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41 Cards in this Set

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543:

PC: Infant. Carpopedal spasm. No thymic shadow on X-ray. Narrow aortic arch on angiography.

What is DX and what failed to developed?
543:

PT have DiGeorge Syndrome, which the 3RD PHARYNGEAL POUH fails to develop, leading to lack of thymus.

** T-cell immunodeficiency.
** Chr-22 deletion
543-A:

What are these embryonic structure?

a. Second branchial cleft
b. Third branchial arch
c. Fourth branchial arch
d. Septum transversum
543-A:

a. 2nd branchial cleft (parhygeal grooves) -- branchial cleft cyst at mandibular angle.
b. 3rd branchial arch - tissue innervated by CN9, glossopharyngeal, the posterior 1/3 tongue.
c. 4th branchil arch - tissues of CN10, vagus, posterior 1/3 of tongue
d. Septum transversum - form diaphragm.
315:

PC: New born male. continuous "machine-like" murmur with systolic accentuation, loudest at LEFT infraclavicular region. PT Dx with PDA.

What is PDA a remnant of?
What keeps PDA open in embryo?
What Rx to closes it after birth?
315:

PGE-1 maintains PDA (6th aortic arch)

Indomethacin and NSAIDS closes. (by inhibit PGE-1)
1344:

PC: 72yo male. Substernal chest pain, SOB, bilateral crackles, 3rd heart sound, distended JVP, 2+ edema of lower extremity. PT DX with MI and is in cardiogenic shock. Started on Dobutamine, Furosemide, and Nitroglycerine.

What is MOA and ACTION of Dobutamine?
1344:

MOA: Beta-adrenergic agonist (predominantly B1-receptor). Used to Tx of acute HF associated with decrease contractility (shock).

Associated with Increase Cardiac Conduction Velocity (undesirable, lead to arrhythmia).
1204:

Study of 200 non-diabetic (chol=195), and 180 (chol=210). Probability due to chance is 5%. There is 20% prob of false negative.

What is power of study?
1204:

B = Type II error (false negative)

POWER = 1 - B

= 1-.20 = 0.80
1204-A:

A statistician asks, "what is the difference between Type-I and Type-II error", and "what are the implication of each"?
1204-A:

a. Type-I error:


b. Type-II error:
1871:

PC: 54yo male. periodic, tight, burning substernal chest pain. Thallium stress test shows hypoperfusion to diaphragmatic side of heart.

What vessel supply this area?
1871:

Diaphragmatic side of heart is made up mainly by the LV, which is supplied by the PDA, a branch of the Right Coronary Artery.
1871-A:

A coronary CT angiogram is shown to a student. Describe coronary vessels and its branches.
1871-A:

LEFT MAIN: divides into LAD and L-CX, which supply most of anterior and left lateral heart.

RIGHT MAIN: give rise to PDA (right dominant, 90%). In 10%, PDA arises from L-CX (left dominant), which supplies inferior LV.
1871-B:

A PT has severe atherosclerosis to LAD coronary artery.

What part of myocardium is affected?
1871-B:

Anterior 2/3 of interventricular septum (septal branches), anterior wall of left ventricle, and part of anterior papillary muscle.
34:

PC: Newborn male. Facial dysmorphia, cleft palate, long arm Chr-22 deletion.

What is DX?
34:

DiGeorge

- T.O.Fallot
- Interrupted aortic arch
- Missing Thymus
34-A:

PT want you to define the following:
a. Kartagener's
b. Tuberous sclerosis
c. Friedreich's
d. Marfan
e. Down
f. Turner's
34-A:

a. Kartagener (AR): microtubular defect, no cilia
b. TS (AD): cutaneous angiofibromas, seizure, mental retardation, visceral cyst.
c. Friedreich's (AR): spinocerebellar degeneration with spinal ataxia. Associated with facial/palatal malformation.
726:

A group of researchers want to use early empiric penicillin to treat bacterial pharyngitis.

- What is most common causative organism?
- What will bact. pharyngitis lead to?
- What would be decrease due to Tx?
726:

- Streptococcal pharyngitis is MC.

- Could lead to Rheumatic Fever (RF)

- Decrease cases of Cardiac Surgery due to RF.
1200:

PC: 68yo male. Heart palpitation, irregularly irregular EKG, absent P-wave. Started on empirical Warfarin.

What should be monitored in this PT?
1200:

Prothrombin time (PT)

Warfarin inhibits gamma-carboxylation of vit-K dependent coag factor "1.9.7.2."
1200-A:

Your attending asks, "when you would follows..."

a. Bleeding Time
b. aPTT
c. Fibrinogen level/ split product
1200-A:

a. Bleeding time: platelet dysfunction. Thrombocytopenis, vWF disease, defect of platelet aggregation, DIC, ASA treatment.
b. aPTT: heparin use
c. D-dimer: DIC
1661:

PC: 46yo female. Murmur, bounding femoral pulses, carotid pulsation, head-bobbing.

What is most likely DX?
1661:

Aortic regurgitation, note that bounding pulses ("water-hammer") is indication of high difference in pulse pressure.
2055:

PC: 56yo male. Tachycardia and irregular rhythm. Report binge drinking previous night.

What do you expect to find on EKG finding?
2055:

New onset palpitation post binge drinking indicated AFIB ("holiday heart syndrome"), which shows as Absent of P-wave on EKG.
205:

PC: A patient with TOF claims that she feels better squatting down when experiencing TET-spells.

What is the physio behind squatting?
205:

Increase systemic vascular resistance (TPR) leads to less shunting and allow greater fraction of total Cardiac Output to pass through lungs, improving arterial oxygenation.
145:

PC: 60yo male. Hx of HTN and Tx with max dose HCTZ and ramipril. Now have BP=160/100, HR=65. PT need another anti-HTN but need to watch out for prolonged AV-conduction.

Which anti-HTN drug has the LEAST affect on AV conduction?
145:

NIFEDIPINE, minimal affect on AV conduction, and causes peripheral vasodilation, which might result on reflex tachycardia.

** Best to Tx HTN with bradycardia.
445:

PC: 40yo dies of MVA. Smoker, drinker, obese. Extensive FHx of MI and stroke.

What are the pattern of Atherosclerotic plaques? Which vessels are most likely?
445:

Atherosclerosis most likely affect LARGE vessels (i.e. aorta, carotids) and muscular arteries (i.e. coronary, popliteal)

Aorta > coronary > popliteal > internal carotic > circle of willis.
2108:

PC: 71yo male. Hx of progressive exertional dyspnea and difficulty sleeping.

Without listening to heart sound, what are the most likely DX and pathophysiology?
2108:

MCC oth dyspnea and nocturnal dyspnea is congestive heart failure (CHF), characterized by increase LV EDV (heart fluid overload).
1652:

PC: 45yo male. 2 days Hx of dyspnea, orthopnea, and ankle swelling. Doctor prescribe NITROPRUSSIDE and asks what is its mechanism.

What is you answer?
1652:

NITROPRUSSIDE is a short-acting BALANCED Venous and Arterial VASODILATOR, which decreases both preload and afterload, therefore decreases the volume (preload) and pressure (afterload) of the LV.
144:

PC: 55yo male. HTN and cardiac disease. Attending considered adding Verapamil (Ca++ Blocker) to reduce blood pressure.

Knowing that skeletal muscles uses Calcium to depol, will this affect these muscles?
144:

No, Verapamil will not affect skeletal muscles due to the fact that MSK muscle has its own independent Ca++ supply. Not relying on plasma.
1505:

PC: 65yo. Fever, joint pain, body rash, serum ANA positive. Hx of CAD, CHF, and arrhythmia.

What is this patient taking? I.e. These are the side effects of what drug?
1505:

PROCAINAMIDE (1A anti-arrhythmic)

SE:
LUPUS (fever, joint pain, body rash, serum ANA positive), arrhythmia, and psychotic disturbance.
2107:

PC: 65yo male. Hx HTN, DM-2, smoker. Jog 3 miles per day, BMI = 28.5, FHx normal. Doctor decide to auscultate at apex.

Without listening to heart sound, what is your provisional DX?
2107:

Apex = ventricular heaves
Left ventricular hypertrophy
136:

PC: PT has severe retrosternal chest pain. Nitroglycerin IV relief pain and decrease BP.

What is the skeletal muscle molecular target of nitrates as a side effect to its MOA?
136:

Nitric Oxide (NO) stimulates GUANYLATE CYCLASE to convert GTP into cGMP.

Increase cGMP concentration decrease free intracellular Ca++, whic decrease Myosin light-chain kinase activity, and finally decrease myosin light-chain dephosphoryllation?
1047:

PC: 56yo male. Fatigue and dyspnea. Lower edema and decreased peripheral sensation. Cardiac dilation and increased CO.

What nutrient is he deficient in?
1047:

Vitamin B1 (Thiamin)

Infant beriberi = cardiomegaly, tachy, cyanosis, dyspnea, vomiting.
Wernicke-Korsakoff = EtOh, confabulation
Adult dry = symmetrical neuropathy
Adult wet = dry + cardiac involvement
1948:

PC: 45yo. BP 155/100 (1st) and 160/100 (2nd). HR 85. Low sodium diet, exercise regularly. You decide to prescribe Metoprolol.

What changes to do you expect to see as a result of this prescription?
1948:

Metoprolol (selective B1-blocker, which are found in cardiac tissue and renal JG cell).

Decreased level of circulating renin
1252:

Pharmaceutical company makes a new drug, Drug-X, that will (1) relax smooth mm. of arterioles but (2) does NOT affect veins.

What side effects would you expect to see on clinical trials?
1252:

This drug causes arteriodilation, which will be picked up by baroceptor in Aorta and Carotid as hypovolemia.

This will trigger reflex sympathetic to increase HR, contractility, and renin release.
1653:

PC: 46yo female undergo cardiac cath. 1st pass = 27mmHg to 2mmHg. After two inches advance, 2nd pass = 26mmHg to 10mmHg.

What is the initial location (1st pass) of the cath?
1653:

Must be in the RIGHT VENTRICLE, since there is a higher pulse pressure.
975:

PC: 38yo male IV drug user. High grade fever, tague, dyspnea, and died in ICU. Autopsy shows patchy lung necrosis ("wedge shape hemorrhagic infarcts").

What is this patient most likely suffered from?
975:

Tricuspid valve endocarditis,

which is most common with STAPH AUREUS in IVDU. Staph likes to affect right-heart, and any necrosis in lung is hemorrhagic due to dual blood supply.

He likely have gotten a PE from septic emboli.
1609:

PC: 65yo male. Loss consciousness after buttoning his collar. BP = 70/40, HR = 45.

What happened?
1609:

He gave himself a carotid massage, which stimulates baroceptors in carotid bifurcation (CN-9).
2070:

PC: 34yo male. 2mo Hx of dyspnea and edema. Evil doctor asks you to interpret this JVP wave reading.

What are different part of the JVP -- A, C, X, Y, V ?
2070:

A (1st peak) - RA contraction
C (2nd peak) - bulging tricuspid
X (1st dip) - RA relax
V (3rd peak) - inflow of venous blood
Y (2nd dip) - passive emptying (diastole)
230:

PC: 36yo female. R-side weakness, speech difficulty. Hx of fatigue, low grade fever. PT died in hospital. Autopsy shows Mitral Valve with extensive vegetation.

What condition allows PT to have Mitral Valve infection?
230:

Mitral Valve Prolapse,

PT seems to have Native Valve Bacterial Endocarditis (NVBE), which is complicated by embolic event.
1977:

PC: 69yo male. Palpitation and dyspnea. EKG shows HR 120, irregular rhythm, narrow QRS, and no P-wave.

What seems to be the determinant of ventricular rhythm rate in this patient?
1977:

AV node refractory period,

which patient is appear to experience AFIB, which is controlled only by the slow conduction of AV node.
195:

PC: 62yo female with MI dies on day 4 of admission. Autopsy shows infarcted heart at distal LAD.

What is the cause of her death?
195:

Profound hypotension,

because the damaged heart (LV) cannot pump blood anymore (cardiogenic shock).
153:

PC: 70yo male with syncopal episode. Hx of severe constipation, COPD, and admited to hosp for AFIB and tachycardia. EKG shows second-degree AV block, which is believed to be a SE of his medication.

Which medication is he taking?
153:

VERAPAMIL,

a Ca++ blocker that is preferentially used to treat AFIB because it slows down AV conduction.
229:

PC: 23yo male with 3wks Hx of fatigue, cardiac murmur, now have have mild proteinuria and hematuria. Creatinine level is 2.3 and urine has RED CELL CAST.

Which are most likely cause of urine finding?
229:

RBC CAST = infection,

most likely caused by Bacterial Endocarditis (BE) in this patient. The TWO FOLD in creatinine indicates 50% reduction in renal GFR.
74:

PC: 3yo male with endocardial thickening (fibrous deposit) around tricuspid and pulmonary valve as well as pulmo valve stenosis. Left cardiac chambers and valve are normal.

What are Carcinoid Syndrome? And how is it detect in blood?
74:

Carcinoid Syndrome = increase production of SEROTONIN by carcinoid tumors, causing FLUSHING, CRAMP, and N/V/D. Also endocardial fibrosis.

Detect via urine 5-hydroxy-indole-acetic acid.
83:

PC: 16yo male collapsed and died while jogging. Extensive FHx of sudden death.

What is the genetic defect in this PT?
83:

Patient most likely died of hypertrophic cardiomyopathy (HCM), which is due to a mutation in

Cardiac SARCOMERE protein,

most likely a point mutation in the beta-myosin heavy chain.
1001:

PC: A PT with infective endocarditis found to have STEP BOVIS in his blood culture.

What condition would predispose him to higher risk of infection by STEP BOVIS?
1001:

Anything to do with the COLON, since Strep Bovis is a normal gut flora.
199:

PC: 35yo female with dyspnea and dizziness on exertion. She's on strict weight-reduction diet and use appetite-suppressant medication. BP 110/80, HR 90. Unfortunately, PT dies 6 mo post initial visit.

What causes this PT to die, according to her history?
199:

Appetite-suppressant Rx has tendency to cause SECONDARY PULMONARY HYPERTENSION if used more than 3 months.

This will lead to RV hypertrophy.