laracrystalo's version from 2015-06-12 22:39


Question Answer
Young Liver Synthesizes BloodFetal erythropoiesis occurs in Yolk sac (3-8 wks) Liver (6wks - birth) Spleen (10-28 wks) Bone marrow (18 wks - adult)
Alpha Always; Gamma Goes, Becomes BetaHbF = alpha2gamma2 HbA1 = alpha2beta2
Prostaglandins E1 and E2 kEEpPDA open, Indomethacin helps close PDA
AllaNtois --> urachusMediaN umbilical ligament
UmbiLical arteriesmediaL umbilical ligaments
SV CAPStroke Volume affected by Contractility, Afterload, Preload. Increase SV with increase contractility, increased preload, decreased afterload.
increase myoCARDial O2 demand byincreasing Contractility, Afterload (proportional to arterial pressure), heart Rate, Diameter of ventricle (increase wall tension)
vEnodilatorsdecrease prEload (nigroglycerin)
vAsodilatorsdecrease Afterload (Arterial, hydrAlAzine)
preload approximated byEDV
after load approximated byMAP
organ removalincreases TPR, decreases CO
Resistance in seriesincreases overall resistance--sum of individual parts
Resistance in paralleldecreases overall resistance-- 1/TR = 1/R1 + 1/R2 + 1/R3
blood viscosity decreased inanemia
blood viscosity increased inMM, polycythemia, high protein states

heart embryo

Question Answer
truncus arteriosusascending aorta and pulm trunk
bulbus cordissmooth parts of L and R ventricles
primitive atriumtrabeculated part of L and R atria
primitive ventricletrabeculated L and R ventricles
primitive pulm veinsmooth part of L atrium
L horn of sinus venosuscoronary sinus
R horn of sinus venosussmooth part of R atrium (sinus venarum)
R common cardinal vein and R anterior cardinal veinSVC
bipasses lungsforamen ovale
bipasses portal circulationductus venous
connects pulm trunk to aortaductus arteriosus

Fetal-postsanatal derivatives

Question Answer
allaNtois --> urachusmediaN umbilical ligament
ductus arteriosiusligamentum arteriosum
ductus venosusligamentum venosum
formaen ovalefossa ovalis
notochordnucleus pulposis
umbiLical arteriesmediaL umbilical ligaments
umbilical veinLigamentum teres hepatis (in falciform ligament)

ECG localization of STEMI

Question Answer
LAD anteroseptalV1 - V2
distal LAD anteroapicalV3 - V4
LAD or LCX anterolateralV5 - V6
inFerior RCAII, III, aVF


Question Answer
wide splittingpulmonic stenosis, RBBB (delayed RV emptying)
fixed splittingASD
paradoxical splittingaortic stenosis, LBBB (normalizes during inspiration) (delayed aortic valve closure)
T wave inversionrecent MI
U wavehypokalemia, bradycardia
speed of conductionpurkinje > atria > ventricles > AV node
pacemakersSA > AV > bundle of His/purkinje/ventricles
conduction pathwaySA --> atria --> AV --> common bundle --> bundle branches --> fascicles --> purkinje fibers --> ventricles
drug induced prolonged QTantiArrhythmics, antiBiotics, anti Cychotics, antiDepressants, antiEmetics
treatment of torsadesmagnesium sulfate
WPWAbnormal fast accessory pathway (via bundle of Kent that bypasses AV node). delta wave, shortened PR, widened QRS. May result in reentry circuit, supra ventricular tachycardia
pseudo RBBB and ST elevations of V1-V3Brugada syndrome (AD), common in Asian males. Prevent with ICD
AFib treatmentcardioversion, digoxin, antiarrhythmics, beta blocker, Ca++ channel blocker
atrial flutter treatmentcatheter ablation
V fib treatmentCPR and defibrillation immediately
prolonged PR1st degree AV block--no treatment needed
progressively prolonged PR until beat drops2nd degree AV block mobitz type I (wenkebach)
dropped beats without PR length changeMoritz type II (av block). treated with pacemaker
P waves in no relation to QRS3rd degree complete heart block
what can lyme disease cause?complete heart block
treatment for complete heart block?pacemaker
what releases ANP?atrial myocytes in response to increased volume and pressure
what releases BNP?ventricular myocytes in response to increased tension
BNP blood testvery good negative predictive value for diagnosing Heart Failure
Nesiritiderecombinant BNP for HF treatment
carotid massageincreases baroreceptors --> decrease HR
what do peripheral chemoreceptors respond to?decreased O2
what to central chemoreceptors respond to?changes in pH and CO2
causes of edema in terms of starling forcesincreased capillary pressure, decreased plasma proteins, increased capillary permeability, increased interstitial fluid colloid oncotic pressure)
increased PcHF (increased capillary pressure --> edema)
decreased oncotic pressure of capillariesdecreased plasma proteins (nephrotic syndrome, liver failure)
increased Kftoxins, infections, burns --> increased capillary permeability --> edema
increased oncotic pressure of interstitiallymphatic blockage --> edema
hemosiderin laden macrophagespulmonary edema, L heart failure cells


Question Answer
most commonDCM
eccentric hypertrophyDCM (sarcomeres added in series)
alcohol abuseDCM
wet beriberiDCM
Coxsackie B virusDCM, acute pericarditis
Chagas diseaseDCM
hemochromatosisDCM, RCM
sarcoidosisDCM, RCM
peripartum cardiomyopathyDCM
balloon appearance of heartDCM
box-car nucleiDCM
titin TTN mutationDCM
beta myosin heavy chain mutationHCM
friedrich ataxiaHCM
syncope during exerciseHCM
sudden death in athleteHCM
mitral regurgHCM
myofibrillary disarrayHCM
fatal arrhythmiaHCM
endocardial fibroelastosisRCM
loffler syndromeRCM
eosinophilic infiltrateloffler syndrome and RCM
diastolic dysfunctionHCM, RCM
systolic dysfunctionDCM
low voltage ECGRCM
asymmetric septal hypertrophyHCM
number 1 cause of Vfib in under 30 yoHCM
preserved ejection fractionHCM, RCM
treat HCM?beta blockers


Question Answer
aschoff bodiesrheumatic fever granuloma with giant cells
anitschkow cellsenlarged macrophages look like caterpillar nucleus in rheumatic fever
friction rubacute pericarditis
tripodingacute pericarditis, tetrolagy of fallot
pain aggravated by inspirationacute pericarditis
beck's triadhypotension, distended neck veins, distant heart sounds (cardiac tamponade)
electrical alternanscardiac tamponade
distant heart soundscardiac tamponade
pulsus paradoxuscardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup
tree bark aortasyphilitic heart disease (disruption of vasa vasorum of aorta, dilation of vessel wall, calcification of root and arch)
most common heart tumormetastasis
most common primary heart tumormyxoma
ball valve obstructionmyxoma
early diastolic tumor plop soundmyxoma
multiple syncopal episodesmyxoma
most frequent cardiac tumor in kidsrhabdomyoma
kussmaul signconstrictive pericarditis, RCM, R sided heart tumors. Increased JVP on inspiration (instead of normal decrease)
vinyl chloride and arsenic exposurehepatic angiosarcoma
mistaken for kaposi sarcomabacillary angiomatosis (bartonela hensleae) in AIDS pts has neutrophilic infiltrate (vs kaposi that has lymphocytic)
Turners syndrome high yield associationscoarctation of aorta, bicuspid aortic valve, cystic hygroma, widened nipples, thick neck, long hair line.
Raynaud's syndromeSLE, CREST. decreased blood flow to skin due to arteriolar vasosmpasm (small vessel) in response to cold or stress. white, blue, red


Question Answer
polymyalgia rheumaticagiant cell (temporal) Arteritis
jaw claudicationgiant cell arteritis
pulseless diseasetakayasu
older than 50giant cell
younger than 50takayasu
branches of carotidgiant cell
left subclavian affectedtakayasu
difference in Sbp between armstakayasu
decreased pulses in armstakayasu
histopathological findings of giant cell and takayasu?intimal thickening with granulomatous inflammation, giant cells, narrowed lumen, internal elastic lamina fragmentation
affects renal arteries but NOT capillaries, arterioles or venulesPAN (so no glomerulonephritis)
inflammatory aneurysms with string of pearls appearancePAN
associated with chronic hep B infectionPAN
spares the lungs!PAN
cause of death is often renal hypertentionPAN
fibrinoid necrosis bc of ag-ab complex deposition and fibrinPAN
autoantibodies to endothelial and smooth muscle cellsKawasaki
predilection for coronary arteriesKawasaki
MI in childrenKawasaki
treatment for kawasaki?IV Ig, aspirin to reduce the rate of CAD!
symptoms of kawasaki?mucocutaneous lymph node syndrome + fever: Conjunctivitis, Rash (erythematous and desquamation), Adenopathy (cervical lymph node enlargement), strawberry tongue, hands and feet
what are the large vessel vasculitides?giant cell arteritis and takayasu
what are the medium vessel vasculitides?PAN, kawasaki
what are the small vessel vasculitides?ANCA associated--Granulomatosis with polyangitis (wegener granulomatosis), Eosinophilic granulomatosis with polyangiitis (Churg strauss syndrome), microscopic polyangiitis. And, immune complex SVV--cryoglobulinemia and cutaneous leucosystoclastic vasculitis
what are the ANCA associated vasculitides?small vessels! Wegener (granulomatosis with polyangitis), Churg strauss (eosinophilic granulomatosis with polyangiitis), or microscopic polyangiitis
which are P ANCA related?Remember, P-ANCA is MPO-ANCA. These are Churg Strauss (eosinophilic granulomatosis) and Microscopic polyangitis
which are C ANCA related?Remember, C-ANCA is PR3-ANCA. This is Wegener granulomatosis (granulomatosis with polyangitis)
which is associated with a triad of symptoms and what is the triad?Wegener granulomatosis with polyangitis. C anca. Necrotizing vasculitis. 1. granulomatous necrotizing inflammation of the lungs 2. vasculitis prominent in respiratory organs, renal disease of necrotizing glomerulonephritis
nodular lesions on lung seen in CXR or grossly?Wegener granulomatosis with polyangitis
necrotizing glomerulonephritis?Wegener granulomatosis with polyangitis and Microscopic Polyangitis (remember, PAN affects kidneys, but not capillaries so NO glomerulonephritis!)t
necrotizing inflammation of the lungs?Wegener granulomatosis with polyangitis
granuloma with abundant eosinophils?Churg Strauss Eosinophilic granulomatosis with polyangitis
associated with asthma and allergic rhinitis?Churg Strauss Eosinophilic granulomatosis with polyangitis
high IgE?Churg Strauss Eosinophilic granulomatosis with polyangitis
NO eosinophils and NO granulomas?Microscopic polyangitis
Pauci-immune associated?Microscopic polyangitis
necrotizing vasculitis?Microscopic polyangitis, wegener granulomatosis with polyangitis
treatment for small vessel vasculitides?steroids!
80% of patients die within 1 yearWegener's granulomatosis with polyangitis
treat with TNF blockersWegener's granulomatosis with polyangitis
autoamputation of digitsBuerger disease (thromboangiitis obliterans)
digit gangreneBuerger disease (thromboangiitis obliterans)
renal microaneurysmspolyarteritis nodosa
coronary artery aneurysmkawasaki
oral mucositiskawasaki strawberry tongue
antibodies to tobaccoBuerger (thromboangiitis obliterans)
transmural inflammation of arterial wall with fibrinoid necrosisPAN
granulomatous inflammation of the mediagiant cell
superficial nodular flebitisbuerger (thromboangiitis obliterans)


Question Answer
HTN in pregnancy?Hydralazing, Methyldopa, Labetalol, Nifedepine
non-dihydropyridine on heartverapamil, diltiazem (block L type calcium channels)
cause AV blockverapamil and diltiazem
gingival hyperplasiacalcium channel blockers
drug induced SLEhydralazine, procainamide
decreaed afterloadhydralazine
cyanide toxicitynitroprusside
HTN emergency medsnitroprusside, fenoldopam
decreases prelaodnitrates
nitrate with highest bioavailabilityisosorbide mononitrate
Monday diseaseindustrial exposure to nitrates develop tolerance during work week, then lost over weekend, reexposure on monday causes tacky, dizzy, headache
lowers LDL the moststatins
lowers TG the mostvibrates
lower LDL while slightly increasing HDL and TGbile acid resins
lowers LDL aloneezetimibe
best at increasing HDLniacin (B3)
how to decrease side effect of niacin?NSIADS or long term use can decrease the red flushed face seen in niacin use
GI upset and decreased absorption of fat soluble vitaminsbiel acid resins
decrease TG but not the greatest at itomega III fatty acids
cardiac glycoside side effectsdigoxin! N/V, diarrhea, blurry yellow vision, arrhythmia, AV block, hyperkalemia
antidote for cardiac glycosidefor digoxin! anti-digoxin Fab fragments, Mg++, cardiac pacer, normalize K+ slowly
side effect of thrombocytopenia, tornadoes, cinchonismquinidine
side effect of AV block / bradycardiabeta blockers
side effect of masking hypoglycemiabeta blockers
best post-MIClass IB --> Lidocaine, Mexiletine, Tocainamide
contraindicated post-MIClass IC --> Flecainide, Propafenone
decrease slope of phase 0class 1 sodium channel blockers
decrease SA and AV node activity and decrease slope of phase 4class II beta blockers
beta blocker overdose treatmentglucagon, atropine, saline
shortest acting beta blockeresmolol
elongate phase III refractory periodclass III K+ channel blockers
this has the most side effectsamiodarone
corneal deposits and gray skin depositsamiodarone
what to monitor with amiodaronePFTs, LFTs, TFTs, (K+ channel blocker)
decrease phase O and AV node conductionclass IV calcium channel blockers (verapamil, diltiazem)
abolish supra ventricular tachycardia?adenosine
sense of impending doomadenosine
short acting about 15 secondsadenosine
what blunts the effects of adenosine?theophylline and caffeine
causes bradycardia and prolonged QTsotalol (class III and beta blocker)
gingival hyperplasia and constipationverapamil (class IV)

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