Cardiology U WORLD Questions Flashcards by Lauren Walgren

harsh crescendo-decrescendo systolic mumur, right sternal border, syncope, dizzy, angina, on exertion

Most common cause world wide?

Most common cause in US?

3rd cause

aortic stenosis

Rheumatic heart disease

calcific aortic valve disease

congenital bicuspid valve that calcifies

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malaise, SOB, dec appetite, decrescendo diastolic murmur at 3rd intercostal space LSB, low hemoglobin, + Strep gallolyticus

symptoms similar to?

associated w/??

Subacute bacterial endocarditis

Strep viridans SBE

Colonic neoplasia (25%)

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multiple epidoses of syncope, young male, sedentary, family history of sudden cardiac death

genetic mutation in

leads to

results in

congenital prolonged QT syndrome

K+ channel protein (dec. outward K flow)

prolonged QT interval and action potential

Ventricular arrhythmias (TSD, Vtach), sudden cardiac death

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dyspnea, gen weakness, fatigue, palpitations, tingling and numbness in both lower limbs, bilateral edema, basal crackles, dec. touch and vibration, dec DTRs

Dry vs wet

Thiamine deficiency

Dry is peripheral neuropathy, wet include HF

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non nodal conduction

rapid upstroke Na+, plateau w/ Ca++, hyperpolarize w/ K+

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two categorical variables association test

Chi square test for independence

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stroke symptoms + afib, normal valves =

most like formed in

treatment

thromboembolic event

left atrial appendage

long term anticoagulation

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myocardial cells increase in size due to ischemia caused by?

Ca2++ accumulation and Na+ accumulation, draw water into cell

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1st aortic arch

2nd aortic arch

3rd aortic arch

4th aortic arch

5th aortic arch

6th aortic arch

maxillary artery

stapedial artery

common and proximal internal carotid arteries

true aortic arch and subclavian (portion of)

obliterated

pulmonary arteries and ductus arteriosis

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vasodilation of skeletal muscles blood vessels during active exercise results in ______ despite inc sympathetic tone

sympathetic tone inc

dec in Total systemic vascular resistence

inc Caridac output and splanchnic vasoconstriction

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NAVEL femoral triangle

Nerve, artery, vein, empty space, lymphatics

lateral to medial

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exertional dyspnea, orthopnea, bibasilar crackles, elevated JVP, LE edema =

diastolic HF due to and caused by

LV pressure/volume

decompensated congestive heart failure

dec. ventricular compliance
HTN, obesity, infiltrative disorders (TTR amyloidosis, sarcoidosis)

up and to the left

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easy fatigue, exertional dyspnea, diminshed first heart sound, apical holosystolic murmur radiating to the axilla, diffuse pulmonary crackles, no elevated JVP, no peripheral edema =

major determinant of forward to regurgitant flow ratio

mitral regurgitation with left sided heart failure

left ventricular afterload

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episodic substernal chest pain, inc w/ activity and dec w/ rest, HTN, hyperLipid, smoker, S4 heart sound, LVH on ECG, inducible ischemia on inferior surface of heart =

which coronary artery occluded

angina

posterior descending branch of RCA

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exertional dizzyness then syncope, followed by LOC; ECG bradycardia, unsynched P and QRS =

paced by

3rd degree heart block

AV node

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severe midback pain, nausea, diaphoresis, lightheadness, HTN, CKD, dissection flap of desc. aorta =

usually originates

Type A refers to?

usually originates

Standford Type B dissection

origin of L subclavian A

ascending aorta

sinotubular jxn

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ANP secreted by

effects?

accentuated by

atrial cardiomyocytes

inc urinary exc. of Na+ and vasodilation

Neprilysin inhibitors (Sacubitril) prevents degradation

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Sudden palpitations in young man, carotid sinus massage leads to

PNS tone inc via vagus nerve, dec AV node conduction and prolonged AV node refractory period

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CO =

CO also =

SV x HR

rate of O2 consumption / AV O2 content difference

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infant, continuous murmur along w/ inspiratory splitting of S2 machine like in left infraclavicular region

PDA

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synthesis of fibrous cap on athersclerotic plaque caused by

Vascular smooth muscle cells

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Lungs ant/post to heart?

midclavicular stab wound?

left lung, deep enough apex of LV

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Wide fixed splitting S2 that does not vary w/ respiration =

can produce?

type of shunt

ASD

chronic pulmonary HTN, sclerosis, Eisenmenger syndrome (reversal of shunt)

L-to-R

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dec in BP >10mmHg on inspiration, JV distention, tachycardia after blunt chest trauma, muffled heart sounds, hypotension

lung exam

cardiac tamponade

normal

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most common cause of Mitral Stenosis characteristics can cause? sounds like

Rheumatic fever fibrous thickening and fusion of valve leaflets atrial enlargement, a fib, mural thrombosis loud S1, opening snap, mid diastolic murmur

Migratory superficial thrombophlebitis (Trousseau) due to

paraneoplastic syndrome of visceral cancer

short stature, short thick neck, broad chest, short metacarpals = most common congenital cardiac malformation = sound at risk for

Turner Syndrome Bicuspid aortic valve early systolic high frequency click over right 2nd ICS stenosis, insufficiency, infxn

afib w/ rapid ventricular response treated w/ ____ for rate control works by also used in

digoxin dec. AV node conduction, inc PNS vagal tone, block Na+/K+ ATPase pump heart failure

low grade fever, fatique, early distolic murmur at left sternal edge, subungal splinter hemorrhages, elevated ESR gram stain synthesize associated w/

endocarditis: Strep viridans G+ cocci dextrans from sucrose dental caries

young adult, progressive exertional dyspnea past 6mos, no chest pain, light headness or syncope, FH of mother dying of pulm HTN young adult, loud second heart sound at upper left sternal border, clear lung fields, RAD = if inherited caused by Gene

idiopathic pulmonary HTN vascular sm muscle proliferation BMPR2

10 yo, SOB, palpitations, fever, poor appetite, fatigue for few days, tachypnea, tachycardia, hypotension, new holosystolic murmur pathology

acute rheumatic fever (untreated grp A Strep) - pancarditis, mitral regurg interstitial myocardial granuloma (aschoff body)

Sudden death of young adult, usually athletic biopsy shows Genetics

HCM myocyte hypertrophy and haphazard arrangemet AD familial 50%

flushing, watery diarrhea, bronchospams, valvular fibrous plaque, abnormal growth in adult diagnosis

carcinoid syndrome elevated 24hr 5hydroxyindoeacetic acid (HIAA) (product of serotonin metabolism)

acute graft rejection in cardiac transplant

dense interstitial lymphocytic infiltrate weeks after transplant: cell mediated

STEMI, days later chest pain inc w/ coughing and swallowing, radiates to neck, low grade fever

pericarditis overlying necrotic segment

immigrant, fever, progressive weakness, dyspnea, vegetations on mitral valve = most likely history of = predisposing factor initiating step (strep cultured)

infective endocarditis Rheumatic heart disease valvular abnormalities (valvular inflammation and scarring) fibrin deposition

Dobutamine inc = receptor? increases? used for?

heart rate and contractility B1 myocardial oxygen consumption acute MI w/ acute severe HF

young adult, progressive fatigue, dyspnea on exertion, LE edema over last 2 weeks w/ fever runny nose and myalgias resolved several days before, JVD, bibasilar crackles Echo results

decompensated heart failure of DCM caused by viral myocarditis Dilated ventricles w/ abnormal systolic ventricular fxn

decompensated systolic HF as a result of chemo for NHLymphoma: after initial stabilization use:

long term beta blockers: carvedilol, metoprolol

sudden death 1 week after after acute MI due to: actual cause of death

free wall rupture of left ventricle (anterior wall MI) profound hypotension and shock

pulsatile vessels w/in the intercostal spaces and diminished femoral pulses relative to brachial pulses in a 12 yo girl syndrome other problem w/ same syndrome

aortic coarctation Turners Bicuspid aortic valve

5yo, turning blue w/ exertion, relieved by squatting, prominent right ventricular impulse and a harsh systolic murmur Embryological mechanism Squatting does what

Tetralogy of Fallot: VSD, overriding aorta, Right ventricular outflow tract obstruction, RVH deviation of infundibular septum (neural crest) inc afterload and dec R-L shunt across VSD

chest pain, diaphoresis, dyspnea, thrombosis, elevated homocysteine in plasma, mutation in THF reductase = inc risk of?

impaired conversion of homocysteine to methionine Thromboembolic events

patient started on low dose aspirin but experiences SOB and wheezing, best alternative? Mechanism?

Clopidogrel (blocks P2Y12 of ADP platelet receptors) prevents aggregation

vascular endothelium secretes ____ to inhibit platelet aggregation? what enhances platelet aggregation?

prostacyclin (PGI2) TXA2

number need to treat = ARR =

1/ARR control rate - experimental rate

common cardinal veins give rise to

superior vena cava (know on CT)

AV node located at

RA near orifice of coronary sinus, radio ablated in afib

calcium efflux from cardiac cells prior to relaxation is mediated by ____

Na+/Ca++ exchange pump

progressively worsening dyspnea, orthopnea, HTN, bilateral basilar crackles, JVD, LE edema, hilar prominence and cardiomegaly, LVH on ECG, echo shows PHTN: Mechanism

vasoconstriction due to pulmonary venous congestion Pulmonary HTN due to hypertensive heart disease

nitric oxide endothelial vasodilation requires ____

arginine, eNOS, cGMP

Flow(Q) = reduced by factor of __ means?

P1-P2/R or r^4 (radius of blood vessel to 4th power) divided by

chronic AV shunt such as ____ would ____ CO because of SNS stim to heart and____ venous return

chronic arteriovenous fistula increase increase

chest wound directed posterior adjacent to LSB in 4th ICS would injure would not injure?

RV last (anterior surface of the heart left lung (no middle lobe)

4 year old, irritable, vomit, traveled to china, fever, bilateral conjunctivaal injection, brigh red tongue, cracked lips, nonpitting edema on hands and feet, Asian = artery size? greatest risk for?

Kawaski disease medium coronary artery aneurysms

CHF (dyspnea, orthopnea, JVD, edema) results in ____ CO, _____ renal perfusion, and _____ renin production by JGA cells substance higher in pulmonary vein than pulmonary artery

decreased decreased increased Angiotensin II

flank pain, hematuria, wedge shaped kidney infarct = due to

thrombotic renal infarction Afib

primary collagen in MI scars is

type I found in tendons

aorta and LV pressure dont match up = peak of murmur intensity =

aortic stenosis ventricle pressure

amiodarone, sotalol, dofetilide work on downslope pahse ___

Class II antiarrhythmics: block K+ channels 3 of cardiac cycle

Free wall rupture occurs ____

5-14 days after acute MI

harsh ejection type systolic murmur at base of heart radiating to neck = due to

aortic stenosis calcific degen of trileaflet aortic valve (developed nations)

LV leads in biventricular pacemakers course thru _____ which resides in _____ on _______ aspect of heart

coronary sinus AV groove posterior

young boy, fatigue, clubbing, cyanosis w/o blood pressure-pulse discrepancy = sounds like

PDA continuous machine like murmur

ANP, BNP, and sildenafil (PDEI) all use

cGMP

depression, HTN, obtunded, hypotensive, bradycardic, IV glucagon admin and she improves = treatment of choice pathophys

beta blocker overdose glucagon glucagon increases cAMP, inc Ca++ release and inc SA node firing

lightning storm, dead, most likely cause of death

fatal arrhythmia

small heart, atherosclerosis, myocardial cells show intracytoplasmic granules tinged yellow brown due to ____ pigment name

lipid peroxidation lipofuscin (wear and tear of aging)

flail posterior mitral valve leaflet leads to ___left atrial pressure, ______ LV EDV (preload), and _____ afterload

acute mitral regurg due to chordae tendinae rupture increased, increased, decreased

drug resistant hypertension, shrunken kidney due to?

oxygen and nutrient deprivation from unilateral renal artery stenosis

spironolactone, eplerenone = spare? improve? should not be used with (2)

MC receptor antagonists: CHF K+ ventricle remodeling and LV EF hyperK or RF

absence of myocardial necrosis and scarring despite vessel occlusion explained by?

slow growth of occluding plaque

breast cancer survivor with radical mastectomy, radiation, presents with persistent right arm swelling: increased risk for

lymphangiosarcoma

chronic cough and angioedema due to

ACEI family (prils)

highest athersclerotic burden is on the ____ and ____ arteries

abdominal aorta coronary

endocarditis, gram +, catalase -, grow in hypertonic saline and bile = procedures in past month

enterococcus (normal UG flora) cystoscopy

Statin MOA Results in?

block HMG CoA increase in hepatocyte LDLR density

post endocarditis, holosystoli murmur that increases during inspiration

Tricuspid regurg, 2nd and 3rd ICS Left

increased HR, CO, unchanged parital pressures of O2 and CO2 =

exercise

amlodipine, felodipine, nifedipine location of action effects verapil effects? Dilitazem effects?

Ca++ channel blockers vascular smooth muscle only vasodilate ( lower BP, no ECG change) cardiac muscle (only ECG change) Both, vascular and cardiac mscle, combined effects

Vancomycin binds to resistance via

D alanyl D alanine D Lactate substitute D alanine

neither pts nor physicians aware of who takes drug or placebo = eliminates

double blind observer bias

increase in blood O2 saturation from right atria to right ventricle indicates Most commonly sounds like

left to right shunt VSD holosystolic murmur over L Sternal border

most heavily involved vessel in athersclerosis

abdominal aorta

sudden onset vision loss, left sided neck bruit = pathway

embolus ICA, ophthalmic artery, retinal artery

Left dominance coronary circulation = ____ supplies posterior descending artery. Right dominance = _____ supplies PDA. AV nodal artery arises from dominant artery

left circumflex artery right coronary artery

the most important mediator of coronary vascular dilation in larger arteries and pre arteriolar vessels is

fastest to slowest cardiac tissue conduction velocity

PAVA Purkinje, atrial, ventricular, AV

dec in LV size, sigmoid shaped ventricular septum, myocardial atrophy, inc collagen deposition, ipofuscin pigment =

normal aging heart

cyanotic newborn, elevated serum lactate, machine murmur between scapulae, aorta anterior, inferior, and right of pulmonary artery = failure of must have ____ to survive

Transposition of great vessels spiraling PDA, patent foramen ovale, or septal defect

rapid bacterial endocarditis, rigors, high fever, IV drug use = can cause ____ sided endocarditis w/ ______ into the lungs

S aureus right septic embolization

combined use of __________ and ______ can lead to

verapamil, dilitiazem atenolol bradycardia and hypotension

abrupt onset severe chest pain radiates to back, high blood pressure =

aortic dissection: intimal tearing

chest pain reproduced w/ palpation and worsened w/ movement changes = follows

costochondritis repetitive activity

Rapid surge of serum CK due to

cell membrane damage from ischemia

nitroglycerin mainly affects

large veins

viridans infx, pre existing valvular lesion, adhere via

fibrin-platelet aggreagates

low frequency S3 over apex in older =

left ventricular failure and inc LV EDV

long history of HTN, S4 due to

inc stiffness of LV wall

measure for assessing the degree of mitral stenosis

A2 split to opening snap time interval, shorter is worse

Natriuretic peptides effects (3) metabolized by?? drug??

inc GFR dec Prox. Na+ resorb dec renin secretion neprilysin metalloprotease neprilysin inhibitor

severe fatigue and dyspnea, HF, chest radiation or viral illness or TB in endemic areas = path? Signs

constrictive pericarditis thick fibrous rigid pericardium Inc JVP, on inspiration (usually drops), pulsus paradoxus, pericardial knock

Nitrates are _____dilators that _____ preload, _____ LV EDV, ______ peripheral venous capacitance, and ______ systemic vascular resistance

venous dec dec incr dec

the best indicator of severity of MR is ____ sound Murmur associated w/ MR?

S3 gallop holosystolic best heart at apex of heart, radiates to axilla

chronic cough, sometimes blood when coughing hard, right sided face and arm swelling and engorgement of subcutaneous veins on same side of neck = due to blockage of subclavian vein would cause blockage of SVC would cause blockage of JV would cause

right brachiocephalic vein obstruction apical lung tumor or thrombotic occlusion (catheter placement) unilateral arm swelling only bilateral swelling unilateral face swelling only

IVC formed by union of

R and L common iliac veins

recurrent episodes of paroxysmal afib, usually treated w/

sotalol, Beta adrenergic and K+ channel block, both rate and rhythm control

cardiac tamponade due to pericardial fluid accumulation can result in ______ in pulse amplitude during _______ called? also seen in?

decrease inspiration pulsus paradoxus (>10mmHg) constrictive pericarditis

midsystolic click followed by mid to late systolic murmur at cardiac apex that disappears w/ squatting is due to ___ Squatting ____ venous return and LV volume

MVP, connective tissue disorder increases

common side effects of statins include _____ and _____ toxicity Labs needed before initiation of therapy?

muscle and liver hepatic transaminases

ate lots of fancy meats and cheeses w/ history of depression can lead to ______ because of ______ in the foods interaction w/ __________ used to treat depression

HTN emergency tyramine MOAI

started on low dose atenolol, stable angina w/ elevated BP acts on ____ receptors at ____ results in____cAMP of cardiac myocytes and JGA cells, and has ______ in cAMP in vascular smooth muscle

B1 receptors on cardiac myocytes and JGA cells (renal) decreased no effect

recurrent paroxysmal SVT in healthy individual manifests as _______ ECG finding?

WPW syndrome delta wave at start of QRS, short PR, widened QRS

0-4 hours after MI, biopsy would show ________ on cardiac myocytes 4-12 hours post MI 12-24hours post MI 1-5 days post MI 5-10 days post MI 10-14 days post MI 2wks - 2months post MI

minimal change early coagulation, wavy fibers coagulation necrosis neutrophil infiltrate macrophage infiltrate granulation tissue and neovascularization collagen deposition and scar

vague feeling of heaviness in legs, standing for long periods = physical finding complication very rare complication

venous stasis varicose veins skin ulcerations pulmonary embolism

Paroxysmal SVT (nodal arrhythmia) treated w/ ____ 2 drugs in this class block what type of channel

class IV antiarrhythmics verapamil, diltiazem L type Calcium channels

harsh holosystolic murmur, flat face, protruding tongue, small ears = due to =

Down syndrome meiotic nondysjxn

severe mitral regurg and pulmonary edema post MI due to rupture of posteromedial papillary muscle occurs because compromised blood flow through ______ artery

posterior descending

deep chest pain exacerbated on exertion or emotional stress relieved w/ nitroglycerin = due to _____% blockage of lumen of a coronary artery

stable angina >75%

cryptogenic stroke in young adult, +bubble study =

ASD or Patent foramen ovale due to incomplee fusion of atrial septum primum and secundum

old, isolated systolic HTN and HA due

aortic stiffening

young healthy boy, audible LSB sound, accentuated w/ handgrip (______afterload) =

increase VSD

immigrant, gray pharynx, cervical LAD, soft palate paralysis = mechanism of exotoxin risk of

Corynebacterium diphtheriae diphtheria toxin, intracellular ribosylation EF2 myocarditis

cardiac cath through common femoral artery above inguinal ligament leads to risk of ________ hemorrhage looks like

retroperitoneal ecchymosis surrounding puncture site

antiarrhythmic agent bids to rapidly depolarizing ischemic ventricular myocardial fibers = drug of choice? effect on normal ventricular myocardium

lidocaine no Amiodarone minimal

QT prolongation syndrome also called

Romano-ward Jervell and Lange Nielson

adenosine______ phase 4 in cardiac pacemaker cells by ______ K conductance

prolongs increasing

posterior surface of the heart is the _____atrium enlargement from _____ can lead to cardiovascular ________ from pressure on esophagus

left mitral stenosis/regurg from RHD dysphagia

bicuspid aortic valve predispose to early

aortic stenosis (50s rather than 70s-80s)

compare the means of 2 groups of subjects with

two sample T test

righward widening of the pressure volume loop due to an _____ in preload such as saline infusion

increase

best choice for long term HTN w/ congestive heart failure is not a diuretic but a ______

ACEI

coffee ground emesis, tachycardia, cool extremeties = first intervention = increases?

hypovolemic shock saline infusion rapid end diastolic sarcomere length due to increase preload

familial hypercholesteremia in heterozygotes common segment on effected individuals in a southern blot would represent the ______ gene

AD, high LDL, premature athersclerosis mutated

first peak on JVP tracing is second, small peak is steep decline is 3rd peak is 3rd decline is

RA contraction tricuspid bulge on RV contraction RA relax inflow venous blood passive RA emptying after Tricuspid open

thickened and calcified ring on CT around heart is = slowly progressive dyspnea, peripheral edema, ascites

constrictive pericarditis some clinical symptoms

early diastolic murmur at LSB at RSB in developed countries can be due to

Aortic regurg aortic root dilation aortic root dilation or bicuspid aortic valve

WPW due to young, palpitations, light headed, rapid heart beats

accessory pathway bypasses AV node

infant, rapid breathing, tired, mid diastolic rumbe at LSB, holosystolic murmur at apex radiates to axilla, defect in lower interatrial septum and interventricular septum = most common with?

complete AV canal defect Down syndrome tri 21

HTN crisis and hyperplastic arteriosclerosis in renal arteries looks like

onion like concentric thickening of arteriolar walls

exertional calf pain, foot ulcers, hypersensitivity to tobacco extract = path

thromboangiitis obliterans (Buergers) segmental hypersensitivity vasculitis into veins and nerves

progressive fatigue, splinter hemorrhages on nails due to = cause sound associated

microemboli infective endocarditis regurgitant murmur

thigh and leg pain, hypercoagulable, weak dorsalis pedis pulse = drug that acts as arterial vasodilator and inhibits platelet agg? mechanism should also recieve

peripheral artery disease cilstazol PDEI aspirin or clopidogrel (antiplatelet)

muscle pain and cramps that remits w/ rest and decreased sexual performance, MI history, symptoms caused by defined as

lipid filled intimal plaque claudication

acute onset chest pain and dyspnea, HTN, large perfusion defect = most likely from

pulmonary embolism DVT

sudden cardiac death in young athlete most likely due to

HCM

lightheaded while buttoning tight shirt collar, pass out, low pulse, HTN, DM = due to stimulation of _____ in carotid sinus afferent limb? efferent limb?

carotid sinus hypersensitivity baroreceptors CN9 CN10

dystrophic calcification of aortic valve preceded by

damaged or necrotic tissue

very high concentrations of NE, still no effect on BP drug? mechanism?

irreversible inhibitor phenoxybenzamine alpha 1 and 2 adrenergic antagonist

statins, muscle pain, fatigue, dark urine = metabolized by? precipitated by

stain induced myopathy CYP450 3A4 macrolides (mycins)

family history of sudden death, young, systolic murmur that accentuates with standing from supine = medications to avoid?

HCM vasodilators, diuretics

sublingual nitroglycerin in stable angina = ______ in LV EDV

decrease

nontender lesions on foot or palms in infective endocarditis = painful nodules on finger tips and toes in endcarditis =

vascular microemboli (Janeway lesions) immune complex Osler nodes

ivabradine inhibits _______ channels, thus ______ SA node firing w/o affecting ______

funny sodium channels slowing contractility

side effects of ACEI = use _____ instead

cough, angioedema ARB, sartans

adverse effects of thiazide diuretics

hypoNa, K HyperCa, glycemia, cholesterolemia, uricemia

esmolol is an IV _____ that decreases ______ node conduction, which correlates to PR interval _____ elongation

Beta blocker AV elongation

mitral valve replacement, fever, baceremia w/ catalase positive, coagulase neg g+ cocci in clusters adhere w/ ? assumed to be _____ resistant, so treat w/

nosocomial coagulase negative staph polysaccharide slime methacillin resistant vancomycin

nonbacterial platelet rich thrombi characteristic of ______ due to______

nonbacterial thrombotic endocarditis advanced malignancy

crescendo-decresendo systolic murmur peaking in midsystole, super old, due to _____ or ______ stenosis due to _______

aortic, pulmonic valvular calfication

medial branch off of external iliac artery is lateral branch is

inferior epigastric deep circumflex iliac artery

IV drug that causes increased contractility and deccresed systemic vascular resistance is receptors

isoproterenol B1 and 2

pregnant, hypotension while supine = due to =

supine hypotension syndrome compression of IVC and reduced venous return

phenylephrine, methoaxamine are _______ that vasoconstrict systemic blood pressure. This stimulates carotid baroreceptors to increase ____ tone and _____ conduction through ____ node

alpha 1 selective adrenergic agonists vagal decrease AV

during ventricular systole (QRS), coronary arteries are _____ leading to a ________ in coronary blood flow

compressed reduction

10 yr old, restlessness, involuntary jerking, sore throat 3 months ago_____ which is a neuro manifestation of _____ due to anti strep antibodies affecting the ______. Patient is at a high risk of _________

Sydenham chorea acute rheumatic fever basal ganglia valvular heart disease

pulmonary edema, cephalization of pulmonary vessels, perihilar alveolar edema, plunting of costophrenic angles from pleural effusions =

acute decompensated HF

fatigue, progressive dyspnea, orthopnea, S3, recent MI = third heart sound best heard when listening at

decompensated heart failure end expiration in Lateral recumbent left side

LV EDV in MS is _____, and is _______ in combined aortic and mitral valve disease

decreased, increased

normal bleeding time indicates______ normal activated partial thromboplastin time indicates ______ prolonged Prothrombin time in setting of normal aPTT indicates _____ such as _____

adequate platelet hemostatic fxn intact intrinsic coagulation system (Factor VIII) defective extrinsic pathway in step not shared w/ intrinsic pathway such as deficient Factor VII

renin and BP stay the same after 3weeks of anti HTN therapy =

medication noncompliance

fatty streaks are the ______ lesions of atherosclerosis and are a collection of lipid laden ______ or foam cells in the intima

earliest macrophages

acute asthma and COPD exacerbations controlled by _____ such as _______ by _______ via

Beta adrenergic agonists, clenbuterol relaxing bronchial smooth muscle inc cAMP in smooth muscle cells

patients with tetralogy of fallot, the major determing factor of resulting cyanosis is the

degree of right ventricular outflow tract obstruction

doxorubicin forAML can cause presents w/

DCM exertional dyspnea and orthopnea

varicose veins result from chronically elevated venous pressure and ____

incompetent venous valves

severe chest pain, thrombus, thickened mitral valve leaflets w/ vegetations, glomerular basement membrane thickening, young adult woman =

SLE

polyarteritis nodosa (PAN) affects ______ but spares _____ fever, weight loss, myalgias, abdominal pain, high blood pressure

kidneys, heart, liver, GI tract pulmonary arteries

consolidation of _____ lung lobe can obscure x ray silhouette of ______ on X ray

right middle right atrium

MAAM COCO opening snap of mitral valve stenosis heard at bottom left corner of ventricular pressure looop (MO)

Mitral valve close Aortic Valve open Aortic Valve close Mitral valve open

dobutamine is a ____ agonist, acting at a ______ and ______ cAMP, which _______ contractility

B1 and weak B2 Gs GPCR increases increases

HCM involves is an ____ inherited disorder invovling sacromere genes that encode for _______ and ________

autosomal dominant beta myosin heavy chain myosin binding protein C

cough, chronic HTN, hemosiderin laden macrophages =

left sided heart failure

higher dose of oral nitrate needed compared to sublingual due to _____

first pass metabolism

slightly elongated QRS at high heart rate (stress test) due to Class_____ antiarrhythmics such as ______

1C flecainide (Na+)

pregnancy induced DVT, best anticogulant is

LMWH, such as enoxaparin

occasional dizzyness while moving UE, retrograde flow in left vertebral artery = results from _________ of proximal subclavian artery

subclavian steal syndrome severe stenosis

reliable valid

how many times can you hit the bullseye can you hit the bullseye

most coronary venous blood drains through

coronary sinus

abdominal pain, vascular tumor, arsenic or polyvinly chloride exposure, CD31+ cell

liver angiosarcoma: PECAM1

PDA remains open due to sounds like closes w/

PGE2 continous machine murmur indomethacin or ibuprofen

aspirin is associated w/ _____ injury and bleeding

GI mucosal

newborn benign vascular lesion, cutaneous strawberry type = most likely will

juvenile hemangioma first inc in size then regress

spontaneous episodes of rest and nighttime angina w/ transient ST elevation = due to can be caused by____ which is used to treat____ can also be caused by____ treatment

Prinzmetal angia (variant) coronary vasospams dihydroergotamine, migraines smoking, cocaine, meth, triptans amlodipine, Ca++ channel blocker that vasodilates

descending thoracic aorta lies ____to the esophagus and the left atrium

posterior

sudden cardiac death post MI most commonly due to

Vfib

K+ sparing diuretics such as ______ act on the _____ and the ____ to antagonize the effects of

spironolactone and eplerenone late distal tubule and CCD aldosterone

young, constitutional symptoms, mid diastolic rumbling murmur heard best at apex, positional dyspnea, large pedunculated mass in LA = Path?

atrial myxoma scattered cells w/in a mucopolysaccharide stroma, abnormal blood vessels and hemorrhaging

aortic regurg murmur most loudly heard after _____

aortic valve closure

ACEIs can cause significant first dose hypotension in patients w/ ______ from ______ or ______

volume depletion diuretic use heart failure

around the clock nitrate administration rapidly results in the development of ______

tolerance

myxomatous changes w/ pooling of proteoglycans in the media layer of large arteries predisposes to ______

aortic aneurysms

an abnormally prominent left atrial "v" wave during cardiac cath is a finding of presents w/

mitral regurg exertional dyspnea and orthopnea

smokers over the age of 35 are contraindicated for

OCPs

an increase in stroke volume or EF is depicted on the LV pressure-volume relationship by widening of the loop to the _____

left

adenosine and dipyridamole are selective vaso______ that can cause coronary _____ _____ where blood flow to an ischemic area is reduced

dilators - arterial steal syndrome

Subacute IE complicated by embolic stroke, most common predisposing factor in developed nations? in developing nations?

regurgitant MVP RHD

maintenance dose = half life = loading dose=

(desired steady state concentration x clearance) converted to hours Volume distribution x 0.7/clearance Volume distribution x Cpss/bioavailability fraction

ACEI induced angioedema is due to

bradykinin accumulation

Losartan (ARB) will cause an _____ in renin, AngI, AngII, and a ____ in aldosterone, with _____ in bradykinin

increase decrease no change

Milrinone is a selective ____ that ____ cAMP levels to causes systemic arterial and venous _____ and _____ contractility

PDE3 inhibitor increases dilation increases

night palpitations, pounding heart and head bobbing w/ exertions = due to

AR widening of pulse pressure

warfarin monitored w/ unfractionated heparin monitored w/

PT or INR aPTT

left ventricular systolic dysfunction due to reduced coronary blood flow at rest in angina completely reversible by

Hibernating myocardium coronary revascularization

nitrates are contraindicated for 24hrs w/ due to

PDEI cGMP accumulation

HyperK+ secondary to ACEI therapy is most common in patients w/ _____ and in patients taking _______ such as _____

renal insufficiency K+ sparing diuretics amiloride, triamterene, spironolactone

statin induced myopathy risk increased w/ co administration of ____ such as ____ that impair hepatic clearance of statins

fibrates gemfibrozil

most common adverse effect of alteplase post MI is

intracerebral hemorrhage

long standing HTN heart changes LA LV mass LV wall thickness

enlarged increased increased

Class IA drugs (3) are _______ inhibitors of phase 0 depolarization and _____ action potential. CLass IB drugs (2) are _____ inhibitors of phase 0 and ____action potential. Class IC drugs (2) are ____ inhibtors of phase 0 depolarization and have ______ on action potental

IA: quinidine, procainamide, disopyramide intermediate prolong IB: lidocaine, mexiletine weak shorten IC: flecainide, propafenone strong no change

arteriovenous shunts ____ preload and ____ afterload, which decrease LV pressure and increase LV volume

increase decrease

Leads I and aVL correspond to the lateral limb lead on ECG correspond to supplied by

lateral aspect of left ventricle Left circumflex artery

Fibrates (2) activate _______, which leads to _____ hepatic ________ production

gemfibrozil, fenofibrate PPAR-alpha VLDL production

Normal pressure in SVC and RA RV Pulmonary artery

1-6mmHg 15-30mmHg 6-12mmHg

great saphenous graft accessed just ____ to the _____

inferolateral pubic tubercle

marfanoid habitus is associated w/

aortic disease and dissections

leads II, II, aVF correspond to supplied by hemodynamic findings

inferior wall infaraction RCA dec CO, pulmonary capillary wedge pressure, inc central venous pressure

ST elevation and subsequent Q wave formation result of

transmural myocardial infarction fully obstructive thrombus

at 20minutes post ischemia, myocardium will at 30 minutes damage is

stop contracting irreversible

_______ provide major proliferative stimuli for cellular components of atherosclerotic plaque provide (mediator) macrophages promote ______ migration

platelets PDGF smooth muscle

Digoxins initial cellular event is to _____ sodium ion efflux

decrease

cortisol exerts a ____ effect on many hormones to improve response to stressors. It increases bronchial smooth muscle reactivity to _______

permissive catecholamines

DCM heart failure is due to

decreased ventricular contraction force

high interplaque activity of _____ results in MI

metalloproteinases

HCM murmur sounds like decreased intesnity by increased intensity by

harsh crescendo decrescendo at apex due to LVOT obstruction passive leg raise, phenylephrine, squatting, sustained hand grip sudden standing

selective arteriolar vasodilators (2) lower BP by reducing systemic vascular resistence. also results in reflex _____ activation, which inc HR, contractility and cardiac output. IT also stimulates ______ axis that results in ________ retention

hydralazine, minoxidil sympathetic RAA sodium and fluid

cardiac arrhythmia, nausea, vomit, confusion, weakness, visual problems, ELEVATED K

digoxin toxicity

pulmonary artery catheters pressure reading most likley corresponds to pressure in

let atrium

CLass III antiarrhythmic drugs (3) block _____ channels, thus prolonging repolarization

amiodarone, sotalol, dofetilide K+

old, progressive exertional dyspnea, edema, ascites, elevated JVP, prominent S4, left atrial enlargement, LVH, normal ejection fraction = due to = major causes acellular pink material =

diastolic heart fialure restrictive cardiomyopathy amyloidosis, sarcoidosis, hemochormatosis amyloid

straining during urination, HTN, which drug mechanism used for

Doxazosin alpha 1 blocker BPH

metnal status change, seizure, prolonged QRS, hallucinations, depression, arrhythmias, anticholinergic findings = drug used to treat cardiac toxicity

TCA toxicity sodium bicarbonate

metoprolol is a ____ blocker that ____ release of renin from renal JGA cells via B1 receptors

Beta inhibits

adrenergic various effects (up then down) with different doses = drug used receptor

dopamine D1

young adult dies of HTN problems and intrracerebral hemorrhage with no history of head trauma associated w/

coarctation of the aorta

progressive exertional dyspnea, smoker, inc AP diameter of chest, scattered wheezes, dilated RV, absence of peripheral edema is explained by?

increased tissue lymphatic drainage

SA node located at the right atrium near the opening of the ____

SVC

nitroprusside dec both ____ and ____

preload afterload

Congenital long QT syndrome mutations

KCNQ1, KCNE1

verapamil affects cardiac contractility but not skeletal muscle because skeletal muscle has little dependence on ______ influx

extracellular calcium

left atrial enlargement can impinge on _____ presents w/ also called

left recurrent laryngeal nerve hoarseness Ortner syndrome

supine dyspnea relieved by sitting up is indicative of

left sided heart failure

atherosclerosis is initiated by repetitive _______

endothelial cell injury

SLE cardiac manifestations

pericardial inflammation

statins inhibit

HMG CoA reductase

bounding femoral pulses, carotid pulsations, head bobbing =

aortic regurgitation

the ____ is an organ that is not vulnerable to arterial occulsion due to its dual blood supply, the ___ vein and_____ artery

liver portal hepatic

isolated diastolic heart failure shows ____ LVEDP, _____ LVEDV, _____LV EF

increased normal normal

IV agent that increased peripheral vascular resistance, increases systolic BP, decreases pulse pressure, decreases heart rate

phenylephrine: selective alpha 1 adrenergic receptor agonist

QT prolongation, lowest incidence of Torsades, what drug

amiodarone

MMA course deep to _____ and is a branch of the _____ artery. Laceration can lead to ______

pterion maxillary epidural hematoma

paradoxical embolism, atrial left to righ shunt: =

ASD wide a fixed splitting of S2

MI w/ COPD, use cardioselective beta blockers such as

meoprolol, atenolol, bisoprolol, nebivolol

compression in left renal vein can yield ____ can also form

hematuria and flank pain varicocele

main adverse effects of nitrates are

HA and flushing

IV medication that causes arteriolar dilation, improves renal perfusion, and increases natriuresis =

fenoldopam - HTN crisisL D1 receptor agonist

ST elevation in leads II, III, and aVF =

RCA

thickened aortic on CT = due to HTN

aortic dissection

severe aortic regurgitation is compensated by an ___ in total

increase stroke volume

ventricular contraction rate in Afib is determined by

AV node refractory period

skin and mucosal telangiectasia with recurrent severe nosebleeds = inheritence

Osler Weber Rendu syndrome (hereditary hemorrhagic telangiectasia) AD

sharp mid chest pain that increases with deep inspiration and decreases when he sits up = sounds?

acute pericarditis friction rub

normal LV EDP, LV Peak systolic pressure, elevated pulmonary capillary wedge pressure

mitral stenosis

filter to preent further embolization is placed in the

IVC

central abdominal mass that pulsates = characterized by

abdominal aortic aneurysm chronic transmural inflammation

propranolol blocks ___ effects on HR and vasodilation

Epinephrine

Class IC>IA>IB ?

sodium channel binding strength

NE IV drip in vein, becomes white, cold, hard, pale = treated with ____ injection of the affected tissue

NE extravasation phentolamine

TdP polymorphic Vtach is precipitated by

sotalol, quinidine haloperidol macrolides fluoroquinolones

S4 due to _____ or ____

restrictive cardiomyopathy and LVH

palpitations, tachycardia, irregularly irregular rhythm = previous alcohol consumption night before

Afib, no P waves

orthostatic hypotension can be due to ____ blockade

alpha 1 adrenergic

hydralazine, procainamide, isoniazid can induce _____which shows with a rash and very high ____titers

lupus ANA

HCM has a thickened ______ and abnormal systolic anterior motion of ____ leaflet

interventricular septum anterior mitral valve

post op saddle embolism prevneted by

low dose heparin

constipation, AV block, worsening HF due CCB therapy such as (drugs)

diltiazem verapamil

palpitations and PSVT relieved by IV injection of

adenosine

_NS activation of ____ and the _____ system result in an increased afterload and contribute to HF symptoms

SNS JG cells RAA

sterile draping + alcohol based hand scrub prior to beginning procedure would prevent intravascular _____ related infxns

catheter

systemic and pulmonary circulation maintain similar

blood flow per minute

severe aortic stenosis can result in a sudden decrease in _____ and syncope

left ventricular preload

undectable pulse during inspiration + JVP

cardiac tamponade

CHF reulsts in a decrease in ___ output

Cardiac

irreversible myocardial cell injury indicated by mitochondrial _____

vacuolization

blowing, holosystolic murmur heard best over the cardiac apex w/ radiation to the axilla

S aureus in IV drug user + for infective endocarditis is most likely to infect which valve

tricuspid

proximal pulmonary arteries and the ductus arteriosus develop from the ____ aortic arch

6th

increased levels of cGMP (nitrates) lead to _____ dephosphorylation, resulting in vascular smooth muscle relaxation

myosin light chain

niacin causes cutaneous flushing, warmth, itching, due to release of ____

prostaglandins

no murmur at birth but murmur at sternal border present 1 week after is indicatie of a ____ due to a decrease in pulmonary vascular resistance

VSD

difficulty chewing, persistent HA, tenderness over temples

Takaysu or temporal or giant cell arteritis (granulomatous)

myocardial infarction causes a sharp decrease in ____ and no change in venous return acutely

Cardiac output

sensitivity =

a/a+c

Specificty =

d/b+d

true positive =

sensitivity x # of pts w/ disease

truee negative =

1- specificty x # of pts w/disease

most common site of injury to the aorta in a MVA is the ____ because it is immobile and tethered by the ______

aortic isthmus ligamentum arteriosum

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Cardiology U WORLD Questions Flashcards

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