Clinmed Test 3

Front 1

T/F Both pulmonary and systemic circulatory circuits are pulsatile.

Back 1

False. Only the systemic circuit is pulsatile

Front 2

Physical principals governing pressure, flow and resistance within the cardiovascular system

Back 2

Hemodynamics

Front 3

Describes layering of blood components so plasma is near smooth vessel wall while formed blood is within the vessel

Back 3

Laminar Flow

Front 4

Describes disordered blood flow so that blood moves crosswise and lengthwise in blood vessel causing murmurs and bruits

Back 4

Turbulent Flow

Front 5

What effect do ionotropic drugs have on the heart?

Back 5

Increase contractility

Front 6

List the three pools of cardiac control located in the medullary cardiovascular neurons

Back 6

Acceleration of heart rate (Sympathetic)
Blood vessel tone (Sympathetic)
Slowing of heart rate (Parasympathetic)

Front 7

Volume of blood in the ventricles at the end of diastole

Back 7

Preload

Front 8

The pressure that the heart must generate to overcome mean arterial pressure in the aorta

Back 8

Afterload

Front 9

VLDL carries large amounts of ____?

Back 9

Triglycerides

Front 10

LDL carries mainly ______?

Back 10

Cholesterol

Front 11

HDL is made up of 50% _________?

Back 11

Protein

Front 12

What are the two sites of lipoprotein synthesis?

Back 12

Small intestine and liver

Front 13

Approximately 75% of LDL receptors are located on _____ in this organ.

Back 13

Hepatocytes/liver

Front 14

List the signs of metabolic syndrome (syndrome X)

Back 14

- Abdominal Obesity [Men Waist Circumference > 102 cm (42 inches), Women Waist Circumference > 88 cm (35 inches)]
- Elevated triglycerides > 150 mg/dL
- Low HDL-C [Men HDL-C < 40, Women HDL-C < 50]
- Elevated Blood pressure > 130/85
- Elevated Fasting blood glucose > 110 mg/dL

Front 15

A progressive disease that characterized by arterial thickenings that exude pasty yellow cholesterol ester "mush"

Back 15

Atherosclerosis

Front 16

The formation of fibrofatty lesions in the intimal lining of the large and medium-sized arteries such as the aorta and its branches, the coronary arteries, and the large vessels that supply the brain

Back 16

Atherosclerosis

Front 17

This CHD marker can cause atherosclerosis by binding to macrophages through a high-affinity receptor that promotes foam cell formation and the deposition of cholesterol in atherosclerotic plaques

Back 17

Lipoprotein(a)

Front 18

Thin, flat, yellow intimal discolorations of the arterial endothelium that progressively enlarge by becoming thicker and slightly elevated as they grow in length. Histologically, they consist of macrophages and smooth muscle cells that have become distended with lipid to form foam cells.

Back 18

Fatty Streaks

Front 19

The basic lesion of clinical atherosclerosis. It is characterized by the accumulation of intracellular and extracellular lipids, proliferation of vascular smooth muscle cells, formation of scar tissue, and calcification.

Back 19

Fibrous plaque

Front 20

Hemorrhage, ulceration, and scar tissue deposits in fibrous plaques of the endothelial lining of arteries.

Back 20

Complicated lesions

Front 21

List the steps in the pregressive development of atherosclerotic lesions.

Back 21

(1) endothelial cell injury
(2) migration of inflammatory cells
(3) smooth muscle cell proliferation and lipid deposition
(4) gradual development of the atheromatous plaque with a lipid core.

Front 22

Inflammatory injury and necrosis of the blood vessel wall

Back 22

Vasculitis

Front 23

Necrotizing vasculitis with few or no immune deposits affecting medium and small blood vessels, including capillaries, venules, arterioles; necrotizing glomerulonephritis and involvement of the pulmonary capillaries is common

Back 23

Microscopic polyangiitis
(small vessel vasculitis)

Front 24

Granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting capillaries, venules, arterioles, and arteries; necrotizing glomerulonephritis is common

Back 24

Wegener granulomatosis
(small vessel vasculitis)

Front 25

Necrotizing inflammation of medium-sized or small arteries without vasculitis in arteries, capillaries, or venules; usually associated with underlying disease or environmental agents

Back 25

Polyarteritis nodosa (PAN)
(medium vessel vasculitis)

Front 26

Involves large, medium-sized, and small arteries (frequently the coronaries) and is associated with mucocutaneous lymph node syndrome; usually occurs in small children

Back 26

Kawasaki disease
(medium vessel vasculitis)

Front 27

Segmental, thrombosing, acute and chronic inflammation of the medium-sized and small arteries, principally the tibial and radial arteries but sometimes extending to the veins and nerves of the extremities; occurs almost exclusively in men who are heavy smokers

Back 27

Thromboangiitis obliterans
(medium vessel vasculitis)

Front 28

Granulomatous inflammation of the aorta and its major branches with predilection for extracranial vessels of the carotid artery; infiltration of vessel wall with giant cells and mononuclear cells; usually occurs in people older than 50 years of age and is often associated with polymyalgia rheumatica

Back 28

Giant cell (temporal) arteritis
(large vessel vasculitis)

Front 29

Granulomatous inflammation of the aorta and its branches; usually occurs in people younger than 50 years of age

Back 29

Takayasu arteritis
(Large vessel vasculitis)

Front 30

The aneurysm is bounded by a complete vessel wall so that the blood remains within the vascular compartment.

Back 30

True aneurysm

Front 31

A localized dissection or tear in the inner wall of the artery with formation of an extravascular hematoma that causes vessel enlargement.

Back 31

False aneurysms

Front 32

Aneurysm that involves the entire circumference of the vessel and is characterized by a gradual and progressive dilation of the vessel. These aneurysms, which vary in diameter (up to 20 cm) and length, may involve the entire ascending and transverse portions of the thoracic aorta or may extend over large segments of the abdominal aorta

Back 32

Fusiform aneurysm

Front 33

Aneurysm that extends over part of the circumference of the vessel

Back 33

Saccular aneurysm

Front 34

Patient has blood pressure 150/102. Name the blood pressure category(s) for systolic and diastolic.

Back 34

Systolic HTN stage 1
Diastolic HTN stage 2

Front 35

List a diagnostic workup of hypertension

Back 35

-Risk factors?
-Secondary causes?
-Target organ damage?
-Labs (Kidneys, DMII and Lipids)
-ECG

Front 36

List major risk factors for CVD

Back 36

-HTN
-Obesity
-DMII
-Dyslipidemia
-Smoking
-Inactivity
-Microalbuminuria
-Men>55 or Women>65
-Fhx premature CVD

Front 37

List identifiable causes of HTN

Back 37

-Sleep apnea
-Drug related
-Kidney disease
-Primary aldosteronism
-Renal artery
-Cushings
-Steroid therapy
-Pheocromocytoma
-Coarctation of the aorta
-Thyroid

Front 38

What is the blood pressure goal in a patient with diabetes or chronic kidney disease?

Back 38

< 130/80 mmHg

Front 39

What drug for Stage 1 HTN without compelling indications?

Back 39

Thiazide to 140-159/90-99

Front 40

What drug for Stage 2 HTN without compelling indications?

Back 40

Thiazide and ACEi or ARB or BB or CCB >160/100

Front 41

List compelling indications in treatment of HTN?

Back 41

-Heart failure
-Post myocardial infarction
-High CVD risk
-Diabetes
-Chronic kidney disease
-Recurrent stroke prevention

Front 42

List 'in-office' blood pressure measurement techniques.

Back 42

-two readings
-5 minutes apart
-sitting in chair/feet on floor
-confirm elevated pressure in other arm

Front 43

Patient uses ambulatory blood pressure technique and finds she has the same blood pressure all night. Identify this problem.

Back 43

Flat line blood pressure at night is a 'nondipper' and may be at an increased risk for CVD because normally blood pressure dips during sleep 10-20mmHg.

Front 44

List the causes for resistant HTN.

Back 44

-Improper BP measurement
-Excess sodium intake
-Inadequate diuretic therapy
-Excess alcohol
-Identifiable cause of HTN
-Medications (Too little, Too much or OTC)

Front 45

List lifestyle modifications to treat HTN

Back 45

-Weight reduction (BMI 18-24)
-DASH
-Reduce sodium intake (<6g/day)
-Aerobic activity
-Moderate alcohol consumption

Front 46

A pregnant woman with blood pressure of 150/92 and protein in urine of 350 at 35 weeks. Possible Dx? Other Sx/Sx? Rx Treatment?

Back 46

Pre-eclampsia
Look for HELLP (Hemolysis, Elevated Liver Enzymes and Low platelets)
Hydralazine and lebatolol and prophylatic use of MgSO4 prior to delivery.

Front 47

Never treat a pregnant woman with pre-ecalmpsia by administering what?

Back 47

Fluids and electrolytes greatly increase mortality of women with preeclampsia

Front 48

A pregnant woman at 33 weeks with blood pressure of 160/110 and protein in urine of 6g? Dx and treatment?

Back 48

Severe preeclampsia. Bed rest for one week and deliver the baby at 34 weeks.

Front 49

5 year old girl with +20mmHg blood pressure in arms compared to legs. Tests, Dx and Tx?

Back 49

CXR for 3 sign positive
Aortic Coarctation
Surgery

Front 50

55 yo male with HTN and hyperkalemia with PRA and PAC > 20? HTN does not respond to ACEi. Dx?

Back 50

Primary hyperaldosteronsim... look for a tumor.

Front 51

60 yo female complains of frequent headaches and palpitations. Ambulatory blood pressure monitoring shows marked variability in blood pressure between attacks. Dx, DDx and Tx?

Back 51

Pheochromocytosis
Multiple Endocrine Neoplasia (MEN)
Surgical removal of adrenal tumor from chromoffin cells

Front 52

29 yo male has no response to ACEi and no Fx of HTN but presents to the ER with accute HTN. What would you check first and how would you confirm the Dx?

Back 52

Abdominal bruit over the renal artery
Confirm renal vascular HTN with renal arteriography

Front 53

66 yo male complains of pain in the arch of his foot when walking his do but rest seems to help. Dx?

Back 53

Thromboangitis obliterans

Front 54

A 25 yo male wreaking of smoke complains of pain in his hands. Physical reveals absent pulses in the radial arteries. Dx and Tx?

Back 54

Thromboangitis obliterans
Stop smoking!!!
Angiography can confirm occlusion of small and medium vessels

Front 55

A 58 yo woman presents with absent peripheral pulses and a difference in blood pressure of 22 mmHg between left and right arm. Dx and Tx?

Back 55

Takayasu arteritis
Corticosteroids

Front 56

Elderly woman with a headache and unilateral loss of vision. Dx and Tx.

Back 56

Giant cell arteritis
High dose IV steroids

Front 57

A 3 year old male with fever of 104 for five days and desquamation on fingers and toes. Dx and Tx?

Back 57

Kawasakis
IVIG, asprin
Get baseline ECG

Front 58

Elderly woman with positive Homan's sign, red, tender cord and leg pain. What do you suspect and what two tests will confirm? Tx?

Back 58

Deep Vein Thrombosis
D-dimer
Compression ultrasound
Warfarin

Front 59

Elderly woman with brawny tissue under the skin? What do you suspect? Tests to confirm?

Back 59

Trendelenberg's test
Doppler study

Front 60

A 20 year old female presents with numbness in fingers. You notice she has thick nails. She describes her fingers turning white, then blue then red whenever she holds ice in her hands. Dx and Tx?

Back 60

Reynaud's phenomenon
Quit smoking and avoid cold

Front 61

A 60 yo male presents with HTN. He has smoked for 40 years. He has abrupt onset hoarsness and can barely speak. Dx and tests to confirm?

Back 61

Aortic aneurysm pushing against the recurrent laryngeal nerve
ECG and ultrasound

Front 62

A 50 year old woman with an abdominal aneurysm that was 3.5 cm a year ago is now 4.0 cm. Recommendation?

Back 62

Move from yearly ultrasound to 6 month ultrasound. Refer to vascular specialist at >4.5cm for surgical repair

Front 63

Where are psuedo or false aneurysms usually found?

Back 63

Ascending aorta and thoracic aorta

Front 64

Hyperlipidemia can be a result of this genetic abnormality.

Back 64

apoB-100 of the apoprotein LDL

Front 65

This disease is caused by a defect in the ABCA1 transporter on HDL and increases atherosclerosis.

Back 65

Tangier Disease

Front 66

Is familial hypercholesterolemia autosomal dominant, recessive or sex linked?

Back 66

Autosomal Dominant

Front 67

Patient on gemfibrozil (fibrate) for hypertriglyceridemia presents with pain in the URQ. What do you supsect?

Back 67

Gallstones

Front 68

What is the mechanism for statins?

Back 68

HMG-CoA reductase inhibitor - blocks hepatic synthesis of cholesterol

Front 69

colesevelam?

Back 69

Bile acid binding resin

Front 70

What is the most common side effect of nicotinic acid (niacin). List contraindications for niacin.

Back 70

flushing
liver disease, severe gout and peptic ulcers.

Front 71

80 year old woman presents with fever, myalgia and malaise. What might you suspect and what test could confirm?

Back 71

vasculitis
serum ANCA titers

Front 72

A 50 year old male known to abuse drugs and positive for hepatitis C presents with livedo reticularis. Dx and Tx? What organ do you want to check?

Back 72

PAN (polyarteritis nodosa)
High dose corticosteroids and immunosuppresive agents
check kidneys

Front 73

Elderly woman with red tender cord on the leg with a linear pattern. She has had a fever for two days? Dx and Tx?

Back 73

Superficial thrombophlebitis
IV antibiotics, NSAIDs, anticoagulants, heat and elevation

Front 74

Elderly woman with superficial thrombophlebitis is having hip replacement surgery. What drug should follow surgery?

Back 74

Lovonox (low dose heprin)

Front 75

Stage this pressure sore: intact skin with redness

Back 75

Stage I

Front 76

Stage this pressure sore: loss of skin thickness into the epidermis (abrasion or blister)

Back 76

Stage II

Front 77

Stage this pressure sore: necrosis of underlying tissue to fascia

Back 77

Stage III

Front 78

Stage this pressure sore: full thickness loss with extension through fascia into muscle, bone and supporting structures

Back 78

Stage IV