Cardiology

Question 1

S4

Answer 1

Just prior to S1
Caused by left atrial contraction that forces atrial blood into a poorly compliant left ventricle that is nearly filled to capacity.
Causes: LV hypertrophy / diastolic heart failure

Question 2

What are the cardioselective beta blockers?

Answer 2

Metoprolol
Atenolol
Bisoprolol
Nebivolol
safe to use in stable COPD

Question 3

What are the combined beta and alpha receptor blockers?

Answer 3

Carvedilol
Labetalol
safe to use in stable COPD

Question 4

What is carcinoid syndrome

Answer 4

Well differentiated neuroendocrine tumors found in distal intestine and proximal colon and metastasis to liver
Secrete Histamine, serotonin and VIP into systemic circulation -> carcinoid syndrome

Question 5

What causes carcinoid heart disease

Answer 5

excessive secretion of serotonin, which stimulates fibroblast growth and fibrogenesis

Question 6

Carcinoid syndrome symptoms

Answer 6

Skin: Flushing, telangiectasia
GI: Diarrhea, cramping
Cardiac: Valvular lesions (R>L)
Pulmonary: Bronchospasm
Misc: Niacin deficiency

Question 7

Carcinoid Syndrome Diagnosis

Answer 7

elevated urinary excretion of 5-HIAA
Right heart valve fibrosis
CT/MRI of abdomen
Somatostatin receptor based imaging

Question 8

Carcinoid syndrome treatment

Answer 8

octreotide for symptomatic patients and prior to surgery/anesthesia
Surgery for liver metastases

Question 9

peripheral edema develops when

Answer 9

transcapillary plasma filtration exceeds the resorptive capacity of the lymphatics

Question 10

Ventricular septal defect

Answer 10

holosystolic murmur along the lower left sternal border