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USMLE Step 1 > Cardio - Phys/Ana/Emb > Flashcards

Cardio - Phys/Ana/Emb Flashcards

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USMLE® Step 1 flashcards
1
Q

Vitelline veins

A

Portal system veins

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2
Q

Cardinal veins

A

systemic circulation veins

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3
Q

Truncus arteriosus

A

Ascending aorta and pulmonary trunk

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4
Q

Bulbus cordis

A

Smooth parts (outflow tract) of left and right ventricles

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5
Q

Primitive atrium

A

trabeculated part of L/R atria

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6
Q

Primitive ventricle

A

trabeculated part of L/R ventricles

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7
Q

Primitive pulmonary vein

A

smooth part of left atrium

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8
Q

Left horn of sinus venosus

A

Coronary sinus

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9
Q

Right horn of sinus venosus

A

Smooth part of right atrium (sinus venarum)

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10
Q

Right common cardinal vein and right anterior cardinal vein

A

SVC

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11
Q

When does heart start beating?

A

4 weeks (first functional organ)

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12
Q

Atrial septation

A

Septum primum –> Foramen primum –> Foramen secundum —>Septum secundum –>foramen ovale

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13
Q

Outflow tract from?

A

Neural crest migration + endocardial cushion migration

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14
Q

All valve origins?

A

Endocardial cushions

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15
Q

Fetal erythropoiesis

A

Young Liver Synthesizes Blood

  • Yolk sac (3-8wks)
  • Liver (6wks - birth)
  • Spleen (10-28wks)
  • Bone marrow (18wks - adult)
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16
Q

HbF unique?

A

Less avid binding 2,3-BPG

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17
Q

Umbilical vein O2

A

PO2 = 30mmHg

80% saturation

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18
Q

Ductus venosus

A

Shunts blood from umbilical vein into IVC

- becomes ligamentum venosum

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19
Q

Allantois–>Urachus

A

Median umbilical ligament

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20
Q

Ductus arteriosus becomes

A

Ligamentum arteriosum

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21
Q

Foramen ovale becomes

A

Fossa ovale

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22
Q

Umbilical arteries

A

Medial umbilical ligaments

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23
Q

Umbilical vein

A

Ligamentum teres hepatis contained in falciform ligament

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24
Q

SA and AV node blood supply

A

SA - RCA

AV - branch of posterior descending artery (RCA or LCA)

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25
Q

LCX

A
  • lateral and posterior walls of LV

- anterolateral papillary muscle

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26
Q

LAD

A
  • ant. 2/3 of IV septum
  • anterolateral papillary muscle
  • ant surface of LV
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27
Q

PDA

A
  • post 1/3 of IV septum
  • post walls of ventricles
  • posteromedial papillary muscle
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28
Q

CO =

A

= SV x HR

= rate of O2 consumption/(arterial O2 content - venous O2 content)

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29
Q

MAP =

A

CO x TPR

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30
Q

Pulse pressure and SV/arterial compliance

A

PP is proportional to SV

PP is inversely proportional to arterial compliance

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31
Q

Increased Pulse Pressure

A

Hyperthyroidism, aortic regurgitation, aortic stiffening (isolated systolic HT in elderly), obstructive sleep apnea (increased sympathetic tone), exercise (transient)

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32
Q

Decreased Pulse Pressure

A

Aortic stenosis, cardiogenic shock, cardiac tamponade, advanced heart failure (HF)

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33
Q

Increased contractility

A
  • Catecholamine (Increase activity of Ca2+ pump in SR)
  • Increased intracellular Ca
  • Decreased extracellular Na
  • Digitalis
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34
Q

Decreased contractility

A
  • B1 blockage
  • HF w/systolic dysfunction
  • acidosis
  • hypoxia/hypercapnia
  • Non-dihydropyridine Ca channel blockers
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35
Q

Increased diameter of ventricle

A

Increased wall tension –> increased myocardial O2 demand

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36
Q

ACEI/ARBs - preload and afterload?

A

decrease both

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37
Q

Normal EF

A

> 55%

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38
Q

Phospholamban

A

Dephorphorylated phospholamban binds SERCA-2 (SR Ca-ATPase) and decreases affinity for Ca2+

  • membrane protein
  • decreased rate of muscle relaxation and contractility (decreased HR and SV)
  • phosphorylated by PKA (adrenergic)
39
Q

Organ removal (eg. nephrectomy)…

A

Increases TPR and decreases CO

40
Q

Driving pressure =

A

Q x R

Q=flow velocity x cross sectional area
R=8nl/3.14r^4

41
Q

TPR on venous return

A

(+) TPR - decreased

(-) TPR - increased

42
Q

TPR (increase and decrease)

A

Increased by: vassopressors (constrictors)

Decreased by: exercise, AV shunt

43
Q

Period of highest O2 consumption (LV cycle)

A

Isovolumetric contraction

44
Q

Jugular venous pulse

A

a wave - atrial contraction (absent in a-fib)
c wave - RV contraction
x descent - atrial relax + downward tricuspid displacement (absent in tricuspid regurg)
v wave - atrial filling against closed tricuspid
y descent - RA empties into RV

45
Q

Constrictive pericarditis

A

rapid y descent that is deeper and steeper w/ inspiration

46
Q

S1

A

loudest at mitral area

47
Q

S2

A

loudest at left upper sternal border

48
Q

S3

A
  • @ early diastole
  • increased filling pressure (mitral regurg, HF)
  • more common in dilated ventricles
  • normal in kids and pregos’
  • heard best at apex while lying lateral decubitus @ end-expiration
49
Q

S4

A
  • @ late diastole
  • “atrial kick”
  • high atrial pressure
  • assoc. w/ ventricular hypertrophy (LA must push against stiff LV wall)
  • heard best at apex while lying lateral decubitus @ end-expiration
50
Q

Wide splitting

A

Delayed RV emptying (ex. pulmonic stenosis, right bundle branch block)

51
Q

Fixed splitting

A

ASD

52
Q

Paradoxical splitting

A

Delayed aortic valve closure (ex. aortic stenosis, left bundle branch block)
- A2 after P2, decreased gap with inspiration

53
Q

Left sternal border

A

Diastolic murmor

  • aortic regurg
  • pulmonic regurg

Systolic murmor
- hypertrophic cardiomyopathy

54
Q

VSD murmor

A

Pansystolic @ tricuspid area

55
Q

ASD presentation

A
  • pulmonary flow murmur (pulmonary valve)
  • diastolic rumble (tricuspid valve)

(later progresses to louder diastolic murmur of pulmonic regurgitation from pulmonary a. dilation)

56
Q

Bedside maneuver: Inspiration (venous return)

A

Increased intensity of right heart sounds

57
Q

Bedside maneuver: Hand grip (afterload)

A
  • Increased intensity of MR, AR, VSD murmurs
  • Decreased hypertrophic cardiomyopathy murmurs
  • MVP: later onset of click/murmur
58
Q

Bedside maneuver: Valsalva (phase II), standing up

preload decrease

A
  • Decreased intensity of most murmurs (including AS)
  • Increased intensity of hypertrophic cardiomyopathy murmor (LVOT obstruction)
  • MVP: early onset of click/murmur
59
Q

Bedside maneuver: Rapid squatting (preload increase)

A
  • Decreased intensity of hypertrophic cardiomyopathy murmur
  • Increased intensity of AS murmor
  • MVP: later onset of click/murmur
60
Q

Pulsus parvus et tardus

A

pulses are weak w/ delayed peak

- aortic stenosis

61
Q

Mitral regurg

A
  • Radiates towards axilla

- often d/t MI, MVP, LV dilation

62
Q

Most frequent valvular lesion

A

MVP

63
Q

Best indicator of AR severity

A

Presence of S3 (high rate of ventricular filling)

64
Q

AR auscultation

A

Best heard @ left sternal border b/t 3/4, while patient sitting, leaning forward and at end expiration

65
Q

Ortner Syndrome

A

LA dilation impinges on left recurrent laryngeal n.

- can be d/t mitral stenosis

66
Q

Skeletal vs. cardiac muscle Ca release from SR

A
  • Ryanodine receptor linked L-type Ca channel

- L-type Ca channel causes Ca influx inducing Ca release

67
Q

Conduction speed

A

Purkinje fibers > atrial myocytes > ventricular myocytes > AV node

68
Q

PR interval

A

less than 200 msec normally

69
Q

QRS interval

A

less than 120 msec normally

70
Q

J point

A

Junction b/t end of QRS and start of ST segment

71
Q

U wave

A

Caused by hypokalemia or bradycardia

72
Q

AV node delay

A

100 msec

73
Q

Torsades de pointes causes

A

1) Drugs (ABCDE)
- AntiArrhythmics (class IA, III)
- AntiBiotics (eg. macrolides)
- Anti”C”ychotics (eg. haloperidol)
- AntiDepressants (eg. TCA)
- AntiEmetics (eg. ondansetron)
2) Hypokalemia
3) Hypomagnesia
4) Long QT syndrome

74
Q

Torsades de pointes Rx

A

Magnesium sulfate

75
Q

Romano-Ward syndrome

A
  • Congenital long QT syndrome (AD)

- NO deafness

76
Q

Jervell and Lange-Nielsen syndrome

A
  • Congenital long QT syndrome (AR)

- sensorineural deafness

77
Q

Brugada syndrome

A
  • ECG pattern of pseudo-right bundle branch block and ST elevations in V1-V3
  • AD more common in asian males
  • Increased risk of ventricular tachyarrhythmias and SCD

Rx: Prevent SCD w/ implantable cardioverter-defib

78
Q

Delta wave

A

Wolff-Parkinson-White syndrome

- associated w/ widened QRS and shortened PR

79
Q

Binge drinking “Holliday Heart”

A

A-fib

80
Q

PR interval >200 msec

A

1st degree AV block

81
Q

Wenckebach

A

Second degree heart block: Mobitz type 1

82
Q

Lyme disease can cause…

A

complete (3rd degree) heart block

83
Q

ANP

A
  • acts via cGMP
  • from atrial myocytes
  • vasodilation and decreased Na reabsorption in CT
  • Renal aff. dilation and eff. constriction (aldosterone escape)
84
Q

BNP

A
  • ventricular myocytes
  • longer half-life than ANP
  • GOOD negative predictive value for Dx HF
85
Q

Nesiritide

A

Recombinant BNF for treating HF

86
Q

Aortic arch and carotid sinus nerve relay

A

AA - vagus n –> solitary nucleus of medulla

CS - glossopharyngeal n –>solitary nucleus of medulla

87
Q

Cushing reaction

A

Triad of hypertension, bradycardia, respiratory depression
- Increased ICP constricts arterioles –> decrease pH –> sympathetic reflex –> HYPERTENSION –> baroreflex causes BRADYCARDIA. Pressure on brainstem causes RESP. DEP.

88
Q

Heart pressures

A 
RA: less than 5
RV: 25/5
PA: 25/10
PCWP: less than 12
LA: less than 12
LV: 130/10
A: 130/90
89
Q

Mitral stenosis PCWP

A

PCWP > LV

90
Q

Hormone permissiveness

A

When one hormone allows another to exert its maximal effect (the aiding hormone has no intrinsic effect)

91
Q

Exercise on TPR

A

DECREAED

92
Q

Most deoxygenated blood in body

A

Cardiac venous blood

myocardium has HIGH O2 extraction (60-75%

93
Q

Ach, Bradykinin, shear stress –>

A

Argine + O2 —–eNOS—–>NO + citrulline

94
Q

Sudden deceleration ruptures the….

A

Aortic isthmus

USMLE Step 1 (26 decks)

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