Cardio Flashcards
1
Q
Atherosclerosis is mainly caused by
A
endothelial cell dysfunction
2
Q
Treatment of Prinzmetal angina
A
Calcium channel Blocker and nitrates
3
Q
In myocardial infarction what do you observe in the 0-24hrs
A
- Early coagulative necrosis
- Edema and wavy fibers
- NEUTROPHILS appear
4
Q
What is the mechanism of the short acting nitroprusside
A
Balance venous and arterial vasodilators; decreases left ventricular preload and After load
5
Q
Best heard at the left 3rd and 4th intercostal spaces. Murmur is usually loud and accompanied by thrill
A
Ventricular Septal Defect
6
Q
Endocarditis in (IVDU) intravenous drug users is caused by
A
Staphylococcus Aureus
7
Q
The x descent is reduced or absent on the JVP (jugular venous pulse) graph in what conditions?
A
- Tricuspid Regurgitation
- Right side HF
(d/t reduced pressure gradients)
8
Q
Which cardiac medication for AFib can cause Torsades de Pointes
A
SOTALOL, amiodarone, dofetilide (Class III antiarrhythmics)
9
Q
Loss of sensation over right suprapubic area. Which nerve is most likely injured
A
IIiohypogastric nerve
10
Q
CYP450 inducers
A
Carbamazapine, Phenobarbital, Phenytoin, Rifampin, Griseofulvin, Chronic Alcoholic use, Grapefruit Juice
11
Q
Which antibiotic is most appropriate for treating lung abscess in alcoholoics
A
Clindamycin
12
Q
Concurrent use of which medication with STATINS is associated with increased risk of MYOPATHY and RHABDOMYOLYSIS (muscle pain, dark urine)
A
Erythromycin (CYP 450 inhibitor)
13
Q
Prominent Y descent on JVP (jugular venous pulse) graph is indicative of what condition?
A
Constrictive Pericarditis
14
Q
Acetylcholine dilates epicardial coronary vessels by acting on
A
Arginine
15
Q
Which medication is used to to reduce heart rate, cardiac output and myocardial oxygen demand
A
Cardio-selective Beta Blockers
Metoprolol, atenolol, bisoprolol, nebivolol
16
Q
Atherosclerosis mainly affect
A
Abdominal aorta > coronary artery > popliteal artery > carotid artery
17
Q
What is dextrocardia?
A
Heart on right side
18
Q
Medication for Focal seizures, Depressive episodes and adverse effect of Steven -Johnson syndrome
A
Lamotrigne
19
Q
Endomyocardial fibrosis with prominent eosinophilic infiltrate
A
Loffler syndrome
20
Q
Thrombosis with incomplete coronary artery occlusion with T-wave inversion on ECG but no cardiac biomarker elevation
A
Unstable Angina
21
Q
In hypovolemic shock what parameters are observed
A
Decrease PCWP (preload), Decrease Cardiac Output (CO) and Increased Systemic Vascular Resistance (SVR)
22
Q
The most common cardiac anomalies with down syndrome are
A
Atrial Septal Defect and Ventricular Septal Defect
23
Q
Which medication is most useful in treating Acute seizure disorder and Bipolar disorder
A
Valproate Acid
24
Q
A thrombus of a LEFT DOMINANT circulation obstructs
A
Left Circumflex Artery
25
Heavy smoker male of <40 years old. Intermittent claudication leading to gangrene. Autoamputation of digits, superficial nodular phlebitis
Buerger disease (Thromboangiitis obliterans)
26
Diastolic murmur heard at the apex of the heart (mitral area) is associated with what? (Diastolic crescendo murmur)
Mitral Stenosis
27
What are the 2 types of holosystolic murmurs heard at the tricuspid area?
1. Tricuspid Regurge
| 2. VSD
28
Exertional chest pain with ST depression on ECG resolved with rest or nitroglycerin
Stable Angina
29
What dz is associated with Paradoxical Splitting?
Aortic Stenosis
| Left Bundle Branch Block
30
Failure of the aorticopulmonary septum to spiral causes
D-transposition of great vessels
31
Increased sensitivity to loud noise (hyperacusis) is most likely associated to injury to which nerve
Facial Nerve (stapedius nerve)
32
Endocardial thickening with dense fibrous thickening around the tricuspid and pulmonary valve
Carcinoid Syndrome
33
Hemorrhage, dehydration, burns, cold and clammy skin
Hypovolemic shock
34
Systolic murmur heard at the apex of the heart (mitral area) is associated with what?
Mitral Valve Prolapse
35
Treatment for Dilated cardiomyopathy
```
Na restriction
ACE inhibitors
Beta Blockers
Diuretics
Digoxin
```
36
What causes Patent Foramen Ovale?
Failure of Septum Primum and Septum Secundum to fuse at birth
37
Where is an S4 heart sound best heard?
At apex w/ pt in left lateral decubitus position
| considered abnormal regardless of age
38
What parameters is most likely to decrease during peak stress compared to resting state
Total systemic vascular resistance
39
Rheumatic heart disease can lead to development of
Mitral Stenosis/Mitral Regurgitation
40
Electrical conduction in the heart flow
AV node--ventricular muscle--atrial muscle--purkinje system
41
What are the lab findings in Takayasu arteritis
1. Granulomatous thickening and narrowing of aortic
arch and proximal great vessels
2. Increased ESR
42
What is Wide S2 Splitting?
Splitting varies on inspiration and expiration
1. Double sound on expiration
2. Double sound is accentuated on inspiration
43
Heavy smoker male of <40 years old. Intermittent claudication. Autoamputation of digits, superficial nodular phlebitis
Buerger disease (Thromboangiitis obliterans)
44
What causes wide splitting?
Conditions that delay the RV emptying --> delayed pulmonic sound on inspiration
45
Mitral Valve Prolapse is a common CONNECTIVE TISSUE disorder in conditions such as
Marfan and Ehlers Danlos Syndrome
46
An exposure to asbestos increase risk of
Bronchogenic Carcinoma
47
Medication for Maniac episode, depression and maintenance associated with Ebstein anomaly
Lithium
48
What is fixed S2 splitting?
| wide and fixed
Splitting does not vary on inspiration and expiration
The splitting sound is equidistant on both expiration and inspiration
(GREATLY Delayed pulmonic closure)
49
MPO-ANCA/p-ANCA, Increase IgE level
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
50
Which valve is the most commonly involved valve in bacterial endocarditis
Mitral valve
51
Most common site for thromboembolism in AFib
Left Atrial Appendage
52
What mechanisms are associated with S4 heart sound?
1. High atrial pressure ---> ventricular noncompliance
| Left atrium pushes against stiff LV wall
53
Carotid artery is derived from which arch
THIRD aortic arch
54
Interruption of which central nervous pathway leads to BILATERAL MILKY NIPPLE DISCHARGE (galactorrhea), AMENORRHEA (absences of menses)
Tuberoinfundibular pathway
55
Treatment for Unstable Angina/NSTEMI
1. Anticoagulation (Heparin)
2. Anti-platelet (Aspirin)
3. Beta blockers
4. ACE
5. Statins
56
Scarlet Fever can predispose to
Rheumatic Fever and Glomerulonephritis
57
Stab wound directed laterally at the anterior chest wall in the fifth intercostal space along mid clavicular line will affect
Left Lung
58
What are the symptoms of pericarditis?
1. Pleuritic pain
2. Pain on inspiration
3. Friction Rub
4. Relieved when lean forward
59
What structure lies at the L1/L2 level to prevent propagation of DVT
Inferior Vena Cava
60
Mid-diastolic, low pitched, rumbling murmur that may begin with an opening snap
Mitral Stenosis
61
Necrotizing vasculitis involving LUNG, KIDNEYS and SKIN with pauci-immune glomerulonephritis and palpable purpura. No granuloma
Microscopic polyangiitis
62
What is Patent Ductus Ateriosus (PDA) derived from
SIXTH Aortic Arch
63
Which medication used to treat MAJOR DEPRESSIVE DISORDER has NO sexual side effects
Bupropion
64
Dilated cardiomyopathy is associated with which conditions
1. Alcohol Abuse
2. Wet Beriberi
3. Coxsackie B viral myocarditis
4. Chronic cocaine use
5. Chagas disease
6. Doxorubicin
65
Friedreich ataxia is associated with which cardiac condition
Hypertrophic cardiomyopathy
66
Turner syndrome is associated with congenital anomalies of the aorta and the most common is
Bicuspid Aortic Valve
| followed by Coarctation of Aorta
67
Cardiac Tamponade can present with
Beck Triad. (Hypotension, distended neck veins, distant heart sound)
68
Lack of aorticopulmonary septum formation leads to
Persistent Truncus Arteriosus
69
HBsAg with elevated ALT and AST is indicative of
Complete Resolution
70
Tearing sudden onset of chest pain radiating to the back (+/- unequal BP in arms). CXR show mediastinal widening.
Aortic Dissection
71
What Rx causes ebstin anomally in utero?
Lithium
72
Holo-systolic murmur best heard at the left 2nd and 3rd intercostal space. Increase with inspiration
Tricuspid Regurgitation
73
Fixed Splitting of the second heart sound
Atrial Septal Defect
74
Oxygen consumption in various organ measured will show the most difference between
Aorta and Coronary Sinus
75
3-14 days of myocardial infarction what is seen
1. Macrophages
| 2. Granulations
76
Examples of Non-cardio selective Beta blockers
Nadolol, propranolol
77
In chronic kidney disease the conversion of which apart of the vitamin D synthesis is impaired
25-hydroxyvitamin D---> 1, 25-dihydroxyvitamin D
78
Posteromedial papillary muscle is supplied by which artery
Posterior Descending Artery
79
Aortic stenosis can lead to...?
SAD
1. Syncope
2. Angina
3. Dyspnea
4. Decreased perfusion (systemic)
80
Migratory polyarthritis, carditis, Nodules in skin, Erythema marginatum and Sydenham chorea
Rheumatic Fever
81
What causes delay in RV emptying?
Pulmonic stenosis
| Right Bundle Branch Block
82
Asthma, sinusitis, skin nodules or purpura, peripheral neuropathy (eg. wrist/foot drop). Increase IgE level and p-ANCA
Churg - Strauss ( Eosinophilic granulomatosis with polyangiitis
83
Flu-like symptoms and joint pain associated with Giant cell arteritis is
Polymyalgia rheumatica
84
A lesion of which anatomical structure will affect adduction of the eye and stimulation of left cornea to elicit corneal reflex
Superior Orbital fissure
85
Late lesion in rheumatic heart disease causes
Mitral Stenosis
86
What artery supplies the atrioventricular node in left Dominant circulation
Left Circumflex Artery
87
What are the abnormalities associated with S4 heart sound?
Hypertrophy
88
Cyanosis of the toes and clubbing but no finger abnormalities. Equal and full extremity pulses. Diagnosis
Patent Ductus Arteriosus
89
What is the result of an enlarged Left atrium
Compression of the Recurrent Laryngeal nerve and Esophagus
90
Infective endocarditis affects mostly
Mitral valve
91
Earliest site of electrical activation in the heart
Right atrium near opening of superior vena cava
92
Which cerebral artery is most likely compromised in a patient with contralateral HOMONYMOUS HEMIANOPIA with macular sparing
Posterior Cerebral Artery
93
In a LINEAR skull fracture a branch of which arteries is severed
Maxillary
94
Inhibitors of metalloprotease (neprilysin) prevent degradation of
Natriuretic Peptide
95
S4 heart sound, Syncope during exercise and may lead to death in an young athlete is
Hypertrophic cardiomyopathy
96
Between Systemic and pulmonary circulation during exercise what parameters is similar
Blood Flow per minute
97
Strong pulse along Inner side of STERNOCLADIOMASTOID MUSCLE originates from
Carotid artery
98
Presentation of Kawasaki disease
Conjunctival injection, Rash ( polymorphous ---> desquamating), Adenopathy (cervical), Strawberry tongue (oral mucositis) and Fever (CRASH and Burn)
99
What is hibernating heart?
Myocytes of ischemic area de rease their contractile ability and O2 demand but once revascularized will function normally again
100
What does splitting refer to?
It referes to the S2 heart sound
101
Heart failure, S3 heart sound, systolic regurgitant murmur, dilated heart on echocardiogram and ballon appearance of heart on CRX
Dilated cardiomyopathy
102
Presentation in Granulomatosis with polyangiitis
1. Upper Respiratory tract-: perforation of nasal septum,
chronic sinusitis, otitis media, mastoiditis
2. Lower Respiratory: hemoptysis, cough, dyspnea
3. Renal : hematuria, red cell cast
103
What are some CYP450 inhibitors
Cimetidine, Ciprofloxacin, Erythromycin, Grapefruit juice, Isoniazid, Retonavir (protease inhibitor)
104
Occluding thrombus overlying a ruptured atherosclerotic plaque in a 30 year female. Butterfly erythema
Systemic Lupus Erythematous
105
Audible heart sound at left sternal boarder that accentuate with hand grip excercise
Ventricular Septal Defect (VSD)
106
What is the mechanism of defect in Kartagener syndrome?
Defect in microtubular protein (Rt --> Lft Dynein)
107
What are the findings in Chronic Granulomatous with polyangiitis
Triad: 1. Focal necrotizing vasculitis
2. Necrotizing granulomatous in the lung and
upper airway
3. Necrotizing glomerulonephritis
PR3-ANCA/c-ANCA
108
Parameters involved in Distributive shock
Decrease Preload (PCWP), Increase Cardiac Output and Decrease After-load (SVR)
109
In what dz is the organs in an adult seen in reverse position?
Kartagener Syndrome
110
Which organ lays POSTERIORLY to the esophagus and left atrium
Descending Aorta
111
on the JVP (jugular venous pulse) graph, an absent a wave is indicative of what condition?
A-fib
112
What is a pulmonary artery Catheter used to measure
Left Atrial Pressure
113
Etanercept is added to methotrexate to treat
Rheumatoid Arthritis
114
What complications is associated with the 3-14days of an MI
Free wall rupture-----> tamponade; papillary muscle rupture----> mitral regurgitation
115
A patient with Marfan syndrome is at an increased risk of which cardiac condition
Aortic Dissection
116
What dz are associated Fixed Splitting?
ASD
| Lft --> Rt shunt --> inc. RA and RV volumes
117
Giant cell arteritis most commonly affects
Carotid artery
118
Protein responsible for rapid decrease in cytoplasmic calcium immediately preceding relaxation
Na / Ca exchange
119
Which pathway regulates coordination of voluntary movements
Nigrostriatal pathway
120
Treatment for Kawasaki disease
Aspirin and IV immunoglobulin
121
What is the most anterior portion of the heart?
Right Ventricle
122
Decrease in amplitude of systolic BP by >10mm Hg during inspiration
Pulsus paradoxus
123
Increase in preload stretches the myocardium causing an
End Diastolic Sarcomere Length
124
Which organ is least vulnerable to infarction when blood flow is interrupted
Liver
125
Bacterial endocarditis with small vegetation on CONGENITALLY ABNORMAL or DISEASED VALVES. Has gradual onset
SUBACUTE--- STAPH Viridans
126
Treatment for Hypertrophic cardiomyopathy
Beta Blockers
| or Non dihydropyridine Ca2+ (verapamil and diltazim)
127
Which cardiac chamber is first encountered when a probe is placed in a mid-esophagus anteriorly
Left Atrium
128
Ischemia of the INFERIOR surface of the heart; which coronary artery is occluded
Posterior descending artery; a branch of the RIGHT coronary artery
129
What complications is associated with the 1st -24hrs of an MI
Ventricular arrhythmia, heart failure and cardiogenic shock
130
Fever, new murmur, Roth spot (white spots on retina surrounded by hemorrhage), Osler node (tender raised lesions on finger or toe pads due to immune complex deposition) and Janeway lesions (small, painless erythematous lesions on palm and or sole)
Bacterial endocarditis
131
Mid-systolic click often accompanied by late systolic murmur
Mitral Valve Prolapse
132
2 weeks after Myocardial infarction light microscopy will show
1. Contracted scar complete
133
A stub wound to the chest in the 4th intercostal space near the left sternal boarder injures
Right ventricle
134
How many types of S2 splitting (heart sounds) exists?
There are four S2 heart sounds:
1. Normal splitting
2. Wide splitting
3. Fixed Splitting
4. Paradoxical Splitting
135
Bacterial endocarditis in IV drug users involves which valve
Tricuspid valve
136
What is fixed S2 splitting?
Splitting does not vary on inspiration and expiration
| 1.
137
What artery supplies the Lower anterior abdominal wall as it runs superiorly and medially
Inferior Epigastric Artery
138
Opening-snap of mitral valve heard throughout diastole
Mitral Stenosis
139
Pt presents with dyspnea on exertion and angina. Physical examination reveals heart sound that is loudest at the heart base and radiates to the carotids and pulses that are weak with delayed peak. What is the diagnosis?
Aortic Stenosis
140
Carotid sinus massage works by
Prolong atrioventricular node refractory Period
141
What is Paradoxical S2 Splitting?
Pulmonic valves close before the Aortic valves
Double wide splitting sound heard on expiration
Single sound heard on Inspiration
142
Displacement of tricuspid valve leaflets downward into Right ventricle. Associated with tricuspid regurgitation and right heart failure
Ebstein anomaly
143
What is the best protein marker for re-infarction following acute MI
CK-MB
144
Palpable purpura on buttocks/legs, arthragias and abdominal pain associated with IgA nephropathy
Henoch-Schonlein purpura
145
Blanching skin lesion (telangiectasis), recurrent epistaxis, skin discoloration, arteriovenous malformation,, GI bleeding, hematuria
Hereditary Hemorrhagic telengeictasia
146
Absence of Tricuspid valve requires both ASD and VSD for viability
Tricuspid Atresia
147
What are some complications of Giant cell arteritis
Irreversible blindness due to ophthalmic artery occlusion
148
PALPABLE PULSATILE abdominal mass. Calcified aortic wall with partial crescent-shaped non-opacification of aorta due flap/clot
Abdominal Aortic Aneurysm
149
An EARLY DIASTOLIC MURMUR that is best heard along the left sternal boarder or over the right second intercostal space
Aortic Regurgitation
150
A mid-systolic murmur that starts after S1 and ends before S2 and heard best at the 2nd interspace
Aortic Stenosis
151
What are the 2 types of diastolic murmurs heard at the tricuspid area?
1. Tricuspid stenosis
| 2. ASD
152
Early lesion in Rheumatic heart disease causes
Mitral regurgitaion
153
Holo-systolic murmur at the Left Lower Sternal Border
Ventricular Septal Defect
154
An intimal tear in Stanford type A aortic dissection (involving the ascending aorta) usually originates in the
Sinotubular junction
155
A crescendo- decrescendo murmur
Aortic Stenosis
156
Holocystolic (high pitched, blowing) murmur heard at the apex of the heart (mitral area) is associated with what?
Mitral Regurge
| Tricuspid Regurge
157
What is Normal S2 Splitting?
Single sound on expiration
| Double sound on inspiration (Inspiratory split)
158
Intravenous fluid increase leads to
Increase in Preload
159
Where is the placement of a pacemaker (radio frequency)
Inter-atrial Septum near the Opening of the coronary sinus
160
What does splitting refer to?
It refers to the different types of S2 heart sounds
161
Kawasaki disease (mucocutaneous lymph node syndrome) is found i which group of people
Asian children < 4years
162
Agatroban is a direct thrombin inhibitor which is used to treat HEPARIN-INDUCED THROMBOCYTOPENIA
Binds to thrombin active site
163
Elderly female older than 50 years with Unilateral headache, jaw claudication. Labs show focal granulomatous inflammation with increased ESR
Giant Cell (temporal) arteritis
164
Lab/pathological findings
Segmental thrombosing vasculitis
165
What is a feature of tricuspid valve regurgitation?
Loudest at tricuspid area ( 4th and 5th intercostal space)
166
What is the path of an embolus to the retina
Internal Carotid---ophthalmic artery---Retinal artery
167
Which medication has the following action increasing peripheral resistance, increase systolic blood pressure, decrease pulse pressure and decrease heart rate
Phenylephrine (alpha-1 adrenergic receptor agonist)
168
Adverse effect of ACE inhibitor (eg. enalapril) in patients with renal artery stenosis, decompensated heart failure, chronics kidney disease and volume depletion
Increase serum creatinine---> Reduction in renal filtration fraction
169
Embryological Structure that gives rise to the Superior Vena Cava
Common Cardinal Vein
170
Two hormones released by atria and ventricle during myocardial wall stretch
Atrial natriuretic peptide (ANP) and Brain natriuretic peptide (BNP)
171
Holosystolic murmur best heard at Apex and radiates to Axilla
Mitral Regurgitation
172
Location of Great Saphenous Vein
Inferior-lateral to the Pubic Tubercle
173
What are the causes of MR?
1. Ischemic Heart dz (post MI)
2. MVP
3. LV dilatation
174
What medication is contraindicated in HYPERTROPHIC CARDIOMYOPATHY
Iso-sorbide Dinitrate
175
Left atrial enlargement can cause
Dysphagia, compression of left recurrent laryngeal nerve----hoarseness
176
A form of arteriosclerosis caused by build up of cholesterol plaques
Atherosclerosis
177
Primary cause of death in lightening (thunderstorm) related death
Cardiac Arrhythmias
178
What is the most posterior portion of the heart?
Left atrium
179
Acute thrombosis due to rupture of coronary artery atherosclerotic plaque
Myocardial Infarction
180
Sharp pain, aggravated by inspiration and relieved by sitting up and leaning forward. Present with friction rub. ECG changes include widespread ST-segment elevation and /or PR depression
Acute pericarditis
181
What is measured to make diagnosis of carcinoid syndrome
Urinary 5-Hydroxyindolectic Acid (5-HIAA)
182
An symmetric inter ventricular septal hypertrophy that presents with a harsh systolic murmur can best be explained by left ventricular outflow obstruction created by
Mitral Valve leaflet and inter-ventricular Septum
183
The junction of frontal, parietal, sphenoid and temporal bones
Pterion
184
In Prospective studies, disproportionate loss to follow-up between the exposed and unexposed creates
Attrition Bias ( a form of selection Bias)
185
What complications is associated with the 1-3day of an MI
Post-infarction fibrinous pericarditis
186
Where is the femoral vein in relation to the femoral artery
Medial to Femoral Artery
187
What is hibernating heart indicative of?
Chronic ischemia
188
What are the three important shunts in fetal circulation?
1. Foramen Ovale
2. Ductus Ateriosus
3. Ductus Venosus
189
What is diagnostic for Myocardial Infarction
Increase CK-MB and Troponin
190
Holosystolic (high pitched, blowing) murmur heard at the apex of the heart (mitral area) is associated with what?
Mitral Regurge
| Tricuspid Regurge
191
Fever, pharyngitis, sandpaper-like rash and strawberry tongue
Scarlet Fever
192
An intimal tear (FLAP) in Stanford type B (aortic dissection involving descending aorta) usually starts near the origin of the
Left subclavian artery
193
What are the two types of VSD and which is more common?
Membraneous >>> Muscular
194
Aortic stenosis can lead to...?
SAD
1. Syncope
2. Angina
3. Dyspnea
195
The y descent is absent on the JVP (jugular venous pulse) graph in what condition?
Cardiac Tamponade
196
Infective endocarditis is mostly caused by
Staphylococcus Aureus
197
Etanercept is best characterized as
Soluble receptor decoy protein
198
Which pathway regulates cognition and behavior
Mesolimbic and mesocortical pathway
199
ANP and BNP release promote
Glomerular Filtration rate
200
Occurs at rest, Coronary artery spasm with transient ST elevation on ECG
(Variant) Prinzmetal Angina
201
Bounding peripheral pulses and palpable thrills over the left upper sternal border
Patent Ductus Ateriosus
202
Diaphoresis, nausea,, vomiting, severe retrosternal pain, pain in left arm and/or jaw, shortness of breath fatigue
Myocardial Infarction
203
What is a feature of mitral valve regurgitation?
Loudest at apex and radiates towards axilla
204
What are the laboratory finding in Rheumatic heart disease
1. Aschoff bodies (granuloma with giant cells)
2. Anitschkow cells (enlarged microphages with ovoid,
wavy rod-like nucleus)
3. Increase ANTI-STREPTOLYSIN O titers.
205
Lab findings id Microscopic polyangiitis
MPO-ANCA/p-ANCA (Anti-microperoxidase)
206
1-3 days during an episode of Myocardial infarction
1. Extensive coagulative necrosis
| 2. Acute inflammation with neutrophils
207
What is the cause of valvular stenosis?
Calcification of the valves
Normal in the aged
Can have early onset calcification in younger pts.
208
Mid-systolic click followed by short late systolic murmur that radiates to apex and disappears with squatting is related to abnormality in
Connective tissue
| Mitral prolapse
