1A: Dt 6 - 3

Front 1

Atheroma vs Xanthoma

Back 1

Atheroma = plaques in BV walls
Xanthomas = Plaques or nodules of lipid-laden histiocytes in skin, esp. eyelids

Front 2

Arteriosclerosis vs Atherosclerosis

Back 2

Arteriosclerosis: hyaline thickening of small aa. in essential HTN or DM; "onion skinning" in malignant HTN

Atherosclerosis: fibrous plaques and atheromas in intima of aa

Front 3

Describe the pathologic progression of atherosclerosis. Begin with endothelial cell dysfunction.

Back 3

Endothelial cell dysfunction-->mac and LDL accumuln
-->foam cell formation
-->Fatty streaks
-->SM cell migration (PDGF and TGF-beta involved)
-->fibrous plaque
-->atheroma

Front 4

Most common site of atherosclerosis.

Back 4

Abdominal aorta
Followed by coronary artery, followed by popliteal, followed by carotid artery

Front 5

Statins:
Drug Class
Effect
AEs

Back 5

HMG-CoA reductase inhibitors

Lower LDL; inhibit cholesterol precursor, mevalonate

AE: Hepatotox (inc'd LFTs), rhabdomyolysis (muscle breakdown)

Front 6

Niacin:
MOA
Effect
AE

Back 6

MOA: inhibit lipolysis in adipose tissue; reduced hepatic VLDL secretion into circulation

Inc HDL (and dec LDL)

AE: Flushing

Front 7

Bile acid resins:
Prefix
MOA
Effect

Back 7

Begin with cholest or coles

Dec'd LDL

Malabsorption of fat (and fat-soluble vits)

Front 8

Ezetimibe:
MOA
Effect

Back 8

Prevents cholesterol reabsorption at small intestine brush border

Lowers LDL, esp. when used with statin

Front 9

Fibrates:
Suffix
Effect

Back 9

-fibrate or -fibrozil

Dec TGs

Front 10

Which lipid-lowering agent:
SE: facial flushing

Back 10

Niacin

Front 11

Which lipid-lowering agent:
elevated LFTs, myositis

Back 11

Fibrates, statins

Front 12

Which lipid-lowering agent:
SE: GI discomfort, bad taste

Back 12

Bile acid resins

Front 13

Which lipid-lowering agent:
best effect on HDL

Back 13

Niacin

Front 14

Which lipid-lowering agent:
best effect on TGs/VLDL

Back 14

Fibrates

Front 15

Which lipid-lowering agent:
best effect on LDL/cholesterol

Back 15

Statins

Front 16

Which lipid-lowering agent:
binds C. diff toxin

Back 16

Cholestyramine

Front 17

A 50-year old man starts lipid-lowering medication.

On first dose, he develops a rash, pruritis, and diarrhea.

What drug is he taking?

Back 17

Niacin--prevent flush with aspirin

Front 18

What is the MOA of cardiac glycosides (digoxin)?

Back 18

Inhibit Na/K ATPase-->dec'd extracell Na-->inc'd intracell Ca-->inc'd contractility

Front 19

What is aortic dissection?
Presentation?
Risk factors

Back 19

Longitudinal intraluminal tear forming false lumen
Assocd w/HTN or Marfan's

Presents w/tearing chest pain radiating to back

CXR w/mediastinal widening

CAN RUPTURE AND RESULT IN DEATH :(

Front 20

Back 20

aortic dissection

Front 21

Back 21

aortic dissection

Front 22

Treatment of aortic dissection.

Back 22

Beta-blocker--inc'd BP will cause greater tearing of aorta

Front 23

When does angina become symptomatic?
Stable vs Unstable

Back 23

CAD narrowing >75%

Stable = predictable; know you'll get angina while walking upstairs

Unstable: comes on unpredictably

Front 24

An abdominal aortic aneurysm is most likely a consequence of what process?

Back 24

HTN

Front 25

What are the 5 deadly causes of acute chest pain?

Back 25

-Aortic dissection
-Unstable angina
-MI
-Tension pneumothorax
-PE

Front 26

What is the likely cause of chest pain:
ST segment elevation only during brief episodes of chest pain

Back 26

Prinzmetal's angina

Front 27

What is the likely cause of chest pain:
Patient is able to point to localize chest pain using one finger

Back 27

M/S chest pain (pulled muscle)

Front 28

What is the likely cause of chest pain:
Chest wall tenderness on palpation

Back 28

M/S chest pain (pulled muscle)

Front 29

What is the likely cause of chest pain:
Rapid onset sharp chest pain that radiates to scapula

Back 29

Aortic dissection

Front 30

What is the likely cause of chest pain:
Rapid onset sharp pain in 20 year-old and associated with dyspnea

Back 30

Spontaneous pneumothorax (lung collapses)

Front 31

What is the likely cause of chest pain:
Occurs after heavy meals, improved with antacids

Back 31

GERD or esophageal spasm

Front 32

What is the likely cause of chest pain:
Acute onset dyspnea, tachycardia, confusion in hospitalized patient

Back 32

PE

Front 33

What is the likely cause of chest pain:
Pain began day following an intensive new exercise program

Back 33

M/S Pain

Front 34

What is the likely cause of chest pain:
Sharp pain lasting hours-days, somewhat relieved by sitting forward

Back 34

Pericarditis

Front 35

What is the likely cause of chest pain:
Pain made worse by deep breathing and/or motion

Back 35

M/S Pain

Front 36

What is the likely cause of chest pain:
Chest pain in dermatomal distribution

Back 36

Shingles (Zoster)

Front 37

What is the likely cause of chest pain:
Most common cause of non-cardiac chest pain

Back 37

GERD

Front 38

Drug classes used to treat angina.
Effects of each.

Back 38

Nitrates (dec'd preload): dec'd myocardial oxygen demand

beta-blockers (dec'd afterload):
dec'd myocardial oxygen demand

Nitrates and beta-blockers:
Super dec'd myocardial oxygen demand

Front 39

Most commonly occluded coronary artery.

Back 39

LAD--anterior wall MI

Front 40

Describe evolution of MI (chronologically):
Gross vs Histo
Risks associated

Back 40

First day:
Gross: dark mottling; pale with terazolium stain
Histo: contraction bands after 12-24 hours (early coagulative necrosis); release of contents of necrotic cells, beginning of nphil emigration

2-4 days:
Gross: hyperemia (dilated vessels)

Histo: tissue surrounding infarct shows inflammn; dilated vessels (hyperemia), nphil emgration

5-10 days:
Gross: Hyperemic border; YELLOW-BROWN softening--maximally yellow and soft by 10 days
Histo: RISK FOR FREE WALL RUPTURE, tamponade, papillary muscle rupture, intraventricular septal septal rupture

7 weeks:
Gross: recanalized artery, gray-white zone of previous infarct

Histo: contracted scar complete; risk of ventricular aneurysms

Front 41

A patient with poorly managed HTN has acute, sharp substernal pain that radiates to the back and progresses over a few hours.
Death occurs shortly thereafter.

Diagnosis?

Back 41

Aortic dissection

Front 42

Describe EKG changes seen in evolution of MI.

Back 42

Front 43

Describe diagnosis of MI.

Back 43

ECG is gold standard.
Cardiac troponin I rises after 4 hours; elevated for 7-10 days

CK-MB predominantly found in myocardium, but can also be released from skeletal muscle; useful in diagnosing reinfarction

AST nonspecific and found in cardiac, liver, and skeletal muscle cells

Front 44

Transmural infarct vs Subendocardial infarct:
General
EKG findings

Back 44

Transmural: due to inc'd necrosis; affects entire wall, ST elevation on EKG, Q waves

Subendocardial infarct: ischemic necrosis <50% of ventricle wall; due to fewer collaterals, higher pressure; ST DEPRESSION on EKG

Front 45

Severe mitral regurgitation days following MI

Back 45

Papillary mm rupture

Front 46

Infarct of LAD:
EKG leads?

Back 46

Q waves in leads V1-V4, V5

Front 47

Infarct of Left Circumflex:
EKG leads?

Back 47

Q waves in leads aVL, V5, V6

Front 48

Infarct of Right Coronary--Inferior wall:
EKG leads?

Back 48

II, III, aVF

Front 49

Infarct of Right Coronary--Posterior wall:
EKG leads?

Back 49

R precordial EKG: V4

Front 50

Thrombolytics:
Examples
MOA
Use
Antidote

Back 50

Streptokinase, urokinase, tPA

Directly or indirectly aid conversion of plasminogen to plasmin, cleaves thrombin and fibrin clots (inc'd PT, inc'd PTT; no change in PLT count)

Use: Early MI, early ischemic stroke

Antidote: Aminocaproic acid

Front 51

Clopidogrel:
MOA
Effects

Back 51

Both inhibit platelet aggregation by irreversibly blocking ADP receptors

Front 52

Abciximab:
MOA

Back 52

MAB that bind GpIIb/IIIa on activated PLTs, prevent agg

Front 53

Dilated cardiomyopathy:
Causes
Concentric or Eccentric?
Diastolic or systolic dysfunction?

Back 53

Alcohol abuse
wet BeriBeri-Thiamine deficiency (B1; 2 i's look like 1)
Coxsackie B virus
Chronic Cocaine, Chagas'
Doxorubicin
(ABCD)

ECCENTRIC (sarcomeres added in series)

SYSTOLIC dysfn

NOTE: ECCENTRIC MEANS NO MUSCLE THICKENING, VENTRICLE IS DILATED

Front 54

Hypertrophic cardiomyopathy:
Causes
Concentric or Eccentric?
Diastolic or systolic dysfunction?

Back 54

Familial
Friedreich's Ataxia
Cause of sudden death in young athletes

Concentric hypertrophy (sarcomeres added in parallel)--proximity of hypertrophied IV septum to mitral leaflet obstructs outflow tract (systolic murmur)

Diastolic dysfn

NOTE: CONCENTRIC MEANS MUSCLE OF VENTRICLE IS THICKENED

Front 55

Restrictive cardiomyopathy:
Causes
Diastolic or systolic dysfunction?

Back 55

Sarcoidosis
Amyloidosis
Postradiation fibrosis
Endocardial fibroelastosis
Hemochromatosis

Diastolic dysfn

Front 56

Dec'd LV contractility:
Causes
Effects
Treatment

Back 56

Causes: MI, chronic HTN

Effects: Low cardiac output-->Inc'd renin-->Inc'd systemic venous pressure-->peripheral edema

-->inc'd symp activity-->inc'd contractility and cardiac output

Tx: Digoxin

Front 57

Left-sided heart failure:
Symptoms

Back 57

Pulmonary congestion

Dyspnea on exertion
Orthopnea (shortness of breath when supine)

Front 58

Right-sided heart failure:
Symptoms

Back 58

Hepatomegaly (nutmeg liver)
Ankle, sacral edema
JVD

Front 59

Digoxin:
MOA
AE
Antidote

Back 59

Direct inihbition of Na/K ATPase activity leading to indirect inhibition of Na/Ca exchanger/antiport-->positive inotropy (stimulates vagus nerve)

AE: Cholinergic--n/v/d, blurry yellow vision***(think Van Gogh)
Hypokalemia--worsened by renal failure

Antidote: Slowly normalize K+, Lidocaine, pacemaker, anti-dig Fab fragments, Mg2+

Front 60

During a high school football game, a young athlete collapses and dies immediately.

What type of cardiac disease did he have?

Back 60

Hypertrophic CM

Front 61

Antidote:
Acetaminophen

Back 61

N-acetylcysteine

Front 62

Antidote:
Salicylates

Back 62

NaHCO3 (trap with basic urine)

Front 63

Antidote:
Amphetamine

Back 63

NH4Cl (acidify urine)

Front 64

Antidote:
AChE-inhibitors
Organophosphates

Back 64

Atropine, pralidoxime

Front 65

Antidote:
Antimuscarinic, anticholinergic agnets

Back 65

-stigmine

Front 66

Antidote:
Beta-blockers

Back 66

Glucagon

Front 67

Antidote:
Digitalis

Back 67

Stop dig
Normalize K+
Lidocaine
Anti-dig Fab frags
Mg2+

Front 68

Antidote:
Fe

Back 68

Deforxamine

Front 69

Antidote:
Pb

Back 69

CaEDTA

Front 70

Antidote:
Mercury, arsenic, cold

Back 70

Dimercaprol (BAL); Dime is a monetary unit, as is gold

Front 71

Antidote:
Copper, arsenic, golc

Back 71

Penicillamine--Copper comes from PENnies

Front 72

Antidote:
Cyanide

Back 72

Nitrite
Thiosulfate
Hydroxocobalamin

Front 73

Antidote:
Methemoglobin

Back 73

METhylene blue
Vit C

Front 74

Antidote:
CO

Back 74

100% O2, hyperbaric O2

Front 75

Antidote:
Methanol, ethylene glycol

Back 75

Ethanol
Dialysis
Fomepizole*** (inhibits alcohol dehydrogenase)

Front 76

Antidote:
Opioids

Back 76

Naloxone/maltrexone

Front 77

Antidote:
Benzodiazepenes

Back 77

Flumazenil

Front 78

Antidote:
TCAs

Back 78

NaHCO3 (plasma alkalinization)

Front 79

Antidote:
Heparin

Back 79

Protamine

Front 80

Antidote:
tPA, streptokinase

Back 80

Aminocaproic acid

Front 81

Antidote:
Theophylline

Back 81

beta-blocker

Front 82

Back 82

1. fasciculus cuneatus (Dorsal column)--from arms
2. fasciculus gracilis (Dorsal column)--from legs
3. Lissauer's tract--info from spinothalamic tract; pain and temp info ascends here and crosses at anterior commissure
4. Lateral corticospinal (voluntary motor info to body)
5. Vestibulospinal tract
6. Reticulospinal tract
7. Anterior/ventral spinal tract (voluntary motor command)
8. Anterior spinothalamic tract
9. Lateral spinothalamic tract (pain, temp sensation)
10. Anterior spinocerebellum tract
11. Posterior cerebellar tract (proprioception)

Front 83

Which spinal tract conveys:
Touch, vibration, and pressure sensation

Back 83

Dorsal column (affected by syphilis)

Front 84

Which spinal tract conveys:
Voluntary motor command from motor cortex to body

Back 84

Corticospinal tracts

Front 85

Which spinal tract conveys:
Voluntary motor command form motor cortex to head/neck

Back 85

Corticobulbar tract

Front 86

Which spinal tract conveys:
Alternate routes for mediation of voluntary movement

Back 86

Reticulo- and rubrospinal tracts

Front 87

Which spinal tract conveys:
Pain and temperature sensation

Back 87

Lateral spinothalamic tract

Front 88

Which spinal tract conveys:
Important for postural adjustments and head movements

Back 88

Vestibulospinal tract

Front 89

Which spinal tract conveys:
Proprioceptive information for cerebellum

Back 89

Dorsal and ventral spinocerebellar tracts