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1
Q

Mitral valve auscultation?

A

Apex

Apex auscultation is typically performed at the point of maximal impulse (PMI) on the chest.

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2
Q

Where is the tricuspid valve (TV) auscultation location?

A

Left parasternal border

This area is often used to assess the function of the tricuspid valve.

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3
Q

Where is the aortic valve (AV) auscultation location?

A

Right 2nd intercostal space

This location is standard for evaluating aortic valve sounds.

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4
Q

Where is the pulmonary valve (PV) auscultation location?

A

Left 2nd intercostal space

This area helps in assessing pulmonary valve activity.

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5
Q

What does S1 signify in heart sounds?

A

Closure of MV and TV

S1 is commonly referred to as the ‘lub’ sound.

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6
Q

What does S2 signify in heart sounds?

A

Closure of AV and PV

S2 is commonly referred to as the ‘dub’ sound.

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7
Q

What happens to A2 and P2 during inspiration?

A

They split due to increased blood in the right side of the heart

This physiological change is important in assessing heart function.

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8
Q

What is S3 and what does it indicate?

A

Abnormal heart sound due to blood entering a volume overloaded ventricle in early diastole

S3 can indicate heart failure or other conditions.

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9
Q

What causes S3 heart sound?

A

Valve regurgitation; congestive heart failure

These conditions lead to volume overload in the ventricles.

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10
Q

What do murmurs indicate?

A

Stretching of the valve ring or damage to the valve

Murmurs can indicate various cardiac conditions.

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11
Q

How does inspiration affect heart sounds and murmurs?

A

Increases right-sided abnormal heart sounds and murmurs

This is due to increased venous return to the right heart.

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12
Q

How does expiration affect heart sounds and murmurs?

A

Increases left-sided abnormal heart sounds and murmurs

This is due to decreased venous return to the left heart.

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13
Q

What is S4 and what does it indicate?

A

Abnormal heart sound due to blood entering a non-compliant ventricle with atrial contraction in late diastole

S4 is often associated with hypertrophy or stiff ventricles.

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14
Q

What causes S4 heart sound?

A

Volume overloaded ventricle; hypertrophy

These conditions lead to decreased compliance of the ventricle.

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15
Q

What do stenosis murmurs indicate?

A

Problem in opening the valve

Stenosis can lead to increased pressure gradients across valves.

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16
Q

What do regurgitation murmurs indicate?

A

Problem in closing the valve

Regurgitation can lead to volume overload in the heart chambers.

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17
Q

Which valves open during systole?

A

AV and PV

This is when blood is ejected from the heart.

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18
Q

Which valves open during diastole?

A

MV and TV

This is when the heart fills with blood.

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19
Q

Which valves close during systole?

A

MV and TV

This closure prevents backflow into the atria.

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20
Q

Which valves close during diastole?

A

AV and PV

This closure prevents backflow into the ventricles.

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21
Q

What is LDL’s role in the body?

A

Primary vehicle for carrying cholesterol

High levels of LDL are associated with increased cardiovascular risk.

22
Q

What is VLDL’s role in the body?

A

Primary vehicle for carrying liver-synthesized triglyceride

VLDL is converted to LDL in the bloodstream.

23
Q

What is Type IV hyperlipoproteinemia associated with?

A

Increased VLDL; commonly seen in alcoholics

This condition can lead to pancreatitis among other issues.

24
Q

What is familial hypercholesterolemia (type II)?

A

Autosomal dominant; deficiency of LDL receptors; increased LDL

This genetic condition leads to high cholesterol levels from birth.

25
What characterizes Type III hyperlipoproteinemia?
Deficiency of apo E; increased remnants (chylomicron, intermediate density) ## Footnote This can lead to premature atherosclerosis.
26
What is the consequence of apo B deficiency?
Deficiency of apo B48 (chylomicrons) and B100 (VLDL); leads to increased CH and TG ## Footnote This condition can cause malabsorption and hemolytic anemia.
27
What are clinical findings in apo B deficiency?
Malabsorption; hemolytic anemia ## Footnote These findings are due to impaired lipid transport.
28
What is atherosclerosis a reaction to?
Injury of endothelial cells ## Footnote This process is complex and involves multiple factors.
29
What are the risk factors for atherosclerosis?
* Smoking * Increased LDL * Increased homocysteine * Chlamydia pneumoniae infection ## Footnote These factors contribute to the development of atherosclerotic plaques.
30
What cells are involved in atherosclerosis?
* Platelets * Macrophages * Smooth muscle cells * T cells with cytokine release ## Footnote These cells play roles in inflammation and plaque formation.
31
What is a fibrous plaque?
Pathognomonic lesion of atherosclerosis ## Footnote This lesion is a hallmark of advanced atherosclerotic disease.
32
What is C-reactive protein a marker of?
An inflammatory atheromatous plaque ## Footnote Elevated levels can indicate increased cardiovascular risk.
33
What does an inflammatory atheromatous plaque predispose to?
Platelet thrombosis ## Footnote This can lead to acute cardiovascular events.
34
What effect does increased plasma homocysteine have?
Promotes vessel thrombosis; associated with folate (MC)/vitamin B12 deficiency ## Footnote Elevated homocysteine levels are a risk factor for cardiovascular diseases.
35
What is hyaline arteriolosclerosis?
Small vessel disease of DM and hypertension; excess protein in vessel wall ## Footnote This condition leads to narrowing of small blood vessels.
36
What mechanisms cause hyaline arteriolosclerosis in diabetes mellitus?
Non-enzymatic glycosylation ## Footnote This process leads to increased permeability of the vessel wall.
37
What happens during non-enzymatic glycosylation?
Glucose attaches to amino acids in the basement membrane; causes increased permeability to protein ## Footnote This is a significant mechanism in diabetic complications.
38
What mechanisms cause hyaline arteriolosclerosis in hypertension?
Pressure pushes proteins into the vessel wall ## Footnote This leads to changes in blood vessel structure.
39
What can cause abdominal aortic aneurysm rupture?
Due to atherosclerosis; presents with flank pain, hypotension, pulsatile mass ## Footnote This is a medical emergency requiring immediate attention.
40
What is a syphilitic aneurysm?
Vasculitis of vasa vasorum of aortic arch; can lead to aortic regurgitation ## Footnote This condition is associated with untreated syphilis.
41
What causes aortic dissection?
Due to hypertension and collagen tissue disorders (e.g., Marfan syndrome) ## Footnote This is a life-threatening condition that requires urgent treatment.
42
What is cystic medial degeneration?
Elastic tissue degeneration creates spaces filled with mucopolysaccharides ## Footnote This is often seen in Marfan syndrome.
43
What causes an intimal tear in the aorta?
Due to wall stress from hypertension and structural weakness ## Footnote This can lead to aortic dissection.
44
What are the types of aortic dissection?
* Proximal (most common) * Distal * Combination of both ## Footnote Proximal dissections are more likely to be life-threatening.
45
What is the most common cause of death in Marfan's and Ehlers-Danlos syndrome?
Aortic dissection ## Footnote These connective tissue disorders predispose individuals to vascular complications.
46
What is phlebothrombosis?
Stasis of blood flow; deep veins below knee are the most common site ## Footnote This condition can lead to deep vein thrombosis.
47
Where do pulmonary thromboemboli originate from?
Femoral veins ## Footnote This can lead to serious complications such as pulmonary embolism.
48
What does superficial migratory thrombophlebitis indicate?
Sign of carcinoma of the head of the pancreas ## Footnote This condition can be a paraneoplastic syndrome.
49
What are the signs and symptoms of proximal aortic dissection?
Chest pain radiating to back, lack of pulse; cardiac tamponade ## Footnote These symptoms indicate a medical emergency.
50
What is the most common cause of death in Marfan's syndrome?
Aortic regurgitation/dissection; lens dislocation; MVP with sudden death ## Footnote These complications are critical in managing patients with Marfan's.
51
What is thoracic outlet syndrome?
Absent radial pulse with positional change ## Footnote This syndrome can cause pain and neurological symptoms.
52
What are the symptoms of Turner's syndrome?
Lymphedema hands/feet in newborn; preductal coarctation ## Footnote Turner's syndrome is a chromosomal disorder affecting females.

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