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S4
2010-253 |
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What phase of the cardiac cycle corresponds with the period between mitral valve closure and aortic valve opening?
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Isovolumetric contraction
2010-253 |
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With regard to auscultation of the heart, in what area is S1 loudest?
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The mitral area (ie, the midclavicular line in the fifth intercostal space)
2010-253 |
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Which heart sound occurs during mitral and tricuspid valve closure?
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S1
2010-253 |
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How is normal S2 splitting increased?
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By inspiration
2010-253 |
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True or false: The presence of an S3 in children always indicates a cardiac defect.
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False; S3 can be a normal finding in children and pregnant women
2010-253 |
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During a physical examination, what diagnostic sign may be observable in the neck of a patient with right heart failure?
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Elevated jugular venous pressure
2010-253 |
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Wide splitting of the S2 heart sound is associated with _____ stenosis.
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Pulmonic
2010-253 |
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What phase of the cardiac cycle corresponds with the period just after mitral valve opening?
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Rapid filling
2010-253 |
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Which heart sound occurs during aortic and pulmonary valve closure?
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S2
2010-253 |
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With regard to auscultation of the heart, in what area is S2 loudest?
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The left sternal border
2010-253 |
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Which abnormal heart sound is associated with a hypertrophic ventricle?
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S4
2010-253 |
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In relation to the cardiac cycle, the "A wave" of the jugular venous pulse is associated with what?
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Contraction of the atrium
2010-253 |
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What phase of the cardiac cycle corresponds with the period of highest oxygen consumption?
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Isovolumetric contraction
2010-253 |
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_____ (Normal/Wide/Fixed/Paradoxical) splitting is seen in conditions that delay right ventricle emptying (ie, pulmonic stenosis and right bundle-branch block).
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Wide
2010-254 |
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_____ (Normal/Wide/Fixed/Paradoxical) splitting is seen in conditions that delay left ventricular emptying (ie, aortic stenosis and left bundle-branch block).
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Paradoxical
2010-254 |
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In normal splitting of the S2 heart sound, the pulmonic valve closes later during inspiration due to _____ (increased/decreased) blood flow in lungs, and the aortic valve closes earlier during inspiration due to _____ (increased/decreased) venous return to the left heart.
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Increased; decreased
2010-254 |
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Normal inspiration causes a _____ (increase/decrease) in intrathoracic pressure, which in turn causes _____ (increased/decreased) capacity for pulmonary blood flow.
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Decrease; increased
2010-254 |
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Regarding auscultation of the heart, in what area is the murmur of a ventricular septal defect best heard?
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The tricuspid area (ie, the left sternal border at the fifth intercostal space)
2010-254 |
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Regarding auscultation of the heart, in what areas are the murmurs of pulmonic stenosis and pulmonic regurgitation best heard?
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The pulmonic area (ie, the left sternal border at the second intercostal space) and the left sternal border, respectively
2010-254 |
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On which part of the chest are mitral valve murmurs best auscultated?
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The mitral area (ie, the midclavicular line at the fifth intercostal space)
2010-254 |
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In which phase of the cardiac cycle is the murmur of aortic stenosis heard?
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Systole
2010-254 |
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Pulmonic flow murmurs and diastolic rumbles are commonly associated with which cardiac defect?
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Atrial septal defects. The pulmonic flow murmur is due to increased flow through the pulmonary valve, and the diastolic rumble is due to increased flow across the tricuspid valve
2010-254 |
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Regarding auscultation of the heart, in what areas are the murmurs of aortic stenosis and aortic regurgitation best heard?
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The aortic area (ie, the right sternal border and the second intercostal space) and the left sternal border, respectively
2010-254 |
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With regard to auscultation of the heart, in what area is the murmur of an atrial septal defect best heard?
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The tricuspid area (ie, the left sternal border at the fifth intercostal space)
2010-254 |
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In which phases of the cardiac cycle are the murmurs of mitral stenosis and mitral regurgitation heard?
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Diastole and systole, respectively
2010-254 |
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In which phase of the cardiac cycle is the murmur of tricuspid stenosis heard?
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Diastole
2010-254 |
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On which part of the chest are tricuspid valve murmurs best auscultated?
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The tricuspid area (ie, the left sternal border at the fifth intercostal space)
2010-254 |
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With regard to auscultation of the heart, in what area are flow murmurs best heard?
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The second intercostal space and both the left and right sternal borders
2010-254 |
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A murmur of hypertrophic cardiomyopathy occurs in the ______ phase of the cardiac cycle.
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Systolic
2010-254 |
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In which phase of the cardiac cycle are the murmurs of aortic regurgitation and pulmonic regurgitation heard?
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Diastole
2010-254 |
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With regard to auscultation of the heart, in what area is the murmur of hypertrophic cardiomyopathy best heard?
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The left sternal border (generally)
2010-254 |
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Which heart murmur is described as a delayed, rumbling, late-diastolic murmur?
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Mitral stenosis
2010-255 |
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What type of murmur occurs in late systole after a midsystolic click and is loudest at S2?
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Mitral prolapse
2010-255 |
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Where is the murmur of mitral regurgitation the loudest?
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At the apex
2010-255 |
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Which heart murmur is described as a crescendo-decrescendo systolic murmur following an ejection click?
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Aortic stenosis
2010-255 |
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Which heart murmur is described as a continuous, machine-like murmur?
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Patent ductus arteriosus
2010-255 |
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What type of murmur is loudest at the left sternal border at the fifth intercostal space and radiates to the right sternal border?
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Tricuspid regurgitation
2010-255 |
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What are three examples of pathological processes that can cause aortic regurgitation?
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Aortic root dilatation, bicuspid aortic valve, or rheumatic fever
2010-255 |
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Murmurs due to valvular defects on the right side of the heart _____ (decrease/increase) in intensity on inspiration.
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Increase
2010-255 |
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What are three examples of pathological processes that can cause mitral regurgitation?
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Ischemic heart disease, mitral valve prolapse, and left ventricular dilatation
2010-255 |
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Which murmur is often due to age-related calcification?
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Aortic stenosis
2010-255 |
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To where does the aortic stenosis murmur radiate?
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The carotid arteries
2010-255 |
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Which heart chamber has the greatest increase in pressure above normal in a patient with mitral stenosis?
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Left atrium
2010-255 |
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What causes the increase in intensity upon expiration of a left-sided cardiac defect?
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Increased blood flow into the left atrium
2010-255 |
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In tricuspid stenosis, the murmur gets louder with _____ (inspiration/expiration) due to increased blood flow into the right atrium.
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Inspiration
2010-255 |
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What are two examples of pathological processes that can cause tricuspid regurgitation?
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Right ventricular dilatation or endocarditis
2010-255 |
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Which heart murmur follows an opening snap?
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Mitral stenosis
2010-255 |
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Which heart murmur is described as a late systolic murmur with midsystolic click?
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Mitral prolapse
2010-255 |
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Which heart murmur can be accompanied by a wide pulse pressure?
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Aortic regurgitation
2010-255 |
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What type of murmur is loudest at the apex and radiates toward the axilla?
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Mitral valve murmurs
2010-255 |
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Which heart murmur is described as a holosystolic, high-pitched, blowing murmur?
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Mitral regurgitation
2010-255 |
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What type of murmur is holosystolic, harsh sounding, and loudest at the left sternal border at the fifth intercostal space?
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Ventricular septal defect
2010-255 |
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Compare the pressures in the left ventricle and aorta in a patient with aortic stenosis with those in a healthy patient.
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In a patient with aortic stenosis, the pressure in the left ventricle is higher than the pressure in the aorta; the ventricle squeezes blood past a stenotic valve, thus the pressure before the valve (the ventricle) is higher than the pressure after the valve (in the aorta)
2010-255 |
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What is the most frequent murmur-causing valvular lesion?
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Mitral prolapse
2010-255 |
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Which heart murmur is described as an immediate high-pitched, "blowing," diastolic murmur?
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Aortic regurgitation
2010-255 |
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When a cardiac defect occurs on the left side of the heart, does the intensity of the corresponding murmur generally increase or decrease upon expiration?
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Increase
2010-255 |
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A ventricular septal defect causes what type of murmur: late systolic, diastolic, or holosystolic?
|
Holosystolic
2010-255 |
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What does the term pulsus parvus et tardus mean?
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Pulses are weak, and the strongest part of the peripheral pulse occurs late after the S1 is heard; this is because it takes a longer time for blood to cross the stenotic aortic valve to fill the vessels
2010-255 |
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Rheumatic fever can lead to which valve abnormality?
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Mitral stenosis
2010-255 |
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Which heart murmur is usually benign, but can predispose to infective endocarditis?
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Mitral prolapse
2010-255 |
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Which heart valve disease process can be associated with syncope?
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Aortic stenosis
2010-255 |
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What is the effect of extracellular calcium entering the cardiac myocyte?
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Calcium release from the cardiac muscle sarcoplasmic reticulum (calcium-induced calcium release); and the resulting muscle contraction
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During what phase of the cardiac myocyte action potential does extracellular calcium enter the cell?
|
The plateau phase
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The plateau in cardiac muscle action potential is caused by what?
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Calcium influx
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Which ion channels cause the automaticity of cardiac nodal cells?
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If channels cause the cells to spontaneously depolarize
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How long does the effective refractory period of the cardiac myocyte last?
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For the duration of the action potential until the cell returns to resting potential
2010-256 |
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What happens during phase 3 of the cardiac myocyte action potential?
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Rapid repolarization due to increased permeability to potassium
2010-256 |
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What happens during phase 2 of the cardiac myocyte action potential?
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Electrical plateau due to equivalent calcium influx and potassium efflux
2010-256 |
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What happens during phase 0 of the cardiac myocyte action potential?
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Rapid depolarization due to increased sodium permeability
2010-256 |
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What is the voltage value of the resting potential of a ventricular myocyte?
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- 85 mV; the value is maintained by the sodium/potassium pump and high permeability to potassium
2010-256 |
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During phase 4 of the action potential in a ventricular myocyte, to which ion is the membrane highly permeable?
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Potassium; as a result, the resting potential of the cell is close to that of potassium
2010-256 |
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What happens during phase 1 of the cardiac myocyte action potential?
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Initial repolarization due to increased potassium permeability
2010-256 |
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What happens during phase 3 of the cardiac myocyte action potential?
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Rapid repolarization due to potassium efflux that returns the cell to a more negative potential
2010-256 |
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What happens in phase 3 of the cardiac pacemaker action potential?
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Inactivation of the calcium channels and activation of the potassium channels
2010-257 |
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As compared with the myocardial action potential, which phases are absent from the pacemaker potential?
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Phases 1 and 2
2010-257 |
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Sympathetic stimulation _____ (decreases/increases)the possibility that If channels are open.
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Increases; as a result, the pacemaker cell depolarizes more frequently and the heart beats faster
2010-257 |
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Cardiac myocytes in which locations have pacemaker action potentials?
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The sinoatrial and the atrioventricular nodes
2010-257 |
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Which ion channels in a pacemaker cell are permeable to sodium?
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If channels
2010-257 |
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The lack of voltage-gated sodium channels in pacemaker cells results in what effect on cardiac conduction?
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A slowed conduction velocity through the atrioventricular node to prolong transmission from the atria to the ventricles
2010-257 |
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What happens in phase 0 of the pacemaker action potential?
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Voltage-gated calcium channels open
2010-257 |
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During the pacemaker action potential, the slope of which phase determines the heart rate?
|
Phase 4
2010-257 |
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What happens in phase 4 of the cardiac pacemaker action potential?
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Slow diastolic depolarization due to increased permeability to sodium ion
2010-257 |
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How does acetylcholine affect the rate of diastolic depolarization and heart rate?
|
It decreases the rate of diastolic depolarization (the slope of phase 4 of the action potential) and thus decreases heart rate
2010-257 |
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In what part of the electrocardiogram is atrial repolarization?
|
Atrial repolarization is masked within the QRS complex
2010-258 |
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On an electrocardiogram, what does the PR segment represent? How long is a normal PR interval?
|
Conduction delay through the atrioventricular node; normally less than 200 msec
2010-258 |
|
|
On an electrocardiogram, what does the P wave represent?
|
Atrial depolarization
2010-258 |
|
|
What is the physiologic benefit of the atrioventricular delay?
|
It allows time for ventricular filling
2010-258 |
|
|
On an electrocardiogram, ventricular repolarization is represented by what?
|
The T wave
2010-258 |
|
|
On an electrocardiogram, what does the ST segment represent?
|
The isoelectric state after the ventricles have been depolarized and before repolarization
2010-258 |
|
|
What do U waves on an electrocardiogram represent?
|
Hypokalemia or bradycardia
2010-258 |
|
|
What segment of the electrocardiogram corresponds with the mechanical contraction of the ventricles?
|
The QT interval
2010-258 |
|
|
On an electrocardiogram, what does the QRS complex represent? What is considered a normal QRS duration?
|
Ventricular depolarization; normally less than 120 msec
2010-258 |
|
|
Define torsades des pointes.
|
A ventricular tachycardia that is characterized by shifting sinusoidal waves on an electrocardiogram; a literal translation is, "twisting of the points"
2010-258 |
|
|
What is the main risk factor for torsades des pointes?
|
Prolongation of the QT interval, usually due to drug adverse effects or genetic syndromes
2010-258 |
|
|
Congenital long QT syndromes can be associated with what other pathology?
|
Severe congenital sensorineural hearing deficit (Jervell and Lange-Nielsen syndrome)
2010-258 |
|
|
What is the etiology of congenital long QT syndromes?
|
Most often they are due to defects in sodium or potassium channels
2010-258 |
|
|
What are the most dangerous sequelae of torsades des pointes?
|
Ventricular fibrillation and death
2010-258 |
|
|
What is the Bundle of Kent?
|
An accessory conduction pathway from atria to ventricles, which bypasses the atrioventricular node; occurring in Wolff-Parkinson-White syndrome
2010-259 |
|
|
What is the electrocardiogram finding pathognomonic for Wolff-Parkinson-White syndrome and what does it signify?
|
A delta wave, which signifies partial early depolarization of the ventricles via an accessory pathway
2010-259 |
|
|
Patients with Wolff-Parkinson-White syndrome are at higher risk for which type of arrhythmia?
|
Supraventricular tachycardia
2010-259 |
|
|
In patients with Wolff-Parkinson-White syndrome, what does the delta wave on electrocardiogram represent?
|
Early depolarization of the ventricle due to the accessory conduction pathway (bundle of Kent), which bypasses the atrioventricular node
2010-259 |
|
|
A 73-year-old female presents with an electrocardiogram tracing with a "sawtooth" pattern. Which three classes of drugs can be given to treat this condition?
|
Class IA, IC, or III antiarrhythmics
2010-259 |
|
|
Which rhythm on electrocardiogram is classically described as having an irregularly irregular pattern with no discrete P waves?
|
Atrial fibrillation
2010-259 |
|
|
Which rhythm on electrocardiogram is described as having a "sawtooth" baseline?
|
Atrial flutter
2010-259 |
|
|
What is the dangerous sequela of atrial fibrillation?
|
Atrial stasis leading to thrombosis, which can embolize and cause stroke
2010-259 |
|
|
A 67-year-old male presents with an irregularly irregular electrocardiogram tracing at a routine doctor's visit. Which drug can decrease his risk of stroke? Which drug can control his heart rate?
|
Warfarin (Coumadin) to prevent thromboembolism and β-blockers or calcium channel blockers to control heart rate
2010-259 |
|
|
Is first-degree atrioventricular block symptomatic or asymptomatic?
|
Asymptomatic
2010-259 |
|
|
What is the characteristic electrocardiogram finding of first-degree atrioventricular block?
|
Prolonged PR interval (> 200 msec) with no lengthening of the interval and no dropped beats
2010-259 |
|
|
Does progressive lengthening of the PR interval take place in Mobitz type I, Mobitz type II, or both?
|
Type I involves progressive lengthening followed by a dropped beat; in type II there are dropped beats without progressive lengthening
2010-260 |
|
|
Which form of second-degree atrioventricular block is more likely to progress to a third-degree block?
|
Mobitz type II
2010-260 |
|
|
In third-degree heart block, the atrial rate is _____ (slower/faster) than the ventricular rate.
|
Faster
2010-260 |
|
|
An electrocardiogram has an increasing PR interval with each successive beat until a QRS complex does not appear after a P wave. The next beat has a normal PR interval. What is the most likely diagnosis?
|
Second-degree atrioventricular block, Mobitz type I (Wenckebach)
2010-260 |
|
|
An electrocardiogram shows P waves and QRS complexes that have no temporal relation to each other. The atrial rate is faster than the ventricular rate. What is the most likely diagnosis?
|
Third degree (complete) atrioventricular block
2010-260 |
|
|
An electrocardiogram shows dropped beats that are not preceded by a change in the length of the PR interval. What is the most likely diagnosis?
|
Second degree atrioventricular block, Mobitz type II
2010-260 |
|
|
A 65-year-old male presents with an electrocardiogram tracing that displays P waves and QRS complexes that occur independently of each other. Which therapeutic intervention would be most appropriate?
|
Treatment with an implantable pacemaker
2010-260 |
|
|
Given an electrocardiogram showing second-degree Mobitz type II heart block, how can the arrhythmia be further classified?
|
By the ratio of P waves to QRS complexes (eg, 2:1 or 3:1)
2010-260 |
|
|
Which infectious disease can cause third-degree heart block?
|
Lyme disease
2010-260 |
|
|
An electrocardiogram shows no identifiable waves. What is the most likely diagnosis?
|
Ventricular fibrillation
2010-260 |
|
|
In what type of heart block do the atria and ventricles beat independently of each other?
|
Third-degree heart block
2010-260 |
|
|
By what mechanism does activation of α-1 receptors cause an increase in mean arterial pressure?
|
α-1 Receptor activation causes venoconstriction, which increases venous return and thus cardiac output; and arterial vasoconstriction, which causes an increase in total peripheral resistance
2010-261 |
|
|
By what mechanism does activation of the sympathetic nervous system cause an increase in mean arterial pressure?
|
By activation of β-1 and α-1 receptors, which cause an increase in cardiac output and total peripheral resistance, respectively
2010-261 |
|
|
By what mechanism does activation of β-1 receptors cause an increase in cardiac output?
|
Activation of β-1 receptors causes an increase in heart rate and contractility
2010-261 |
|
|
What is atrial natriuretic peptide?
|
It is released from the atria in response to elevated pressure and causes vascular relaxation and diuresis in the kidneys
2010-261 |
|
|
By what mechanism does aldosterone increase cardiac output and mean arterial pressure?
|
Aldosterone works in the kidneys to increase blood volume (and thus cardiac output)
2010-261 |
|
|
What are the two main regulators that increase mean arterial pressure when it is low?
|
Increased sympathetic tone and activation of the renin-angiotensin system
2010-261 |
|
|
Atrial natriuretic peptide _____ (constricts/dilates) efferent renal arterioles, and _____ (constricts/dilates) afferent arterioles.
|
Constricts; dilates; as a result, glomerular filtration rate is increased
2010-261 |
|
|
By what two mechanisms is a decrease in mean arterial pressure sensed?
|
The medullary vasomotor center detects decreased baroreceptor firing; the juxtaglomerular apparatus in the kidney detects decreased renal perfusion
2010-261 |
|
|
By what mechanism does angiotensin II increase blood pressure?
|
Angiotensin II causes vasoconstriction
2010-261 |
|
|
By what mechanism does activation of the renin-angiotensin system cause an increase in mean arterial pressure?
|
By production of angiotensin II and aldosterone, which cause increased total peripheral resistance and increased blood volume, respectively
2010-261 |
|
|
What is Cushing's triad?
|
Cushing's triad is the triad of hypertension, bradycardia, and respiratory depression in response to ischemia in the brain
2010 |
|
|
Describe the body's response after baroreceptors sense hypotension.
|
Hypotension causes decreased arterial pressure/stretch, which decreases afferent baroreceptor firing, increases efferent sympathetic firing, and decreases efferent parasympathetic stimulation, all of which cause vasoconstriction, increased heart rate, contractility, and blood pressure
2010 |
|
|
Are peripheral or central chemoreceptors responsible for the Cushing reaction?
|
Central chemoreceptors
2010 |
|
|
Which type of receptors are most important in causing the body's response to severe hemorrhage?
|
Baroreceptors
2010 |
|
|
What chemical changes of blood elicit a response from peripheral chemoreceptors? How do central chemoreceptors differ?
|
Low PO2, (< 60 mmHg), high PCO2, and low pH of blood; central chemoreceptors are not sensitive to oxygen
2010 |
|
|
The carotid sinus receptors transmit impulses to the medulla via which nerve? In response to which stimuli?
|
Carotid sinus receptor afferents travel via the glossopharyngeal nerve in response to both high and low blood pressure
2010 |
|
|
Central chemoreceptors respond to changes in the pH and the partial pressure of carbon dioxide of the brain interstitial fluid, which in turn are influenced by what?
|
Arterial carbon dioxide
2010 |
|
|
The aortic arch receptors transmit impulses to the medulla via which nerve? In response to which stimulus?
|
Aortic receptor afferents travel via the vagus in response to only high blood pressure
2010 |
|
|
Changes in which two parameters of brain interstitial fluid affect the response of central chemoreceptors?
|
pH and the partial pressure of carbon dioxide
2010 |
|
|
Why does carotid massage cause bradycardia?
|
Carotid massage causes increased pressure/stretch on the carotid artery, which causes the afferent baroreceptors to fire, which results in a decrease in heart rate
2010 |
|
|
What is Cushing's reaction?
|
The chain reaction that occurs in response to increased intracranial pressure. Increased intracranial pressure leads to arteriolar vasoconstriction, which causes cerebral ischemia, leading to a sympathetic response of hypertension, and ultimately resulting in reflex bradycardia
2010 |
|
|
A 25-year-old athlete begins training for the Olympics. As she runs her standard 3 miles, is the increased oxygen demand of the heart met by increased coronary blood flow or increased extraction of oxygen?
|
Increased coronary blood flow; the heart always operates with maximal oxygen extraction
2010 |
|
|
Which organ has the greatest arteriovenous oxygen concentration difference and why?
|
The heart, because oxygen extraction is always approximately 100%
2010 |
|
|
Which internal organ gets the largest share of the systemic cardiac output?
|
The liver
2010 |
|
|
Which organ has the highest blood flow per gram of tissue?
|
The kidney
2010 |
|
|
What is the normal pressure for the left atrium?
|
<12 mmHg
2010-262 |
|
|
What is the normal pressure for the aorta during systole and diastole?
|
<130 / 90 mmHg
2010-262 |
|
|
Pulmonary capillary wedge pressure is a good approximation of the pressure of which chamber?
|
The left atrium
2010-262 |
|
|
What is the normal pressure for the left ventricle during systole and diastole?
|
<130 / 10 mmHg
2010-262 |
|
|
A 75-year-old male with congestive heart failure presents with worsening shortness of breath. On physical exam he has a 3/6 diastolic murmur best heard in the fifth intercostal space in the midclavicular line and crackles in the bases of the lungs. What c
|
This patient has mitral stenosis and one would expect the pulmonary capillary wedge pressure to be greater than the left ventricular diastolic pressure
2010-262 |
|
|
What is the normal pressure for the right ventricle during systole and diastole?
|
<25 / <5 mmHg
2010-262 |
|
|
An 80-year-old woman is in shock in the intensive care unit. The attending physician orders the determination of a pulmonary capillary wedge pressure. What instrument is used to perform this study?
|
A Swan-Ganz catheter
2010-262 |
|
|
What is the normal pulmonary capillary wedge pressure?
|
<12 mmHg
2010-262 |
|
|
What is the normal pressure for the pulmonary artery during systole and diastole?
|
<25 / 10 mmHg
2010-262 |
|
|
What is the normal pressure for the right atrium?
|
<5 mmHg
2010-262 |
|
|
In the lungs, what is the physiologic advantage of vasoconstriction in response to hypoxia?
|
The mechanism allows for only well-ventilated areas to remain perfused, optimizing gas exchange
2010-262 |
|
|
Sympathetic stimulation alters perfusion of the skin to control which aspect of homeostasis?
|
Temperature control
2010-262 |
|
|
What is meant by autoregulation of blood flow?
|
The method by which blood flow to an organ remains constant over a wide range of blood pressures
2010-262 |
|
|
Which factor governs autoregulation of perfusion of the skin?
|
Sympathetic stimulation
2010-262 |
|
|
The pulmonary vasculature is unique in that _____ causes vasoconstriction whereas in other organs it causes vasodilation.
|
Hypoxia
2010-262 |
|
|
Which factors govern autoregulation of perfusion of the kidneys?
|
Myogenic and tubuloglomerular feedback
2010-262 |
|
|
Which local metabolite(s) determine autoregulation of perfusion of the brain?
|
Carbon dioxide (or pH)
2010-262 |
|
|
Which local metabolite(s) govern autoregulation of perfusion of the heart?
|
Oxygen, adenosine, and nitric oxide
2010-262 |
|
|
Which local metabolites govern autoregulation of perfusion of the skeletal muscles?
|
Lactate, adenosine, and potassium
2010-262 |
|
|
How is net fluid flow calculated?
|
Net fluid flow = (net filtration pressure) × (filtration constant for capillary permeability)
2010-262 |
|
|
What is the mechanism by which toxins, infections, and burns can cause edema?
|
Any insults (eg, toxins, infections, or burns) that cause increased capillary permeability can cause an increase in the filtration constant (Kf) and subsequently cause fluid to move out of the capillaries and into the interstitial space
2010-262 |
|
|
An 80-year-old male with a history of right-sided heart failure presents with bilateral ankle edema. In terms of capillary fluid exchange, what is the mechanism by which he developed his edema?
|
Heart failure results in increased capillary pressure, which causes fluid to move out of the capillaries and into the interstitial space
2010-262 |
|
|
A 43-year-old female presents with bilateral pitting leg edema and lab results remarkable for high low-density lipoprotein, low albumin, and proteinuria (likely nephrotic syndrome). In terms of capillary fluid exchange, what is the mechanism by which she developed her edema?
|
Nephrotic syndrome results in proteinuria and subsequent hypoalbuminemia, which decreases plasma colloid oncotic pressure, and in turn causes fluid to move out of the capillaries and into the interstitial space
2010-262 |
|
|
A 50-year-old Ethiopian male presents with severe bilateral leg and scrotal edema due to Elephantiasis (lymphatic obstruction caused by filarial nematodes). In terms of capillary fluid exchange, what is the mechanism by which he developed his edema?
|
Lymphatic obstruction causes increased interstitial fluid colloid osmotic pressure, which causes fluid to move out of the capillaries and into the interstitial space
2010-262 |
|
|
A 55-year-old male with long-standing alcoholic cirrhosis presents with bilateral pedal edema and ascites. In terms of capillary fluid exchange, what is the mechanism by which he developed his edema?
|
Liver failure results in decreased plasma proteins, which decreases plasma colloid oncotic pressure, and in turn causes fluid to move out of the capillaries and into the interstitial space
2010-262 |
|
|
The filtration constant for capillary permeability is denoted by what symbol?
|
Kf
2010-262 |
|
|
Which pressures, when increased, have a tendency to cause fluid to move out of the capillaries and into tissue?
|
Capillary fluid pressure and interstitial fluid colloid osmotic pressure
2010-262 |
|
|
What would a patient with excess fluid outflow into the interstitium present with?
|
Swelling (edema)
2010-262 |
|
|
What is the equation for net filtration pressure?
|
Net filtration pressure = [(capillary pressure - interstitial fluid pressure) - (plasma colloid osmotic pressure - interstitial fluid colloid osmotic pressure)]
2010-262 |
|
|
Which pressures, when increased, have a tendency to cause fluid to move into the capillaries and out of tissue?
|
Interstitial fluid pressure and plasma colloid osmotic pressure
2010-262 |
|
|
What is the order of frequency for the three most common causes of left-to-right shunts?
|
Ventricular septal defects, atrial septal defects, patent ductus arteriosus
2010-263 |
|
|
How do neonates with tricuspid atresia remain viable given their severely compromised circulation?
|
In order to maintain viability, both an atrial septal defect and a ventricular septal defect are required for babies with tricuspid atresia
2010-263 |
|
|
What is the most common cause of early cyanotic heart disease?
|
Tetralogy of Fallot
2010-263 |
|
|
What are the heart sounds associated with atrial septal defect?
|
A loud S1 and a wide, fixed split S2
2010-263 |
|
|
What is tricuspid atresia?
|
Absence of the tricuspid valve and a hypoplastic right ventricle
2010-263 |
|
|
What is total anomalous pulmonary venous return?
|
A disorder in which the pulmonary veins drain into right heart circulation (ie, the superior vena cava or carotid sinus) as opposed to the left atrium
2010-263 |
|
|
The "5 T's" of right-to-left (cyanotic) shunts in congenital heart disease are comprised of which diseases?
|
Tetralogy of Fallot, Transposition of the great arteries, Truncus arteriosus, Tricuspid atresia, and TAPVR (total anomalous pulmonary venous return)
2010-263 |
|
|
Do left-to-right shunts cause early or late cyanosis?
|
Late; cyanosis does not occur until the effects of increased pulmonary pressure become significant
2010-263 |
|
|
Do right-to-left shunts cause early or late cyanosis?
|
Early; much of the circulation bypasses the lungs and is not oxygenated
2010-263 |
|
|
A patent ductus arteriosus can be closed by using what drug?
|
Indomethacin, although surgery is sometimes required as well
2010-263 |
|
|
What is Eisenmenger's syndrome?
|
In Eisenmenger's syndrome, a left-to-right shunt overloads the pulmonary circulation and causes increasing pulmonary pressures. When pulmonary pressures equal systemic pressures, the shunt switches to right-to-left and cyanosis ensues
2010-263 |
|
|
What is persistent truncus arteriosus?
|
Failure of the aorticopulmonary septum to divide the embryonic truncus arteriosus into the pulmonary trunk and the aorta
2010-263 |
|
|
How can an uncorrected ventricular septal defect, atrial septal defect, or patent ductus arteriosus result in progressive pulmonary hypertension?
|
They can cause compensatory vascular hypertrophy, which results in progressive pulmonary hypertension
2010-263 |
|
|
What are two physical findings associated with Eisenmenger's syndrome?
|
Clubbing and polycythemia; both are due to hypoxia secondary to right-to-left shunting
2010-263 |
|
|
Which congenital heart diseases can eventually result in Eisenmenger's syndrome?
|
Uncorrected atrial septal defect, ventricular septal defect, or patent ductus arteriosus
2010-263 |
|
|
In which direction is blood shunted in Eisenmenger's syndrome? How does the condition change over time?
|
As pulmonary hypertension increases, the original left-to-right shunt reverses into a right-to-left shunt
2010-263 |
|
|
Name the four clinical features of tetralogy of Fallot.
|
Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, and Ventricular septal defect (remember: PROVe)
2010-263 |
|
|
How does squatting help patients with tetralogy of Fallot improve their symptoms?
|
Squatting compresses femoral arteries, which causes increased arterial pressure, which in turn reduces right-to-left shunting and causes more blood from the right ventricle to enter the pulmonary circulation
2010-263 |
|
|
Tetralogy of Fallot is caused by the displacement of what structure during embryogenesis?
|
The infundibular septum; it is displaced anteriorly and superiorly
2010-263 |
|
|
In patients with tetralogy of Fallot, the severity of which heart lesion determines the patient's prognosis?
|
Pulmonary stenosis
2010-263 |
|
|
In tetralogy of Fallot, why does right-to-left shunting occur?
|
Because the increased pressure in the right ventricle (caused by the stenotic pulmonic valve) causes the blood to be shunted through the path of least resistance (ie, to the left ventricle through the ventricular septal defect)
2010-263 |
|
|
What is the chest x-ray finding that is associated with tetralogy of Fallot?
|
A "boot-shaped" heart, which is due to right ventricular hypertrophy
2010-263 |
|
|
What condition must be present for a fetus with D-transposition of great vessels to remain viable?
|
The presence of a shunt to allow adequate mixing of pulmonary and systemic blood (ie, a ventricular septal defect, atrial septal defect, or patent foramen ovale)
2010-264 |
|
|
What is D-transposition of great vessels?
|
A congenital heart disease characterized by an aorta that leaves the right ventricle (anteriorly) and a pulmonary artery that leaves the left ventricle (posteriorly), causing separation of pulmonary and systemic circulations
2010-264 |
|
|
What is the prognosis for infants with D-transposition of great vessels?
|
They die within the first few months of life if their condition is not surgically corrected by adding a shunt
2010-264 |
|
|
In terms of embryology, what is the cause of D-transposition of great vessels?
|
Failure of the embryonic aorticopulmonary septum to spiral
2010-264 |
|
|
What two congenital or genetic diseases are associated with coarctation of the aorta?
|
Bicuspid aortic valve and Turner's syndrome
2010-264 |
|
|
What is the difference between infantile and adult types of coarctation of the aorta?
|
Infantile type occurs when the aortic stenosis is proximal to the insertion of the ductus arteriosus (preductal), and adult type occurs when the aortic stenosis is distal to the ductus arteriosus (postductal) (remember: INfantile IN close to the heart and ADult type Distal to the Ductus)
2010-264 |
|
|
What cardiac valvular disease can result from coarctation of the aorta?
|
Aortic regurgitation
2010-264 |
|
|
What physical exam findings are associated with adult type coarctation of the aorta?
|
Notched ribs due to increased collateral circulation, hypertension in the upper extremities, and weak pulses in the lower extremities
2010-264 |
|
|
What is the pathogenesis of left-to-right shunting in neonates with patent ductus arteriosus?
|
During the neonatal period, lung resistance decreases and, as a result, the previous right-to-left shunt during the fetal period turns into a left-to-right shunt
2010-264 |
|
|
How would one describe the murmur of patent ductus arteriosus?
|
Continuous, "machine-like" murmur
2010-264 |
|
|
Which drug can be used to maintain a patent ductus arteriosus?
|
Prostaglandin E (remember: PGEE kEEps it open)
2010-264 |
|
|
Which drug can be used to close a patent ductus arteriosus?
|
Indomethacin (remember: ENDomethacin (indomethacin) ENDs patency of PDA)
2010-264 |
|
|
What is the dangerous structural sequela of patent ductus arteriosus?
|
The persistent left-to-right shunt eventually results in right ventricular hypertrophy and heart failure
2010-264 |
|
|
What is the direction of blood flow across the ductus arteriosus before and after birth?
|
During the fetal period of patent ductus arteriosus the shunt is right to left, and during the neonatal period the shunt is left to right
2010-264 |
|
|
The ductus arteriosus remains patent due to which two factors?
|
Prostaglandin E synthesis and low oxygen tension
2010-264 |
|
|
Which viral disease is associated with septal defects, patent ductus arteriosus, and pulmonary artery stenosis?
|
Congenital rubella
2010-264 |
|
|
Which syndrome is associated with coarctation of the aorta?
|
Turner's syndrome
2010-264 |
|
|
The offspring of a diabetic mother are at increased risk of what congenital cardiac defect?
|
Transposition of the great vessels
2010-264 |
|
|
Which genetic syndrome is associated with endocardial cushion defects?
|
Down syndrome
2010-264 |
|
|
Which genetic disorder is associated with truncus arteriosus and tetralogy of Fallot?
|
22q11 deletion syndromes
2010-264 |
|
|
Which three cardiac defects are associated with Down syndrome?
|
Atrial septal defect, ventricular septal defect, and atrioventricular septal defect
2010-264 |
|
|
Marfan's syndrome is associated with what cardiovascular defect?
|
Aortic insufficiency (as a late complication)
2010-264 |
|
|
Hypertension predisposes a person to which pathologic disease processes?
|
Atherosclerosis, left ventricular hypertrophy, stroke, congestive heart failure, renal failure, retinopathy, and aortic dissection
2010-265 |
|
|
What is the most common type of hypertension?
|
Essential (primary) hypertension, which is the cause of 90% of cases of hypertension
2010-265 |
|
|
What are five risk factors for hypertension?
|
Increased age, obesity, diabetes, smoking, genetics
2010-265 |
|
|
Secondary hypertension is most commonly a sequela of disease of which organ?
|
The kidney
2010-265 |
|
|
Which racial group has the greatest risk for developing hypertension: African-Americans, whites, or Asians?
|
African-Americans
2010-265 |
|
|
What is the definition of hypertension in an adult?
|
Blood pressure 140/90 mmHg or above
2010-265 |
|
|
What is a xanthoma?
|
A sign of hyperlipidemia that is described as "plaques or nodules composed of lipid-laden histiocytes in the skin"
2010-265 |
|
|
What is the name of a xanthoma that occurs on the eyelid?
|
Xanthelasma
2010-265 |
|
|
What is a corneal arcus?
|
A lipid deposit in the cornea that appears as lightening of the iris
2010-265 |
|
|
What is an atheroma?
|
A sign of hyperlipidemia that is described as "plaques in the blood vessels"
2010-265 |
|
|
Tendinous xanthomas are classically found in which tendon?
|
The Achilles tendon
2010-265 |
|
|
What is atherosclerosis?
|
A type of arteriosclerosis that involves fibrous plaques and atheromas in the intima of the arteries
2010-265 |
|
|
An 80-year-old veteran is told by his physician that he has calcification of his radial arteries and that it is a relatively benign condition. What is the name of this disease?
|
Mönckeberg arteriosclerosis
2010-265 |
|
|
What arteriolar pathology is seen in malignant hypertension?
|
Hyperplastic "onion skinning" of arteries
2010-265 |
|
|
What is arteriolosclerosis? What diseases is it associated with?
|
Arteriosclerosis is described as hyaline thickening of the small arteries; it is associated with essential hypertension
2010-265 |
|
|
A patient presents to the emergency department with tearing chest pain radiating to the back and dies soon after presentation. Upon autopsy, what vascular pathology would most likely be seen?
|
Longitudinal intraluminal tear forming a false lumen, indicative of aortic dissection
2010-265 |
|
|
A tall patient with long extremities, hyperextensive joints, and arachnodactyly presents to his physician for anticipatory guidance. For which cardiovascular pathology is he at increased risk?
|
Aortic dissection
2010-265 |
|
|
A patient presents to the emergency department with tearing chest pain radiating to the back. What would most likely be seen on x-ray of the chest?
|
Mediastinal widening, suggestive of aortic dissection
2010-265 |
|
|
What aortic pathology predisposes patients with Marfan's syndrome to aortic dissection?
|
Patients with Marfan's syndrome are predisposed to cystic medial necrosis, which puts them at risk for aortic dissection
2010-265 |
|
|
What is the pathogenesis of atherosclerosis?
|
Endothelial cell dysfunction causes macrophage and low-density lipoprotein accumulation, leading to foam cells and fatty streak formation, causing smooth muscle cell migration, which causes the formation of the fibrous plaques that become complex atheroma
2010-266 |
|
|
What are five risk factors for atherosclerosis?
|
Smoking, hypertension, diabetes mellitus, hyperlipidemia, and family history
2010-266 |
|
|
List four common locations for atherosclerosis in order of most common to least common.
|
Abdominal Aorta, coronary artery, popliteal artery, carotid artery
2010-266 |
|
|
Which types of arteries are susceptible to atherosclerosis?
|
Elastic arteries as well as large and medium-sized muscular arteries
2010-266 |
|
|
What are two symptoms of ischemia resulting from atherosclerosis?
|
Angina and claudication
2010-266 |
|
|
Name six possible complications of atherosclerosis.
|
Infarcts, peripheral vascular disease, thrombi, emboli, aneurysms, and ischemia
2010-266 |
|
|
By definition, how soon after the onset of symptoms do people die from sudden cardiac death?
|
Within 1 hour
2010-266 |
|
|
What are the characteristics of stable angina?
|
Chest pain occurring after a known duration of exercise
2010-266 |
|
|
How does the etiology of Prinzmetal's angina differ from other forms of angina?
|
Prinzmetal's angina occurs as a result of coronary artery spasm
2010-266 |
|
|
What electrocardiogram change is one likely to see with Prinzmetal's variant form of angina?
|
ST elevation
2010-266 |
|
|
How does the etiology of unstable angina differ from stable angina?
|
Unstable angina occurs as a result of thrombosis and not necrosis of the coronary artery
2010-266 |
|
|
At what point is ischemic heart disease given the term "myocardial infarction" rather than "unstable angina"?
|
When acute thrombosis due to coronary artery atherosclerosis results in myocyte necrosis
2010-266 |
|
|
What electrocardiogram change is one likely to see with stable angina during an exercise stress test?
|
ST depression
2010-266 |
|
|
What usually causes sudden cardiac death?
|
Lethal arrhythmia, such as ventricular fibrillation
2010-266 |
|
|
Which type(s) of angina occur(s) at rest?
|
Prinzmetal's variant and unstable angina
2010-266 |
|
|
What percentage of blockage must take place in the coronary arteries for angina to occur?
|
>75%
2010-266 |
|
|
What is chronic ischemic heart disease?
|
Progression to congestive heart failure over many years due to ischemic myocardial damage secondary to coronary atherosclerosis
2010-266 |
|
|
Worsening chest pain at rest or with minimal exertion is termed what?
|
Unstable/crescendo angina
2010-266 |
|
|
Describe the gross appearance and coloring of the affected myocardium on the first day of a myocardial infarction.
|
On the first day of a myocardial infarction, the myocardium typically appears darkly mottled and pale with tetrazolium staining
2010-267 |
|
|
What are four possible dangerous sequelae of myocardial infarction in the 5-10 after it occurs?
|
Free wall rupture, tamponade, papillary muscle rupture, interventricular septal rupture
2010-267 |
|
|
Describe the gross appearance and coloring of the affected myocardium 5-10 days after a myocardial infarction.
|
At 5-10 days after a myocardial infarction, the myocardium typically has a hyperemic myocardial infarction border with central yellow-brown softening, which becomes maximally yellow and soft by 10 days
2010-267 |
|
|
How long after a myocardial infarction does early coagulative necrosis begin?
|
After 4 hours
2010-267 |
|
|
Which is the least common coronary artery to be occluded in the evolution of a myocardial infarction: circumflex, right coronary, or left anterior descending?
|
Circumflex
2010-267 |
|
|
How long after a myocardial infarction does the tissue around the infarcted myocardium show acute inflammation?
|
2-4 days; the tissue has dilated vessels with neutrophil emigration into tissue
2010-267 |
|
|
How long after a myocardial infarction does the infarcted myocardium first show contraction bands?
|
After 1-2 hours
2010-267 |
|
|
During what period of time after a myocardial infarction is there the greatest risk for an arrhythmia?
|
At 2-4 days after a myocardial infarction
2010-267 |
|
|
For what duration after a myocardial infarction does the infarcted myocardium appear unchanged on light microscopy?
|
In the first 2-4 hours
2010-267 |
|
|
On a cellular level, what happens to the infarcted myocardium on the first day of myocardial infarction?
|
Release of intracellular contents of necrotic cells into the bloodstream and the start of neutrophil emigration; myocardial enzymes are detected in serum
2010-267 |
|
|
During what period of time after a myocardial infarction is there the greatest risk for ventricular aneurysm?
|
At 7 weeks after a myocardial infarction
2010-267 |
|
|
How long after a myocardial infarction does the infarcted myocardium show recanalized arteries?
|
7 weeks
2010-267 |
|
|
Describe the appearance and coloring of the affected myocardium 7 weeks after a myocardial infarction.
|
At 7 weeks after a myocardial infarction, the myocardium typically appears gray-white, demonstrating a completely contracted scar
2010-267 |
|
|
Describe the gross appearance and coloring of the affected myocardium 2-4 days after a myocardial infarction.
|
At 2-4 days after a myocardial infarction, the myocardium typically appears hyperemic because of dilation of blood vessels
2010-267 |
|
|
Name nine possible symptoms of myocardial infarction.
|
Severe retrosternal pain, nausea, vomiting, pain in the left arm, diaphoresis, jaw pain, shortness of breath, fatigue, and adrenergic symptoms
2010-267 |
|
|
How long after a myocardial infarction does the infarcted myocardium show extensive coagulative necrosis?
|
2-4 days
2010-267 |
|
|
Which is the most common coronary artery to be occluded in the evolution of a myocardial infarction: circumflex, right coronary, or left anterior descending?
|
Left anterior descending
2010-267 |
|
|
Which cardiac protein peaks at 1 day following a myocardial infarction, and is absent by day 3?
|
Creatine kinase-MB
2010-268 |
|
|
Which enzyme peaks between day 1 and 2 following a myocardial infarction, then gradually decreases?
|
Aspartate aminotransferase
2010-268 |
|
|
Which protein marker is the most specific during the early stages of myocardial infarction?
|
Troponin I
2010-268 |
|
|
An ST segment depression on an electrocardiogram indicates what type of damage to the myocardium?
|
Subendocardial infarct
2010-268 |
|
|
Aspartate aminotransferase is a nonspecific marker because it can be found in which three cell types?
|
Cardiac, liver, and skeletal muscle cells
2010-268 |
|
|
During the first 6 hours after a myocardial infarction, what test is the gold standard for establishing the diagnosis?
|
Electrocardiogram
2010-268 |
|
|
Pathologic Q waves on electrocardiogram indicate what type of damage to the myocardium?
|
Transmural infarct
2010-268 |
|
|
Which cardiac marker rises after 4 hours and remains elevated for 7-10 days after myocardial infarction?
|
Troponin I
2010-268 |
|
|
An ST segment elevation on an electrocardiogram indicates what type of damage to the myocardium?
|
Transmural infarct
2010-268 |
|
|
In which tissue other than myocardium is creatine kinase-MB found?
|
Skeletal muscle
2010-268 |
|
|
What electrocardiogram changes would you expect to see with transmural and subendocardial infarcts?
|
With transmural infarcts, one would expect to see ST elevations on electrocardiogram, whereas with subendocardial infarcts, one would expect to see ST depressions on electrocardiogram
2010-268 |
|
|
Why is the subendocardium particularly susceptible to infarction?
|
Because there are few collaterals and high pressure
2010-268 |
|
|
Which complication of myocardial infarction can result in acute-onset severe mitral regurgitation?
|
Papillary muscle rupture
2010-268 |
|
|
What is the cause of the friction rub that can be heard 3-5 days after myocardial infarction?
|
Fibrinous pericarditis
2010-268 |
|
|
What three complications can result from aneurysm formation after a myocardial infarction?
|
Mural thrombus embolization, arrhythmia and decreased cardiac output
2010-268 |
|
|
Which complication is common during the first few days after a myocardial infarction?
|
Cardiac arrhythmia
2010-268 |
|
|
At 6 days after having a myocardial infarction, a patient presents with a new-onset murmur. What is the most likely murmur?
|
Holosystolic murmur of mitral regurgitation, best heard over the apex of the heart
2010-268 |
|
|
What is Dressler's syndrome?
|
An autoimmune syndrome resulting in fibrinous pericarditis several weeks after myocardial infarction
2010-268 |
|
|
Which complication of myocardial infarction can result in cardiac tamponade?
|
Ventricular wall rupture
2010-268 |
|
|
What are six causes of restrictive cardiomyopathy?
|
Sarcoidosis, amyloidosis, radiation fibrosis, endocardial fibroelastosis, Loeffler's syndrome, and hemochromatosis
2010-269 |
|
|
What is endocardial fibroelastosis?
|
Thick fibroelastic tissue found in the endocardium of affected children, which can lead to restrictive cardiomyopathy
2010-269 |
|
|
Which type of cardiomyopathy can lead to outflow tract obstruction?
|
Hypertrophic cardiomyopathy, causing a hypertrophied interventricular septum that is too close to the mitral valve leaflet and blocks outflow through the aortic valve
2010-269 |
|
|
What is the difference between the relation of sarcomeres in dilated vs hypertrophic cardiomyopathy?
|
In dilated cardiomyopathy, the sarcomeres are added in series (eccentric hypertrophy); in hypertrophic cardiomyopathy, the sarcomeres are added in parallel (concentric hypertrophy)
2010-269 |
|
|
Which type of cardiomyopathy presents with an S4 heart sound and a systolic ejection murmur?
|
Hypertrophic cardiomyopathy
2010-269 |
|
|
Which type of cardiomyopathy can cause young athletes to die suddenly?
|
Hypertrophic cardiomyopathy
2010-269 |
|
|
Name eight etiologies of dilated cardiomyopathy.
|
Chronic Alcohol abuse, wet Beriberi, Coxsackie B virus myocarditis, chronic Cocaine use, Chagas' disease, Doxorubicin toxicity, hemochromatosis, and peripartum cardiomyopathy
2010-269 |
|
|
Which septum becomes hypertrophied in hypertrophic cardiomyopathy?
|
The intraventricular septum
2010-269 |
|
|
What is the most common type of cardiomyopathy?
|
Dilated (congestive) cardiomyopathy
2010-269 |
|
|
Which extra heart sound is present in dilated cardiomyopathy?
|
S3
2010-269 |
|
|
Hypertrophic cardiomyopathy is treated with which two drug classes?
|
β-Blockers or heart-specific calcium channel blockers (ie, verapamil)
2010-269 |
|
|
Which type of cardiomyopathy is associated with Friedreich's ataxia?
|
Hypertrophic cardiomyopathy; patients with Friedreich's ataxia commonly die of cardiac pathology
2010-269 |
|
|
What is Loeffler's syndrome?
|
Endomyocardial fibrosis with a prominent eosinophilic infiltrate, which can lead to restrictive cardiomyopathy
2010-269 |
|
|
Which type of cardiomyopathy is peripartum cardiomyopathy?
|
Dilated cardiomyopathy
2010-269 |
|
|
Which cardiomyopathies present with diastolic dysfunction? Systolic dysfunction?
|
Restrictive and hypertrophic cardiomyopathies present with diastolic dysfunction, whereas dilated cardiomyopathies present with systolic dysfunction
2010-269 |
|
|
A 16-year-old male presents for a school physical. On physical exam, you discover a 2/6 systolic murmur at the left sternal border. Upon questioning he says that he has had several fainting episodes. His father, a former Italian soccer player, had similar episodes and died suddenly at the age of 25 years. What is this patient's likely diagnosis? What is the histologic appearance of his cardiac biopsy?
|
Hypertrophic cardiomyopathy; the histologic appearance is disoriented, tangled, hypertrophied myocardial fibers
2010-269 |
|
|
Which hematologic disorder can cause both dilated cardiomyopathy and restrictive/obliterative cardiomyopathy?
|
Hemochromatosis
2010-269 |
|
|
Which chemotherapeutic drug is a possible cause of dilated cardiomyopathy?
|
Doxorubicin
2010-269 |
|
|
What is the inheritance pattern of familial hypertrophic cardiomyopathy? In 50% of cases, what is the etiology of hypertrophic cardiomyopathy?
|
Autosomal dominant; 50% of cases are familial
2010-269 |
|
|
How does the blood pressure on the right side of the heart affect portal venous blood flow?
|
As the pressure in the right heart (and, therefore, the central venous system) increases, portal flow decreases
2010-270 |
|
|
What are "heart failure cells"?
|
Hemosiderin-laden macrophages in the lungs due to microhemorrhages caused by increased pulmonary capillary pressure
2010-270 |
|
|
What is the most common cause of right-sided heart failure?
|
Left-sided heart failure
2010-270 |
|
|
What is congestive heart failure?
|
Congestive heart failure is the constellation of signs and symptoms that occur as a result of poor cardiac function; its severity can be defined symptomatically and with imaging
2010-270 |
|
|
Increased right-sided heart pressure can lead to what finding on abdominal physical exam?
|
Hepatomegaly (nutmeg liver on pathology) and rarely cardiac cirrhosis
2010-270 |
|
|
Does left ventricular failure increase or decrease pulmonary venous pressure?
|
Increase
2010-270 |
|
|
What is the most common cause of right-sided heart failure in the absence of left-sided heart failure?
|
Cor pulmonale, in which the right ventricle fails because of increased pulmonary arterial pressure
2010-270 |
|
|
What is the cause of cardiac dilation in congestive heart failure?
|
Increased ventricular end-diastolic volume
2010-270 |
|
|
What are physical signs of right-sided heart failure?
|
Ankle edema, jugular venous distention, and hepatomegaly
2010-270 |
|
|
Increased venous return in the supine position causes what common symptom of congestive heart failure?
|
Orthopnea, in which patients have difficult breathing when not upright
2010-270 |
|
|
How does the body compensate for the decreased left ventricular contractility (and therefore decreased cardiac output) that occurs with left-sided heart failure?
|
The kidneys increase the activity of the renin-angiotensin-aldosterone system, and sympathetic tone is increased, both of which ultimately increase preload and cardiac output
2010-270 |
|
|
In congestive heart failure, _____ (increased/decreased) left ventricular contractility leads to _____ (increased/decreased) pulmonary venous pressure, which can eventually lead to _______ (increased/decreased) right ventricular output, and ultimately the physical finding of _____ _____.
|
Decreased; increased; decreased; peripheral edema
2010-270 |
|
|
If there is a failure of left ventricular output to increase during exercise, what is the physical symptom that emerges?
|
Dyspnea on exertion
2010-270 |
|
|
In congestive heart failure, _____ (increased/decreased) left ventricular contractility leads to ______ (increased/decreased) pulmonary venous pressure, ultimately leading to _____ _____.
|
Decreased; increased; pulmonary edema
2010-270 |
|
|
In congestive heart failure, _____ (increased/decreased) cardiac output leads to _____ (increased decreased) activity of renin-angiotensin-aldosterone, which leads to ________ (increased/decreased) systemic venous pressure, and ultimately the physical finding of _____ _____.
|
Decreased; increased; increased; peripheral edema
2010-270 |
|
|
Other than Staphylococcus aureus, which organisms are known to cause endocarditis in intravenous drug users?
|
Pseudomonas and Candida
2010-271 |
|
|
Is Staphylococcus aureus bacterial endocarditis rapid or insidious in onset?
|
Rapid; it has a high virulence and results in large vegetations on previously normal valves
2010-271 |
|
|
What is the name for the group of bacteria that cause endocarditis but will not grow in standard culture medium?
|
HACEK
2010-271 |
|
|
Which valve is most likely to be involved in bacterial endocarditis?
|
The mitral valve
2010-271 |
|
|
Which type of endocarditis is associated with dental procedures: acute or subacute bacterial endocarditis?
|
Subacute; smaller vegetations appear on congenitally abnormal or diseased valves, with insidious onset
2010-271 |
|
|
A small, painless erythematous lesion on the palm or sole in a patient with endocarditis is called what?
|
Janeway lesion
2010-271 |
|
|
What symptoms and signs do the letters in the mnemonic FROM JANE represent in bacterial endocarditis?
|
Fever, Roth spots, Osler's nodes, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhages, and Emboli
2010-271 |
|
|
Which pathogen is often responsible for bacterial endocarditis on prosthetic heart valves?
|
Staphylococcus epidermidis
2010-271 |
|
|
In a case of acute bacterial endocarditis, which organism is most likely responsible?
|
Staphylococcus aureus
2010-271 |
|
|
Tender, red, raised lesions on the finger or toe pads in the setting of endocarditis are known as what?
|
Osler's nodes
2010-271 |
|
|
Nonbacterial endocarditis can be the result of which two causes?
|
Malignancy or hypercoagulable state (marantic/thrombotic endocarditis)
2010-271 |
|
|
A round white spot on the retina that is surrounded by hemorrhage in the setting of endocarditis is known as what?
|
Roth spot
2010-271 |
|
|
Is Streptococcus viridans bacterial endocarditis rapid or insidious in onset?
|
Insidious; smaller vegetations appear on congenitally abnormal or diseased valves
2010-271 |
|
|
What is the classic renal complication that can occur after a case of bacterial endocarditis?
|
Glomerulonephritis
2010-271 |
|
|
In a patient with tricuspid valve involvement as a part of bacterial endocarditis, what is the suspected source of the infection?
|
Intravenous drug abuse (remember: "don't tri drugs")
2010-271 |
|
|
In Libman-Sacks endocarditis, which valve is commonly affected?
|
The mitral valve
2010-271 |
|
|
How do the vegetations in Libman-Sacks endocarditis differ from those in bacterial endocarditis?
|
Sterile, verrucous, and occur on both sides of the valve
2010-271 |
|
|
Which murmurs are associated with Libman-Sacks endocarditis?
|
Mitral regurgitation, and less commonly mitral stenosis
2010-271 |
|
|
What type of endocarditis is seen in patients with lupus?
|
Libman-Sacks endocarditis (remember: SLE causes LSE)
2010-271 |
|
|
Which heart valve is most often affected by rheumatic heart disease?
|
The mitral valve
2010-272 |
|
|
Name the components of the FEVERSS mnemonic for rheumatic heart disease.
|
Fever, Erythema marginatum, Valvular damage (vegetation and fibrosis), ESR increase, Red-hot joints (migratory polyarthritis), Subcutaneous nodules (Aschoff bodies), and St. Vitus' dance (chorea)
2010-272 |
|
|
Rheumatic heart disease is an example of type _____ hypersensitivity and involves creation of anti- _____ _____ antibodies.
|
II; M protein
2010-272 |
|
|
What laboratory findings are associated with rheumatic heart disease?
|
Elevated antistreptolysin O titers and elevated erythrocyte sedimentation rate
2010-272 |
|
|
Rheumatic heart disease is a sequela of infection with which organism?
|
Group A β-hemolytic streptococci
2010-272 |
|
|
Histopathology on a biopsy of a valve affected by rheumatic heart disease would show what findings?
|
Aschoff bodies (giant cell-containing granulomas) and anitschkow cells
2010-272 |
|
|
Which conditions can cause the finding of pulsus paradoxus?
|
Severe cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, and croup
2010-272 |
|
|
What is pulsus paradoxus (Kussmaul's pulse)?
|
The condition in which pulse amplitude is decreased by inspiration
2010-272 |
|
|
What are six physical findings associated with cardiac tamponade?
|
Hypotension, jugular venous distention, distant heart sounds, increased heart rate, and pulsus paradoxus
2010-272 |
|
|
How are the pressures of the four heart chambers affected during cardiac tamponade?
|
They equilibrate, leading to an inability to move blood forward in the circulation
2010-272 |
|
|
What is cardiac tamponade?
|
Compression of the heart by fluid, such as blood or effusions, which leads to decreased cardiac output
2010-272 |
|
|
Which two types of pericarditis does uremia cause?
|
Serous and fibrinous
2010-272 |
|
|
What are the potential long-term sequelae of pericarditis?
|
Pericarditis can resolve without scarring or lead to chronic adhesive or chronic constrictive pericarditis
2010-272 |
|
|
What are four causes of serous pericarditis?
|
Uremia, systemic lupus erythematosus, rheumatoid arthritis, and viral infection
2010-272 |
|
|
What are three causes of fibrinous pericarditis?
|
Uremia, myocardial infarction (Dressler's syndrome), and rheumatic fever
2010-272 |
|
|
Which conditions can cause serous pericarditis?
|
Systemic lupus erythematosus, rheumatoid arthritis, viral infections, and uremia
2010-272 |
|
|
In a patient with hemorrhagic pericarditis, what will be seen on an electrocardiogram?
|
ST-segment elevations in multiple leads
2010-272 |
|
|
Tertiary syphilis disrupts the vasa vasorum and subsequently leads to what complications?
|
Dilation of the aorta leading to aneurysm or aortic valve incompetence
2010-272 |
|
|
A 70-year-old former prostitute presents with chest pain radiating to the back and worsening shortness of breath on exertion. Her cardiac enzymes are negative and she has no ST changes on electrocardiogram. An echocardiogram shows aortic regurgitation and and a dilated aortic root. Her labs are significant for a positive rapid plasma reagin. What is the likely cause of her pain and shortness of breath?
|
Ascending aortic aneurysm due to tertiary syphilis
2010-272 |
|
|
In tertiary syphilis, what is the characteristic appearance of the aortic root on gross pathology?
|
It is described as having a "tree bark" appearance
2010-272 |
|
|
Calcification takes place of which two structures in patients with syphilitic heart disease?
|
The aortic root and the ascending aortic arch
2010-272 |
|
|
Which cardiac tumor may present with syncopal episodes? Why?
|
Myxoma; syncope can occur with ball-valve obstruction of the mitral valve
2010-273 |
|
|
Where in the heart do most myxomas tend to occur?
|
90% occur in the left atrium
2010-273 |
|
|
What is the most common primary heart tumor in adults?
|
Myxoma
2010-273 |
|
|
What is the most common primary heart tumor in children?
|
Rhabdomyoma
2010-273 |
|
|
Which neoplasms have the greatest propensity of metastasizing to the heart?
|
Melanoma, lymphoma
2010-273 |
|
|
Cardiac rhabdomyomas in children are associated with what genetic disorder?
|
Tuberous sclerosis
2010-273 |
|
|
What is the most common heart tumor?
|
Metastases, often from melanoma or lymphoma
2010-273 |
|
|
Describe the physical appearance of telangiectasias.
|
Dilated vessels on skin and mucous membranes
2010-273 |
|
|
A patient presents to her physician with complaints of recurrent spontaneous nosebleeds, black stools and permanent red discolorations of the mouth and skin. She reports that her father and younger brother have the same symptoms. What is the most likely diagnosis?
|
Hereditary hemorrhagic telangiectasia (also called Osler-Weber-Rendu syndrome)
2010-273 |
|
|
What are telangiectasias?
|
Arteriovenous malformations in the small blood vessels
2010-273 |
|
|
What is hereditary hemorrhagic telangiectasia?
|
An autosomal dominant disorder that presents with spontaneous nosebleeds and skin discolorations; also called Osler-Weber-Rendu syndrome
2010-273 |
|
|
What are varicose veins?
|
Dilated, tortuous superficial veins due to chronically increased venous pressure, usually in the legs
2010-273 |
|
|
Varicose veins may eventually lead to which other, more serious, conditions?
|
Poor wound healing and venous stasis ulcers
2010-273 |
|
|
A 60-year-old female with varicose veins develops chest pain and shortness of breath in the hospital after left knee replacement surgery. A computed tomography angiogram reveals multiple pulmonary emboli. What was the likely cause of her pulmonary emboli?
|
Thromboembolism from stasis in a deep veins of the leg; despite her varicose veins, thromboembolism from superficial veins is very rare
2010-273 |
|
|
Raynaud's disease occurs most often in which parts of the body?
|
Fingers and toes
2010-273 |
|
|
Raynaud's disease may be associated with which rheumatologic diseases?
|
Mixed connective tissue disease, systemic lupus erythematosus, or CREST syndrome
2010-273 |
|
|
Define Raynaud's phenomenon.
|
Arteriolar vasospasm in response to cold or stress secondary to underlying rheumatologic disease
2010-273 |
|
|
What is Raynaud's disease?
|
A disease characterized by decreased blood flow to the skin due to vasospasm of the arterioles in response to cold exposure or emotional stress
2010-273 |
|
|
Wegener's granulomatosis affects _____ (small/medium/large) vessels.
|
Small
2010-274 |
|
|
In Wegener's granulomatosis, x-ray of the chest may reveal what finding?
|
Large nodular densities
2010-274 |
|
|
Which molecule is a strong serum marker of Wegener's granulomatosis?
|
Antineutrophil cytoplasmic antibodies (c-ANCA)
2010-274 |
|
|
What is Wegener's granulomatosis?
|
A granulomatous vasculitis characterized by a triad of focal necrotizing vasculitis, granulomas in the lung and upper airway, and glomerulonephritis
2010-274 |
|
|
What two therapies are used to treat Wegener's granulomatosis?
|
Corticosteroids and cyclophosphamide
2010-274 |
|
|
Name eight signs or symptoms associated with Wegener's granulomatosis.
|
Perforation of the nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis, and hematuria
2010-274 |
|
|
Patients with Churg-Strauss syndrome usually present with which signs or symptoms?
|
Asthma, skin lesions, sinusitis, and peripheral neuropathy (eg, wrist/foot drop)
2010-274 |
|
|
Which ANCA-positive vasculitis is limited to the kidney?
|
Primary pauci-immune crescentic glomerulonephritis
2010-274 |
|
|
Which five organs are involved in Churg-Strauss syndrome?
|
Lungs, heart, skin, kidneys, and nerves
2010-274 |
|
|
In Churg-Strauss syndrome, the patient will test positive for ______ (p-ANCA/c-ANCA) in serum.
|
P-ANCA
2010-274 |
|
|
Which ANCA-positive vasculitis is a granulomatous vasculitis with eosinophilia?
|
Churg-Strauss syndrome
2010-274 |
|
|
Which p-ANCA-positive vasculitis is similar to Wegener's granulomatosis but lacks granulomas?
|
Microscopic polyangiitis
2010-274 |
|
|
In microscopic polyangiitis, the patient will test positive for _____ (p-ANCA/c-ANCA) in serum, and in Wegener's granulomatosis, the patient will test positive for _____ (p-ANCA/c-ANCA).
|
P-ANCA; c-ANCA
2010-274 |
|
|
All ANCA-positive vasculitides affect _____ (small/medium/large) vessels.
|
Small
2010-274 |
|
|
What is Sturge-Weber disease?
|
Congenital capillary malformations manifesting as port-wine stains, intracerebral arteriovenous malformations, and seizures
2010-274 |
|
|
A patient is diagnosed with Sturge-Weber disease. What neurologic manifestation might be present?
|
Leptomeningeal angiomatosis (intracerebral arteriovenous malformations) and seizures
2010-274 |
|
|
What is the most common childhood systemic vasculitis?
|
Henoch-Schönlein purpura
2010-274 |
|
|
What renal pathology is associated with Henoch-Schönlein purpura?
|
Immunoglobulin A nephropathy
2010-274 |
|
|
A 7-year-old has a viral urinary tract infection followed by worsening abdominal and joint pain. He develops purpura on his legs. What is your diagnosis?
|
Henoch-Schönlein purpura
2010-274 |
|
|
What inciting event commonly precedes Henoch-Schönlein purpura?
|
Upper respiratory infection
2010-274 |
|
|
What five findings are associated with Henoch-Schönlein purpura?
|
Skin rash (palpable purpura) on buttocks and legs, arthralgias, intestinal hemorrhage, abdominal pain, and melena
2010-274 |
|
|
What is Buerger's disease?
|
A thrombosing vasculitis affecting the small and medium-sized peripheral arteries and veins of heavy smokers
2010-275 |
|
|
Buerger's disease may lead to what serious sequela?
|
Gangrene and autoamputation of digits
2010-275 |
|
|
What is the treatment for Buerger's disease?
|
Cessation of cigarette smoking
2010-275 |
|
|
Buerger's disease also has what other name?
|
Thromboangiitis obliterans
2010-275 |
|
|
What are four clinical findings associated with Buerger's disease?
|
Intermittent claudication, superficial nodular phlebitis, Raynaud's phenomenon and severe pain in the digits
2010-275 |
|
|
Kawasaki disease is a(n) _____ (acute/chronic) vasculitis of the small and medium-sized vessels that is ______ (progressive/self-limited).
|
Acute; self-limited
2010-275 |
|
|
What dangerous vascular lesion can patients with Kawasaki disease develop?
|
Coronary aneurysms
2010-275 |
|
|
What are the five clinical findings associated with Kawasaki disease?
|
Fever, congested conjunctivae, changes in the lips and oral mucosa ("strawberry tongue"), and lymphadenitis
2010-275 |
|
|
A 7-year-old Japanese child has 1 week of fever, palpable lymph nodes, erythema of the conjunctiva and tongue, and desquamation of the palms of the hands. What is the diagnosis? How should you treat?
|
Kawasaki disease; treat with intravenous immunoglobulin and aspirin
2010-275 |
|
|
Kawasaki disease is an acute, self-limited disease of what patient population?
|
Infants and children; there is higher incidence in East Asian populations
2010-275 |
|
|
Name 10 clinical findings associated with polyarteritis nodosa.
|
Fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, hypertension, neurologic dysfunction, cutaneous eruption
2010-275 |
|
|
Polyarteritis nodosa is strongly associated with which infectious disease?
|
Hepatitis B
2010-275 |
|
|
What is polyarteritis nodosa?
|
A vasculitis characterized by immune complex-induced necrosis of medium-sized muscular arteries, typically the renal and visceral vessels
2010-275 |
|
|
What findings on arteriogram are seen in patients with polyarteritis nodosa?
|
Multiple aneurysms and constrictions
2010-275 |
|
|
Which two therapies are used to treat polyarteritis nodosa?
|
Corticosteroids and cyclophosphamide
2010-275 |
|
|
With what laboratory finding is Takayasu's arteritis associated?
|
An elevated erythrocyte sedimentation rate
2010-275 |
|
|
Takayasu's arteritis is also known as what?
|
Pulseless disease
2010-275 |
|
|
A 35-year-old female presents with fever, knee and muscle pain, night sweats, and vision change. On physical exam, you notice that her fingers are cold and she has weak radial pulses (compared to the lower extremities). What is the diagnosis?
|
Takayasu's arteritis. The patient has Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular disturbances, and Weak pulses in the upper extremities (remember: FAN MY SKIN On Wednesdays)
2010-275 |
|
|
Which vessels are typically affected in Takayasu's arteritis?
|
Aortic arch and proximal great vessels
2010-275 |
|
|
Which demographic is most affected by Takayasu's arteritis?
|
Asian women younger than 40 years of age
2010-275 |
|
|
Temporal arteritis is associated with what laboratory test results?
|
Erythrocyte sedimentation rate
2010-275 |
|
|
Name three findings commonly associated with temporal arteritis.
|
Unilateral headache, jaw claudication, and impaired vision
2010-275 |
|
|
Temporal arteritis is also known as what?
|
Giant cell arteritis
2010-275 |
|
|
What is the most serious sequela of giant cell arteritis?
|
Permanent blindness
2010-275 |
|
|
A 75-year-old female presents with new-onset right jaw pain and headache at the right temple. What is the diagnosis?
|
Temporal arteritis
2010-275 |
|
|
What is the most common vasculitis affecting medium and large-sized vessels?
|
Temporal arteritis
2010-275 |
|
|
What population is most commonly affected by temporal arteritis?
|
Elderly women
2010-275 |
|
|
Impaired vision in giant cell arteritis is the result of the occlusion of which artery?
|
The ophthalmic artery
2010-275 |
|
|
What findings on temporal artery biopsy would confirm a diagnosis of giant cell arteritis?
|
Focal, granulomatous inflammation
2010-275 |
|
|
Temporal arteritis affects which vessels?
|
Medium and large arteries; usually branches of the carotid artery
2010-275 |
|
|
What is the treatment for temporal arteritis?
|
High-dose steroids
2010-275 |
|
|
One half of patients with temporal arteritis also have which rheumatologic condition?
|
Polymyalgia rheumatica
2010-275 |
|
|
What is a pyogenic granuloma?
|
A common polypoid hemangioma, often seen in the mouth in pregnancy, which can ulcerate and bleed
2010-276 |
|
|
What is a strawberry hemangioma?
|
A benign capillary hemangioma of infancy, which initially grows and then spontaneously regresses by a few years of age
2010-276 |
|
|
What is a glomus tumor?
|
A rare, benign, painful, red-blue tumor found under the fingernails; arises from smooth muscle cells of the glomus body
2010-276 |
|
|
What is lymphangiosarcoma?
|
A lymphatic malignancy that is associated with persistent lymphedema; seen after axillary lymph node dissection for breast cancer
2010-276 |
|
|
What is bacillary angiomatosis?
|
Benign capillary skin papules found in AIDS patients; similar appearance to Kaposi sarcoma; caused by Bartonella infection
2010-276 |
|
|
What is a cherry hemangioma?
|
A benign capillary hemangioma of the elderly; they become more numerous with age
2010-276 |
|
|
What is Kaposi sarcoma?
|
An endothelial malignancy of the skin associated with human herpes virus type 8 and AIDS
2010-276 |
|
|
What is angiosarcoma?
|
Aggressive malignancy of the liver; associated with vinyl chloride, arsenic, and thallium exposure
2010-276 |
|
|
What is a cystic hygroma?
|
A cavernous lymphangioma found in the neck; associated with Turner's syndrome
2010-276 |
|
|
Which pharmacologic agents are used to treat essential hypertension?
|
Diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blocks
2010-276 |
|
|
Which pharmacologic agents are used to treat hypertension in patients with congestive heart failure?
|
Diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blocks, β-blockers (in compensated congested heart failure only) and potassium-sparing diuretics
2010-276 |
|
|
Which pharmacologic agents are used to treat hypertension in patients with diabetes mellitus?
|
Angiotensin-converting enzyme inhibitors/angiotensin II receptor blocks, calcium-channel blockers, diuretics, β-blockers, and α-blockers
2010-276 |
|
|
Why are angiotensin-converting enzyme inhibitors especially important in patients with diabetes mellitus?
|
They have been shown to delay progression to diabetic nephropathy
2010-276 |
|
|
Why is hydralazine contraindicated in patients with angina or coronary artery disease?
|
Because it can cause compensatory tachycardia
2010-276 |
|
|
Hydralazine can induce which autoimmune complication in patients?
|
Systemic lupus erythematosus
2010-276 |
|
|
Which does hydralazine reduce: afterload or preload?
|
Afterload
2010-276 |
|
|
What two agents are first-line therapies for hypertension in pregnancy?
|
Hydralazine with methyldopa
2010-276 |
|
|
Which cardiac adverse effect results from the drop in blood pressure induced by hydralazine?
|
Tachycardia (compensatory)
2010-276 |
|
|
Hydralazine causes smooth muscle relaxation by increasing concentrations of which substance in endothelial cells?
|
cGMP
2010-276 |
|
|
When hydralazine is administered, which vessels dilate more: veins or arterioles?
|
Arterioles
2010-276 |
|
|
Does hydralazine cause fluid excretion or retention?
|
Retention
2010-276 |
|
|
How can the reflex tachycardia that is associated with hydralazine be prevented?
|
By administering it with a β-blocker
2010-276 |
|
|
What are the toxicities of minoxidil?
|
Hypertrichosis, reflex tachycardia, angina, salt retention, and pericardial effusion
2010-276 |
|
|
A 60-year-old man with severe hypertension presents with complaints of increased hair growth and new chest pain. Toxicity of which antihypertensive drug is most likely causing these symptoms?
|
Minoxidil
2010-276 |
|
|
What is the mechanism of action of minoxidil?
|
Minoxidil opens potassium channels on the cell membrane, which causes hyperpolarization and subsequent relaxation of vascular smooth muscle
2010-276 |
|
|
What are the clinical indications for the use of calcium channel blockers?
|
Hypertension, angina, arrhythmias (except nifedipine), Prinzmetal's angina, and Raynaud's disease
2010-277 |
|
|
Which calcium channel blocker is the most cardio-selective?
|
Verapamil
2010-277 |
|
|
A patient is started on antihypertensive therapy. One week later he returns complaining of swollen ankles and flushed skin. Which class of medication was he likely prescribed?
|
Calcium channel blockers
2010-277 |
|
|
Which calcium channel blocker cannot be used as an anti-arrhythmic?
|
Nifedipine
2010-277 |
|
|
Name three pharmaceutical agents that are in the class of calcium channel blockers.
|
Nifedipine, diltiazem, and verapamil
2010-277 |
|
|
Which calcium channel blocker is the most selective for vascular smooth muscle?
|
Nifedipine
2010-277 |
|
|
What is the ultimate function of calcium channel blockers?
|
To decrease cardiac and smooth muscle contractility
2010-277 |
|
|
How does nitric oxide cause smooth muscle relaxation?
|
By increasing cGMP concentration
2010-277 |
|
|
Vasodilation using nitroglycerin is caused by the release of what chemical in smooth muscle?
|
Nitric oxide
2010-277 |
|
|
What are two indications for the use of nitroglycerin?
|
Angina and pulmonary edema
2010-277 |
|
|
Does isosorbide dinitrate dilate veins or arteries more?
|
Veins
2010-277 |
|
|
Are nitrates more effective as preload or afterload reducers?
|
Preload reducers
2010-277 |
|
|
Name four adverse effects of nitroglycerin.
|
Reflex tachycardia, hypotension, flushing, and headache
2010-277 |
|
|
Name three medications indicated to treat malignant hypertension.
|
Nitroprusside, fenoldopam, and diazoxide
2010-277 |
|
|
Fenoldopam is an agonist of which receptor?
|
Dopamine D1; D1 activity relaxes renal vasculature
2010-277 |
|
|
Name an adverse effect of diazoxide.
|
Hyperglycemia, secondary to a reduction in insulin release
2010-277 |
|
|
Nitroprusside is a _____ (short/long) -acting drug.
|
Short
2010-277 |
|
|
Nitroprusside increases the concentration of which substance via direct release of nitric oxide?
|
cGMP
2010-277 |
|
|
Diazoxide causes relaxation of vascular smooth muscle by opening which membrane channel?
|
Potassium
2010-277 |
|
|
What are the effects of nitrates, β-blockers, and a combination of both on myocardial oxygen consumption?
|
β-Blockers and nitrates decrease myocardial oxygen consumption, but a combination of both severely decreases myocardial oxygen consumption
2010-277 |
|
|
What is the mechanism by which pharmacologic treatments can reduce angina?
|
The reduction of myocardial oxygen consumption by decreasing one or more of the determinants of oxygen consumption: end diastolic volume, blood pressure, heart rate, contractility, and/or ejection time
2010-277 |
|
|
What are the effects of nitrates, β-blockers, and a combination of both on blood pressure?
|
β-Blockers, nitrates, and a combination of both all decrease blood pressure
2010-277 |
|
|
Among the calcium channel blocker, which acts most like nitrates in treating angina? Which acts like a β-blocker?
|
Nifedipine; verapamil
2010-277 |
|
|
What are the effects of nitrates, β-beta blockers, and a combination of both on contractility?
|
β-Blockers decrease contractility, nitrates increase contractility (as a reflex response), and a combination of both has little/no effect on contractility
2010-277 |
|
|
What are the effects of nitrates, β-blockers, and a combination of both on heart rate?
|
β-Blockers decrease heart rate, nitrates increase heart rate (as a reflex response), and a combination of both decreases heart rate
2010-277 |
|
|
What are the effects of nitrates, β-blockers, and a combination of both on end diastolic volume?
|
β-Blockers increase end diastolic volume, nitrates decrease end diastolic volume, and a combination of both either has no effect or decreases end diastolic volume
2010-277 |
|
|
What are the effects of nitrates, β-blockers, and a combination of both on ejection time?
|
β-Blockers increase ejection time, nitrates decrease ejection time, and a combination of both has little/no effect on ejection time
2010-277 |
|
|
Which two beta-blockers are contraindicated in angina and why?
|
Pindolol and acebutolol because they are partial beta-agonists and can increase myocardial oxygen consumption
2010-277 |
|
|
What adverse effects does niacin have?
|
Facial flushing, which can be reduced with the use of aspirin and decreases over time; hyperglycemia; and hyperuricemia
2010-278 |
|
|
A patient has recently started taking lovastatin. He presents with diffuse muscle pain and weakness. Which lab test should be ordered?
|
Creatine kinase to test for rhabdomyolysis
2010-278 |
|
|
Which category of lipid-lowering agents works by preventing cholesterol reabsorption at the small intestine brush border?
|
Cholesterol absorption blockers (ezetimibe)
2010-278 |
|
|
What adverse effects do bile acid resins (cholestyramine) have?
|
Bad taste, gastrointestinal discomfort, a decreased effect on the absorption of fat-soluble vitamins, and the production of cholesterol gallstones
2010-278 |
|
|
Which category of lipid-lowering agents works by upregulating lipoprotein lipase, causing increased triglyceride clearance from the blood?
|
Fibrates (gemfibrozil, clofibrate, fenofibrate, bezafibrate)
2010-278 |
|
|
A 50-year-old man with hypercholesterolemia is deficient in vitamins A, D, E and K. He also complains of gastrointestinal discomfort since starting a lipid-lowering agent. Which lipid-lowering agent is the most likely cause?
|
Bile acid resins
2010-278 |
|
|
What adverse effects do fibrates (eg, gemfibrozil, clofibrate) have?
|
Elevated liver enzymes and myositis
2010-278 |
|
|
Which lipid-lowering agents cause the most significant reduction in triglycerides? Which have a more modest benefit?
|
Fibrates reduce triglycerides most significantly; statins, bile acid resins, and niacin have a moderate effect in this regard
2010-278 |
|
|
Other than statins, which drugs are indicated for lowering low-density lipoprotein levels?
|
Niacin, which lowers low-density lipoprotein levels, although less than statins
2010-278 |
|
|
Which class of lipid-lowering agents is contraindicated in patients with gallstones?
|
Bile acid resins
2010-278 |
|
|
Which lipid-lowering agent causes the greatest increase in high-density lipoprotein levels? Which agents cause a more modest increase?
|
Niacin causes the greatest increase in high-density lipoprotein levels; statins have a moderate effect on high-density lipoprotein levels
2010-278 |
|
|
Which lipid-lowering agent works by inhibiting lipolysis in adipose tissue and reducing hepatic very-low-density lipoprotein secretion into circulation?
|
Niacin
2010-278 |
|
|
Which category of lipid-lowering agents works by inhibiting the formation of the cholesterol precursor mevalonate?
|
HMG-CoA reductase inhibitors; this is the rate-limiting step in cholesterol synthesis
2010-278 |
|
|
Which category of lipid-lowering agents works by preventing the intestinal reabsorption of bile acids, causing increased hepatic usage of cholesterol to replenish the bile acids?
|
Bile acid resins (cholestyramine, colestipol)
2010-278 |
|
|
Which drugs have the most powerful low-density lipoprotein-lowering effects?
|
Statins have the strongest reducing effect of all of the lipid-lowering drugs
2010-278 |
|
|
What adverse effects do HMG-CoA reductase inhibitors (eg, lovastatin, atorvastatin) have?
|
Elevated liver enzymes (which is reversible) and rhabdomyolysis
2010-278 |
|
|
Digoxin inhibits which mechanism of transport in the cell membrane?
|
Na+/K+/adenosine triphosphatase
2010-279 |
|
|
Which poison inhibits the calcium release channel in the sarcoplasmic reticulum?
|
Ryanodine
2010-279 |
|
|
Why is external calcium referred to as "trigger" calcium in the cardiac myocyte?
|
Because it is the trigger for release of intracellular calcium stores from the sarcoplasmic reticulum
2010-279 |
|
|
What is the mechanism by which β-1 activation increases cardiac contractility?
|
β-1 activation causes protein kinase A to phosphorylate L-type calcium channels, increasing intracellular calcium and strengthening contraction
2010-279 |
|
|
Because it can increase contractility, digoxin is used to treat what condition?
|
Congestive heart failure
2010-279 |
|
|
How does hypokalemia increase the toxicities of digoxin?
|
Potassium competes with digoxin at the same binding site in sodium/potassium adenosine triphosphatase, so hypokalemia allows for increased digoxin binding, and thus increased digoxin toxicities
2010-279 |
|
|
What are three common gastrointestinal complaints that occur with digoxin use?
|
Nausea, vomiting, and diarrhea
2010-279 |
|
|
What vision complaint can occur with digoxin use?
|
Blurry yellow vision
2010-279 |
|
|
What is the ultimate mechanism of action of cardiac glycosides?
|
To increase intracellular calcium (thereby acting as a positive inotrope), and to stimulate the vagus nerve
2010-279 |
|
|
Digoxin is removed from the body by _____ excretion.
|
Urinary; as a result, renal failure can cause digoxin toxicity
2010-279 |
|
|
What potential heart problem can arise with the use of digoxin?
|
Arrhythmia
2010-279 |
|
|
What is the effect of increased intracellular calcium on cardiac function?
|
Positive inotropy
2010-279 |
|
|
What factors increase the likelihood of digoxin toxicity?
|
Kidney failure (because of decreased excretion), hypokalemia, and quinidine (due to displacement of tissue-binding sites)
2010-279 |
|
|
By what mechanism is digoxin beneficial in atrial fibrillation?
|
Digoxin decreases conduction at the atrioventricular node and causes depression of the sinoatrial node
2010-279 |
|
|
What is the mechanism of action of digoxin?
|
By inhibiting the cardiac myocyte sodium/potassium pump, digoxin also prevents sodium/calcium exchange, increasing intracellular calcium concentration
2010-279 |
|
|
What are some potential electrocardiogram findings in a patient who has digoxin toxicity?
|
Prolonged PR interval, shortened QT interval, scooping, T-wave inversion, arrhythmia, and signs of hyperkalemia
2010-279 |
|
|
What is the approach to treatment of digoxin toxicity?
|
Slow normalization of potassium levels, lidocaine, a cardiac pacer, anti-digoxin antibodies, and magnesium
2010-279 |
|
|
What is the toxicity of class IC antiarrhythmics?
|
They are proarrhythmic because they increase the refractory period of the atrioventricular node; especially in patients who have recently had a myocardial infarction; these drugs are only used as a last resort
2010-280 |
|
|
Which antiarrhythmics belong to class IC?
|
Flecainide, encainide, and propafenone (remember: "Chipotle's Food has Excellent Produce")
2010-280 |
|
|
Quinidine causes symptoms of headache and tinnitus, which are collectively known as what?
|
Cinchonism; which can occur with all quinine derivatives
2010-280 |
|
|
What does it mean when sodium channel blockers are described as "state dependent"?
|
State dependent means that the antiarrhythmics act only on tissue that is frequently depolarized (eg, fast tachycardia)
2010-280 |
|
|
How do sodium channel blocker antiarrhythmics work?
|
They act as local anesthetics, in that they slow or block conduction by decreasing the slope of phase 4 depolarization and increasing the threshold for firing in abnormal pacemaker cells
2010-280 |
|
|
What are the adverse effects of class IB antiarrhythmics?
|
They can cause central nervous system stimulation or depression and cardiovascular depression
2010-280 |
|
|
What do class IB antiarrhythmics do?
|
They decrease action potential duration and preferentially affect ischemic Purkinje and ventricular tissue
2010-280 |
|
|
What are the adverse effects of quinidine?
|
Cinchonism (headache and tinnitus), thrombocytopenia, and torsades de pointes (due to prolonged QT)
2010-280 |
|
|
A patient on procainamide for an arrhythmia develops facial rash and joint pain. She is found to have antihistone antibodies in her serum. What is the diagnosis?
|
Reversible systemic lupus erythematosus-like syndrome
2010-280 |
|
|
Which antiarrhythmics belong to class IA?
|
Quinidine, Procainamide, and Disopyramide; remember the mnemonic "The Queen Proclaims Diso's pyramid"
2010-280 |
|
|
What are class IB antiarrhythmics used for?
|
To treat ventricular arrhythmia (especially after myocardial infarction) and in digitalis-induced arrhythmias
2010-280 |
|
|
Which antiarrhythmics are indicated to prevent arrhythmia after myocardial infarction? Which are contraindicated?
|
Class IB antiarrhythmics are indicated to prevent arrhythmia after myocardial infarction, but class IC antiarrhythmics are contraindicated
2010-280 |
|
|
Which antiepileptic drug can also act as a class IB antiarrhythmic?
|
Phenytoin
2010-280 |
|
|
What are class IC antiarrhythmics useful for?
|
As a last resort in ventricular tachycardia that may progress to ventricular fibrillation, and in intractable supraventricular tachycardia
2010-280 |
|
|
What are class IA antiarrhythmics used for?
|
To treat atrial and ventricular arrhythmias, especially reentrant and ectopic supraventricular and ventricular tachycardia
2010-280 |
|
|
Name the class IB antiarrhythmic drugs.
|
Class IB antiarrhythmics are Lidocaine, Mexiletine, and Tocainide (remember: "I'd Buy Lidy's Mexican Tacos")
2010-280 |
|
|
What electrolyte abnormality increases the toxicity of class I antiarrhythmics?
|
Hyperkalemia
2010-280 |
|
|
What effect do class IA antiarrhythmics have on the electrical activity of the heart?
|
They increase the action potential duration, increase the effective refractory period, and increase the QT interval
2010-280 |
|
|
What effect do class IC antiarrhythmics have on action potential duration?
|
They have no effect on action potential duration
2010-280 |
|
|
Which β-blocker is shortest acting?
|
Esmolol
2010-281 |
|
|
Which cardiac node is most sensitive to β-blockers: the sinoatrial node or the atrioventricular node?
|
The atrioventricular node; as a result, the PR interval is lengthened on electrocardiogram
2010-281 |
|
|
What is the clinical use of β-blockers?
|
To treat ventricular tachycardia and supraventricular tachycardia and to slow ventricular rate during atrial fibrillation and atrial flutter
2010-281 |
|
|
What is the mechanism of action of β-blockers?
|
β-Blockers decrease cAMP and calcium ion current and suppress abnormal pacemakers by decreasing the slope of phase 4 of the pacemaker action potential
2010-281 |
|
|
Which adverse effect is specific to metoprolol as opposed to other β-blockers?
|
Dyslipidemia
2010-281 |
|
|
Why might β-blockers be dangerous for someone who takes insulin?
|
Because they can mask signs of hypoglycemia
2010-281 |
|
|
Which antiarrhythmics belong in class II?
|
β-Blockers, such as propranolol, esmolol, timolol, metoprolol, and atenolol
2010-281 |
|
|
What are the toxicities of β-blockers?
|
Impotence, asthma exacerbation, cardiovascular effects (bradycardia, atrioventricular block, and congestive heart failure), central nervous system effects (sedation and sleep alterations)
2010-281 |
|
|
What is the antidote for β-blocker overdose?
|
Glucagon
2010-281 |
|
|
Why is amiodarone likely to interfere with thyroid function?
|
Because it is 40% iodine by weight
2010-281 |
|
|
Name a potentially fatal adverse effect of ibutilide.
|
Torsades des pointes
2010-281 |
|
|
Which antiarrhythmics belong to class III?
|
Potassium channel blockers, such as sotalol, ibutilide, bretylium, dofetilide, and amiodarone
2010-281 |
|
|
Name two toxicities of sotalol.
|
Torsades des pointes and excessive β-blockade
2010-281 |
|
|
Why does amiodarone have class I, II, III, and IV effects?
|
Because it alters the lipid membrane
2010-281 |
|
|
What three types of testing must be periodically performed for patients who are taking amiodarone?
|
Pulmonary function testing, liver function testing, and thyroid function testing
2010-281 |
|
|
Name eight toxicities of amiodarone.
|
Pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroidism, corneal deposits, blue-gray skin deposits, neurologic effects, constipation, and cardiovascular effects (bradycardia, heart block, and congestive heart failure)
2010-281 |
|
|
What are two toxicities of bretylium?
|
New arrhythmias and hypotension
2010-281 |
|
|
What is the mechanism of action of potassium channel blockers?
|
They increase the action potential duration, increase the effective refractory period, and increase the QT interval
2010-281 |
|
|
How do class IV antiarrhythmics affect conduction velocity through the atrioventricular node?
|
Decrease
2010-282 |
|
|
What is the clinical use of calcium channel blockers?
|
They are used in the prevention of nodal arrhythmias, such as supraventricular tachycardia
2010-282 |
|
|
Class IV antiarrhythmics primarily affect which cardiac myocytes?
|
Atrioventricular nodal pacemaker cells
2010-282 |
|
|
How do class IV antiarrhythmics affect PR intervals on electrocardiogram?
|
Increase; due to slowed conduction through the atrioventricular node
2010-282 |
|
|
How do class IV antiarrhythmics affect the refractory period of cardiac myocytes?
|
Increase
2010-282 |
|
|
What are the adverse effects of calcium channel blockers?
|
Constipation, flushing, edema, and cardiovascular effects (congestive heart failure, atrioventricular block, sinus node depression)
2010-282 |
|
|
Which two antiarrhythmic drugs belong to class IV?
|
Diltiazem and verapamil
2010-282 |
|
|
Which antiarrhythmic is a first-line drug for diagnosing and abolishing supraventricular tachycardia?
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Adenosine
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What is the mechanism of action of adenosine?
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Adenosine increases the amount of potassium flowing out of cells, leading to hyperpolarization of the cell
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Which ion is infused for treatment of torsades des pointes and digoxin toxicity?
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Magnesium
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What is the duration of action of adenosine?
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Adenosine is a short (about 15 seconds)-acting drug
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What are three toxicities of the antiarrhythmic drug adenosine?
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Flushing, hypotension, and chest pain
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