CARDIO

Question 1

Common causes of HFpEF

Answer 1

Aging
Obesity
Hypertension

Question 2

High cardiac output, low SVR HF causes

Answer 2

Thiamine deficiency

Question 3

occurs when there is normal or increased cardiac function and low systemic vascular resistance, but the heart is unable to supply the body’s demands.

Answer 3

High output failure

Question 4

Concentric hypertrophy: A.
Eccentric Hypertrophy: B

Answer 4

A. Pressure Overload (HPN, AS)
B. Volume overload (MR, AR)

Question 5

Potent vasoconstrictors

Answer 5

Aldosterone
Angiotensin II

Question 6

Vasodilators

Answer 6

Bradykinin
Nitric Oxide
Natriuretic Peptides

Question 7

Inactivates bradykinin

Answer 7

Neprilysin

Question 8

MOA of Diuretics in HF

Answer 8

Decreasing pressure within the abdominal compartment, improving renal perfusion

Question 9

alternatingly strong and weak pulse resulting from variation in the left ventricular stroke volume with every cardiac cycle because of incomplete LV recovery.

Answer 9

Pulsus Alternans

Question 10

exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg seen in cardiac tamponade and constrictive pericarditis,

Answer 10

Pulsus Paradoxus

Question 11

weak pulse seen among patients with aortic stenosis.

Answer 11

Pulsus parvus et tardus

Question 12

increased pulse with double systolic peak seen in aortic regurgitation.

Answer 12

Pulsus bifriens

Question 13

Indicates severe biventricular heart failure and is a marker of poor outcome.

Answer 13

Kussmaul’s sign
- rise in JVP with inspiration

Question 14

indicates right-sided heart failure, without necessarily involving the left side.

Answer 14

Hepatojugular reflex

Question 15

Loud P2 component of S2 is seen in patients with

Answer 15

Pulmonary Hypertension

Question 16

Echo findings:

asymmetric hypertrophy of the septum, with the mitral valve moving anteriorly towards it during systole.

Answer 16

HOCM

Question 17

Echo

Pseudonormalization of the mitral inflow velocity pattern

Answer 17

Diastolic dysfunction

Question 18

Echo

billowing of the mitral valve leaflets into the left atrium during systole

Answer 18

MVP

Question 19

Micro infarcts consistent with small vessel ischemia and thrombosis secondary to endothelial dysfunction is a classic histopathology findings

Answer 19

Stimulant-induced cardiomyopathy

Question 20

a typical viral syndrome occurs without cardiac symptoms but with elevated biomarkers

Answer 20

Possible sub clinical myocarditis

Question 21

a typical viral syndrome occurs with cardiac symptoms but with elevated biomarkers

Answer 21

Probable Acute Myocarditis

Question 22

Pericarditis happens after a myocardial infarction

Answer 22

Dressler’s syndrome

Question 23

Main therapeutic agent for Prinzmetal angina

Answer 23

Nitrates
CCB

Question 24

Hemodynamic evidence of systolic function appears when contraction is impaired by _______, whereas infarction of _______% leads to shock.

Answer 24

A. 10-25%
B. >40%

Question 25

Chemo therapeutic agent according to their myocardial damage Recurrent coronary spasm leading to decreased myocardial contractility

Answer 25

5FU, cisplarion, other alkylating agents

Question 26

Chemo therapeutic agent according to their myocardial damage cause myocardial damage via mitochondrial damage and inhibition of DNA repair

Answer 26

Anthracyclines (doxorubicin)

Question 27

Chemo therapeutic agent according to their myocardial damage blocks the normal HER2 action on the cardiomyocytes.

Answer 27

Trastuzumab

Question 28

Chemo therapeutic agent according to their myocardial damage endoplasmic reticulum stress and inflammation among myocytes.

Answer 28

Tyrosine Kinase İnhibitors

Question 29

click and murmur of MVP occur earlier and intensify with

Answer 29

standing strain phase of the Valsalva maneuver and any intervention that decreases LV volume (preload)

Question 30

Click and murmur of MVP is delayed, moves away from S1 or even disappears with

Answer 30

squatting isometric exercises, and passive leg raising which increase LV volume

Question 31

Hemodynamic hallmark of MS

Answer 31

Abnormally elevated left ateioventricular pressure gradient > elevated pulmonary venous and arterial wedge pressures > increased pulmonary vascular resistance, leading to elevation in the right ventricular end-diastolic pressure > LV diastolic pressure is normal in isolated MS.

Question 32

Favors a diagnosis of ASD over MS

Answer 32

Absence of left atrial enlargement and Kerley B lines

Question 33

3 Major determinants of Myocardial Oxygen Demand

Answer 33

Heart Rate Myocardial Contractility Myocardial Wall tension

Question 34

Determinant of adequate oxygen supply

Answer 34

Level of oxygen carrying capacity of blood: inspired O2, pulmonary fxn, hb concentration Level of coronary flow

Question 35

Contraindications to exercise stress testing

Answer 35

rest angina within 48 hrs unstable rhythm, severe aortic stenosis acute myocarditis uncontrolled heart failure severe pulmonary hypertension and active infective endocarditis.

Question 36

most typical symptom is intermittent claudication, which is defined as a pain, ache, cramp, numbness, or a sense of fatigue in the muscles; it occurs during exercise and is relieved by rest.

Answer 36

PAD

Question 37

buttock, hip, thigh, and calf discomfort occurs in patients with A? whereas calf claudication develops in patients with B?

Answer 37

A. aortoiliac disease B. femoral-popliteal disease.

Question 38

Patients complain of rest pain or a feeling of cold or numbness in the foot and toes. Frequently, these symptoms occur at night when the legs are horizontal and improve when the legs are in a dependent position. When, rest pain may be persistent.

Answer 38

Critical Limb Ischemia

Question 39

episodic digital ischemia, manifested clinically by the sequential development of digital blanching, cyanosis, and rubor of the fingers or toes after cold exposure and subsequent rewarming. A sensation of cold or numbness or paresthesia of the digits often accompanies the phases of pallor and cyanosis.

Answer 39

Raynaud’s Phenomenon

Question 40

vasculitic disorder associated with exposure to cold wherein raised erythematous lesions develop most commonly on the toes or fingers in cold weather.

Answer 40

Pernio

Question 41

characterized by burning pain and erythema of the feet more frequently than the hands.

Answer 41

Erythromelalgia

Question 42

arterial vasoconstriction and secondary dilation of the capillaries and venules with resulting persistent cyanosis of the hands and, less frequently, the feet,

Answer 42

Acrocyanosis

Question 43

Edema, stasis dermatitis, and skin ulceration near the ankle may be present if there is

Answer 43

Supervicial venous thrombosis

Question 44

increased leg circumference, venous varicosities, edema, and skin changes.

Answer 44

Deep Venous insufficiency

Question 45

combination of induration, hemosiderin deposition, and inflammation, and typically occurs in the lower part of the leg just above the ankle.

Answer 45

Lipodermatosclerosis

Question 46

white patch of sear tissue, often with focal telangiectasias and a hyperpigmented border; it usually develops near the medial malleolus.

Answer 46

Atrophie blanche

Question 47

Surgical revascularization in acute limb ischemia is indicated in patients with

Answer 47

Restroration of blood flow must occur within 24 hours to prevent limb loss Symptoms of occlusion is present > 2 weeks Amputation: Limb is not viable (loss of sensation, paralysis, absence of Doppler detected blood flow in both arteries and veins

Question 48

Findings indicative of high risk for intracradiac complications from IE

Answer 48

Congestive Heart Failure New regurgitant murmur New electrocardiographic conduction changes

Question 49

Most common complication with aortic valve infection (10-15% with NVE, 45-60% with PVE)

Answer 49

Perivalvular extension

Question 50

Antibiotics for Viridans group IE highly susceptible to Penicillin

Answer 50

Pen G Ceftriaxone Vancomycin Pen G + Genta *4 weeks

Question 51

Early PVE (within 2 months) etiologies

Answer 51

S. Aureus CoNs Fac gram neg bacilli Diphteroids Fungi

Question 52

Staph PVE MSSA antibiotics

Answer 52

Nafcillin, oxacillin, flu + Genta + Rif MRSA: Vanco + Genta + Rif * 6-8 weeks

Question 53

Major indication for cardiac surgery in IE

Answer 53

Mod to Severe HF

Question 54

Lake Louise Criteria for mycoarditis (MRI)

Answer 54

2 out of 3 1. Abnormal T2 2. Early gd enhancement 3. Late gd enhancement Revise Criteria Both 1. T2 with edema 2. T1 with inflammation

Question 55

Most commonly non-infectious inf affecting the myocardium

Answer 55

Granulomatous myocarditis (inc sarcoidosis and giant cell myocarditis)

Question 56

Doppler ultz of tamponade

Answer 56

> tricuspid and pulmonic valve flow velocities increase markedly during inspiration > pulmonic vein, mitral, and aortic flow velocities decrease. In tamponade, > there is diastolic inward motion (collapse) of the right ventricular free wall and the right atrium.