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USMLE STEP 1 - OLD > Cardiology > Flashcards

Cardiology Flashcards

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USMLE® Step 1 flashcards
1
Q

In developing fetus, pressure in R heart > pressure in L heart. Why?

A

Lungs (and thus pulmonary circulation) are not fully functional. This creates increased vascular resistance in pulmonary arterial circulation, and increased pressure in R heart (which supplies pulmonary arterial circulation).

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2
Q

Fetal erythropoiesis occurs in which 4 sites?

A

Yolk sac (3-8 wks)Liver (6 wks - birth)Spleen (10-28 wks)Bone marrow (18 wks - adult)”Young Liver Synthesizes Blood”

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3
Q

Primary site for O2 exchange in fetus?

A

Chorionic villi (Umbilical vein is derived from villus vessels)

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4
Q

Chorionic villi is derived from ___ (maternal/fetal) tissue?

A

Fetal tissue

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5
Q

Fetal circulatory shunt:Ductus venosus = ?

A

Oxygenated blood conducted via umbilical vein bypasses liver (hepatic circulation) via ductus venosus directly into IVC, which drains into RA

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6
Q 
RV - Right acute/marginal artery
LV anterior wall - LAD (LCA)
LV posterior wall - PDA 
LV lateral wall - LCX (LCA)
LV inferior wall - RCA
LV anteroseptal wall - proximal LAD (LCA)
LV anterolateral wall - LCX (LCA)

Anterior 2/3 of IV septum - LAD (LCA)
Posterior 1/3 of IV septum - PDA

Anterior (anterolateral) papillary muscle in LV
- LAD (LCA)

Posterior (posteromedial) papillary muscle in LV - PDA

A

b

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7
Q

Right-dominant coronary circulation?

Left-dominant coronary circulation?

Co-dominant coronary circulation?

A

PDA arises from RCA (80%)

PDA arises from LCX branch of LCA (10%)

PDA arises from both RCA and LCX branch of LCA (10%)

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8
Q

In fetal circulation, most blood that enters RA via SVC is conducted where?

A

SVC –> RA –> RV –> pulmonary artery –> PDA –> descending aorta Blood is conducted/shunted through patent ductus arteriosus into aorta

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9
Q

During fetal development, what maintains patency of ductus arteriosus?

A

PGE2, a vasodilator synthesized by placenta

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10
Q

In fetal circulation, most blood that enters RA via IVC is conducted where?

A

IVC –> RA –> LA –> LV –> ascending aortaOxygenated blood from umbilical vein enters RA via IVC and is conducted/shunted through patent foramen ovale to LA. Oxygenated blood is most important to enter ascending aorta to provide blood with highest O2 tension to head/neck.

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11
Q

Why is blood conducted from RV shunted away from lungs and instead conducted through ductus arteriosus?

A

Low PaO2 –> chronic vasoconstriction of pulmonary arteries –> fetal pulmonary arteries are HYPERTROPHIED (high fetal pulmonary arterial resistance)When baby is born, 1st breath –> increases PaO2 –> decreases pulmonary arterial resistance

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12
Q

What 2 physiologic changes occur at birth that close ductus arteriosus?

A

1st breath –> increases PaO2Separation of placenta –> decreases PGE2

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13
Q

Describe physiologic changes that occur with 1st breath leading to closure of foramen ovale.

A

1st breath –> increases PaO2 –> decreases pulmonary arterial resistance –> blood flows through pulmonary circulation and drains into LA –> increases pressure in LA –> pressure LA > pressure RA –> functionally closes foramen ovale

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14
Q

Drug administered to close a patent ductus arteriosus?

A

Indomethacin

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15
Q

Drug administered to maintain a patent ductus arteriosus?

A

PGE2

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16
Q

EMBRYONIC STRUCTURE:Umbilical veinPost-natal derivative?

A

Ligamentum teres hepatis (within falciform ligament)

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17
Q

EMBRYONIC STRUCTURE:Umbilical arteriesPost-natal derivative?

A

Medial umbilical ligaments (Not to be confused with MEDIAN umbilical ligament, a derivative of urachus)

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18
Q

EMBRYONIC STRUCTURE:Ductus arteriosusPost-natal derivative?

A

Ligamentum arteriosum

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19
Q

EMBRYONIC STRUCTURE:Ductus venosusPost-natal derivative?

A

Ligamentum venosum

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20
Q

EMBRYONIC STRUCTURE:Foramen ovalePost-natal derivative?

A

Fossa ovalis

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21
Q

EMBRYONIC STRUCTURE:NotochordPost-natal derivative?

A

Nucleus polposus of IV disc

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22
Q

EMBRYONIC STRUCTURE:Urachus (allantois)Post-natal derivative?

A

Median umbilical ligament(Not to me confused with MEDIAL umbilical ligaments, derivatives of umbilical arteries)

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23
Q

Anterior surface of heart is formed by?

A

R ventricle

24
Q

Another name for anterior surface of heart?

A

Sternocostal surface

25
Q

Inferior surface of heart is formed by?

A

L and R ventricles

26
Q

Another name for inferior surface of heart?

A

Diaphragmatic surface

27
Q

Posterior surface of heart is formed by?

A

L atrium

28
Q

Apex of heart is formed by?

A

L ventricle

29
Q

Penetrating injury at L sternal border, 2nd intercostal space = injury to?

A

Pulmonary trunk

30
Q

Penetrating injury at R sternal border, 2nd intercostal space = injury to?

A

SVC

31
Q

Penetrating injury at L sternal border, 4th intercostal space = injury to?

A

R ventricle

32
Q

Penetrating injury at L midclavicular line, 5th intercostal space = injury to?

A

L lung5th intercostal space, midclavicular line = location of heart apex (L ventricle), but covered by L lung

33
Q

Right coronary artery (RCA) - 4 branches?

A

SA nodal arteryAV nodal arteryAcute marginal arteryPosterior descending artery (PDA) - in right-dominant (80%) or co-dominant (10%) populations

34
Q

Left coronary artery (LCA) - 3 branches?

A

Left anterior descending artery (LAD)Left circumflex artery (LCX)Posterior descending artery (PDA) - in left-dominant (10%) or co-dominant (10%) populations

35
Q

SA node and AV node supplied by?

A

SA nodal and AV nodal branches of RCA

36
Q

R ventricle supplied by?

A

Acute marginal branch of RCA

37
Q

L atrium supplied by?

A

LCX branch of LCA

38
Q

Anterior wall of LV supplied by?

A

LAD branch of LCA

39
Q

Posterior wall of LV supplied by?

A

PDA

40
Q

Lateral wall of LV supplied by?

A

LCX branch of LCA

41
Q

Anterior 2/3 of IV septum supplied by?

A

LAD branch of LCA

42
Q

Posterior 1/3 of IV septum supplied by?

A

PDA

43
Q

Anterior papillary muscle in LV supplied by?

A

LAD branch of LCA

44
Q

Posterior papillary muscle in LV supplied by?

A

RCA

45
Q

Right-dominant coronary circulation?

A

PDA arises from RCA (80%)

46
Q

Left-dominant coronary circulation?

A

PDA arises from LCX branch of LCA (10%)

47
Q

Co-dominant coronary circulation?

A

PDA arises from both RCA and LCX branch of LCA (10%)

48
Q

1st MC site for coronary artery thrombosis?

A

LAD branch of LCA

49
Q

2nd MC site for coronary artery thrombosis?3rd most common site?

A

2nd - RCA3rd - LCX branch of LCA

50
Q

Coronary arteries fill during which aspect of cardiac cycle?

A

Diastole

51
Q

Tachycardia predisposes to myocardial ischemia because?

A

Tachycardia (> 180 bpm) decreases diastole and filling time –> decreases filling of coronary arteries –> leads to myocardial ischemia

52
Q

How does L atrial enlargement cause dysphagia?

A

Compression of esophagus

53
Q

How does L atrial enlargement cause hoarseness?

A

Compression of left recurrent laryngeal nerve, a branch of vagus nerve

54
Q

Positioning TEE probe anteriorly allows for visualization of?

A

L atrium, atrial septum, and mitral valve

55
Q

Positioning TEE probe posteriorly allows for visualization of?

A

Descending aorta

56
Q

Inferior wall of LV supplied by?

A

PDA

USMLE STEP 1 - OLD (12 decks)

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