Cardio For Step 1 High Yield

Front 1

Congenital cardiac defect associations

22q11 syndromes

Back 1

Truncus arteriosus
Tetralogy of Fallot

Front 2

Congenital cardiac defect associations

Down Syndrome

Back 2

ASD, VSD

Front 3

Congenital cardiac defect associations

Congenital Rubella

Back 3

Septal Defects, PDA

Front 4

Congenital cardiac defect associations

Turner's Syndrome

Back 4

Coarctation of Aorta
Bicuspid Aortic Valve (predisposed to A.S.)

Front 5

Congenital cardiac defect associations

Marfan's Syndrome

Back 5

Aortic Insufficiency due to cystic medial necrosis (no media in vessel)

Front 6

Congenital cardiac defect associations

Offspring of diabetic mother

Back 6

Transposition of Great Vessels

Front 7

Reaction of hyperlipidemia medication is rash, itchiness, GI upset

Back 7

Niacin

Front 8

Pericarditis:
Viral Infection
SLE
RA
Uremia

Back 8

Serous Pericarditis

if there is an increased JVD on INSPIRATION --> Kussmaul sign --> Constrictive Pericarditis --> Compromised CO

Front 9

Pericarditis:
Uremia
MI
Rheumatic fever

Back 9

Fibrinous Pericarditis

Front 10

Pericarditis:
Tb
Malignancy

Back 10

Hemorrhagic Pericarditis

Front 11

Pressure in all four chambers of the heart are equal. Total arterial BP is decreased. Pulsus paradoxus is present (dec. in BP less than 10 mmHg during inspiration)

Back 11

Cardiac Tamponade

Front 12

Temporal arteritis is associated with what condition? Hint: pain and stiffness in shoulders and hips associated with fever, malaise, wt loss and increased ESR

Back 12

Polymyalgia rheumatica

Rx: prednisone

Front 13

C-ANCA
Small-medium vessels
Lungs --> Cystic lesions on CT
Renal: C-ANCA associated RPGN

Do not treat with methotrexate

Back 13

Wegener's Granulomatosis

***similar in presentation to Goodpasture's syndrome***

Tx with cyclophophamide and steroids. Methotrexate is nephrotoxic

Front 14

Wide Splitting S2

Back 14

Pulmonary Stenosis

Front 15

Fixed Splitting S2

Back 15

ASD (no widening that is expected on inspiration)

Front 16

Parodoxical Splitting S2

Back 16

P2 --> A2

Aortic Stenosis

Front 17

During which phase of myocardial AP is the muscle contraction?

Back 17

Phase 2: Calcium spark

Front 18

What are the two leak currents in myocardial cells

Back 18

K out
Ca in

Front 19

What is one of the most common congenital LQT syndromes presenting with syncope, Torsades de pointes and deafness

Back 19

Jervell & Lange-Nielson Syndrome

A.R.

Front 20

What causes Tetralogy of Fallot?

Back 20

Anterosuperior displacement of infundibular septum

Front 21

Why is the abdominal aorta the most vulnerable to atherosclerosis and aneurysms?

Back 21

No vaso vasorum below renal artery so easily ischemic and damaged.

Front 22

Why are infarcts to the lung liver and intestines red?

Back 22

Hemorrhage
Loose Tissues
Lots of collateral circulation
On reperfusion, the increases PO2 causes increases reactive oxygen species because conc. of O2 is too high and forms radicals.

Front 23

When is someone at risk for ventricular aneurysm post-MI?

Back 23

~ 7 days (scar formation complete)

Front 24

6 days after an MI someone presents to the ER and you can barely hear the heart sounds plus pulsus paradoxus is present. What is your dx?

Back 24

Free wall rupture leading to cardiac tamponade.

Front 25

4 days after an MI someone presents to the ER with pain in their chest and upon auscultation you notice a friction rub. What is your dx?

Back 25

Fibrinous Pericarditis

Front 26

Major causes of restrictive/obliterative cardiomyopathy?

Back 26

Sarcoidosis
Amyloidosis
Postradiation Fibrosis
Endocardial Fibroelastosis
Endomyocardial fibrosis (Loeffler's --> ass with cancer)
Hemochromatosis

Front 27

How would you differentiate between right and left sided murmurs?

Back 27

If it's worse on inspiration, it's most likely on the right side of heart (increased venous return)

Front 28

Focal interstitial myocardial inflammation with fragmented collagen and FIBRINOID material

Back 28

Aschoff bodies in Rheum heart diseaes

Autoimmune destruction = Fibrinoid necrosis

Front 29

Dobutamine

Back 29

B-adrenergic agonist (b1 mostly)

used in CHF associated with decreased myocardial contractility (cardiogenic shock)

Increased cAMP (Gs)
1. inc contractility -> increase CO, decreased ventricular filling pressures

2. Inc HR and myocardial O2 consumption (less so than giving pure dopamine)

3. Increased conduction velocity --> Arrhythmias

Front 30

Child presents with hypertension, hypokalemia, and an enlarged clitoris. She was born with ambigious genitalia. Her labia are fused. What is the most likely diagnosis?

Back 30

11 beta hydroxylase deficiency.

Front 31

Where is the mutation for the following deficiency?

autosomal dominant or recessive?

Back 31

CYP11B1 gene

AR

Front 32

How would you treat this patient?

Back 32

Dexamethasone or hydrocortisone (replace where the patient isn't making)

Front 33

Child presents with hypotension, hyperkalemia, and an enlarged clitoris. She was born with ambigious genitalia. Her labia are fused. What is the most likely diagnosis?

Back 33

21 beta hydroxylase deficiency

Front 34

What will this patient's renin levels be?

Back 34

increased because there are no mineralocorticoids being produced.

Front 35

A 40 yo patient presents with weakness, orthostatic hypotension, hyperpigmented skin, low bicarbonate, low sodium levels, high potassium levels and low cortisol. What is the most likely diagnosis?

Back 35

Addison's Disease.

Front 36

What is the most likely etiology?

Back 36

Autoimmune/idiopathic

Also
DIC
Waterhouse-Fridrichson Syndrome (post meningococcal infection)
Tb (miliary -> most common in developing countries)
HIV

Front 37

What is conn's syndrome?

Back 37

primary hyperaldosteronism

Front 38

What is the likely etiology of conn's syndrome?

Back 38

#1 - adenoma of zona granulosa
#2 - bilateral hyperplasia of zona glomerulosa

Front 39

What will hypokalemia (secondary to increased aldosterone prod in conn's) present with on an EKG?

Back 39

prominent U waves
flattened T waves
ST segment depression

Front 40

How would you treat conn's syndrome?

Back 40

Spironolactone or Epotereone (latter does not have anti-andronergic effects)

Front 41

What is the treatment for cushing's syndrome?

Back 41

1. Ketoconazole - inhibits desmolase
2. Metyrapone
3. Aminoglutethimide

Front 42

What if cushing's syndrome is cause by a neoplasia?

Back 42

Surgery

Front 43

A new patient is dx with Type I D.M. with high glucose levels. Why not give rapid insulin therapy?

Back 43

Cerebral edema secondary to decreased EC osmolality and influx of water into neurons

Hypokalemia (insulin drives K+ into cells)

Hypoglycemia

Front 44

What are the two treatments for chronic gout?

Back 44

Probenecid --> inhibits renal reabsorption of uric acid

Allopurinol --> inhibits xanthine oxidase (contraindicated in patients taking mercaptopurine, thiazide diuretics)

Front 45

WHat are the common causes of hypercalcemia? (MISHAP)

Back 45

Malignancy
Intox of Vit D
Sarcoidosis
Hyperparathyroidism (painful bones, stones, groans, moans)
Alkali syndrome
Paget's Disease of Bone

Front 46

A biopsy of the thyroid shows nests of cells in AMYLOID stroma. What is your diagnosis?

Back 46

Medullary ca of the thyroid (MEN II and II --> RET --> AD)

Front 47

What is pseudohypoparathyroidism?

Back 47

The kidney doesn't respond to PTH.

Front 48

What is the genetic cause of this?

Back 48

mutated G_s-alpha_1 protein of adenylyl cyclase

Associated with Albright's Hereditary Osteodrystrophy (some patients have GHRH resistance)

Front 49

What are common causes of hypothyroidism?

Back 49

Alcohol
Autoimmune (hashimoto's)
Drugs (amiodarone, lithium)
infection

Front 50

Ascaris Lumbricoides

Back 50

Southern U.S., Tropical Climates

Most common worldwide

1.) Eat eggs
2.) Larvae in SI
3.) Move to alveoli
4.) Cough and swallow
5.) GI (again!) as adults
6.) Go to bile ducts and pancreas

Test: Stool --> Eggs are knobby rough surface

Rx: Mebendazole, Pyrantel Palmoate

Front 51

45 degree branched hyphae

Back 51

Aspergillus

Front 52

What would a CXR look like of someone infected with this and is immunocompromised?

Back 52

"Fungus ball" in preexisting lung lesions --> aspergilloma

Front 53

How would you treat aspergillosis?

Back 53

Amphotericin B (binds to ergo)
AE: Kidney prob, arrhythmias, fever, chills, hypotension

Front 54

What is invasive aspergillosis?

Back 54

Can go to kidneys and pericardium causing oliguria and chest pain

Front 55

Pork Tapeworm

Back 55

T. solium

Front 56

T. solium

Back 56

Cysticercosis

Front 57

How do you get cysticercosis?

Back 57

1. Eat undercooked pork
2. Larvae in GI and mature
3. Release Eggs in feces

THEN

4. Fecal --> Oral (eat your feces)
5. Eat EGGS (not larvae like initially) that go to GI tract
6. Egg hatch into onchospheres
7. Penetrate GI wall
8. Migrate to eye (blindness), brain (seizures) and muscle

Front 58

What would you see on head CT of someone who has cysticercosis?

Back 58

Calcified lesions

Front 59

What is the treatment?

Back 59

Praziquantal or albendazole + steroids or anticonvulsants for neurocysticercosis

Front 60

Wuchereria bancrofti

Back 60

Elephantitis

Front 61

How do you get this?

Back 61

Bite of a mosquito

Front 62

What happens then?

Back 62

Larvae go to lymphatics and block them by maturing

1 year later --> adult worms in LYMPH NODES causes inflamm response and repeated bouts of inflammation cause fibrosis which blocks lymph nodes

Front 63

How would you dx elephantitis?

Back 63

draw blood in evening (larvae = microfilariae)

Front 64

How would you treat this?

Back 64

diethylcarbamzine to kill larvae

Front 65

What causes ITP?

Back 65

Autoimmune in which the body makes Ab against platelets

Front 66

What do you need for a diagnosis?

Back 66

low platelets
coomb's test positive
petechiae and purpura of mucus membranes

Front 67

What happens to the control of blood flow to the kidney when giving NSAIDs?

Back 67

NSAIDS inhibit prod of PGE2 which is the primary regulator of afferent arterioles. Therefore the only control on renal blood blow is the potent vasoconstrictor.

Front 68

What is that vasoconstrictor?

Back 68

AT II --> Increases risk of ischemic damage to medulla

Front 69

Fusion of podocytes =

Back 69

Sign of nephrotic syndrome

Front 70

Mutations to different genes cause similar phenotypes

Back 70

Genetic heterogeneity

Ex:
Marfans (fibrillin 1 gene) and Homocystinuria both have marfanoid like body habitus and lens dyslocation

Front 71

Genetic Heterogeneity

Back 71

Mutations to different genes cause similar phenotypes

Front 72

Alleleic Heterogeneity

Back 72

different mutations on same locus cause same phenotype

Front 73

Phenotypic heterogeneity

Back 73

mutations on SAME gene cause different phenotype

Front 74

What happens to Type I and II errors and power if the study's statistical significance is changed from 0.05 to 0.01?

Back 74

Type I (alpha) will decrease
(you will have less chance of rejecting the null hypothesis when it is actually true)

Type II (beta) error will increase

Power will decrease (P = 1 - beta)

Front 75

Bacterial antibiotic efflux pumps (resistance to Ab()

Back 75

Need energy

1.) proton gradient
2.) sodium gradient
3.) ATP

Front 76

Catecholamine degradation

Back 76

1. MAO -> oxid. deamination (MITOCHONDRIA = MAO)

2. COMT -> methylation (CYTOSOL)

Yields Vanillymandelic acid (VMA)

Front 77

Mutations on Chr 7

Back 77

Cystic Fibrosis
Ehlers Danlos Syndrome
Osteogenesis imperfecta

Front 78

Mutations on Chr 16

Back 78

Adult PKD
Tuberous Sclerosis

Front 79

Paget's disease of bone places someone at increased risk of...

Back 79

Osteosarcoma (DUH)

mixed radiolucent and radiodense areas on the bone

CODMAN's TRIANGLE

SUNBURST

Front 80

Viruses in the paramyxoviridae family

Back 80

Mumps
Measles (3 C's)
RSV (bronciolitis in < 2 y.o, Tx: Ribavirin)
Parainfluenza (Croup)

Front 81

Acute Intermittent Porphyria

Back 81

Auto Dom

No Uroporphyrinogen I synthetase AKA HMB synthase

S/S: episodes of stomach pain with neuro symptoms after exposure to offending agent

Urine from patients will turn dark upon standing

NO NO NO NO NO NO photosensitivity (those are later in the Heme pathway)

Front 82

DNA laddering (fragments of DNA on southern blot)

Back 82

Apoptosis (Karyohexis?)

Front 83

AE of cyclosporine

Back 83

Renal Injury (you can't ride your bike through the kidney)

Front 84

What if someone is drinking grapefruit juice and taking cyclosporine?

Back 84

Worse renal injury because GF juice is an inhibitor of P450 (which is not only in the liver but also in the GI tract supposedly)

This is a pharmacokinetic interaction)

Front 85

Analgesic abuse + acetominaphen in kidneys

Back 85

Thickened vasa recta capillaries

Intermittent tubular necrosis

Eventually PAPILLARY NECROSIS
FOCAL/SEGMENTAL GLOMERULOSCLEROSIS
Interstitial infiltration/fibrosis

Front 86

X-linked disease
Trinucleotide repeat
Bulbospinal muscular atrophy leading to difficult swallowing, facial and tongue fasciculations

Back 86

Kennedy Disease (yeah, I know, I never heard of it either but apparently it exists)

Front 87

Calcium dependent adhesion molecules that help muscle and epi cells bind together

Back 87

Cadherins (in desmosomes and adeherens)

Not in hemidesmosomes

Front 88

Lets play a game:

You remove on kidney. What happens to GFR?

After 1 week?

After 6 weeks?

Back 88

Immediately it will decrease by 50% (DUH)

1 week later --> Increase to 65-70%

4-6 Weeks later --> 80%

How? remaining kidney hypertrophies and hyperfiltrates

Front 89

What is the most common organism in endometriosis post-partum?

Back 89

Bacteroides and mixed flora

Front 90

What are the components of the inguinal canal?

Back 90

Deep inguinal ring (defect in transversalis fascia_)

Posterior wall (conjoint tendon of transversus abdominus and internal oblique mm)

Superficial inguinal ring --> defect in external oblique mm aponeurosis

Front 91

Child with rash on legs and buttocks, increased IgA levels, knee and ankle stiffness plus stomach pain. What is the most likely dx?

Back 91

HSP
small vessel vasculitis

etiology: usually idiopathic but follows an URI in children. IgA deposition in blood vessels cause leaking leading to purpura and petechiae.

Front 92

What renal pathology is similar to HSP's pathophys?

Back 92

IgA (berger's) nephropathy

Front 93

HIV, Heroin --> Nephrotic Syndrome

Back 93

Focal Segmental Glomerulosclerosis

Front 94

What can this lead to?

Back 94

Collapsing glomerulopathy where there is collapse and sclerosis of the whole glomerular tuft.

Front 95

What are the most common causes of hypokalemia?

Back 95

1. decreased intake (rare)
2. Increased loss
3. Increased movement into cells

Front 96

How can you lose too much K?

Back 96

GI (vomiting, diarrhea, laxatives) or urinary (diuretics, primary aldosteronism, loss of gastric secretions, metabolic acidosis or polyuria)

Front 97

How would metabolic acidosis lead to hypokalemia?

Back 97

H ions go into cell pushing out K ions. This increases serum levels of K+ but ultimately results in increased K excretion in kidney

Front 98

How is hypokalemia cause dby increased movement into cells?

Back 98

Alkalosis, Beta-adrenergic stim, hypothermia

Front 99

Why is hypocitraturia associated with renal calculi?

Back 99

Citrate is a potent inhibitor of stone formation because it's a great chelator of calcium.

Front 100

How do you calculate serum osmolality?

Back 100

2*Na + glucose/18 + BUN/2.8

Front 101

How does demeclocycline help SIADH?

Back 101

It poisons the collecting tubule making it unresponsive to ADH