Module 10 Flashcards by Anson Lam

___% of the cell in heart are specialized for electrical activityconduction

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What is the pacemaker of the heart ?

SA node

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What is the electrical relay station of the heart ?

AV node

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What is the main transmission line of the heart ?

Bundle of His

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Purkinjie fibers distribute_________to_________

electrical signals to ventricular cells

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Omega_____can be pro inflammatory
Omega_____is anti inflammatory

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(Saturated/Unsaturated) fats are more healthy

Unsaturated

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What form a micelle in digestion

products from fat digestion & bile acids

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What is the fxn of chylomicrons ?

Act as lipid transporting particles

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T/F, smoking is a risk factor for dvlping artheroscelorosis

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Cholesterol absorption is hindered by__________content

high fiber

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Transient constant influx of _____ions cause the myocyte to contract

K+

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(Atrial/Ventricular) tachycardia is more common ?

Atrial

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What is the complication of atrial tachycardia ?

Clots may form & get pumped out > stroke

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(Atrial/Ventricular) tachycardia is more life threatening ?

Ventricular

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What does Digoxin inhibit ?

Na/K ATPase

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T/F, Digoxin has a wide therapeutic index ?

F, narrow

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What 3 classes of drugs to avoid when using digoxin

NSAIDS
Macrolides ab
Tetracycline ab

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Angine is chest pain due to___________

Reduced blood flow

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Nitrate drugs are metabolised into_________

Nitric Oxide

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What drugs are 1st line therapy to high cholesterol

Statins

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What drug is commonly added if statin is not adequate ?

Ezetimibe

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Acute Rheumatic Fever is an acute often recurrent, immunological inflammatory disorder which potentially follows_______or_________

systemic infection or upper respiratory infection

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(Endo/Myo/Pericarditis) pose the greatest significance because_________

Endocarditis, it is a precursor to heart failure

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Most of the rheumatic endocarditis happen on which side of heart ?

Left

Rhematic endocarditis is host response to_____________

bacterial vegetation

Which streptococcus species can cause endocarditis ?

Strep Pyogenes & Mutans

What specie can cause strep throat ?

Strep pyogenes

What is the difference between endocarditis & rheumatic fever (RF) ?

Both affect the heart. Endocarditis is infection of the endocardium while RF is immunological inflammatory disorder following systemic infection (i.e. oral infection)

What could digoxin be used to treat ?

heart failure w/ atrial fibrillation

50% of septic shock is caused by which 2 bacterias

E. Coli/ K pneumoniae

- Strep contributes to_______% of sepsis - Staph contributes to_______% of sepsis

- 20 - 20

amoxicillin is a (long/short) acting antibiotics

short

Bacteraemia asso w/ dental procedures usually involves which group of streptococci

Viridans

If patient is taking long term benzathine benzylPENICILLIN for prevention of RF, what ab is appropriate for endocarditis prophylaxis ?

Amoxicillin

If patient is taking long term Beta-Lactam for prevention of RF, what ab is appropriate for endocarditis prophylaxis ?

Non beta-lactam ab (e.g., clindamycin)

what does having more p waves than qrs waves imply

Heart block

what does having more qra waves than p waves imply

ventricular cells contracting on their own

What are the 2 underlying mechanisms for arrhythmias ?

1. Ectopic automaticity (myocytes become pace makers) 2. Re-entry events

List 2 tx for arrhymias

Beta blockers, K+ channel blockers

What are the 3 types of antibiotics therapy ?

Prophylaxis, Empirical therapy, Directed therapy

List 4 ways antibiotics can be classified

drug class, structure, mechanism of action, generation

__________of a healthy blood vessel help maintain smooth blood flow & prevent clotting in vessel

Confluent endothelium

Atrial depolarization occurs during____wave

What occur during T wave

ventricular Repolarization

What happens during QRS complex

ventricular depolarization & (atrial repolarization ?)

Metronidazole is effective against what bacteria

Strict anaerobes

Beta lactams are effective against what bacteria

Gram + cocci (inhibit peptidoglycan syn.)

Fluclox is taken (w/ or w/out) food ?

w/ out only

Metronidazole is taken (w/ or w/out) food ?

w/ only

what antibiotics should be avoided on patients w/ renal issues

Clindamycin, Lincomycin

What antibiotic has good alveolar bone penetration

Clindamycin

What antibiotic may lead to neurological side effect

Metronidazole (flagyl)

Thrombus occurs when______is exposed to the blood in the process of artherosclerosis

lipid-rich core of plaque

_________produced from metabolism of dietary choline & l-carnitine INHIBITS cholesterol metabolism & promotes atherosclerosis

TMAO

Which 2 drugs diminish the effect of RAA sys. and thus reducing the work required by heart to pump

ACEI/Sartan

What antibiotics inc the risk of prolonged QT interval ?

Macrolides

Using of lidocaine on patienta taking which antibiotic may lead to toxicity

Amiodarone (macrolide)

List 3 drugs used for Angina

1. Ca channel blocker (inc O2 availability) 2. Beta blockers (reduce SYMPATHETIC effects on heart) 3. Nitrates (relax vascular smooth muscle)

Which drug that can be used to treat angina has potentially fatal drug interaction w/ viagara

Nitrates

What is used for first aid in angina

Nitroglycerin spray/tablets

Statin has significant drug interactions w/ what antibiotics ?

Macrolides

- Aschoff Nodule is commonly found in what disease

- Rheumatic Fever/Carditis

What are 2 key characteristic of Anitschkow cell in Aschoff Nodule

Prominent nucleoli (Anitschkow cell) Aschoff multi-nucleated giant cells

T/F, giant cells are found in rheumatic endocarditis ?

Aortic regurgitation is a result of___________

cusp rigidity

A full glass of water is recommended to lower GI irritation with which ab

Clindamycin, Linomycin

What is the typical dose range for Clindamycins ?

300-600mg

What does statins inhibit ?

HMG-CoA reductase converting into mevalonate

Which segment of the ECG wave may be altered by combining certain classes of drugs, such as antiarrhythmics and macrolide antibiotics? ST segment PR interval PR segment QRS complex QT interval

QT interval

Fibrinous / haemorrhagic pericarditis is characterised by which of the following sequalae? Ischaemic heart disease Fibrin, mixed with small amounts of blood, into the pericardial space Valvular vegetations Valvular haemorrhage Collagen, mixed with small amounts of blood, into the pericardial space

Fibrin, mixed with small amounts of blood, into the pericardial space

All of the following are true regarding Omega-3 fats EXCEPT: They regulate blood clotting They reduce blood pressure They are essential They should be eaten no more than once per week They are the starting point for hormone manufacture

They should be eaten no more than once per week

Which statement below concerning Streptococcus pyogenes is false: S. pyogenes is a Gram positive coccus and is classified as a Group A Streptococcus. Bleeding during oral surgery can result in S. pyogenes entering the bloodstream. S. pyogenes can cause lysis of red blood cells. A throat infection by S. pyogenes cannot be misdiagnosed as a viral infection. An S. pyogenes infection of the tonsils can result areas of white pus.

A throat infection by S. pyogenes cannot be misdiagnosed as a viral infection.

Which of the following regarding modification of antibiotics for surgical prophylaxis is CORRECT? It is needed for patients currently taking long-term antibiotics for another indication It is always needed in patients who have recently received antibiotic therapy It is needed for patients who have recently received surgical prophylaxis It is needed for patients who have taken a short course of antibiotics within the previous 4 weeks It is needed for patients who have taken a short course of antibiotics within the previous 4 weeks and who are currently taking long-term antibiotics for another indication

It is needed for patients currently taking long-term antibiotics for another indication

Why are mono and polyunsaturated fats important to include in the diet: Their structure allows them to be tightly packed together to be solid at room temperature They are completely hydrogenated They raise triglyceride levels which protects against stroke They raise Low Density Lipoproteins (LDL’s) to protect against cardiovascular disease Can improve blood cholesterol profiles and regulate inflammation

Can improve blood cholesterol profiles and regulate inflammation

In the case of a normal heartbeat, depolarization stimulus arises in which of the following? Atrioventricular node (AV node) Bundle of His Endocardium Epicardium Sinoatrial node (SA node)

Sinoatrial node (SA node)

A man aged 53 suffered from weakness and fainting attacks for 2 years, and for 3 months prior to death showed generalised oedema and was diagnosed with recurrent rheumatic fever. Which of the following is TRUE on inspection of the impacted cardiac valve? Low blood pressure predominantly results in right-sided valve damage Vegetations are focused to muscle tissues surrounding the affected valve Evidence of fibrin, mixed with small amounts of blood Recurrent inflammation leads to endothelial ulceration on the valve surfaces Bacterial vegetation has grown over surface epithelial cells

Recurrent inflammation leads to endothelial ulceration on the valve surfaces

Which of the following drugs inhibits β-lactamase to enhance activity of amoxicillin? Azithromycin Clavulanic acid Digoxin Clindamycin Phenoxymethylpenicillin

Clavulanic acid

Which of the following about amoxicillin is INCORRECT: is a beta-lactam is effective against some Gram negative bacteria works by inhibiting protein synthesis is a broad spectrum antibiotic is bactericidal

works by inhibiting protein synthesis

What is the maximum dose of paracetamol for an adult over 24 hours?

4000mg

Which of the following is a complication occurring after infective endocarditis? Thinning of the chordae tendineae Valvular vegetations Diffuse proliferative glomerular nephritis Aortic vegetations Intracerebral haemorrhage

What is the most likely event immediately following the rupture of an unstable plaque? Depolarisation Endothelial dysfunction Non ST-Elevation Myocardial Infarction Thrombosis Atherosclerosis

Thrombosis

What are the 3 types of ECG

Resting, Ambulatory, Stress

The resting potential of cardiomyocyte is ~______mV

-90

A slight delay between the P & the QRS sequence indicate_____degree heart block

First

ST segment depression can be found in what cardio disease ?

Angina

ST segment elevation can be found in what cardio disease ?

Myocardial Infarction

List 2 medications that could cause arrhythmias

Beta blocker, K+ channel blocker

Scaring of heart and cardiovascular conductive system can cause what cardio disease

Arrhythmias

Which of the following antibiotics is often recommended to be co-prescribed with amoxicillin to provide anaerobic coverage? Metronidazole Clindamycin Cefalexin Trimethoprim Flucloxacillin

Metronidazole

Subsequent to formation of vegetations on the chordae tendinaea of the mitral valve, which of the following is TRUE? Commonly enhances valve elasticity The mitral cusps become thinner and more flexible due to fibrosis Typically results in enhanced ejection fraction A high prevalence of adhesion and fusion of chordae tendinaea Lengthens the chordae tendinaea

A high prevalence of adhesion and fusion of chordae tendinaea

Which segment of the ECG wave may be altered by combining certain classes of drugs, such as antiarrhythmics and macrolide antibiotics? QRS complex ST segment PR segment PR interval QT interval

QT interval

Ventricular depolarization occurs in_____wave

Ventricular contraction occurs in_____wave

What is hypervolemia

Having too much blood

Which drug treat heart failure by slowing heart down and stop excessive stimulation

Beta blockers

Which drugs treat heart failure by reducing blood volume

Diuretics`

Sacubitril treats heart failure by____________

inhibiting an enzyme that is responsible for degrading vasoactive peptides (i.e. bradykinin)

Sacubitril must be co-administered w/_________

Sartan/ACEI

Which class of antibiotic inc. the risk of prolonged QT interval

Macrolides

What is angina

chest pain due to reduced blood flow

What is the definition of septic shock ?

Cardiovascular collapse due to septicaemia

The depolarization of_______node cause atrium to contract

Anti-diarrheal meds should be avoided when taking which class of antibiotics

Lincosamides (i.e. clindamycin)

Which class of antibiotic should be avoided in patients w/ renal transplant/dz

Lincosamides (i.e. clindamycin)

Which antibiotic could cause metallic taste >

Metronidazole

Which aspect of plaque formation contributes most directly to the formation of the lipid core? Smooth muscle cell proliferation leading to plaque fibrous cap formation Thinning of the fibrous cap exposing the plaque to platelets and fibrin Apoptosis of macrophages leading to spilled lipids in the vessel wall Endothelial cell adhesion molecule expression and oxidation of LDL cholesterol Migration of leukocytes leading to increased cytokine secretion

Apoptosis of macrophages leading to spilled lipids in the vessel wall

Which segment of the ECG wave may be altered by combining certain classes of drugs, such as antiarrhythmics and macrolide antibiotics? PR segment QT interval ST segment QRS complex PR interval

QT interval

The MOST appropriate choice of infective endocarditis prophylaxis for an adult patient who cannot take medicines orally with a documented history of immediate severe hypersensitivity to penicillins is: Cefazolin 2 g intramuscularly 30 minutes before the procedure Clindamycin 600 mg orally 60 to 120 minutes before the procedure Cefalexin 2 g orally 60 minutes before the procedure Clindamycin 600 mg intravenously within the 120 minutes before the procedure Cefazolin 2 g intravenously within the 60 minutes before the procedure

Clindamycin 600 mg intravenously within the 120 minutes before the procedure

When a patient has risk factors including high blood pressure, smoking, and high blood glucose, this can cause damage to the endothelium. Which two events are most likely to occur as a result of endothelial dysfunction? Decreased blood flow and increased blood pressure Disruption of the smooth muscle cell proliferation and fibrous cap formation Decreased platelet aggregation and increased blood clotting Increased LDL cholesterol oxidation and immune cell infiltration Oversupply of oxygen and ischaemic damage

Increased LDL cholesterol oxidation and immune cell infiltration

What is the most likely event immediately following the rupture of an unstable plaque? Non ST-Elevation Myocardial Infarction Depolarisation Thrombosis Atherosclerosis Endothelial dysfunction

Thrombosis

Which process form foam cell

macrophages digesting cholesterol & oxidized LDLs

What is the cause of STEMI myocardial infarction ?

Complete occlusion of coronary artery

What is the cause of non-STEMI myocardial infarction ?

Partial occlusion of coronary artery

Sacubitril must be co-administered w/____________

Valsartan & ACEI/Sartans

What is the definition of myocardial infarction

Lack of oxygen to cardiac tissue coz of blocked CORONARY artery > severe pain & potentially fatal

Fibrinous pericardial exudate containing hemorrhage can be seen in what condition

fibrinous haemorrhagic pericarditis

Aschoff nodule is a foci of_________

swollen eosinophilic collagen surrounded by lymphocytes

(tooth brushing & flossing/episodic dental tx) pose higher risk for infective endocarditis & prosthetic joint infection

tooth brushing & flossing

What are the 3 special patient groups for surgical prophylaxis ?

1. Pre-existing prothetic joint prothesis 2. pre-existing breast implant 3. patients w/ profound immune compromise

What is the drug of choice of infective endocarditis prophylaxis generally

amoxicillin 2g orally 60 min b4 procedure

The MOST appropriate choice of infective endocarditis prophylaxis for an adult patient who can take medicines orally with a documented history of severe hypersensitivity to penicillins is: Cefazolin 2 g intramuscularly 30 minutes before the procedure Clindamycin 600 mg orally 60 to 120 minutes before the procedure Cefalexin 2 g orally 60 minutes before the procedure Clindamycin 600 mg intravenously within the 120 minutes before the procedure Cefazolin 2 g intravenously within the 60 minutes before the procedure

Cefalexin 2 g orally 60 minutes before the procedure

Amoxicilin +_______will turn it into broad spectrum drug

clavulonate

Cefalexin is a_______spectrum antibiotic

moderate

Penicillin is a________spectrum antibiotic

Narrow

Which class of antibiotic is bacterioSTATIC

Lincosamides

Which of the following regarding modification of antibiotics for surgical prophylaxis is CORRECT? It is needed for patients who have taken a short course of antibiotics within the previous 4 weeks It is always needed in patients who have recently received antibiotic therapy It is needed for patients who have recently received surgical prophylaxis It is needed for patients who have taken a short course of antibiotics within the previous 4 weeks and who are currently taking long-term antibiotics for another indication It is needed for patients currently taking long-term antibiotics for another indication

It is needed for patients currently taking long-term antibiotics for another indication

Which of the following is NOT a consequence of rheumatic endocarditis? Aortic stenosis Aortic regurgitation Mitral regurgitation Aortic valve degeneration Myocardial infarction

Myocardial infarction

Module 10 Flashcards

(128 cards)