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TOP THE BOARDS!!!!!! > Cardiology > Flashcards

Cardiology Flashcards

1
Q

PR interval

A

0.12-0.20

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2
Q

PR segment

A

0.05-0.12

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3
Q

QRS complex

A

0.08-0.12

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4
Q

QT interval

A

Less than or equal to 0.45 in males, 0.46 in females

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5
Q

Corrected QT

A

Bazett’s formula: QT interval/square root of RR in seconds

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6
Q

When to correct for QT

A

Tachycardia or bradycardia

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7
Q

How to measure heart rate for regular rhythm

A

1500/number of small boxes from R-R

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8
Q

1 small box: second/s

A

0.04

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9
Q

5 small boxes (1 big box): second/s

A

0.2

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10
Q

1 small box: mm

A

1

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11
Q

5 small boxes (1 big box): mm

A

5

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12
Q

Normal axis

A

-30 to 100

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13
Q

Examples of LAD (4)

A

1) LVH
2) Inferior wall MI
3) Hyperkalemia
4) Normal variant

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14
Q

Examples of RAD (6)

A

1) RVH
2) Anterolateral wall MI
3) Pulmonary embolism
4) Chronic lung disease
5) ASD, VSD
6) Normal variant in children and thin adults

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15
Q

Leads for eyeballing of axis

A

1) Lead I

2) aVF

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16
Q

Heart rate in sinus rhythm

A

60-100bpm

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17
Q

Heart rate in junctional rhythm

A

40-60bpm

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18
Q

Heart rate in idioventricular rhythm

A

15-40

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19
Q

Anterior wall: Supplied by

A

LAD

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20
Q

Anterior wall: Leads

A

v1-4

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21
Q

Anteroseptal wall: Supplied by

A

LAD

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22
Q

Anteroseptal wall: Leads

A

V1-2

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23
Q

Anterolateral wall: Supplied by

A

LCX

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24
Q

Anterolateral wall: Leads

A

V4-6

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25
Q

Lateral wall: Supplied by

A

LCX

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26
Q

Lateral wall: Leads

A

I, aVL

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27
Q

Inferior wall: Supplied by

A

RCA

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28
Q

Inferior wall: Leads

A

II, III, aVF

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29
Q

Vessels that comprise the largest total cross-sectional and surface area of circulation

A

Capillaries

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30
Q

T/F: Venules have autonomic innervation

A

T

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31
Q

Correponds to the distensibility of blood vessel

A

Capacitance/compliance

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32
Q

Artery vs vein: Greater capacitance

A

Vein

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33
Q

Most important determinant of pulse pressure

A

Stroke volume

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34
Q

Palpation mtd of BP measurement: Artery used

A

1) Brachial

2) Radial

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35
Q

Palpation mtd of BP measurement: Inflate the cuff ___ mmHg above the point where loss of pulse is noted

A

30

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36
Q

Auscultation mtd of BP measurement: Inflate cuff ___ mmHg above systolic pressure

A

30

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37
Q

Palpation mtd of BP measurement: Rate of decrease in pressure should be

A

2-3 mmHg/sec

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38
Q

Korotkoff phase: Onset of tapping

A

Phase 1

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39
Q

Korotkoff phase: Reappearance of tapping sound

A

Phase 3

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40
Q

Korotkoff phase: Disappearance of sound

A

Phase 5

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41
Q

Korotkoff phase: 10-15mmHg lower than previous phase during which a murmur may be heard after tap

A

Phase 2

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42
Q

Korotkoff phase: Muffling of heart sound

A

Phase 4

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43
Q

Normal BP difference of both arms

A

Less than 10 mmHg

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44
Q

UE vs LE: Higher BP

A

LE

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45
Q

BP is __mmHg higher in legs than arms

A

20

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46
Q

Orthostatic hypotension: Fall in SBP by __mmHg

A

20

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47
Q

Orthostatic hypotension: Fall in DBP by __mmHg

A

> 10

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48
Q

Effect of inspiration to SBP

A

Decrease

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49
Q

Exaggerated fall in SBP with normal respiration

A

Pulsus paradoxus

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50
Q

mmHg fall in pulsus paradoxus

A

10mmHg or more

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51
Q

Slow rise in arterial pulse

A

Pulsus tardus

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52
Q

Pulsus tardus is seen in

A

Aortic stenosis

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53
Q

Non-cardiac causes of rapid rise in arterial pressure or bounding pulse (3)

A

1) Thyrotoxicosis
2) Pregnancy
3) Anemia

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54
Q

Cardiac causes of rapid rise in arterial pressure or bounding pulse (3)

A

1) PDA
2) AR
3) Coarctation of the aorta

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55
Q

Twice beating or double-peaked arterial pulse

A

Pulsus bisferiens

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56
Q

Condition: Pulsus bisferiens

A

AR

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57
Q

Single most common cause of heart failure

A

CAD

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58
Q

***Most common cause of pump failure hence CHF

A

Myocardial hypertrophy usually sec to htn

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59
Q

Measure of LV function

A

EF

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60
Q

Heart failure with depressed EF

A

Systolic failure

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61
Q

Heart failure with preserved EF

A

Diastolic failure

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62
Q

Treatment for systolic failure

A

Digoxin

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63
Q

Most common manifestation of left-sided heart failure

A

Pulmonary congestion and edema

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64
Q

Heart failure cells

A

Hemosiderin-laden macrophages

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65
Q

Most common cause of right-sided heart failure

A

Left-sided heart failure

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66
Q

Left vs right sided heart failure, etiology: Pulmonary emboli

A

Right

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67
Q

Left vs right sided heart failure, etiology: Any disease interfering with pulmonary ventilation

A

Right

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68
Q

Left vs right sided heart failure, etiology: Cystic fibrosis

A

Right

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69
Q

Left vs right sided heart failure, etiology: Ischemia

A

Left

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70
Q

Left vs right sided heart failure, etiology: Systemic htn

A

Left

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71
Q

Left vs right sided heart failure, etiology: Myocardial disease/cardiomyopathy

A

Left

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72
Q

Right-sided heart failure caused by pulmonary htn from intrinsic lung dse

A

Cor pulmonale

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73
Q

Right-sided heart failure results on __ in the liver

A

Chronic passive congestion

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74
Q

Histologic morphology of liver in right-sided heart failure

A

Centrilobular congestion and atrophy of central hepatocytes described as nutmeg liver

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75
Q

Functional capacity class: Ordinary physical activity does not cause undue fatigue

A

I

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76
Q

Functional capacity class: SLIGHT limitation. Ordinary physical activity results in fatigue.

A

II

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77
Q

Functional capacity class: MARKED limitation. Less than ordinary activity causes fatigue.

A

III

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78
Q

Functional capacity class: Symptoms present even at rest

A

IV

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79
Q

Cardinal symptoms of heart failure (2)

A

1) Fatigue

2) Shortness of breath

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80
Q

Periodic respiration or cyclic respiration

A

Cheyne-Stokes

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81
Q

Mgt of heart failure with depressed EF (less than 40%)

A

1) Screen and treat comorbidities
2) Stop smoking and limit alcohol
3) Avoid extremes of temp and heavy physical exertion
4) Diuretics

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82
Q

Most common sustained arrhythmia

A

Atrial fibrillation

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83
Q

Typical rate of afib

A

120-160bpm

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84
Q

Treatment for afib (2)

A

1) Rate controller

2) Anticoagulant

85
Q

When to begin IV heparin in afib (2 conditions)

A

1) Duration >12hrs

2) Presence of risk factors for stroke in Afib

86
Q

Risk factors for stroke in Afib (9)

A

1) History of stroke or TIA
2) Mitral stenosis
3) Htn
4) DM
5) Age >75
6) CHF
7) LV dysfunction
8) Marked left atrial enlargement (>5.0cm)
9) Spontaneous echo contrast

87
Q

Membrane channel inhibited by Digoxin

A

Na/K ATPase pump

88
Q

Electrolyte imbalances that worsen Digoxin toxicity

A

1) HypoK

2) Hypomag

89
Q

Transient or concealed ST elevation in V1-V3 typically provoked with Na channel-blocking drugs

A

Brugada syndrome

90
Q

Brugada syndrome: Provoking drugs

A

1) Ajmaline
2) Procainamide
3) Flecainide

91
Q

Brugada syndrome: Gene mutation in 20% of patients

A

scn5a

92
Q

Brugada syndrome: Most common in

A

Young males

93
Q

Brugada syndrome: Responsible for ___ in southeast asian men

A

SUNDS

94
Q

Brugada syndrome: Risk of developing

A

Polymorphic ventricular arrhythmia

95
Q

Brugada syndrome: Predictors of adverse outcome

A

1) Spontaneous coved-type ST elevation in the right precordial leads
2) History of syncope
3) Aborted sudden cardiac death

96
Q

Brugada syndrome: Treatment

A

Procainamide

97
Q

***Most common type of heart disease among children

A

Congenital heart disease

98
Q

Congenital heart disease develops at which week of gestation

A

3rd to 8th

99
Q

Incidence of congenital heart disease

A

1% of livebirths

100
Q

Congenital heart disease: L-R shunt (4)

A

1) ASD
2) VSD
3) PDA
4) AVSD (atrioventricular septal defect)

101
Q

Most common congenital cardiac anomaly in adults

A

ASD

102
Q

Male vs female: ASD

A

Female

103
Q

Types of ASD (3)

A

1) Sinus venosus
2) Ostium primum
3) Ostium secundum

104
Q

Most common form of ASD

A

Ostium secundum

105
Q

Syndrome in which a mutation in tbx5 transcription factor causes ASD and VSD

A

Holt-Oram syndrome

106
Q

S2 in ASD

A

Widely split

107
Q

ECG change in ASD

A

rSr’ pattern in the right precordial leads representing enlargement of RV outflow tract

108
Q

Surgical repair of ASD should not be carried out in

A

1) Small defects
2) Trivial L-R shunts
3) Severe pulmonary vascular disease without a significant L-R shunt

109
Q

Location of sinus venosus

A

High in the atrial septum near the entry of SVC

110
Q

Sinus venosus ASD is frequently associated with

A

Anomalous pulmonary venous connection from the right lung to the SVC or right atrium

111
Q

Location of ostium primum

A

Adjacent to the AV valves which may be deformed or regurgitant

112
Q

Location of ostium secundum

A

Midseptal and involves fossa ovalis

113
Q

Most common congenital cardiac anomaly overall

A

VSD

114
Q

Congenital anomaly frequently associated with VSD

A

Tetralogy of Fallot

115
Q

Isolated vs with association: VSD

A

With association

116
Q

Single vs multiple: Opening/s in VSD

A

Single (MC single because MC is membranous; Trabecular or muscular VSD is characteristically “Swiss cheese” in appearance because of multiple openings)

117
Q

Membranous vs infundibular: Opening in VSD

A

Membranous

118
Q

Principal determinant of clinical manifestations, course, and feasibility of surgical repair of a given VSD

A

Pulmonary vascular bed

119
Q

Large communication b/w 2 circulations and bidirectional or predominantly right-to-left shunts because of high resistance and obstructive pulmonary htn

A

Eisenmenger syndrome

120
Q

Small shunt: Pulmonary-systemic flow ratio

A

Less than 1.5 to 2:1

121
Q

Small shunt: Surgery

A

Surgery not recommended

122
Q

Medium to large shunt: Pulmonary-systemic flow ratio

A

> 1.5 or 2:1

123
Q

Medium to large shunt: Surgery

A

Operative or transcatheter

124
Q

Eisenmenger VSD: Management (3)

A

1) Pulmonary arterial vasodilators
2) Single lung transplantation with intracardiac defect repair
3) Total heart-lung transplantation

125
Q

Therapeutic phlebotomy: Amount of blood removed

A

500

126
Q

Therapeutic phlebotomy: Duration

A

45 mins

127
Q

Therapeutic phlebotomy: Replacement of extracted volume

A

Isovolumetric replacement with isotonic saline

128
Q

Outcome of R-L shunt (3)

A

1) Cyanosis
2) Clubbing
3) Erythrocytosis

129
Q

Cause of erythrocytosis in R-L shunt

A

Chronic hypoxemia and EPO production

130
Q

Compensated vs decompensated erythrocytosis: Therapeutic phlebotomy

A

Decompensated

131
Q

Caveat of therapeutic phlebotomy

A

Limits O2 delivery

132
Q

Isolated vs with association: PDA

A

Isolated

133
Q

10% of PDA is associated with (3)

A

1) Pulmonary or aortic stenosis
2) Coarctation
3) VSD

134
Q

PDA is associated with what gestational conditions

A

1) Prematurity (HMD)

2) Congenital rubella infection

135
Q

Murmur associated with PDA

A

Machinery

136
Q

Congenital heart diseases: R-L shunt

A

5 T’s

1) Tetralogy
2) TOGV
3) Tricuspid atresia
4) Persistent Truncus
5) TAPVR

137
Q

Most common cause of heart disease in children

A

RHD

138
Q

RHD: Etiology

A

Immunologic hypersensitivity rxn to streptococcal antigens

139
Q

RHD: Major criteria

A

1) Chorea
2) Carditis
3) Polyarthritis
4) Subcutaneous nodules
5) Erythema nodosum

140
Q

RHD: Etiologic agent

A

GABHS

141
Q

RHD: Foci of swollen eosinophilic collagen surr by lymphocytes, occ plasma cells, and plump macrophages (granuloma)

A

Aschoff bodies

142
Q

RHD: Activated histiocytes/plump macrophages pathognomonic of RHD

A

Anitschkow’s cells

143
Q

RHD: Multinucleated giant cells seen in aschoff bodies

A

Aschoff cells

144
Q

Most common clinical presentations of ARF (2)

A

1) Fever

2) Polyarthritis

145
Q

Clinical features of RF (9)

A

FEVERSS PE

1) Fever
2) ESR elevation
3) Valvular damage
4) Erythema marginatum
5) Red hot joints (polyarthritis)
6) Subcutaneous nodules
7) St. Vitus dance (Chorea)
8) Polyarthralgia
9) ECG: Prolonged PR interval

146
Q

Criteria for diagnosis of RF

A

Jones criteria

147
Q

Jones criteria

A

Evidence of GABHS infection +

1) 2 major
2) 1 major + 2 minor
3) 2 minor for recurrence

148
Q

Hallmark of rheumatic carditis

A

Valvular damage

149
Q

RHD: Valve that is almost always affected

A

Mitral

150
Q

T/F: Isolated aortic valve involvement is common in RHD

A

F

151
Q

Rapid purposeless movements that affect particularly the head with a characteristic darting movement of the tongue

A

Sydenham’s chorea

152
Q

Evidence of GABHS infection is required for diagnosis of RF except

A

When discovered after a long latent period

153
Q

Acute RF resolves in

A

3 months without treatment

154
Q

Chronic RF is cxd persistence of symptoms for

A

More than 6 months

155
Q

Polyarthritis in RF: Resolution

A

Within 2-4 weeks without permanent damage

156
Q

Polyarthritis in RF: Symmetrical vs asymmetrical

A

Symmetrical

157
Q

Polyarthritis in RF: Large vs small joints

A

Small

158
Q

Polyarthritis in RF: Rare sequelae

A

Periarticular fibrosis called Jaccoud joint

159
Q

Polyarthritis in RF: May be monoarticular with early use of what drug

A

NSAID

160
Q

RF: Age of predilection

A

5-15 y/o

161
Q

RF: Rare after what age

A

35 y/o

162
Q

RF: Symptoms more common in females (2)

A

1) Mitral stenosis

2) Sydenham’s chorea

163
Q

RF: Major criteria most common in children

A

Carditis

164
Q

RF: Major criteria most common in adults

A

Polyarthritis

165
Q

RF: Major criteria that are very rare in adults (3)

A

1) Erythema nodosum
2) St. Vitus dance
3) Subcutaneous nodules

166
Q

The ONLY manifestation of ARF with significant potential to cause long-term disability and/or death

A

Carditis

167
Q

T/F: Carditis in RF is a PANCARDITIS

A

T

168
Q

RF Chorea: Pathophy

A

Autoantibodies react with brain ganglioside

169
Q

RF manifestation covered by clothing due to predilection for trunk and proximal aspects of limbs hence frequently missed by parents

A

Erythema marginatum

170
Q

Erythema marginatum T/F: Pruritic

A

F

171
Q

Erythema marginatum T/F: Painful

A

F

172
Q

RF subcutaneous nodules resolve within

A

1-2 weeks

173
Q

VSD: Defects in muscular septum

A

Multiple

174
Q

VSD: Appearance of muscular defect

A

Swiss cheese

175
Q

Components of TOF

A

PROVe

1) Pulmo stenosis
2) RVH
3) Overriding of aorta
4) VSD

176
Q

T/F A fraction of VSDs close spontaneously

A

T

177
Q

VSD: Timing of spontaneous closure

A

30-50% in the first 2 years of life

178
Q

Congenital heart disease: Snowman or figure of 8

A

TAPVR

179
Q

PDA: Permanent closure

A

8 weeks after birth

180
Q

PDA: Inversely related to (2)

A

1) Gestational age

2) Birth weight

181
Q

PDA: Attached to which portion of aorta

A

Descending

182
Q

Classical rash of congenital rubella

A

Blueberry muffin rash

183
Q

PDA: Mgt

A

Prostaglandin synthase inhibitors

1) Indomethacin
2) Ibuprofen

184
Q

PDA: Drug associated with premature closure

A

Ibuprofen

185
Q

Congenital heart disease: Boot-shaped heart

A

TOF

186
Q

Most common cyanotic congenital anomaly

A

TOF

187
Q

TOF: Prognosis is dependent on

A

Degree of pulmonary stenosis

188
Q

TOF: Paroxysmal hypercyanotic attacks

A

Tet spells

189
Q

TOF: Tet spells are due to

A

R-L flow across VSD due to overload from pulmo stenosis

190
Q

TOF: Pharmacologic management

A

b-blocker

191
Q

TOF: Physiologic management

A

Squatting or knee to chest position

192
Q

TOF: Surgical management

A

Blalock-Tausig shunt

193
Q

TOF: Best timing for Blalock-Tausig shunt

A

1st month

194
Q

Most common aorticopulmonary anastomosis

A

Blalock-Tausig shunt

195
Q

Anomalous in TOGV

A

Aorticopulmonary septum

196
Q

TOGV: Risk factor

A

Diabetic mother

197
Q

Congenital defect and associated cardiac disease: Down

A

ASD, VSD, AV septal defect (endocardial cushion defect)

198
Q

Congenital defect and associated cardiac disease: Congenital rubella

A

PDA, pulmonary artery stenosis

199
Q

Congenital defect and associated cardiac disease: Turner

A

Preductal coarctation of aorta

200
Q

Congenital defect and associated cardiac disease: Marfan

A

Aortic insufficiency and dissection (late complication)

201
Q

Congenital defect and associated cardiac disease: Infant of diabetic mother

A

TOGV

202
Q

“Tree bark” aorta is seen in

A

Syphilitic heart disease

203
Q

Most common PRIMARY cardiac tumor

A

Myxoma

204
Q

90% of cardiac myxomas occur in

A

Atria, mostly left atrium

205
Q

“Ball valve” obstruction of the left atrium

A

Cardiac myxoma

206
Q

Most frequent primary cardiac tumor in children

A

Rhabdomyomas

207
Q

Most common heart tumor

A

Metastasis

208
Q

Most common tumours that metastasize to the heart

A

Melanoma, lymphoma

TOP THE BOARDS!!!!!! (23 decks)

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