Cardio Rapid Fire Facts

Question 1

What disease is associated with a Chromosome 22q11 deletion?

Answer 1

DiGeorge syndrome:
Tetralogy of Fallot
Truncus arteriosus

Question 2

What heart defect is associated with Down’s syndrome?

Answer 2

Endocardial cushion defect which can cause: ASD, VSD, AV septal defect.

Question 3

What cardiac defects are associated with congenital rubella?

Answer 3

PDA
Pulmonary artery stenosis
Septal defect

Question 4

What cardiac abnormalities are associated with Turner’s Syndrome?

Answer 4

Coarctation of the aorta
Aortic root dilation
Bicuspid aortic valve

*coarctation of aorta may also have notching of the ribs on CXR

Question 5

What cardiac abnormalities are associated with Marfan’s syndrome?

Answer 5

Aortic insufficiency due to abnormal aortic valve stretch —>(mitral regurgitation)
Aortic root dilatation
Aortic dissection (deadly)

Question 6

An 80 YO patient presents with a systolic crescendo-decrescendo murmur, what is the most likely cause?

Answer 6

Aortic Stenosis

Question 7

What are the normal blood pressures of the right and left ventricles of the heart?

Answer 7

Right ventricle- 25/5

Left ventricle- 130/10

Question 8

What heart sounds are considered benign (4), if there is no evidence of disease?

Answer 8

Split S1
Split S2 on inspiration
S3 heart sound in patient <40 years old
Early quiet systolic murmur

Question 9

What is the most common congenital cardiac anomaly?

Answer 9

VSD - ventricular septal defect

Question 10

What is the defect in transposition of the great vessels??

Answer 10

Pulmonary trunk attaches to the left ventricle, and the aorta attaches to the right ventricle

Question 11

Describe the problem in a PDA (Patent Ductus Arteriosus):

Answer 11

Left to right shunt

Aorta —> pulmonary artery

Question 12

What are the three L to R shunts that can cause an S3 heart sound?

Answer 12

VSD, ASD, and a PDA

Question 13

What pathologies are associated with an S4 heart sound?? Why is it heard?

Answer 13

Hypertrophic cardiomyopathy
Aortic stenosis
Chronic hypertension with LVH
Post-MI

It’s heard because the LA has to push against a stiff Left ventricle wall. (Stiff wall and atrial kick)

Question 14

What gives rise to the Jugular Venous a, c, and v wave?

Answer 14

a wave - atrial contraction

c wave - ventricular contraction

v wave - atria filling against closed tricuspid valve

Question 15

Where does the QRS complex fall in relation to valvular dynamics?

Answer 15

Atrioventricular valve closure

—> because it’s electrical signal of the QRS complex that’s causing the ventricles to contract and that increases the pressure in the ventricles, which causes the valves to close.

Question 16

What Cardiac pathologies (6) are associated with an S3 heart sound?

Answer 16

Dilated cardiomyopathy 
Congestive heart failure
Mitral regurgitation 
Left to right shunting - ASD, VSD, AND PDA
Children (can be normal)
Pregnant women

Question 17

When does isovolumeteic contraction take place?

Answer 17

It’s taking place during the QRS after mitral valve closure, but before the aortic valve opens.

Question 18

What are the diastolic murmurs??

Answer 18

Mitral Stenosis
Tricuspid Stenosis
Aortic Regurgitation
Pulmonic Regurgitation

Question 19

A 60yo patient presents with the following PE findings:

Bounding pulses, head bobbing, wide pulse pressure, and a diastolic murmur. What is the most likely pathology at hand?

Answer 19

Aortic regurgitation

Wide pulse pressure can be something like 120/40.

Question 20

What are the systolic heart murmurs (6)?

Answer 20

Aortic Stenosis
Mitral Regurgitation 
Mitral Valve Prolapse 
Tricuspid Valve Prolapse 
VSD
Pulmonic Stenosis

Question 21

An elderly patient walks in to the office but presents with a history of syncope, angina, and dyspnea. What should you rule out first?

Answer 21

The possibility of having Aortic Stenosis. If the patient presents with ANY of these symptoms, you should think about the possibility of having the heart valve replaced.

Question 22

What are the 5 MCCs of Acute Chest Pain?

Answer 22

Aortic dissection (or dissecting aortic aneurysm)
Unstable Angina
MI
Tension Pneumothorax 
Pulmonary Embolism

Question 23

Where are the MC locations for formation of atherosclerotic plaques (rank in order)?

Answer 23

Abdominal Aorta: AAA
Coronary Arteries: MI, angina
Popliteal arteries: Claudication/Peripheral Vascular Disease
Carotid Arteries: TIA, Strokes, multi-vascular dementia

Question 24

What is the definition of arteriolosclerosis? What is the difference with atherosclerosis?

Answer 24

Hyaline thickening of arterioles… 2 types: hyaline (seen with diabetes or HTN) and hyper plastic (onion skin appearance seen with severe HTN)
may not have hyperlipidemia

Atherosclerosis- fibrous plaques and atheromas of intima of arteries

Question 25

What would be the cause of the following complications post MI:
Cardiac tamponade

Answer 25

Rupture of the ventricular wall

Question 26

What would be the cause of the following complications post MI:
Severe mitral regurgitation

Answer 26

Rupture of papillary muscle

Question 27

What would be the cause of the following complications post MI:
New VSD

Answer 27

Rupture of intraventricular septum

Question 28

What would be the cause of the following complications post MI:
Stroke

Answer 28

Mural thrombus —> embolus

Question 29

What are the Non-Suppurative Complications of Group A Strep infection?

Answer 29

Scarlet Fever - Toxin mediated
Post Streptococcal glomerulonephritis - type III hypersensitivity
Acute Rheumatic Fever - type II Hypers.
Strep Toxic Shock Sd - skin or vaginal infection

Question 30

What are the Jones Criteria for group A infection?

Answer 30

2 major and 1 minor:
Major: joints, heart (pancarditis), Nodules (subcutaneous)
Erythema marginatum (multiple small ring like lesions)
Sydenham chorea (face, tongue, upper-limb)

Minor:
Arthralgia, Fever, elevated ESR or CRP, prolonged QT

Question 31

Affects medium sized arteries. Calcification of internal elastic lamina and media of arteries —> vascular stiffening without obstruction. “Pipestem” appearance on X-ray. Does not obstruct blood flow; íntima not involved.

Answer 31

Monckeberg Sclerosis (medial calcific sclerosis)

Question 32

What is the triad for Grabulomatosis with Polyangiitis (Wegener)?

Answer 32

• Focal necrotizing vasculitis
• Necrotizing granulomas in the lung and upper airway
• Necrotizing glomerulonephritis

Question 33

What is the MOA of BNP? Where is it produced?

Answer 33

Produced in cardiac ventricles in response to stretch.

MOA: causes vasodilation and increased excretion of Na+ and water in urine