Cardiology — Flashcards

Flashcard 2491: Patient present with acute Gout, and renal disease. -What is the best line of Tx?

Answer: Glucocorticoids (e.g., oral Prednisone or intra-articular steroids)

Extra: NSAIDs are contraindicated in patients with renal disease (CKD). While Colchicine can be used with dose adjustment, Glucocorticoids are generally preferred and safer in the setting of significant renal impairment.

Flashcard 2492: A 54-year-old patient presents with an acute gouty attack. He has a history of recent epigastric pain and suspected peptic ulcer disease. What is the preferred treatment for his gout?

Answer: Colchicine NSAIDs are contraindicated in patients with peptic ulcer disease. Colchicine works by inhibiting microtubule polymerization, which interferes with neutrophil chemotaxis.

Flashcard 2493: Match the following markers/antigens to their clinical associations: - Centromeres - Citrullinated peptides - Double-stranded DNA - Fc portion of human IgG - Nuclear basic proteins - Phospholipids

Answer: - Centromeres: Associated with CREST syndrome (anti-centromere antibodies) - Citrullinated peptides: Rheumatoid arthritis (Anti-CCP; highly specific) - Double-stranded DNA: SLE (Anti-dsDNA; highly specific) - Fc portion of human IgG: Rheumatoid Factor (RF is an autoantibody, usually IgM, directed against the Fc portion of IgG) - Nuclear basic proteins: Antinuclear antibodies (ANA); associated with SLE and other connective tissue diseases - Phospholipids: Antiphospholipid syndrome, SLE

Flashcard 2494: 47 y/o woman comes with joint pain and swelling in her hands for the past several months. -Complains of easy fatigability that has gradually worsened. -Morning activities are especially difficult for her due to prolonged stiffness. -Examination: joints reveals warmth, swelling & tenderness involving PIP joints, MCP joints, & wrists bilaterally. -Serum with high specificity for this patient's condition are most likely to react with what?

Answer: Citrullinated peptides. Very specific for Rheumatoid arthritis (95%-98%). More specific than Rheumatoid Factor (which reacts with the Fc portion of human IgG).

Flashcard 2495: 17 y/o girl comes for follow-up on anemia. - She has taken iron supplements regularly since being diagnosed with iron-deficiency anemia 3 months ago. - She has occasional gingival bleeding when brushing her teeth. - Heavy menses. - Further evaluation: patient's platelets do not aggregate appropriately in response to ristocetin. - When normal plasma is added to the solution of patient platelets and ristocetin, appropriate platelet aggregation occurs. - What is the most likely deficiency in this patient?

Answer: von Willebrand factor (vWF) When normal plasma (containing vWF) is added, appropriate aggregation occurs. Ristocetin activates vWF to bind to GpIb for platelets to aggregate. Rx: Desmopressin, as it stimulates vWF release from the endothelium (Weibel-Palade bodies).

Flashcard 2496: 40 y/o woman presents with a 3-month history of progressive fatigue and decreased exercise tolerance. - Physical exam: Conjunctival and palmar pallor. - Labs: Hemoglobin 9 g/dL, MCV 72 fL. - Bone marrow biopsy: Ring sideroblasts seen on Prussian blue stain. Decreased activity of what enzyme most likely explains this patient's anemia?

Answer: δ-Aminolevulinate synthase (ALA synthase)

Extra: Sideroblastic anemia results from defective heme synthesis. The rate-limiting step is catalyzed by ALA synthase, which requires Vitamin B6 (pyridoxine) as a cofactor. Key clinical features: - Microcytic anemia (sometimes dimorphic) - Increased serum iron and ferritin, decreased TIBC - Ring sideroblasts (iron-laden mitochondria surrounding the nucleus) on Prussian blue stain of bone marrow. Common causes: - Hereditary (X-linked) - Acquired: Lead poisoning, Isoniazid (B6 antagonist), Alcohol, Myelodysplastic syndrome.

Flashcard 2497: What is the treatment for Buerger disease?_____

Answer: Smoking cessation

Flashcard 2498: Trastuzumab (herceptin) is used to treat HER2+ _____ cancer

Answer: breast

Flashcard 2499: Which form of cancer is the 2nd most common cause of cancer death in men? _____

Answer: Prostate cancer

Flashcard 2500: Do patients with erectile dysfunction due to medical etiologies have nocturnal penile tumescence?_____

Answer: No