Cardiovascular

Question 1

Embryology: left horn of sinus venosus becomes what

Answer 1

Coronary sinus

Question 2

Patent foramen ovale, embryologic orign

Answer 2

Failure of septum secundum and septum primum to fuse after birth leaving the foramen secundum still patent

Question 3

(Embryology) Endocardial cushions role

Answer 3

Separates atria from ventricles (also forms valves). Becomes part of atrial septation, and membranous portion (not muscular portion) of ventricular septum. This is most common location for VSDs to form

Question 4

Prostaglandins for maintaining a patent ductus arteriosis

Answer 4

PGE1, PGE2. Provided by placenta until separation (birth) which along with increased O2 saturation from lungs causes closure of ductus

Question 5

Ligamentum teres vs ligamentum venosum

Answer 5

Ligamentum teres (in falciform ligament) comes from umbilical vein. Ligamentum venosum derived from ductus venosus (actual shunt to IVC)

Question 6

Opening snap followed by diastolic rumble. Diagnosis? What correlates with disease severity?

Answer 6

Mitral stenosis. Opening snap occurs just after S2 (closing of aortic valve) from increased atrial pressure required to burst open the stiff and stenotic mitral valve leaflets. Decreased interval between S2 and opening snap correlates with increased severity of disease. (idk man, this doesn’t make intuitive sense)

Question 7

Torsades de pointes associated with what metabolic abnormality

Answer 7

Hypokalemia or hypomagnesemia. Idk, how to remember this bro

Question 8

Ramono-Ward Syndrome

Jervell & Lange-Nielsen Syndrome

Answer 8

Both are congenital long QT syndromes from defective K channels. Ramano-Ward is autosomal dominant with pure cardiac phenotype. Jervell & Lange-Nielsen is autosomal recessive with associated sensorineural deafness

Question 9

Brugada syndrome

Answer 9

Autosomal dominant cardiac abnormality (mostly asians). Manifests as right-bundle branch block and sometimes ST elevations. Rx: pacemaker

Question 10

Heart block associated with lyme disease

Answer 10

3rd degree! Ain’t that some shit

Question 11

Action of ANP and BNP on kidney

Answer 11

Promote natriuresis by dilating afferent arteriole and constriction of efferent arterioles promoting natriuresis by increasing GFR

Question 12

Cushing reaction physiology

Answer 12

Triad of HTN, bradycardia, and respiratory depression caused by increased intracranial pressure. CSF pressure builds to above MAP compresses cerebral arterioles -> ischemia -> central activation of sympathetic response -> alpha-adrenergic HTN -> peripheral baroreceptors (aorta) respond -> parasympathetic response -> bradycardia.
Continued compression of brainstem from HTN -> respiratory depression

Question 13

Total anomalous pulmonary venous return (TAPVR) physiology

Answer 13

Pulmonary veins coming back from heart empty into R atrium/SVC. Cardiac output maintained with ASD or PDA allowing for right to left shunting

Question 14

Atrial septal defects embryology

Answer 14

Defect in septum secundum formation is most common (ostium secundum results)

Question 15

Congenital disease syndrome associated with pulmonary artery stenosis

Answer 15

Rubella

Question 16

Infant born to a diabetic mother. What cardiovascular abnormality is most likely

Answer 16

Transposition of great vessels

Question 17

Most common location for atherosclerotic plaques to form

Answer 17

Abdominal aorta > coronary artery

Question 18

Dipyridamole given for pharmacologic cardiac stress test. MOA and physiology of stress test?

Answer 18

Dipyridamole is a PDE inhibitor that causes coronary artery vasodilation. Coronary steal syndrome is physiology behind test. Stenotic arteries are already maximally dilated at baseline

Question 19

Most common causes of acute and subacute bacterial endocarditis

Answer 19

Acute: staph aureus with large vegetations
Subacute: viridans strep with small vegetation, associated with dental procedures

Question 20

Distinguishing bacillary angiomatosis from kaposi sarcoma

Answer 20

Both present in AIDS patients (not that severely immunocompromised though). Bacillary angiomatosis (Bartonella henselae infection) is predominantly neutrophilic infiltrate on biopsy. Kaposi’s (HHV-8) is predominantly lymphocytic infiltrate

Question 21

Polyarteritis nodosa associated with what illness

Answer 21

Hepatitis B in 30% of patients

Medium vessel vasculitis manifesting as renal microaneurysms and GI melena, etc

Question 22

Patient with erosion of nasal septum, hemoptysis, and hematuria with RBC casts. Dx? Lab study to clench Dx?

Answer 22

Granulomatosis with Polyangiitis (Wegners)

c-ANCA positive

Question 23

anti-myeloperoxidase antibodies

Answer 23

Microscopic polyangiitis (p-ANCA = myeloperoxidase)
Pauci-immune glomerulonephritis is characteristic (also seen in Churg-Strauss, eosinophilic granulomatosis with polyangiitis)

Question 24

4 options for anti-hypertensives in pregnant women

Answer 24

Hydralazine, labetalol, methyldopa, nifedipine

Question 25

Non-DHP CCB with greatest effect on heart

Answer 25

Verapamil > Diltiazem

Question 26

Antihypertensive known to cause hyperprolactinemia

Answer 26

Verapamil

Question 27

Two mechanisms of fibrates (gemfibrozil, clofibrate, etc)

Two side effects

Answer 27

1) Stimulate lipoprotein lipase enzyme in endothelial cells resulting in triglyceride clearance (strongest effect)
2) Activate PPAR-alpha to increase HDL synthesis
Side effects: potentiate myopathy with statins, cholesterol gallstones

Question 28

Class I antiarrhythmics effect on ERP

Answer 28

IA: increase effective refractory period (Disopyramide, Quinidine, Procainamide)
IB: decrease effective refractory period (Lidocaine, tocainide, mexiletine)
IC: no effect on ERP (Moricizine, flecainide, propafenone)

Question 29

Class I antiarrhythmic preferentially used in post-MI arrhythmias and digitalis-induced arrhythmias

Answer 29

Class IB

Question 30

Class I antiarrhythmic preferentially used for SVTs (including atrial fibrillation)

Answer 30

Class IC: Moricizine, Flecainide, propafenone

Question 31

Class I antiarrhythmic showing use dependence. Define use dependence

Answer 31

Class IC antiarrhythmics. Become more effective with increased firing i.e. with increased heart rate QRS will actually increase rather than decrease due to larger effect at higher heart rates

Question 32

Overdose of beta-blockers. Rx?

Answer 32

Glucagon, atropine, saline

Question 33

Antiarrhythmic with both class II and class III properties

Answer 33

Sotalol (not esmolol!)