Cardiology — Flashcards

Flashcard 2481: 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 2482: 55 y/o man is found to have abnormal serum chemistries on lab testing. -He has history of hypertension, for which he's being treated with pharmacological therapy, weight reduction, & decreased sodium intake. -Lab results: Serum Na 134 K 3.8 BUN 18 Creatinine 0.8 Calcium 11 Blood Glucose 98 PTH: Decreased What is the most likely responsible for these findings? a. Familial hypocalciuric hypercalcemia b. Hypothyroidism c. Medication d. Primary hyperparathyroidism e. Secondary hyperparathyroidism

Answer: c. Medication (Thiazide diuretics) Thiazides increase renal calcium reabsorption in the distal tubule, leading to hypercalcemia which suppresses PTH secretion.

Flashcard 2483: 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 2484: How do the following deficiencies/conditions affect platelet aggregation in response to ristocetin, and what diseases are they associated with? - Glycoprotein Ib receptors - Glycoprotein IIb-IIIa receptors - Hageman factor - Thromboxane A2 - von Willebrand factor

Answer: - **Glycoprotein Ib (GPIb) receptors:** Bernard-Soulier Syndrome. Ristocetin-induced aggregation is absent and does **not** correct with normal plasma (contains vWF but lacks receptor). Features: giant platelets, thrombocytopenia. - **Glycoprotein IIb-IIIa receptors:** Glanzmann Thrombasthenia. Ristocetin-induced aggregation is **normal** (interaction is via GPIb-vWF). - **Hageman factor (Factor XII):** Factor XII deficiency. Ristocetin test is normal. Presents with a prolonged aPTT but no clinical bleeding (thromboembolic risk). - **Thromboxane A2 (TXA2):** Aspirin effect (COX-1 inhibition). Ristocetin-induced aggregation is **normal**. - **von Willebrand factor (vWF):** von Willebrand Disease (vWD). Ristocetin-induced aggregation is absent but **corrects** with the addition of normal plasma (which provides vWF).

Flashcard 2485: What is the 1st line of Tx for acute gout.

Answer: NSAIDS

Flashcard 2486: 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 2487: 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 2488: 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 2489: 38 y/o patient present with hypercoagulability, paradoxical partial thromboplastin time (PTT) prolongation, and recurrent miscarriages. -What is the most likely antibody present and DX?

Answer: Antiphospholipid antibodies. Antiphospholipid syndrome. due to blood clots with recurrent miscarriage.

Flashcard 2490: 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.