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MCQ Review > Cardiology (Heart + Vessels) > Flashcards

Cardiology (Heart + Vessels) Flashcards

1
Q

Sharp retrosternal chest pain, tachycardic, hypertensive., Mediastinal widening on CXR. ST depression on ECG. Diagnosis?

A

Aortic dissection

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2
Q

Risk factors for aortic dissection

A

Older age (60-80, male; older in women)
collagen disorders in younger popu., (e.g. Marfans)
Inflammatory vasculitides
pre-existing aortic aneurysm`

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3
Q

Glove and stocking dyasthesias, pins and needles, burning discomfort

A

Peripheral neuropathy

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4
Q

Deep seated calf pain and tenderness with or without edema, color change, fever, tachycardia

A

Deep venous thrombosis

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5
Q

Leg pain precipitated by exertion

A

Intermittent claudication

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6
Q

Drug of choice for paroxysmal supraventricular tachycardia

A

Adenosine or Verapamil

beta blockers are second line (eg metoprolol, propanolol)

Increase vagal tone via carotid sinus massage and valsalva

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7
Q

Heart lesion most likely to be problematic in pregnancy

A

mitral stenosis
The pregnancy induced increase in blood volume, cardiac output and elevation of pulse can lead to pulmonary hypertension and pulmonary edema

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8
Q

Cause of “silent MI” in older and diabetic patients

A

Cardiac autonomic neuropathy

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9
Q

Normal aortic systolic gradient in heart catheterisation

A

<10mmHg

If Cardiac Output is normal, a gradient >50mmHg indicates severe aortic stenosis indicated for surgery

If CO is decreased, indication of even more severe disease

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10
Q

Most likely arterial injury produced by posterior dislocation of the knee

A

popliteal artery injury

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11
Q

Most serious complication of atrial fibrillation

A

thromboembolism

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12
Q

Necrotizing vasculitis involving medium-sized arteries usually affecting kidneys, gut, nerves, muscles often sparing the lungs

A

Polyarteritis nodosa

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13
Q

Nonatherosclerotic, segmental inflammatory disease of the small and medium sized arteries, veins and nerves of the extremities

A

throboangilitis obliterans (Buerger disease)

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14
Q

Most common risk factor for Buerger disease

A

Smoking, more commonly with home made cigarettes using raw tobacco

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15
Q

Most common underlying causes of atrial fibrillation

A

in developed countries - IHD, thyrotoxicosis, hypertension

In developing countries - rheumatic heart disease

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16
Q

Test for early diagnosis of pulmonary embolism

A

computed tomogram pulmonary angiogram (CTPA)

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17
Q

Most common form of vasculitis in older adults (>50)

A

Temporal (Giant Cell) Arteritis

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18
Q

Arteries usually affected by giant cell arteritis

A

branches of carotid artery particularly the temporal branch

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19
Q

Flulike symptoms with joint and muscle pains in a patient with giant cell arteritis

A

polymyalgia rheumatica

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20
Q

True or false: Negative biopsy will rule out giant cell arteritis

A

False; in giant cell arteritis lesions are SEGMENTAL, so a negative biopsy does not exclude disease

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21
Q

Arteries usually affected by takayasu arteritis

A

branches of the aortic arch

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22
Q

Organs spared in polyarteritis nodosa

A

lungs

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23
Q

String of pearls appearance due to alternating areas of fibrinoid necrosis + transmural inflammation and healed fibrosis

A

polyarteritis nodosa

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24
Q

Treatment of polyarteritis nodosa

A

Corticosteroids + cyclophosphamide

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25
Q

Artery usually affected by kawasaki disease

A

coronary artery – RISK FOR MI in young or aneurysm

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26
Q

Treatment for Kawasaki disease

A

Aspirin and IVIG

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27
Q

AHA Diagnostic criteria of Kawasaki disease

A

mnemonic - FEBRILE
F - ever >5 days; PLUS 4/5 of the ff:
E - nanthem: strawberry tongue , fissuring
B - ulbar conjunctival injection, painless
R - ash, polymorphous
I - nternal organ involvement
L - ymphadenopathy, nonpurulent, cervical
E - xtremity changes: reddening of hands and soles progressing to membranous desquamation; transverse grooves across nails called Beau lines

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28
Q

Necrotizing vasculitis involving ulceration, gangrene and autoamputation of fingers and toes

A

Buerger Disease

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29
Q

vasospasm leading to discoloration

A

Raynaud phenomenon

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30
Q

Necrotizing granulomatous vasculitis involving nasopharynx, lungs and kidneys

A

Wegener granulomatosis

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31
Q

Vasculitis associated with increased serum c-ANCA levels

A

Wegener granulomatosis

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32
Q

Treatment for Wegener granulomatosis

A

Cyclophosphamide and corticosteroids

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33
Q

Necrotizing granulomatous vasculitis involving lungs and kidneys, NO nasopharyngeal involvement

A

microscopic polyangitis

34
Q

Vasculitis associated with increased serum p-ANCA levels

A

microscopic polyangitis, Churg-Strauss Syndrome

to differentiate: no granulomas in MP, CS has asthma association and peripheral eosinophilia

35
Q

Treatment for microscopic polyangitis

A

Cyclophosphamide and corticosteroids

36
Q

Most common vasculitis in children

A

HSP

37
Q

Vasculitis due to IgA immune complex deposition

A

HSP

38
Q

Palpable purpura on buttocks and legs; GI pain and bleeding, Hematuria, joint pain, usually occurs after URTI

A

HSP

39
Q

atherosclerosis usually affects _______ vessels (size)

A

medium to large;

40
Q

atherosclerosis most commonly occurs in these arteries

A

abdominal aorta, coronary, popliteal, internal carotid

41
Q

4 Modifiable risk factors of atherosclerosis

A

HTN
Hypercholesterolemia
smoking
diabetes

Non-modifiable: age, gender, genetics

42
Q

Percentage of stenosis before acquiring symptoms

A

70% stenosis

43
Q

Histologic hallmark of atherosclerotic plaque embolus

A

Cholesterol clefts

44
Q

Classic end-organ damage associated with hyaline arteriolosclerosis

A

glomerular scarring -> chronic renal failure

45
Q

2 major causes of hyaline arteriolosclerosis

A

1) benign HTN

2) Diabetes

46
Q

Narrowing of small arterioles due to proteins leaking into vessel wall

A

hyaline arteriolosclerosis

arteriolonephrosclerosis

47
Q

“Onion-skin” thickening of vessel wall

A

hyperplastic arteriolosclerosis

48
Q

Cause of hyperplastic arteriosclerosis

A

malignant hypertension

49
Q

Causes Acute Renal Failure with flea-bitten appearance (pinpoint hemorrhages)

A

hyperplastic arteriolosclerosis

50
Q

Vascular pattern of calcification on mammogram

A

Monckeberg medial calcification - non-obstructive; not clinically significant, but may be confounding in mammogram where calcification is identified

51
Q

Intimal tear allows blood to pool inside media of aorta

A

Aortic dissection

52
Q

Where does aortic dissection occur?

A

Proximal 10cm of aorta (high pressure) with pre-existing weakness of media

53
Q

Character of chest pain in aortic dissection

A

sharp, tearing, radiating to back

54
Q

Most common cause of death in aortic dissection

A

pericardial tamponade

55
Q

Classic cause of THORACIC aneurysm

A

Tertiary syphilis end-arteriris

56
Q

Most important complication of thoracic aortic aneurysm

A

Dilatation of aortic valve root resulting in aortic insufficiency

others: compression of mediastinal structures, thrombosis, embolism

57
Q

Usual location of AAA

A

BELOW renal arteries, ABOVE aortic bifurcation

58
Q

Classic cause of ABDOMINAL aortic aneurysm

A

ATHEROSCLEROSIS (usually male smokers >60y with HTN)

59
Q

Major complication of AAA

A

RUPTURE; esp. when >5cm

60
Q

AAA rupture triad

A

hypotension, pulsatile abdominal mass, flank pain

61
Q

Time of ischemia that will lead to myocyte death (angina vs MI)

A

> 20 mins

62
Q

3 Most common artery in MI

A
  1. left anterior descending - anterior LV wall and anterior interventricular septum
  2. Right coronary a. - posterior wall and posterior septum
  3. left circumflex - lateral wall
63
Q

Most sensitive and specific marker for MI

A

Trop I

64
Q

Rises 2-4 hrs after infarction, Peaks at 24 hours, returns to normal 7-10 days

A

Trop I

65
Q

Rises 4-6 hrs after infarction, peaks at 24 hours, returns to normal by 72 hours

A

CK-MB - useful in diagnosis second infarction few days after first

66
Q

Treatment of MI

A 
Aspirin/heparin
Supplemental O2
Nitrates 
Beta blockers 
Ace inhibitor
Fibrinolysis or angioplasty
67
Q

Drug class causing venous dilatation and decreased preload

A

Nitrates

68
Q

Drug class causing decreased heart rate and decreases demand for oxygen; decreased arrhythmia risk

A

B-blockers

69
Q

prevents peripheral arteriole constriction, reduces afterload;

A

ACE inhibitors

70
Q

Complications of fibrinolysis/angioplasty

A

Blood is introduced back to dead myocytes;

1) contraction band necrosis (due to Ca2+ causing contractions)
2) reperfusion injury (due to free radical injury)

71
Q

Complications <4 hours from infarction

A

No microscopic changes; Cardiogenic shock, CHF, arrhythmia

72
Q

Complication 4-24h from infarction

A

Coagulative necrosis –> damaged conductive system –> arrhythmia

73
Q

Complication 1-3 days from infarction

A

Neutrophilic stage -> inflammatory cells leak into pericardium
= fibrinous pericarditis (chest pain +friction rub)

74
Q

Complication 4-7 days from infarction

A

macrophages “eat” necrotic debris = thinning and weakening of wall = RUPTURE => possible cardiac tamponade or septal shunt or mitral insufficiency (rupture of papillary ms)

75
Q

Complication months after infarction

A

fibrosis - weak wall; risk for aneurysm, mural thrombus or Dressler syndrome (formation of antibodies against pericardial antigens = autoimmune pericarditis)

76
Q

Unexpected death due to cardiac disease occurring without symptoms or <1 hour after symptoms arise, due to fatal ventricular arrhythmia

A

sudden cardiac death

77
Q

Hemosiderin-laden macrophages in alveolar air sac

A

heart failure cells (left-sided HF)

78
Q

Most common cause of right-sided heart failure

A

left-sided heart failure

79
Q

blood vessels of the lungs constrict d/t hypoxia, causing increased work for right side of heart, eventually causing failure

A

Cor pulmonale

80
Q

liver discoloration d/t cardiac cirrhosis in RSHF

A

nutmeg liver

MCQ Review (12 decks)

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