Cardio

Question 0

Remnant of fetal Umbilical arteries & allantois

Answer 0

aa => MediaL umbilical ligaments
(= 2 folds just off midline in anterior abdominal wall), No f(x) in adult

allantois => urachus & mediaN umbilical ligament = duct btwn bladder & belly button, no f(x) in adult.

Question 1

Remnant of fetal umbilical vein

Answer 1

ligamentum teres hepatis

(in falciform ligament, = vertically across anterior side of liver at midpoint) no f(x) in adult.

Question 2

Remnant of fetal ductus arteriosus

Answer 2

Ligamentum arteriosum
(stretches btwn pulmonary artery and aortic arch) no function in adult.
Recurrent laryngeal n. (from vagus) travels just underneath this lig.

Question 3

Remnant of fetal ductus venosus

Answer 3

ligamentum venosum

(on posterior side of liver, near midline) no f(x) in adult.

Question 4

factors for increased stroke volume of heart

Answer 4

1. increased Contractility
2. increased Preload
3. decreased Afterload

Question 5

factors for increased heart contractility:

Answer 5

Increased intracellular Ca2+ => increased muscle action

1. catecholamines (increase Ca pump @ Sarcoplasmic reticulum)
2. low soduim (less Na into cell = more Ca stays in cell)
3. digitalis (blocks Na/Ca2+ pump)

Question 6

preload measures ?

Answer 6

preload measures ventricular End Diastolic Volume
(how much blood entered from venous return during diastole, now needs to be pumped out)
force of contraction is proportional to EDV!

Question 7

Mockenberg Arteriosclerosis

Answer 7

calcification of the MEDIA of arteries, = benign (not obstructive)

Question 8

Arteriolosclerosis (2 types)

Answer 8

1. Hyaline arteriolosclerosis: thickened small aa. *essential HTN or DM
2. Hyperplastic arteriolosclerosis: “onion skinning” in arteries
   => malignant HTN

Question 9

Atherosclerosis

Answer 9

= fibrous plaques in intima of medium & large muscular aa & elastic aa

• includes sm. muscle cell migration w/ build-up
• • may have high plasma homocysteine levels

Question 10

Diseases associated with thoracic aortic aneurysms

Answer 10

HTN, cystic medial necrosis (w/ Marfan’s), & tertiary syphilis

Question 11

Coronary Steal Syndrome

Answer 11

aggravation of ischemia by vasodilator
bc shunt blood away from stenosis, & towards higher perfusion area
(but the stenotic area really needs the blood)

Question 12

Transmural vs. Subendocardial infarctions

Answer 12

Transmural: “Full” MI, w/ necrosis affecting entire wall.
= ST elevation or pathologic Q waves (old)
Subendocardial: partial MI (<50% of ventricle wall)
= ST depression

Question 13

What are some specific visible signs of bacterial endocarditis? (4)

Answer 13

1. Roth spots (white spots on retina w/ surrounding hemorrhage)
2. Osler’s nodes (tender, raised lesions on fingers or toes)
3. Janeway lesions (painless, erythematous, on palms or soles)
4. splinter hemorrhages

Question 14

Acute Rheumatic fever vs. Late sequelae

Answer 14

(type II hypersensitivity rxn after group A B-hemolytic strep infection)
Fever (acute): mitral regurgitation => holosystolic blowing murmur
& mitral valve prolapse => midsystolic click w/ late crescendo murmur

Late: mitral stenosis (or aortic) => diastolic opening snap w/ rumbling murmur

Question 15

Syphilitic heart disease

Answer 15

ascending aorta dilation & wall atrophy bc disrupted vasa vasorum.
=> aortic root calcification & “tree bark” aorta
** risk aneurysm or aortic insufficiency **

Question 16

Pulsus paradoxicus occurs in these cases: (5)

Answer 16

1. severe cardiac tamponade
2. asthma
3. obstructive sleep apnea
4. pericarditis
5. croup

Question 17

cardiac tamponade

Answer 17

compression of heart by fluid in pericardium

=> low CO –> hypotension, JVD, increase HR, pulsus paradoxicus

Question 18

Cases w/ + Kussmaul’s sign: (4)

Answer 18

(= abnormal increase in JVP on inspiration – normal = decrease)

1. constrictive pericarditis
2. restrictive cardiomyopathies
3. RA/RV tumors
4. cardiac tamponade

Question 19

Immune complex-mediated vasculitis types (2)

Answer 19

1. Polyarteritis nodosa (med. vessels esp. renal & GI, w/ neuro Sxs)
2. Henoch-Schonlein purpura (small vessels, IgA in kids after cold)

Question 20

Large vessel vasculitis types

Answer 20

Both: high ESR, granulomatous inflammation.

1. Takayasu’s arteritis: asian F <40yrs old, weak upper pulses
2. Temporal arteritis: elderly F, jaw claudication, vision loss
   
   • assoc. w/ polymyalgia rheumatica

Question 21

Medium vessel vasculitis types (3)

Answer 21

1. Polyarteritis nodosa: fibrinoid necrosis bc ICs *assoc. w/ HepB
2. Kawasaki disease: asian kids, *desquam rash! & strawb. tongue, risk coronary aneurysm/MI
3. Buerger’s/thromboangitis obliterans: heavy smokers (M), gangrene of digits! (intermittent claudication)

Question 22

Small vessel vasculitis types (4)

Answer 22

1. Microscopic polyangitis: pANCA, “pauci-immune”
2. Granulomatosis w/ polyangitis (wegener’s): cANCA,
3. Churg-Strauss: eosinophilia & IgE; sinusitis & periph. neuropathy
4. Henoch-Schonlein Purpura: kids after URI, = IgA deposition.

Question 23

3 types of veins in fetus (& what they become in adult)

Answer 23

1. Umbilical – degenerate
2. Vitelline – portal vein
3. Cardinal – systemic veins (common cardinal v -> Sup. Vena Cava)

Question 24

Characteristic triad for cardiac tamponade

Answer 24

1. muffled/distant heart sounds
2. JVD
3. hypotension
   * also: pulsus paradoxicus

Question 25

cases which present with pulsus paradoxicus

Answer 25

1. cardiac tamponade
2. constrictive pericarditis
3. asthma, COPD
4. Pulmonary Embolism