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(***) (U-World) All Subjects > Cardiology U WORLD Questions > Flashcards

Cardiology U WORLD Questions Flashcards

1
Q

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

A

aortic stenosis

Rheumatic heart disease

calcific aortic valve disease

congenital bicuspid valve that calcifies

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2
Q

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

symptoms similar to?

associated w/??

A

Subacute bacterial endocarditis

Strep viridans SBE

Colonic neoplasia (25%)

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3
Q

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

genetic mutation in

leads to

results in

A

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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4
Q

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

A

Thiamine deficiency

Dry is peripheral neuropathy, wet include HF

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5
Q

non nodal conduction

A

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

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6
Q

two categorical variables association test

A

Chi square test for independence

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7
Q

stroke symptoms + afib, normal valves =

most like formed in

treatment

A

thromboembolic event

left atrial appendage

long term anticoagulation

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8
Q

myocardial cells increase in size due to ischemia caused by?

A

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

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9
Q

1st aortic arch

2nd aortic arch

3rd aortic arch

4th aortic arch

5th aortic arch

6th aortic arch

A

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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10
Q

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

sympathetic tone inc

A

dec in Total systemic vascular resistence

inc Caridac output and splanchnic vasoconstriction

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11
Q

NAVEL femoral triangle

A

Nerve, artery, vein, empty space, lymphatics

lateral to medial

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12
Q

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

diastolic HF due to and caused by

LV pressure/volume

A

decompensated congestive heart failure

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

up and to the left

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13
Q

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

A

mitral regurgitation with left sided heart failure

left ventricular afterload

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14
Q

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

A

angina

posterior descending branch of RCA

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15
Q

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

paced by

A

3rd degree heart block

AV node

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16
Q

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

usually originates

Type A refers to?

usually originates

A

Standford Type B dissection

origin of L subclavian A

ascending aorta

sinotubular jxn

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17
Q

ANP secreted by

effects?

accentuated by

A

atrial cardiomyocytes

inc urinary exc. of Na+ and vasodilation

Neprilysin inhibitors (Sacubitril) prevents degradation

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18
Q

Sudden palpitations in young man, carotid sinus massage leads to

A

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

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19
Q

CO =

CO also =

A

SV x HR

rate of O2 consumption / AV O2 content difference

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20
Q

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

A

PDA

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21
Q

synthesis of fibrous cap on athersclerotic plaque caused by

A

Vascular smooth muscle cells

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22
Q

Lungs ant/post to heart?

midclavicular stab wound?

A

anterior

left lung, deep enough apex of LV

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23
Q

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

can produce?

type of shunt

A

ASD

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

L-to-R

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24
Q

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

lung exam

A

cardiac tamponade

normal

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25
Q

most common cause of Mitral Stenosis

characteristics

can cause?

sounds like

A

Rheumatic fever

fibrous thickening and fusion of valve leaflets

atrial enlargement, a fib, mural thrombosis

loud S1, opening snap, mid diastolic murmur

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26
Q

Migratory superficial thrombophlebitis (Trousseau) due to

A

paraneoplastic syndrome of visceral cancer

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27
Q

short stature, short thick neck, broad chest, short metacarpals =

most common congenital cardiac malformation =

sound

at risk for

A

Turner Syndrome

Bicuspid aortic valve

early systolic high frequency click over right 2nd ICS

stenosis, insufficiency, infxn

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28
Q

afib w/ rapid ventricular response treated w/ ____ for rate control

works by

also used in

A

digoxin

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

heart failure

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29
Q

low grade fever, fatique, early distolic murmur at left sternal edge, subungal splinter hemorrhages, elevated ESR

gram stain

synthesize

associated w/

A

endocarditis: Strep viridans

G+ cocci

dextrans from sucrose

dental caries

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30
Q

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

A

idiopathic pulmonary HTN

vascular sm muscle proliferation

BMPR2

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31
Q

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

pathology

A

acute rheumatic fever (untreated grp A Strep) - pancarditis, mitral regurg

interstitial myocardial granuloma (aschoff body)

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32
Q

Sudden death of young adult, usually athletic

biopsy shows

Genetics

A

HCM

myocyte hypertrophy and haphazard arrangemet

AD familial 50%

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33
Q

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

diagnosis

A

carcinoid syndrome

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

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34
Q

acute graft rejection in cardiac transplant

A

dense interstitial lymphocytic infiltrate weeks after transplant: cell mediated

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35
Q

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

A

pericarditis overlying necrotic segment

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36
Q

immigrant, fever, progressive weakness, dyspnea, vegetations on mitral valve =

most likely history of =

predisposing factor

initiating step (strep cultured)

A

infective endocarditis

Rheumatic heart disease

valvular abnormalities (valvular inflammation and scarring)

fibrin deposition

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37
Q

Dobutamine inc =

receptor?

increases?

used for?

A

heart rate and contractility

B1

myocardial oxygen consumption

acute MI w/ acute severe HF

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38
Q

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

A

decompensated heart failure of DCM caused by viral myocarditis

Dilated ventricles w/ abnormal systolic ventricular fxn

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39
Q

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

A

long term beta blockers: carvedilol, metoprolol

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40
Q

sudden death 1 week after after acute MI due to:

actual cause of death

A

free wall rupture of left ventricle (anterior wall MI)

profound hypotension and shock

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41
Q

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

A

aortic coarctation

Turners

Bicuspid aortic valve

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42
Q

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

Embryological mechanism

Squatting does what

A

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

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43
Q

chest pain, diaphoresis, dyspnea, thrombosis, elevated homocysteine in plasma, mutation in THF reductase =

inc risk of?

A

impaired conversion of homocysteine to methionine

Thromboembolic events

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44
Q

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

Mechanism?

A

Clopidogrel (blocks P2Y12 of ADP platelet receptors)

prevents aggregation

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45
Q

vascular endothelium secretes ____ to inhibit platelet aggregation?

what enhances platelet aggregation?

A

prostacyclin (PGI2)

TXA2

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46
Q

number need to treat =

ARR =

A

1/ARR

control rate - experimental rate

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47
Q

common cardinal veins give rise to

A

superior vena cava (know on CT)

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48
Q

AV node located at

A

RA near orifice of coronary sinus, radio ablated in afib

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49
Q

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

A

Na+/Ca++ exchange pump

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50
Q

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

Mechanism

A

vasoconstriction due to pulmonary venous congestion

Pulmonary HTN due to hypertensive heart disease

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51
Q

nitric oxide endothelial vasodilation requires ____

A

arginine, eNOS, cGMP

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52
Q

Flow(Q) =

reduced by factor of __ means?

A

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

divided by

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53
Q

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

A

chronic arteriovenous fistula

increase

increase

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54
Q

chest wound directed posterior adjacent to LSB in 4th ICS would injure

would not injure?

A

RV last (anterior surface of the heart

left lung (no middle lobe)

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55
Q

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?

A

Kawaski disease

medium

coronary artery aneurysms

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56
Q

CHF (dyspnea, orthopnea, JVD, edema) results in ____ CO, _____ renal perfusion, and _____ renin production by JGA cells

substance higher in pulmonary vein than pulmonary artery

A

decreased

decreased

increased

Angiotensin II

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57
Q

flank pain, hematuria, wedge shaped kidney infarct =

due to

A

thrombotic renal infarction

Afib

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58
Q

primary collagen in MI scars is

A

type I found in tendons

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59
Q

aorta and LV pressure dont match up =

peak of murmur intensity =

A

aortic stenosis

ventricle pressure

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60
Q

amiodarone, sotalol, dofetilide

work on downslope pahse ___

A

Class II antiarrhythmics: block K+ channels

3 of cardiac cycle

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61
Q

Free wall rupture occurs ____

A

5-14 days after acute MI

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62
Q

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

due to

A

aortic stenosis

calcific degen of trileaflet aortic valve (developed nations)

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63
Q

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

A

coronary sinus

AV groove

posterior

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64
Q

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

sounds like

A

PDA

continuous machine like murmur

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65
Q

ANP, BNP, and sildenafil (PDEI) all use

A

cGMP

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66
Q

depression, HTN, obtunded, hypotensive, bradycardic, IV glucagon admin and she improves =

treatment of choice

pathophys

A

beta blocker overdose

glucagon

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

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67
Q

lightning storm, dead, most likely cause of death

A

fatal arrhythmia

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68
Q

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

pigment name

A

lipid peroxidation

lipofuscin (wear and tear of aging)

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69
Q

flail posterior mitral valve leaflet

leads to ___left atrial pressure, ______ LV EDV (preload), and _____ afterload

A

acute mitral regurg due to chordae tendinae rupture

increased, increased, decreased

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70
Q

drug resistant hypertension, shrunken kidney due to?

A

oxygen and nutrient deprivation from unilateral renal artery stenosis

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71
Q

spironolactone, eplerenone =

spare?

improve?

should not be used with (2)

A

MC receptor antagonists: CHF

K+

ventricle remodeling and LV EF

hyperK or RF

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72
Q

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

A

slow growth of occluding plaque

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73
Q

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

A

lymphangiosarcoma

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74
Q

chronic cough and angioedema due to

A

ACEI family (prils)

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75
Q

highest athersclerotic burden is on the ____ and ____ arteries

A

abdominal aorta

coronary

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76
Q

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

procedures in past month

A

enterococcus (normal UG flora)

cystoscopy

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77
Q

Statin MOA

Results in?

A

block HMG CoA

increase in hepatocyte LDLR density

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78
Q

post endocarditis, holosystoli murmur that increases during inspiration

A

Tricuspid regurg, 2nd and 3rd ICS Left

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79
Q

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

A

exercise

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80
Q

amlodipine, felodipine, nifedipine

location of action

effects

verapil effects?

Dilitazem effects?

A

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

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81
Q

Vancomycin binds to

resistance via

A

D alanyl D alanine

D Lactate substitute D alanine

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82
Q

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

eliminates

A

double blind

observer bias

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83
Q

increase in blood O2 saturation from right atria to right ventricle indicates

Most commonly

sounds like

A

left to right shunt

VSD

holosystolic murmur over L Sternal border

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84
Q

most heavily involved vessel in athersclerosis

A

abdominal aorta

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85
Q

sudden onset vision loss, left sided neck bruit =

pathway

A

embolus

ICA, ophthalmic artery, retinal artery

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86
Q

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

A

left circumflex artery

right coronary artery

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87
Q

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

A

NO

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88
Q

fastest to slowest cardiac tissue conduction velocity

A

PAVA

Purkinje, atrial, ventricular, AV

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89
Q

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

A

normal aging heart

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90
Q

cyanotic newborn, elevated serum lactate, machine murmur between scapulae, aorta anterior, inferior, and right of pulmonary artery =

failure of

must have ____ to survive

A

Transposition of great vessels

spiraling

PDA, patent foramen ovale, or septal defect

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91
Q

rapid bacterial endocarditis, rigors, high fever, IV drug use =

can cause ____ sided endocarditis w/ ______ into the lungs

A

S aureus

right

septic embolization

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92
Q

combined use of __________ and ______ can lead to

A

verapamil, dilitiazem

atenolol

bradycardia and hypotension

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93
Q

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

A

aortic dissection: intimal tearing

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94
Q

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

follows

A

costochondritis

repetitive activity

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95
Q

Rapid surge of serum CK due to

A

cell membrane damage from ischemia

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96
Q

nitroglycerin mainly affects

A

large veins

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97
Q

viridans infx, pre existing valvular lesion, adhere via

A

fibrin-platelet aggreagates

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98
Q

low frequency S3 over apex in older =

A

left ventricular failure and inc LV EDV

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99
Q

long history of HTN, S4 due to

A

inc stiffness of LV wall

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100
Q

measure for assessing the degree of mitral stenosis

A

A2 split to opening snap time interval, shorter is worse

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101
Q

Natriuretic peptides effects (3)

metabolized by??

drug??

A

inc GFR

dec Prox. Na+ resorb

dec renin secretion

neprilysin metalloprotease

neprilysin inhibitor

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102
Q

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

path?

Signs

A

constrictive pericarditis

thick fibrous rigid pericardium

Inc JVP, on inspiration (usually drops), pulsus paradoxus, pericardial knock

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103
Q

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

A

venous

dec

dec

incr

dec

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104
Q

the best indicator of severity of MR is ____ sound

Murmur associated w/ MR?

A

S3 gallop

holosystolic best heart at apex of heart, radiates to axilla

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105
Q

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

A

right brachiocephalic vein obstruction

apical lung tumor or thrombotic occlusion (catheter placement)

unilateral arm swelling only

bilateral swelling

unilateral face swelling only

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106
Q

IVC formed by union of

A

R and L common iliac veins

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107
Q

recurrent episodes of paroxysmal afib, usually treated w/

A

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

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108
Q

cardiac tamponade due to pericardial fluid accumulation can result in ______ in pulse amplitude during _______

called?

also seen in?

A

decrease

inspiration

pulsus paradoxus (>10mmHg)

constrictive pericarditis

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109
Q

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

A

MVP, connective tissue disorder

increases

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110
Q

common side effects of statins include _____ and _____ toxicity

Labs needed before initiation of therapy?

A

muscle and liver

hepatic transaminases

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111
Q

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

A

HTN emergency

tyramine

MOAI

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112
Q

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

A

B1 receptors on cardiac myocytes and JGA cells (renal)

decreased

no effect

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113
Q

recurrent paroxysmal SVT in healthy individual manifests as _______

ECG finding?

A

WPW syndrome

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

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114
Q

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

A

minimal change

early coagulation, wavy fibers

coagulation necrosis

neutrophil infiltrate

macrophage infiltrate

granulation tissue and neovascularization

collagen deposition and scar

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115
Q

vague feeling of heaviness in legs, standing for long periods =

physical finding

complication

very rare complication

A

venous stasis

varicose veins

skin ulcerations

pulmonary embolism

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116
Q

Paroxysmal SVT (nodal arrhythmia) treated w/ ____

2 drugs in this class

block what type of channel

A

class IV antiarrhythmics

verapamil, diltiazem

L type Calcium channels

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117
Q

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

due to =

A

Down syndrome

meiotic nondysjxn

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118
Q

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

A

posterior descending

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119
Q

deep chest pain exacerbated on exertion or emotional stress relieved w/ nitroglycerin =

due to _____% blockage of lumen of a coronary artery

A

stable angina

> 75%

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120
Q

cryptogenic stroke in young adult, +bubble study =

A

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

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121
Q

old, isolated systolic HTN and HA due

A

aortic stiffening

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122
Q

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

A

increase

VSD

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123
Q

immigrant, gray pharynx, cervical LAD, soft palate paralysis =

mechanism of exotoxin

risk of

A

Corynebacterium diphtheriae

diphtheria toxin, intracellular ribosylation EF2

myocarditis

124
Q

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

looks like

A

retroperitoneal

ecchymosis surrounding puncture site

125
Q

antiarrhythmic agent bids to rapidly depolarizing ischemic ventricular myocardial fibers =

drug of choice?

effect on normal ventricular myocardium

A

lidocaine

no Amiodarone

minimal

126
Q

QT prolongation syndrome also called

A

Romano-ward

Jervell and Lange Nielson

127
Q

adenosine______ phase 4 in cardiac pacemaker cells by ______ K conductance

A

prolongs

increasing

128
Q

posterior surface of the heart is the _____atrium

enlargement from _____ can lead to cardiovascular ________ from pressure on esophagus

A

left

mitral stenosis/regurg from RHD

dysphagia

129
Q

bicuspid aortic valve predispose to early

A

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

130
Q

compare the means of 2 groups of subjects with

A

two sample T test

131
Q

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

A

increase

132
Q

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

A

ACEI

133
Q

coffee ground emesis, tachycardia, cool extremeties =

first intervention =

increases?

A

hypovolemic shock

saline infusion rapid

end diastolic sarcomere length due to increase preload

134
Q

familial hypercholesteremia in heterozygotes

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

A

AD, high LDL, premature athersclerosis

mutated

135
Q

first peak on JVP tracing is

second, small peak is

steep decline is

3rd peak is

3rd decline is

A

RA contraction

tricuspid bulge on RV contraction

RA relax

inflow venous blood

passive RA emptying after Tricuspid open

136
Q

thickened and calcified ring on CT around heart is =

slowly progressive dyspnea, peripheral edema, ascites

A

constrictive pericarditis

some clinical symptoms

137
Q

early diastolic murmur at LSB

at RSB in developed countries

can be due to

A

Aortic regurg

aortic root dilation

aortic root dilation or bicuspid aortic valve

138
Q

WPW due to

young, palpitations, light headed, rapid heart beats

A

accessory pathway bypasses AV node

139
Q

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?

A

complete AV canal defect

Down syndrome tri 21

140
Q

HTN crisis and hyperplastic arteriosclerosis in renal arteries looks like

A

onion like concentric thickening of arteriolar walls

141
Q

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

path

A

thromboangiitis obliterans (Buergers)

segmental hypersensitivity vasculitis into veins and nerves

142
Q

progressive fatigue, splinter hemorrhages on nails due to =

cause

sound associated

A

microemboli

infective endocarditis

regurgitant murmur

143
Q

thigh and leg pain, hypercoagulable, weak dorsalis pedis pulse =

drug that acts as arterial vasodilator and inhibits platelet agg?

mechanism

should also recieve

A

peripheral artery disease

cilstazol

PDEI

aspirin or clopidogrel (antiplatelet)

144
Q

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

defined as

A

lipid filled intimal plaque

claudication

145
Q

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

most likely from

A

pulmonary embolism

DVT

146
Q

sudden cardiac death in young athlete most likely due to

A

HCM

147
Q

lightheaded while buttoning tight shirt collar, pass out, low pulse, HTN, DM =

due to stimulation of _____ in carotid sinus

afferent limb?

efferent limb?

A

carotid sinus hypersensitivity

baroreceptors

CN9

CN10

148
Q

dystrophic calcification of aortic valve preceded by

A

damaged or necrotic tissue

149
Q

very high concentrations of NE, still no effect on BP

drug?

mechanism?

A

irreversible inhibitor

phenoxybenzamine

alpha 1 and 2 adrenergic antagonist

150
Q

statins, muscle pain, fatigue, dark urine =

metabolized by?

precipitated by

A

stain induced myopathy

CYP450 3A4

macrolides (mycins)

151
Q

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

medications to avoid?

A

HCM

vasodilators, diuretics

152
Q

sublingual nitroglycerin in stable angina = ______ in LV EDV

A

decrease

153
Q

nontender lesions on foot or palms in infective endocarditis =

painful nodules on finger tips and toes in endcarditis =

A

vascular microemboli (Janeway lesions)

immune complex Osler nodes

154
Q

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

A

funny sodium channels

slowing

contractility

155
Q

side effects of ACEI =

use _____ instead

A

cough, angioedema

ARB, sartans

156
Q

adverse effects of thiazide diuretics

A

hypoNa, K

HyperCa, glycemia, cholesterolemia, uricemia

157
Q

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

A

Beta blocker

AV

elongation

158
Q

mitral valve replacement, fever, baceremia w/ catalase positive, coagulase neg g+ cocci in clusters

adhere w/ ?

assumed to be _____ resistant, so treat w/

A

nosocomial coagulase negative staph

polysaccharide slime

methacillin resistant

vancomycin

159
Q

nonbacterial platelet rich thrombi characteristic of ______

due to______

A

nonbacterial thrombotic endocarditis

advanced malignancy

160
Q

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

due to _______

A

aortic, pulmonic

valvular calfication

161
Q

medial branch off of external iliac artery is

lateral branch is

A

inferior epigastric

deep circumflex iliac artery

162
Q

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

receptors

A

isoproterenol

B1 and 2

163
Q

pregnant, hypotension while supine =

due to =

A

supine hypotension syndrome

compression of IVC and reduced venous return

164
Q

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

A

alpha 1 selective adrenergic agonists

vagal

decrease

AV

165
Q

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

A

compressed

reduction

166
Q

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 _________

A

Sydenham chorea

acute rheumatic fever

basal ganglia

valvular heart disease

167
Q

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

A

acute decompensated HF

168
Q

fatigue, progressive dyspnea, orthopnea, S3, recent MI =

third heart sound best heard when listening at

A

decompensated heart failure

end expiration in Lateral recumbent left side

169
Q

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

A

decreased, increased

170
Q

normal bleeding time indicates______

normal activated partial thromboplastin time indicates ______

prolonged Prothrombin time in setting of normal aPTT indicates _____ such as _____

A

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

171
Q

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

A

medication noncompliance

172
Q

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

A

earliest

macrophages

173
Q

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

A

Beta adrenergic agonists, clenbuterol

relaxing bronchial smooth muscle

inc cAMP in smooth muscle cells

174
Q

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

A

degree of right ventricular outflow tract obstruction

175
Q

doxorubicin forAML can cause

presents w/

A

DCM

exertional dyspnea and orthopnea

176
Q

varicose veins result from chronically elevated venous pressure and ____

A

incompetent venous valves

177
Q

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

A

SLE

178
Q

polyarteritis nodosa (PAN) affects ______ but spares _____

fever, weight loss, myalgias, abdominal pain, high blood pressure

A

kidneys, heart, liver, GI tract

pulmonary arteries

179
Q

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

A

right middle

right atrium

180
Q

MAAM COCO

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

A

Mitral valve close

Aortic Valve open

Aortic Valve close

Mitral valve open

181
Q

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

A

B1 and weak B2

Gs GPCR

increases

increases

182
Q

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

A

autosomal dominant

beta myosin heavy chain

myosin binding protein C

183
Q

cough, chronic HTN, hemosiderin laden macrophages =

A

left sided heart failure

184
Q

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

A

first pass metabolism

185
Q

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

A

1C

flecainide (Na+)

186
Q

pregnancy induced DVT, best anticogulant is

A

LMWH, such as enoxaparin

187
Q

occasional dizzyness while moving UE, retrograde flow in left vertebral artery =

results from _________ of proximal subclavian artery

A

subclavian steal syndrome

severe stenosis

188
Q

reliable

valid

A

how many times can you hit the bullseye

can you hit the bullseye

189
Q

most coronary venous blood drains through

A

coronary sinus

190
Q

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

A

liver angiosarcoma: PECAM1

191
Q

PDA remains open due to

sounds like

closes w/

A

PGE2

continous machine murmur

indomethacin or ibuprofen

192
Q

aspirin is associated w/ _____ injury and bleeding

A

GI mucosal

193
Q

newborn benign vascular lesion, cutaneous strawberry type =

most likely will

A

juvenile hemangioma

first inc in size then regress

194
Q

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

A

Prinzmetal angia (variant)

coronary vasospams

dihydroergotamine, migraines

smoking, cocaine, meth, triptans

amlodipine, Ca++ channel blocker that vasodilates

195
Q

descending thoracic aorta lies ____to the esophagus and the left atrium

A

posterior

196
Q

sudden cardiac death post MI most commonly due to

A

Vfib

197
Q

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

A

spironolactone and eplerenone

late distal tubule and CCD

aldosterone

198
Q

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

Path?

A

atrial myxoma

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

199
Q

aortic regurg murmur most loudly heard after _____

A

aortic valve closure

200
Q

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

A

volume depletion

diuretic use

heart failure

201
Q

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

A

tolerance

202
Q

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

A

aortic aneurysms

203
Q

an abnormally prominent left atrial “v” wave during cardiac cath is a finding of

presents w/

A

mitral regurg

exertional dyspnea and orthopnea

204
Q

smokers over the age of 35 are contraindicated for

A

OCPs

205
Q

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

A

left

206
Q

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

A

dilators - arterial

steal syndrome

207
Q

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

in developing nations?

A

regurgitant MVP

RHD

208
Q

maintenance dose =

half life =

loading dose=

A

(desired steady state concentration x clearance) converted to hours

Volume distribution x 0.7/clearance

Volume distribution x Cpss/bioavailability fraction

209
Q

ACEI induced angioedema is due to

A

bradykinin accumulation

210
Q

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

A

increase

decrease

no change

211
Q

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

A

PDE3 inhibitor

increases

dilation

increases

212
Q

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

due to

A

AR

widening of pulse pressure

213
Q

warfarin monitored w/

unfractionated heparin monitored w/

A

PT or INR

aPTT

214
Q

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

completely reversible by

A

Hibernating myocardium

coronary revascularization

215
Q

nitrates are contraindicated for 24hrs w/

due to

A

PDEI

cGMP accumulation

216
Q

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

A

renal insufficiency

K+ sparing diuretics

amiloride, triamterene, spironolactone

217
Q

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

A

fibrates

gemfibrozil

218
Q

most common adverse effect of alteplase post MI is

A

intracerebral hemorrhage

219
Q

long standing HTN heart changes

LA

LV mass

LV wall thickness

A

enlarged

increased

increased

220
Q

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

A

IA: quinidine, procainamide, disopyramide
intermediate
prolong

IB: lidocaine, mexiletine
weak
shorten

IC: flecainide, propafenone
strong
no change

221
Q

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

A

increase

decrease

222
Q

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

supplied by

A

lateral aspect of left ventricle

Left circumflex artery

223
Q

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

A

gemfibrozil, fenofibrate

PPAR-alpha

VLDL production

224
Q

Normal pressure in SVC and RA

RV

Pulmonary artery

A

1-6mmHg

15-30mmHg

6-12mmHg

225
Q

great saphenous graft accessed just ____ to the _____

A

inferolateral

pubic tubercle

226
Q

marfanoid habitus is associated w/

A

aortic disease and dissections

227
Q

leads II, II, aVF correspond to

supplied by

hemodynamic findings

A

inferior wall infaraction

RCA

dec CO, pulmonary capillary wedge pressure, inc central venous pressure

228
Q

ST elevation and subsequent Q wave formation

result of

A

transmural myocardial infarction

fully obstructive thrombus

229
Q

at 20minutes post ischemia, myocardium will

at 30 minutes damage is

A

stop contracting

irreversible

230
Q

_______ provide major proliferative stimuli for cellular components of atherosclerotic plaque

provide (mediator)

macrophages promote ______ migration

A

platelets

PDGF

smooth muscle

231
Q

Digoxins initial cellular event is to _____ sodium ion efflux

A

decrease

232
Q

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

A

permissive

catecholamines

233
Q

DCM heart failure is due to

A

decreased ventricular contraction force

234
Q

high interplaque activity of _____ results in MI

A

metalloproteinases

235
Q

HCM murmur sounds like

decreased intesnity by

increased intensity by

A

harsh crescendo decrescendo at apex due to LVOT obstruction

passive leg raise, phenylephrine, squatting, sustained hand grip

sudden standing

236
Q

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

A

hydralazine, minoxidil

sympathetic

RAA

sodium and fluid

237
Q

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

A

digoxin toxicity

238
Q

pulmonary artery catheters pressure reading most likley corresponds to pressure in

A

let atrium

239
Q

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

A

amiodarone, sotalol, dofetilide

K+

240
Q

old, progressive exertional dyspnea, edema, ascites, elevated JVP, prominent S4, left atrial enlargement, LVH, normal ejection fraction =

due to =

major causes

acellular pink material =

A

diastolic heart fialure

restrictive cardiomyopathy

amyloidosis, sarcoidosis, hemochormatosis

amyloid

241
Q

straining during urination, HTN, which drug

mechanism

used for

A

Doxazosin

alpha 1 blocker

BPH

242
Q

metnal status change, seizure, prolonged QRS, hallucinations, depression, arrhythmias, anticholinergic findings =

drug used to treat cardiac toxicity

A

TCA toxicity

sodium bicarbonate

243
Q

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

A

Beta

inhibits

244
Q

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

receptor

A

dopamine

D1

245
Q

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

A

coarctation of the aorta

246
Q

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

A

increased tissue lymphatic drainage

247
Q

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

A

SVC

248
Q

nitroprusside dec both ____ and ____

A

preload

afterload

249
Q

Congenital long QT syndrome mutations

A

KCNQ1, KCNE1

250
Q

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

A

extracellular calcium

251
Q

left atrial enlargement can impinge on _____

presents w/

also called

A

left recurrent laryngeal nerve

hoarseness

Ortner syndrome

252
Q

supine dyspnea relieved by sitting up is indicative of

A

left sided heart failure

253
Q

atherosclerosis is initiated by repetitive _______

A

endothelial cell injury

254
Q

SLE cardiac manifestations

A

pericardial inflammation

255
Q

statins inhibit

A

HMG CoA reductase

256
Q

bounding femoral pulses, carotid pulsations, head bobbing =

A

aortic regurgitation

257
Q

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

A

liver

portal

hepatic

258
Q

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

A

increased

normal

normal

259
Q

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

A

phenylephrine: selective alpha 1 adrenergic receptor agonist

260
Q

QT prolongation, lowest incidence of Torsades, what drug

A

amiodarone

261
Q

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

A

pterion

maxillary

epidural hematoma

262
Q

paradoxical embolism, atrial left to righ shunt: =

A

ASD wide a fixed splitting of S2

263
Q

MI w/ COPD, use cardioselective beta blockers such as

A

meoprolol, atenolol, bisoprolol, nebivolol

264
Q

compression in left renal vein can yield ____

can also form

A

hematuria and flank pain

varicocele

265
Q

main adverse effects of nitrates are

A

HA and flushing

266
Q

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

A

fenoldopam - HTN crisisL D1 receptor agonist

267
Q

ST elevation in leads II, III, and aVF =

A

RCA

268
Q

thickened aortic on CT =

due to HTN

A

aortic dissection

269
Q

severe aortic regurgitation is compensated by an ___ in total

A

increase

stroke volume

270
Q

ventricular contraction rate in Afib is determined by

A

AV node refractory period

271
Q

skin and mucosal telangiectasia with recurrent severe nosebleeds =

inheritence

A

Osler Weber Rendu syndrome (hereditary hemorrhagic telangiectasia)

AD

272
Q

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

sounds?

A

acute pericarditis

friction rub

273
Q

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

A

mitral stenosis

274
Q

filter to preent further embolization is placed in the

A

IVC

275
Q

central abdominal mass that pulsates =

characterized by

A

abdominal aortic aneurysm

chronic transmural inflammation

276
Q

propranolol blocks ___ effects on HR and vasodilation

A

Epinephrine

277
Q

Class IC>IA>IB ?

A

sodium channel binding strength

278
Q

NE IV drip in vein, becomes white, cold, hard, pale =

treated with ____ injection of the affected tissue

A

NE extravasation

phentolamine

279
Q

TdP polymorphic Vtach is precipitated by

A

sotalol, quinidine

haloperidol

macrolides

fluoroquinolones

280
Q

S4 due to _____ or ____

A

restrictive cardiomyopathy and LVH

281
Q

palpitations, tachycardia, irregularly irregular rhythm =

previous alcohol consumption night before

A

Afib, no P waves

282
Q

orthostatic hypotension can be due to ____ blockade

A

alpha 1 adrenergic

283
Q

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

A

lupus

ANA

284
Q

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

A

interventricular septum

anterior mitral valve

285
Q

post op saddle embolism prevneted by

A

low dose heparin

286
Q

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

A

diltiazem

verapamil

287
Q

palpitations and PSVT relieved by IV injection of

A

adenosine

288
Q

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

A

SNS

JG cells

RAA

289
Q

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

A

catheter

290
Q

systemic and pulmonary circulation maintain similar

A

blood flow per minute

291
Q

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

A

left ventricular preload

292
Q

undectable pulse during inspiration + JVP

A

cardiac tamponade

293
Q

CHF reulsts in a decrease in ___ output

A

Cardiac

294
Q

irreversible myocardial cell injury indicated by mitochondrial _____

A

vacuolization

295
Q

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

A

MR

296
Q

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

A

tricuspid

297
Q

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

A

6th

298
Q

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

A

myosin light chain

299
Q

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

A

prostaglandins

300
Q

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

A

VSD

301
Q

difficulty chewing, persistent HA, tenderness over temples

A

Takaysu or temporal or giant cell arteritis (granulomatous)

302
Q

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

A

Cardiac output

303
Q

sensitivity =

A

a/a+c

304
Q

Specificty =

A

d/b+d

305
Q

true positive =

A

sensitivity x # of pts w/ disease

306
Q

truee negative =

A

1- specificty x # of pts w/disease

307
Q

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

A

aortic isthmus

ligamentum arteriosum

(***) (U-World) All Subjects (20 decks)

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