Ms2- Test 2 - Week 3

Front 1

The greatest impairment in schizophrenia arises from dysfunction of what brain part?

Back 1

Dorsolateral Prefrontal Cortex = Negative symptoms

Front 2

What gets better when people with schizophrenia are given APD's?

Back 2

The positive symptoms - hallucinations, delusions, etc

Front 3

Blocking what receptor & pathway reduces positive symptoms?

Back 3

DA2 receptors

Mesolimbic DA pathway

Front 4

What SE do you worry about 1st generation APD's?

What SE do you worry about for 2nd generation APD's?

Back 4

Neurologic & Endocrine


Metabolic

Front 5

Parkinsonism and dystonia are common side effects of antispychotic drugs that block what pathway?

What other SE's are common?

Back 5

Nigro-striatal pathway

Akathisia & Tardive dyskinesia

Front 6

What are the key symptoms of neuroleptic malignant syndrome & what pathways are involved?

Back 6

DA block of:

Nigrostriatal -> rigidity
Hypothalamic -> high fever
Hypothalamic spinal -> labile BP
Mesocortical DA -> confusion, delirium

Front 7

What 2nd generation antipsychotic is a the patient on if they present with galactorrhea, breast enlargement, impotence, and amenorrhea?

Back 7

Risperidone - increases prolactin

Front 8

What antispsychotic is dangerous because it causes agranulocytosis?

When should you use it?

Back 8

Clozapine

After 2-3 failed trials of other drugs

Front 9

In order, what are the three most common causes of death after an MI?

Back 9

Ventricular fibrilliation/Arrthymia

Acute Heart Failure/Cardiogenic Shock

Ventricular Free Wall Rupture

Front 10

What are four common manifestations of LV cardiogenic shock?

Back 10

Decreased CO

Decreased Systolic BP

Increased Afterload

Increased PAWP = Pulmonary Edema

Front 11

What are four common manifestations of RV cardiogenic shock?

Back 11

Decreased CO b/c less LV filling

Systemic Hypotension

Increased Afterload

Increased PAWP w/ clear lungs

Increased JVP

Paradoxical pulse

Front 12

An ST segment elevation in lead III greater than that observed in lead II =?

Back 12

Inferior MI -> RV infarct

Front 13

If a patient presents with ECG abnormalities in the II, III, & AVF - as well as an acute pulmonary edema, what kind of murmur would you suspect to hear?

Back 13

Papillary muscle dysfunction

Early systolic murmur, that decrescendos toward S2

Front 14

The posterior papillary muscle is most often ruptured in an MI why?

Back 14

B/c supplied only by the posterior-descending branch of the RCA

Front 15

What is the drug of choice in the treatment of LV cardiogenic shock?

Back 15

Dobutamine

Front 16

What is the diagnostic finding in a ventricular septal rupture?

Back 16

O2 step up b/w RA & RV

Front 17

What is the diagnostic finding for papillary muscle rupture?

Back 17

Acute PAWP > 22

Giant V waves in PAWP tracing

Front 18

What is the diagnostic finding for ventricular free wall rupture?

Back 18

Pericardial Tamponade =

Equal and elevated diastolic pressure in all four cardiac chambers including PAWP

Front 19

What is the initiating event in atherosclerosis?

Back 19

When oxidized LDL (b/c of lipid peroxidation) binds endothelial cells of coronary arteries

Front 20

What are the cell populations involved in atherosclerosis?

Back 20

Monocytes -> Macrophages -> foam cells

VSM -> foam cells

TH2 cells cause the thick stable fibrous cap

Front 21

What drugs shorten the duration of action potentials in fast response cells?

Back 21

Ca channel blockers (verapamil)

Front 22

The ST segment on ECG corresponds to what phase in fast response cell action potential?

Back 22

Phase 2

Front 23

In phase 3, rapid repolarization:

What drug decreases K permeability = increased action potential duration?

What drug increases K permeability = decreased action potential duration?

Back 23

Quinidine

Lidocaine

Front 24

Movement of what ions are responsible for phase 0 in slow response action potentials?

Why do fast Na channels NOT play a role?

Back 24

Ca

Because the resting membrane potential is NOT negative enough to activate the fast Na channels

Front 25

In fast response tissue - what determines the refractoriness?

In slow response tissue - what determines the refractoriness?

Back 25

Membrane Voltage (Fast Na channel)

Time (slow Ca channel)

Front 26

What two pathologic insults result in abnormal automaticity?

Back 26

Myocardial Ischemia

Hypokalemia

Front 27

What ion is responsible for delayed afterdepolarizations seen in late phase 3 and early phase 4?

Back 27

Influx of Na by Na/Ca Exchanger

3 Na in, for every 1 Ca out

Front 28

Digoxin toxicity initiates what kind of afterdepolarization event?

What tachycardia does it classically cause?

Back 28

Delayed afterdepolarization event

Paroxysmal Atrial Tachycardia

Front 29

What kind of drugs are likely candidates for precipitating triggered activity from EAD's?

Back 29

Class 1A anti-arrhythmic drugs

- Quinidine
- Procainamide

Front 30

What is the most common cause of paroxysmal Atrial Tachycardia with block?

What is the most common cause of paroxysmal supraventricular tachycardia?

Back 30

Digoxin Toxicity

Re-entry possibly caused by Atrial fibrillation

Front 31

Torsades de pointes is most commonly due to what?

Back 31

Early afterdepolarization

Most commonly due to quinidine or procainamide

Front 32

What is the most likely cause of ventricular tachycardia that occurs in patients with familial long QT syndrome?

Back 32

EAD's

Front 33

What two drugs have the notorious side effect of prolonging QT interval?

Back 33

Quinidine (antiarrhythmic)

Macrolide (antibiotic)

Front 34

What are the two drugs of choice for preventing EAD triggered arrythmias?

Back 34

Beta adrenergic antagonists

Magnesium

Front 35

What are the three necessary requirements for re-entry to develop?

Back 35

A unidirectional block

Slow conduction of impulse

Differences in refractoriness b/w regions

Front 36

What initiates re-entrant arrhythmias?

Back 36

Premature impulses:

Afib, atrial flutter, Vfib, etc.

Front 37

What are the drugs of choice to terminate re-entrant supraventricular tachycardia?

Back 37

Adenosine

Verapamil (calcium channel blocker)

Front 38

A child is sleeping in a room, and awakens the next day with a bite mark along with a bat next to him. What virus class would you expect will cause his disease?

What is the unique morphology of this virus?

Back 38

Rhabdovirus - Rabies

Linear (-) RNA

Bullet shaped

Front 39

In (-) RNA viruses the insertion of what protein is the cause of syncytia formation?

In what class is this mostly found?

Back 39

Fusion protein

Paramyxoviruses

Front 40

What paramyxovirus only has F glycoprotein?

What is a classical symptom associated with this disease?

Back 40

Respiratory Syncytial Virus

A baby who has a constant cough

Front 41

What unique histological feature would you see in a patient who has pain/itching at the bite site of a crazy dog?

Back 41

Negri bodies

Front 42

In general pandemics are caused by what kind of antigenic change?

Back 42

Antigenic Shift = dramatic change in surface glycoproteins

Front 43

Many classic 'flu' symptoms that are associated with induction of what mediator?

Back 43

Interferon

Front 44

What RNA virus has a 'sandy' appearance?

What is the 'sandy' thing?

Back 44

Arenaviruses

Ribosomes

Front 45

What is the only RNA virus to use the host DNA-dependent RNA -polymerase to make its mRNA?

Back 45

Deltavirus - Hepatitis D virus

Front 46

What is the virulence factor for the dsRNA virus that causes infantile gastroenteritis?

Back 46

nsP4

Reovirus -> Rotavirus

Front 47

If a patient has chronic kidney disease and is put on opietin alfa for a prolonged period of time, what other drug would be important to add?

Back 47

Iron

Front 48

What is the most common cause of ventricular fibrillation following an MI?

Back 48

Functional Re-entry

Front 49

What cardiac infection can cause 2nd or 3rd degree AV block leading to bradycardia?

Back 49

Lyme Disease

Front 50

What is the greatest risk factor for developing Sudden Cardiac Death?

What is the most common cause for SCD?

What is the main therapeutic intervention for SCD?

Back 50

Left Ventricular Dysfunction

Ventricular Tachyarhythmias

Defibrillator

Front 51

What are the 4 pressor-growth promoters that trigger VSM hypertrophy?

Back 51

NE
ATN II
PDGF-1
Endothelin 1
Uric Acid

Front 52

What two metabolites are produced locally within the kidney to increase renin release?

Back 52

PGE2

PGI2

Front 53

True or False

Hyperkalemia increases renin release

Back 53

False

It decreases renin release, b/c it causes depolarization = increased Ca permeability

Front 54

If a patient presents sleepy, lethargic, and difficult to arouse with right muscle weakness and sensory loss, as well as a right homonymous hemianopsia what is the problem?

Back 54

Left Putamen Hemorrhage

Front 55

If a patient presents sleepy, lethargic, and difficult to arouse with right muscle weakness & sensory loss, as well as limited eye movements what is the problem?

What is causing the the eye problems?

Back 55

Left Thalamic Hemorrhage

Compression of the midbrain is causing the problem

Front 56

If a patient suddenly collapses at work (with abrupt loss of consciousness) and pinpoint pupils what is the problem?

Back 56

Pontine Hemorrhage

Front 57

If a patient presents sleepy, lethargic, and difficult to arouse, and with an occipital HA. Plus also comes in with an inability to walk, what is the problem?

Back 57

Cerebellar Hemorrhage

Front 58

If a patient presents with a sudden terrible headache and a eye down and out, what is the problem?

Back 58

Posterior Communicating Artery Hemorrhage = subarachnoid hemorrhage

Front 59

What are three conditions that affect vertical eye movements?

Back 59

PSP (midbrain degeneration)

Pineal Gland Tumor

Thalamic Hemorrhage

Front 60

If an older patient comes in with lightheadedness upon standing, what is the most probable cause of this dizziness?

Back 60

Medication

Front 61

What are the two main populations that are affected most by a deficiency of NO?

Back 61

Systolic HTN in elderly

Obesity related HTN

Front 62

Endothelin 1 causes HTN in what two groups?


Via what receptor?

Back 62

Preeclampsia women

Postmenopausal women

ET A

Front 63

What are the four ways that increased Na causes high BP?

Back 63

Sodium itself increases SNS activity

Decreases endothelial NO production

Increased plasma volume and CO

Inhibits Na/K ATPase activity in VSM = vasoconstriction

Front 64

What is a main cause of systolic HTN in the elderly?

Back 64

Decreased endothelial NO synthesis

Front 65

What are the 3 mechanisms by which impaired Na excretion causes HTN?

Back 65

SNS hyperactivity

Decreased Na/K ATPase (digoxin like) = decreased Na reabsorption

Increased Na/H exchanger

Front 66

What is the most common cause of heart failure in the United States?

What is the second most common cause?

Back 66

HTN


Ischemia

Front 67

What are the three different mechanisms by which chronic hypokalemia decreases urinary Na excretion?

Back 67

Increased Na/H exchange in PCT

Increased Renin-ATN II secretion

Increased Na/K ATPase activity in renal tubular cells

Front 68

What is the main cause for increased parathyroid hormone & Vit. D release?

Back 68

Decreased plasma Ca levels

PTH - inhibits Na/K ATPase
Vit D - increases Ca uptake by VSM

Front 69

True or False

Leptin decreases SNS activity?

Back 69

False, it increases it

Front 70

What are the 6 main complications of HTN?

Back 70

Atherosclerosis
LVH
Arrythmias
AAA or Dissecting Aortic Aneurysm
Stroke (CVD)
ESRD

Front 71

What is the strongest risk factor for CAD in the elderly (>60)?

Back 71

Wide pulse pressure

Front 72

What is the most common identifiable risk factor for the development of CHF?

Back 72

HTN

Front 73

When is blood pressure the highest?

When do most strokes occur?

Back 73

BP is highest in the morning

Morning

Front 74

If a patient presents with slowly progressive hearing loss and tinnitus, followed by a vertigo that is less intense what would you suspect is the problem?

What is the normal progression of items involved?

Back 74

Acoustic Schwannoma

CN VIII (first) -> VII (upper & lower face paralysis)-> cerebellum (ipsilateral ataxia), trigeminal nerve (ipsilateral face)!

Front 75

If a patient presents with dizziness that is worse when they are sitting what is the most probable cause?

If a patient presents with dizziness that is worse when they are walking what is the most probable cause?

Back 75

Central or Peripheral Vertigo

Proprioceptive or Visual Deficits = peripheral nueropathy

Front 76

In what kind of headaches is the neurologic examination normal?

Back 76

Essential Headaches - Migraines (except for right before)

Front 77

If a patient presents with a sudden onset, severe headache with neck stiffness what is the most likely cause?

Back 77

Subarachnoid hemorrhage -> Meningeal Inflammation

Front 78

True or False

Ruptured cerebral aneurysms produce a sudden onset exploding headache with no focal findings?

Back 78

True

EXCEPT - Posterior Communicating Artery aneurysm presents with CN III palsy + headache

Front 79

If a young overweight woman comes in with a progressive headache and enlargement of blind spot what would you find on eye exam?

What is the cause of her problem?

What would you find on lumbar puncture?

Back 79

Eye exam = papilledema

Defect of CSF absorption through arachnoid granulations

Elevated opening pressure

Front 80

If a 70 yr old man comes in with a new headache that gets worse with chewing, what is the dz & what is the important complication?

Back 80

Temporal Arteritis

Total blindness b/y of opthalmic artery infarct

Front 81

What is the drug of choice to give pregnant women who have migraines?

Back 81

Narcotics

Front 82

If an older man comes in with pain in his right eye that feels like a “hot poker”, and lasts for 40 minutes, which seems to recur at precise intervals everyday what is the dx?

What is the best treatment?

Back 82

Cluster HA

100% Oxygen

Front 83

If a young women comes in with episodic severe episodes of pain in the cheeks, that is triggered every time she brushes her teeth, what is the dx?

What is the best treatment?

Back 83

Trigeminal Neuralgia

Carbamazepine!! or Gabapentin

Front 84

What are the two drugs that preferentially bind to the activated or inactivated Na channels?

Back 84

Quinidine

Lidocaine

Front 85

What is the drug of choice to use for treating digitalis-induced arrhythmias?

Back 85

Lidocaine

Front 86

What drug markedly depresses the rate of phase 0 depolarization and maximal phase 0 depolarization more so than any other class I agent?

Back 86

Flecainide

Front 87

What antiarrythmic is reserved for the treatment of life threatening arrhythmias that do not respond to other drugs/

Back 87

Flecainide

Front 88

What class of drugs are best used for the prophlyaxis of of arrhythmias?

Back 88

Beta Blockers

Metopralol

Front 89

What class of antiarrythmic drugs work by slowing down phase 4 repolarization = prolonged QT?

Back 89

Dofetilide

Front 90

What is the drug of choice of treatment of superventricular tachycardia?

Back 90

Adenosine - helps with conversion back to normal

(or Verapamil - used as tx)

Front 91

What antiarrythmic is "safe" to be used in patients with congestive heart failure?

Back 91

Diltiazem (Ca channel blocker - Class IV)

Front 92

What is the drug of choice for the treatment of Heprain Induced Thrombocytopenia?

Back 92

Lepiruidin

(or Argatroban)

Front 93

What drug is used to prevent the progression or recurrence of a DVT or pulmonary embolism?

Back 93

Warfarin

Front 94

What drug is used to reduce bleeding after prostate surgery or after tooth extraction in hemophiliacs?

MOA?

Back 94

Aminocaproic Acid

Blocks interaction of plasmin w/ fibirin