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Prolong QT interval causes
- Macrolides (erythromycin)
- Antimalarials (Chloroquine/ mephaquine)
- Haloperidol
- Risperidone
- Methadone
- protease inhbitors
- Antiarrythmics (class 1A)
- K+ channels blockers
-
Treatment for the cause of delta waves on EKG
- WOLFF- PARKINSON WHITE SYNDROME
- Accessory conduction pathway from atria to ventricle
-
Treatment of the bug that can cause 3rd degree heart block
Borreli burgdoferi - lyme disease
- Adults - doxycycline
- children- amoxicillin
- pregnant- erythromycin
- and ceftriaxone
Late stage = minocycline(neuro) or ceftriaxone
-
Barocreceptor response to decrease MAP
- B1 - increase HR and contractility -> inc CO
- a1- venoconstriction -> increase venous return -> increase CO
- a1- arteriolar vasoconstriction -> inc TPR
-
Autoregulation of blood flow to skeletal muscle
Local metabolites- lactate, adenosine, and K+
-
Common congeital heart disease seen in DiGeorge syndrome
- tetralogy of Fallot
- aortic arch anomalies
-
Patient has hypertension in upper extremities and weak pulses in the lower extremities, what is the most common asosciation
This is postductal coarctation of the aorta
Association = bicupsid aortic valve
Can result in aortic regurgitation
-
Congenital cardiac defect seen with Congenital Rubella
- septal defects
- PDA
- pulmonary artery stenosis
-
Associated with Aortic dissection
- Hypertension
- cystic medial necrosis (Marfans)
-
MI markers
- troponin (0-8 hours) lasts longer
- CKMB (8-24 hours) Down by day 2 = good for reinfarction sign
- AST (1 day)
- LDH (2-7 days)
-
Causes of Dilated (congestive) cardiomyopathy
- Alcohol abuse
- wet Beriberi (Thiamine deficiency)
- Coxsackie B virus myocarditis
- chronic Cocaine use
- Chagas disease
- Doxorubicin toxicity (radical formation)
- hemochromatosis
- peripartum cardiomyopathy
-
What is the cause of orthopnea
Increased venous return in supine position exacerbates pulmonary vascular congestion
-
Symptoms of bacterial endocarditis
- Fever
- Roth spots (white spots on retina surrounded by hemorrhage)
- Osler nodes (painful lesions on finger pads)
- Murmur
- Janeway lesions (painless small erythematous lesions on palm or sole)
- Anemia
- Nail-bed hemorrhage
- Emboli
FROM JANE
-
Rheumatic heart disease findings
- HISTO
- Aschoff bodies (granuloma with giant cells)
- Anitschkow's cells (activatedhistiocytes)
- elevated ASO titers = type II hypersensitivity (ab-M protein) Group A B-hemolytic Streptococci
- Major criteria
- Joints (migratory polyarthritis)
- Pancarditis
- Nodules (sub Q)
- Erythema marginatum
- Sydenhams chorea
JONES
-
p-ANCA vasculitides
- Microscopic polyangiitis:
- - necrotizing vasculitis (nongranulomatous)
- - affects small vessels
- Churg Strauss syndrome
- - granulomatous vasculitis with eosinophilia
- - presents with asthma, sinusitis, skin lesions, and peripheral neuropathy
- - involve heart, GI, and kidneys
- - affects small vessels
-
Buergers disease
- (Thromboangiitis obliterans)
- Segmental thrombosing vasculitis of small and medium peripheral arteries and veins
- Heavy smokers
- Affects small and medium vessels
- SX:
- - intermittent claudication
- - superficial nodular phlebitis
- - cold sensitivity
- - -> gangrene and autoamputation of digits
TX: STOP SMOKING
-
Glomus tumor
- Vascular tumor
- Benign, painful, red-blue tumor under fingernails.
- Arises from modified smooth muscle cells of glomus body(in dermis of skin and involved in temp regulation)
-
Diazoxide
K+ channel opener -> hyperpolarizes and relaxes vascular smooth muscle.
Cause hyperglycemia by reducing amount of insulin released
-
B-blocker MOA
- Inhibit Gs -> no increase in IC cAMP levels
- relaxation of cardiac tissue and renal juxtaglomerular cells
-
What lipid lowering drugs are known to cause hepatotoxicity
Statins - HMG-CoA reductase inhibitor
Ezetimibe - cholesterol absorption blocker
Fibrates- upregulate LPL
-
B1 receptors and contractility
Gs -> PKA -> phosphorylation of L-type Ca2+ channels and phospholamban -> increased intracellular Ca2+ during contraction
-
Class IB antiarrhythmics
Lidocaine, Mexiletine, Tocainide
- Dec AP duration
- Prefers ischemic or depolarized Purkinje and ventricular tissue (post MI)
- acute ventricular arrhythmias and digitalis induced arrhythmias
-
What are the toxicities associated with class III antiarrhythmics
- Sotalol - torsades de pointes, excessive B-block
- ibutilide- torsades
- bretylium- new arrhythmias, hypotension
- amiodarone- pulmonary fibrosis, hepatoxicity, thyroid dysfunction, smurf
-
Coronary steal
Adenosine and dipyridamole (increases adenosine -> vasodilation) -> selective vasodilators of coronary vessels
leads to coronary steal= blood from ischemic areas via microvessel collaterals
-
How to differentiate pheochromocytoma and neuroblastoma via urine
Pheochromocytoma: increased VMA(NEP breakdown product)
Neuroblastoma: increased HVA (Dopamine breakdown product)
-
Metyrapone
- Blocks 11-Bhydroxylase -> increased deoxycortisol which leads to no feedback inhibtion -> inc ACTH = normal response
- Also 17 hydroxy-corticosteroid in the urine
-
How does gallstone ileus present?
- Gas w/in gallbladder and biliary tree
- Midabdominal pain due to gallstone in ileocecal valve
-
Effect of lowering the cutoff point
- increase sensitivity
- increase true positives
- big increase in false positives
- decrease in positive predictive value
- decrease in false negative
-
How does Superior mesenteric artery obstruction present
- Apple peel atresia
- spiral around ileocecal valve
-
Pancreatic pseudocyst
granulation and no epithelial lining
-
Gastrectomy needs this for life
Lifelong parenteral B12
-
NF-kB
transcription factor for cytokine production
-
Galacotsyle B-1,4 glucose
Lactose
-
opioid analgesics side effect -> RUQ pain
contraction of smooth muscle in the sphincter of Oddi
-
Shigatoxin mechanism
inactivates 60s ribosomal subunit -> no protein synthesis
-
Carcinoids
malignant transformation of enterochromaffin cells
-
Cricopharyngeal muscle dysfunction leads to
Zenkers diverticulum
-
Diffuse esophageal spasm
uncoordinated peristalsis
-
What stimulates pancrease to secrete HCO3-
secretin from the duodenum
-
Erosions do not invade the
muscularis mucosa
-
live attenuated virus leads to
better mucosal IgA immunity
-
C. dificile B toxin
- actin depolymerization
- loss of cellular integrity
- cell death and mucosal necrosis
-
Indirect inguinal hernia
- Lateral to inferior epigastric artery
- follows descent of testes into scrotum
- covered by all 3 layers of spermatic fascia
-
What is the most likely cause of an ulcer in the distal duodenum?
- Zollinger-Ellison Syndrome
- (nongastric neoplasm)
-
Glucose suppression on E.coli enzymes
Decrease in cAMP -> poor CAP binding -> dec lac operon
-
How does candida spread hematogenously?
In the case of neutropenia
-
What is one difference between prokaryotic mRNA and eukaryotic mRNA
Prokaryotic mRNA is polycistronic
-
AN ulcer in the posterior aspect of the duodenal bulbar leads to what
Hemorrhage via erosion of the gastroduodenal artery
-
Arsenic poioning is treated with what antidote
Dimercaprol
(patient has garlic breath)
-
Mechanism of Ribavirin
inhibits viral RNA polymerase
-
ETEC toxins
- Heat labile = cholera like -> inc cAMP
- Heat stabile -> inc cGMP -> inc guanylate cyclase
-
What does C. jejunum casue
Inflammatory gastroenteritis
From domestic animals or contaminated food
-
Crohns malabsorption presents with
calcium oxalate kidney stones, anemia, hypoproteinemia, B12 and folate def., and gallstones
-
Treatment for C. difficle
Metronidazole
-
Systemic mastocytosis
Increased histamine -> increase gastric cell stimulation
-
VIPoma
- pancreatic cholera diarrhea
- Treatment is somatostatin
-
Where are lipids absorbed
In the jejunum along with folate
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