Step 1- Warm-Up And Quick Quiz Cardiovasc #2

Front 1

What lab test monitors heparin levels

Back 1

PTT

Front 2

What lab test monitors warfarin levels

Back 2

PT/INR

Front 3

What lab test would monitor enoxaparin

Back 3

factor Xa activity, rarely done

Front 4

Classify the antiarrhythmic based on channel blocking ability:

Back 4

Class I: Na+ channel blockers
Class II: B-blockers
Class III: K+ channel blockers
Class IV: Ca2+ channel blockers

Front 5

Drug-induced lupus

Back 5

Sulfonamides
Hyrdralazine
Isoniazid
Procainamide
Phenytoin
“SHIPP”

Front 6

Sotalol

Back 6

Class III antiarrhythmic

Front 7

Propranolol

Back 7

Class II antiarrhythmic

Front 8

Bretylium

Back 8

Class III antiarrhythmic

Front 9

Quinidine

Back 9

Class I antiarrhythmic

Front 10

Procainamide

Back 10

Class I antiarrhythmic

Front 11

Lidocaine

Back 11

Class I antiarrhythmic

Front 12

Diltiazem

Back 12

Class IV antiarrhythmic

Front 13

MOA of Adenosine

Back 13

Increase the outward K+ current
Hyperpolarization of cells
Decreasing intracellular calcium

Front 14

5 hereditary thrombosis syndromes:

Back 14

Factor V Leiden
Prothrombin 20210 mutation
Protein C deficiency
Protein S deficiency
Antithrombin deficiency

Front 15

Drugs that prolong the QT interval:

Back 15

Anti-infectives: macrolides (erythromycin), chloroquine
Anti-psychotics: haloperidol, risperidone, methadone
Anti-HIV: protease inhibitors (-navirs)
Anti-arrhythmics: Class 1A and Class III

Front 16

Describe the characteristics of Primary Biliary Cirrhosis:

Back 16

Autoimmune disease
Associated c. CREST scleroderma
Positive AMA
Middle-aged females

Front 17

Describe the characteristics of primary Sclerosing Cholangitis:

Back 17

Unknown etiology
Positive pANCA (60%)
Males over 40yrs
Associated c. ulcerative colitis and cholangiocarcinoma
ERCP- alternating beading and structuring

Front 18

HY, testable teratogens

Back 18

ACE inhibitors
Valproate, phenytoin
Lithium
Tetracycline, aminoglycosides
Warfarin
Excessive vitamin A
Smoking, alcohol, cocaine
Diethylstilbestrol (DES)

Front 19

Tall thin male teenager has abrupt onset of dyspnea and left-sided chest pain. Percussion over the area reveals hyperresonance and diminished breath sounds, what is the dx

Back 19

Spontaneous pneumothorax

Front 20

80yr old male c. crescendo-decrescendo murmur, what is the most likely cause

Back 20

Aortic stenosis

Front 21

HTN c. paroxysms of increased sympathetic tone: Anxiety, palpitations, diaphoresis

Back 21

pheochromocytoma, due to release of catacholamines

Front 22

HTN c. age on onset between 20 and 50

Back 22

Primary HTN

Front 23

HTN c. elevated serum ceratinine and abnormal UA

Back 23

renal disease

Front 24

HTN c. abdominal bruit

Back 24

renal artery stenosis

Front 25

HTN c. BP in arm > legs

Back 25

coarctation of the aorta

Front 26

FHx HTN

Back 26

primary HTN

Front 27

HTN c. tachycardia, heat intolerance, and diarrhea

Back 27

hyperthyroidism

Front 28

HTN c. hyperkalemia

Back 28

Renal failure

Front 29

HTN c. episodic sweating and tachycardia

Back 29

pheochromocytoma

Front 30

HTN c. abrupt onset in pt <20yrs or >50yrs, and depressed serum K+ levels

Back 30

Hyperaldosteronemia

Front 31

HTN c. central obesity, moon-shaped face, hirsutism

Back 31

Cushing syndrome

Front 32

HTN c. NL UA and NL serum K+ levels

Back 32

primary HTN

Front 33

HTN in young pt c. acute onset tachycardia

Back 33

cocaine or amphetamines

Front 34

HTN c. hypokalemia

Back 34

Renal artery stenosis

Front 35

HTN c. proteinuria

Back 35

Renal disease

Front 36

CXR finding of aortic dissection

Back 36

mediastinal widening and Tx c. B-blockers

Front 37

Use of ACE inhibitors and ARBs:

Back 37

HTN
CHF
Post MI
DM renal disease

Front 38

How do ACE inhibitors lower BP

Back 38

-Inhibit angiotensin converting enzyme (ACE) that converts angiotensin I into angiotensin II
-Inhibition of the potent vasoconstrictor angiotensin II
-ACE also degrades and inactivates bradykinin, an important vasodilator → inhibition leads to more vasodilation

Front 39

Drugs for HTN in pregnancy

Back 39

Hydralazine
Methyldopa
Labetalol
Nifedipine
“HTN Moms Love Nifedipine”

Front 40

Shown to save lives in CHF pts

Back 40

ACE inhibitors
ARBs
Aldosterone antagonists
B-Blockers → carvedilol, metoprolol, bisoprolol

Front 41

What drugs cause gynecomastia?

Back 41

Spironolactone
Digitalis
Cimetidine
Alcohol
Ketoconozole
“Some Drugs Create Awesome Knockers”

Front 42

Intracellular obligate bacteria:

Back 42

Rickettsia, cannot make their own ATP
Chlamydia, cannot make their own ATP
Legionella

Front 43

Marker of inflammation produced by the liver and found within atherosclerotic plaques is a strong predictor of MI risk

Back 43

C-reactive protein (CRP)

Front 44

5 deadly causes of chest pain:

Back 44

Aortic dissection, tearing pain with pain radiating to the back
Unstable angina
MI
Tension pneumothorax, one-way valve
Pulmonary embolus, clot in lungs

Front 45

Most common locations for atherosclerosis and what are the clinical complications?

Back 45

Abdominal aorta: AAA
Coronary arteries: angina, MI
Popliteal arteries: claudication, PVD
Carotid arteries: TIA, strokes, dementia

Front 46

Which calcium channel blockers can be used to tx both HTN and tachy arrhythmias?

Back 46

Diltiazem
Verapamil

These are non-dihydropyridine calcium channel blockers

Front 47

What are the systolic heart murmurs?

Back 47

Mitral and tricuspid regurgitation
Aortic stenosis
VSD, ventricular septal defect
Mitral prolapse
PDA, patent ductus arteriosus – continuous murmur

Front 48

Lipid lowering agent c. SE: facial flusing

Back 48

Niacin

Front 49

Lipid lowering agent c. SE: elevated LFTS, myositis

Back 49

Statins, fibrates

Front 50

Lipid lowering agent c. SE: GI discomfort, bad taste

Back 50

Bile acid binding resins

Front 51

Lipid lowering agent c. best effect on HDL

Back 51

Niacin

Front 52

Lipid lowering agent c. best effect on triglyverides/VLDL

Back 52

Fibrates, omega-3 fatty acids

Front 53

Lipid lowering agent c. best effect on LDL/cholesterol

Back 53

Statins

Front 54

Lipid lowering agent that binds C. diff toxin

Back 54

Cholestyramine

Front 55

AA precursor for histamine

Back 55

histidine

Front 56

AA precursor for porphyrin, heme

Back 56

glycine

Front 57

AA precursor for NO

Back 57

arginine

Front 58

AA precursor for GABA

Back 58

gulatmate

Front 59

AA precursor for S-adenosyl-methionine (SAM)

Back 59

Methionine

Front 60

AA precursor for creatine

Back 60

arginine

Front 61

EKG changes c. MI (only seen in 50%)

Back 61

ST segment elevation of at least 1mm in 2 contiguous leads
T wave inversion
New BBB
New Q waves

Front 62

Serial cardiac enzymes

Back 62

CK-MB
Troponin I, most specific
CPK
Myoglobin

Front 63

MI Tx

Back 63

Morphine, decrease pain
Oxygen
Nitrates, decrease of preload
Aspirin, chewable 81mg, antiplatelet
“MONA”

Front 64

B-blockers for the tx of MI

Back 64

Decrease O2 demand, infarct size, and mortality
Increase risk of acute cardiogenic shock if LV dysfunction

Front 65

ACE inhibitors for the tx of MI

Back 65

Decrease afterload, O2 demand, cardiac remodeling, risk of HF and death

Front 66

Statins for the tx of MI

Back 66

Stabilize atherosclerotic plaque
May reduce inflammation
Decreased LDL

Front 67

Drugs used to reduce myocardial oxygen demand in pt having heart attack

Back 67

Nitrate to reduce preload
ACE inhibitor or ARB to reduce afterload
B-blocker to decrease contractility and heart rate

Front 68

Characteristics of acute bacterial endocarditis

Back 68

Caused by Staph aureus
Onset is rapid
NL valves can be affected

Front 69

Characteristics of subacute endocarditis

Back 69

Caused by Strep viridans
Preexisting valvular damage
Insidious onset

Front 70

Signs and symptoms that can be seen in bacterial endocarditis

Back 70

Fever
Roth’s spots
Osler’s nodes, painful on fingertips
Murmur
Janeway lesions, painless on palms and soles
Anemia
Nail-bed hemorrhage
Emboli
“FROM JANE”

Front 71

4 possible nonsuppurative complications of group A b-hemolytic strep infxn:

Back 71

Scarlet fever → Type IV hypersensitivity
Post-streptococcal GN → Type II hypersensitivity
Acute rheumatic fever → Type II hypersensitivity
Strep toxic shock syndrome

Front 72

EKG finding c. acute pericarditis

Back 72

Diffuse ST elevation and possibly diffuse PR depression

Front 73

EKG finding c. cardiac tamponade

Back 73

Electrical alternans
Beat to beat variability, alternating amplitude of QRS segment

Front 74

Under what circumstances might you see pulsus paradoxus

Back 74

Cardiac tamponade
Asthma
Croup
Obstructive sleep apnea
Severe COPD
→ Essentially anything c. exaggerated inspiration

Front 75

Jones Criteria for Rheumatic fever

Back 75

Joints
<3- pancarditis (endo/peri/myocarditis)
Nodules
Erythema marginatum
Sydenham chorea/St. Vitus dance

Front 76

Diffuse myocardial inflammation c. necrosis and mononuclear cells?

Back 76

Myocarditis

Front 77

Focal myocardial inflammation c. multinucleate giant cells

Back 77

Rheumatic heart disease, Aschoff bodies

Front 78

Fever + IVDA + new heart murmur

Back 78

Bacterial endocarditis, Tricuspid valve

Front 79

Chest pain and course rubbing heart sounds in pts c. Cr of 5.0

Back 79

Uremic pericarditis

Front 80

Tree-barking of the aorta

Back 80

Syphilis heart disease

Front 81

Child c. fever, joint pain, cutaneous nodules 4 wks after a throat infxn

Back 81

Rheumatic fever

Front 82

ST elevations see in all EKG leads

Back 82

Pericarditis

Front 83

Disordered growth of myocytes

Back 83

Hypertrophic cardiomyopathy

Front 84

Characteristics of Alkaptonuria:

Back 84

Deficiency in homogentisic acid oxidase
Dark organs and connective tissue
Dark urine when out for an extended period of time
Benign disease

Front 85

Characteristics of Granulomatosis c. Polyangiitis (Wegener’s)

Back 85

Focal necrotizing vasculitis
Granulomas in the lung and upper airway
Glomerulonephritis

Front 86

Disorders associated c. Raynaud’s phenomenon?

Back 86

Lupus
CREST scleroderma
Buerger disease
Mixed connective tissue disease

Front 87

HY Characteristics of Kawasaki disease

Back 87

Vasculitis of small and medium arteries in children
Coronary aneurysms
Bright red inflammation of the lips and oral mucosa
Strawberry tongue
Desquamative rash of the palms and soles