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Uworld Journal > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Failure to thrive + respiratory distress + machine-like murmur + palpable thrill over L infraclavicular border

A

Patent Ductus Arteriosus

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2
Q

Two main causes of cyanosis at birth

A

Transposition of the great arteries

Tetralogy of Fallot

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3
Q

Definition: Permissiveness

A

When one hormone allows another to exert its maximal effect.

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4
Q

First step in the pathogenesis of Coronary Artery Atherosclerosis?

A

Endothelial cell injury

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5
Q

Main difference - Skeletal muscle vs Cardiac/Smooth muscle

A

Skeletal muscle does not require external calcium for contraction. Cardiac and Smooth muscle undergo calcium-induced calcium release.

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6
Q

Mid-systolic click in murmur?

A

Mitral valve prolapse

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7
Q

Holosystolic murmur? (2)

A
  • Mitral/Tricuspid regurgitation

- Ventral Septal Defect

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8
Q

Bounding femoral and carotid pulses + head bobbing + murmur

A

Aortic regurgitation

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9
Q

Congenital cardiac defect(s) associated with diabetic mothers (1)

A

Transposition of great vessels

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10
Q

Congenital cardiac defect(s) associated with Marfan Syndrome (4)

A
  • Mitral Valve Prolapse
  • Thoracic aortic aneurysm
  • Thoracic aortic dissection
  • Aortic regurgitation
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11
Q

Congenital cardiac defect(s) associated with Turner Syndrome (2)

A
  • Aortic coarctation

- Bicuspid aortic valve

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12
Q

Congenital cardiac defect(s) associated with DiGeorge Syndrome (3)

A
  • Tetralogy of Fallot
  • Interrupted aortic arch
  • Truncus arteriosus
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13
Q

Congenital cardiac defect(s) associated with Freidrich ataxia (1)

A

Hypertrophic cardiomyopathy

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14
Q

Congenital cardiac defect(s) associated with Fetal Alcohol Syndrome (4)

A
  • Ventral Septal Defect
  • Atrial Septal Defect
  • Patent Ductus Arteriosus
  • Tetralogy of Fallot
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15
Q

Cells involved in producing atheromas?

A

Endothelial cells
Leukocytes
Vascular smooth muscle cells

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16
Q

Types of vegetations found in subacute endocarditis?

A

Fibrin + platelets (thrombotic vegetations)

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17
Q

Flat facies, epicanthal folds, oblique palpebral fissures, single palmar crease, endocardial cushion defect =

A

Down syndrome (trisomy 21 via chromosomal nondisjunction)

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18
Q

Mechanism of diphtheria AB exotoxin

A

Active subunit A transfers a ribose from NAD onto histadine on Elongaton Factor 2. The ribosylation of EF-2 inhibits protein synthesis.

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19
Q

Myofibrillar dysarrray on light microscopy

A

Hypertrophic Cardiomyopathy

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20
Q

Lipofuscin - definition, where it is found

A

Product of lipid peroxidation, yellow-brown pigment. Accumulates in aging cells (heart, liver).

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21
Q

What parameter is most similar between the systemic and pulmonary circuits?

A

Blood flow per minute

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22
Q

Fracture of the pterion results in laceration of _ and formation of _ hematoma?

A
  • Middle meningial artery

- Epidural hematoma

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23
Q

Wide fixed splitting of S2 is caused by?

A

Atrial Septal Defect

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24
Q

The significant increase in blood oxygen saturation between two right sided vessels/chambers indicates =

A

L->R shunt (most likely a VSD)

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25
Q

Pericardial friction rub 3 days after an acute MI is caused by =

A

fibrinous pericarditis as a reaction to transmural necrosis

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26
Q

Pericardial friction rub several weeks after an acute MI is caused by =

A

fibrinous pericarditis caused by an autoimmune reaction against the pericardium

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27
Q

10 yo + clubbing + cyanosis in toes only + exertional dyspnea and fatigue + no regular checkups + equal extremity pulses + no murmur =

A

Large PDA

differential cyanosis

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28
Q

Where is O2 extraction the highest?

A

Myocardium

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29
Q

63 yo male + progressive exertional dyspnea + orthopnea + hypertension + elevated JVP + pitting edema

Is his Ang II level elevated or decreased?

A

Ang II will be elevated

CHF -> decreased CO -> decreased RBF -> (+) JG apparatus -> renin -> Ang II + Aldo + ADH -> aberrant salt and fluid retention and vasoconstriction -> elevated BP

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30
Q

Right sided varicocele indicates occlusion of _

A

IVC - usually due to a renal malignancy that has spread to the right renal vein and then thrombosed into the IVC

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31
Q

Which holosystolic murmur increases intensity upon inspiration =

A

increases VR to the right heart

-Tricuspid regurgitation

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32
Q

Which murmur increases intensity on standing or doing a valsalva maneuver?

A

decreases VR

  • Hypertrophic cardiomyopathy
  • Mitral valve prolapse
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33
Q

Which murmur increases intensity on squatting ?

A

increases VR

-Aortic stenosis

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34
Q

Which murmur increases intensity on hand grip?

A

increases afterload

  • Aortic regurgitation
  • Mitral regurgitation
  • VSD
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35
Q

2 most susceptible locations for atherosclerotic disease

A
  • Lower abodminal aorta

- Coronary arteries

36
Q

Traumatic aortic rupture from a MVA affects where on the aorta?

A

aortic isthmus - it is held by the ligamentum arteriosum and therefore is relatively immobile

37
Q

Hypotension + elevated JVD + diminished heart sounds + no pulse on inspiration =

A

Cardiac tamponade

Beck’s triad = hypotension + distended neck veins + distant heart sounds

no pulse on inspiration = Pulsus paradoxus

38
Q

Cardiac sinus massage mechanism =

A

Increased firing of carotid sinus -> increased afferent (IX) firing -> medulla -> increased efferent (X) firing -> parasympathetic stimulation to the heart -> decreased AV node conduction -> terminates tachycardia

39
Q

Ebstein’s anomaly

A

ASD + no tricuspid valve

seen in lithium teratogenicity

40
Q

beta-blocker effect on ECG =

A

slow AV conduction + prolongs AV nodal delay -> prolongs PR interval

41
Q

Mechanism of ventricular free wall rupture leading to sudden death

A

rupture -> hemopericardium -> cardiac tamponade -> hypotension + shock -> pulseless activity -> death

42
Q

earliest microscopic change seen in ischemic stroke in the brain =

in the heart =

A

@12 hours - red neurons

@4 hours - wavy myofibrils

43
Q

JVP waveform:

  • a wave =
  • c wave =
  • x descent =
  • v wave =
  • y descent =
A
  • a wave = Atrial contraction
  • c wave = RV contraction, tricuspid valve bulges into the atrium
  • x descent = atrial relaXation
  • v wave = atrial pressure increases as there is filling against a closed tricuspid valve
  • y descent = RA emptying into RV
44
Q

S4 or S3 in children - normal or pathological

A

S4 in children - always pathological

S3 in children - normal

45
Q

ECG with delta wave + widened QRS + shortened PR interval =

A

Wolff-Parkinson White syndrome - ventricular pre-excitation syndrome, bypasses the rate-slowing AV node

46
Q

Cherry hemangioma - population? progression?

A
  • benign
  • capillary hemangioma of the elderly
  • does not regress
47
Q

Strawberry hemangioma - population? progression?

A
  • benin
  • capillary hemagioma of infancy
  • grows rapidly and then regresses spontaneously by 5-8 yo
48
Q

Differences (1) and Similarities (4) between Temporal arteritis and Takayasu arteritis

A

Differences =
-location
Temporal arteritis - temporal artery
Takayasu arteritis - aortic arch + proximal great vessels

Similarities =

  • large vessel vasculitis
  • increased ESR
  • granulomatous inflammation
  • treatment - corticosteroids
49
Q

“immune complex deposition-mediated transmural inflammationn of the arterial wall with fibrinoid necrosis” - what type of vasculitis?

A

Polyarteritis nodosa

50
Q

“segmental thrombosing vasculitis of medium sized arteries” - what type of vasculitis?

A

Buerger disease. Also known as: thromboangiitis obliterans.

51
Q

Biventricular pacemakers put leads to pace 3 locations

A
  • RA
  • RV
  • RA -> coronary sinus (atrioventricular groove) -> lateral venous tributary -> LV
52
Q

Thick band of atrial muscle that separates the smooth sinus venosus from the Right atrial appendage and atrium proper + site of origin of atrial pectinate muscle =

A

Crista terminalis

53
Q

L/R atrial appendage =

A

Small sac-like structure in the atria that is susceptible to thrombus formation

54
Q

Migratory thrombophlebitis indicates =

A

Visceral cancer (adenocarcinoma of the pancreas, colon or lung)

Trousseau syndrome - paraneoplastic hypercoagulability

55
Q

Most common cause of death post-common femoral artery catheterization =

A

Retroperitoneal hemorrhage -> shock

56
Q
  • Painful thromboses
  • Stasis dermatitis
  • Skin ulceration
  • Poor wound healing
  • Superficial infections

These are complications of _

A

varicose veins

57
Q

MI involving the RCA resulting in damage to the inferior wall may present as

A

Abdominal discomfort

58
Q

Deep, broad Q waves on ECG indicates

A

prior/old MI

59
Q

ANP - What triggers its release? What does it do?

A

Released when: increased atrial pressure, increased blood volume in heart

Actions: vasodilation, decreased sodium reabsorbed at the CD

60
Q

Anemia causes increased or decreased CO?

A

Increased CO due to the reduced O2 carrying capacity of RBCs, more blood needs to be shunted past tissues to ensure appropriate oxygen delivery

61
Q

2 vessels used for bypass surgery:

A
  • Internal mammary artery

- Saphenous vein

62
Q

Systolic murmurs and Diastolic murmurs

A

Systolic: AS, MR, TR, MVP, VSD

Diastolic: AR, MS

63
Q

AV shunt hemodynamic changes (preload, afterload, SV)

A
  • Because the AV shunt moves from the arteral system straight to the venous system, blood flow is much faster and at a higher volume returning to the heart -> increased preload
  • Becauses the AV shunt bypasses the arterioles, there is a decrease in TPR -> decreased afterload
  • Increased preload + Decreased afterload = Increased SV
64
Q

Ortner Syndrome =

A

Mitral stenosis -> LA dilation -> impinges on the L recurrent laryngeal nerve -> hoarseness

65
Q

Murmurs that decrease on squatting (2)

A
  • Hypertrophic cardiomyopathy

- Mitral valve prolapse (mid-systolic click is closer to S1)

66
Q

Buerger disease treatment =

A

Smoking cessation

67
Q

Serious complication of Kawasaki disease =

A

Coronary artery aneurysm

68
Q

Penetrating injury at the left sternal border at 4th and 2nd intercostal spaces:

A

@4th intercostal space (T4) = RV

@2nd intercostal space (T2) = pulmonary trunk

69
Q

Dyslipidemia: associated with obesity and insulin resistance and increased VLDL in circulation

A

Type IV - familial hypertriglyceridemia

  • Hepatic overproduction of VLDL
  • AD
70
Q

Dyslipidemia: premature peripheral vascular disease + tuberoeruptive and palmar xanthomas

A

Type III - familial dysbetalipoproteinemia

-Defective ApoE -> increased chylomicrons and VLDL remnants in circulation

71
Q

Dyslipidemia: tendon xanthomas + xanthelasmas + corneal arcus

A

Type II - familial hypercholesterolemia

  • AD
  • Defective LDL receptor -> increased LDL and cholesterol in circulation
  • Also presents with premature CAD in the family - MI before age of 20
72
Q

Dyslipidemia: creamy supernatant + acute pancreatitis + eruptive skin xanthomas + AR

A

Type I - familial chylomicronemia

-Defective LPL -> increased in chylomicrons in circulation

73
Q

“Polymorphic QRS complexes that change in amplitude and cycle length”

A

Torsades de Pointes

Always will have a prolonged QT as well - distinguishes TdP from other polymorphic ventricular tachycardias

74
Q

Cardiac tissue conduction speeds

A

(Fastest) Purkinje > Atria > Ventricles > AV node (Slowest)

Park At Venture Avenue

75
Q

Phenomenon where blood flow is diverted away from ischemic areas due to vasodilator action in nonischemic areas

A

Coronary steal syndrome - leads to hypoperfusion and worsening of existing ischemia

Concept used during stress testing to identify cardiac “lesions”

76
Q

1 week old boy with an uncomplicated pregnancy and birth now has a harsh holosystolic murmur heard at the L mid to lower sternal border. His exam prior to leaving the hospital after birth had no cardiac findings. What is this new murmur?

A
  • Small VSD - no symptoms/cyanosis, audible around age 4-10 days when PVR lowers enough to allow a L->R shunt
  • Small VSDs close spontaneously

-A large VSD would have presented with failure to thrive right away and requires surgical intervention

77
Q

Leukocytoclastic vasculitis

A

Microscopic polyangitis - segmental fibrinoid necrosis of small vessels

78
Q

Portal vein = _ + _

A

Superior mesenteric vein + Splenic vein

79
Q

Bicuspid aortic valve predisposes to an increased risk for developing _

A

premature aortic stenosis (~50 yo)

Normal aging stenosis of the aortic valve becomes symptomatic ~65 yo

80
Q

Irregularly irregular rhythm - describe P waves, QRS, and R-R

A
  • Absent P waves
  • Narrow QRS
  • Varying R-R interval
81
Q

Nitrates cause increase/decrease in HR?

A

The hypotension caused by venodilation results in reflex tachycardia (increased HR)

82
Q

Where is the great saphenous vein accessed to use in grafting?

A

inferolateral to the pubic tubercule

  • travels up the leg medially
  • the small saphenous vein is lateral
83
Q

Middle meningial artery comes off of _ artery

A

External carotid -> maxillary artery -> middle meningial artery

84
Q

pathology of an AAA

A

Chronic transmural inflammation of the aortic wall -> degradation of elastin and collagen -> wall weakening -> aneurysm

85
Q

pathology of intermittent claudication

A

atheroscloerosis (lipid filled intimal plaque)

86
Q

polyarteritis nodosa spares what arteries?

A

pulmonary arteries

Uworld Journal (12 decks)

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