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USMLE S1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

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USMLE® Step 1 flashcards
1
Q

what are the conduction velocities of cardiac tissues?

(relative to each other, not absolute)

A

FAST - purkinje fibres > atrial muscle > ventricular muscle > AV node - SLOW

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2
Q

kawasaki disease Rx

A

aspirin and IVIG

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3
Q

what is the mechanism and antedote of TCA toxicity?

A

binds to and blocks inward Na+ channels

also antimuscarinic, alpha-adrenoceptor and histamine receptors

Rx = sodium bicarb, more Na+ for competitive inhibition and alkalinisation of serum ionizes the TCA, stopping its binding to the target channel

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4
Q

by 4 weeks gestation, what has been established in the primitive heart?

A

beating of the primative heart tube

L/R polarity

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5
Q

2 causes of pulsus paradoxus

A
  1. pericardial disease (effusion or constrictive pericarditis) 2. COPD/asthma
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6
Q

what is the distinguishing sign of digoxin toxicity?

A

yellow vision

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7
Q

ST elevation in V5-6

A

anteriolateral, distal LAD or LCx

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8
Q

kawasaki disease major complication

A

coronary artery aneurysm and rupture thrombosis and MI

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9
Q

what branch of the coronary circulation supplies the inferior surface of the heart?

what part of the heart is the inferior surface?

A

posterior descending/interventricular artery

2/3 is post wall of left ventricle, 1/3 is post. wall of right ventricle

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10
Q

how does flow mediated dilatation occur?

A

increased flow, increases shear stress on endothelium

opens shear-activated K+ channels, hyperpolarisation

K+-gates Ca++ channels open, Ca++ increases within the cell

Ca++-dependent activation of eNOS, NO generation

vasodilatation

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11
Q

what are the class IB antiarrythmics?

A

Lidocaine and mexiletine

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12
Q

function of ductus arteriosus

A

shunts blood from the pulmonary trunk to the descending aorta due to high pulmonary arterial resistance

mixing of very oxygenated with very deoxygenated blood gives PaO2 of 30 mmHg to foetus which is adequate

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13
Q

harsh systolic crescendo-decrescendo murmur heard best at the lower left sternal border

A

HOCM

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14
Q

WG blood finding

A

positive cANCA - levels correlate with disease activity

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15
Q

what is the mechanism and adverse effect of nitroprusside?

A

short acting direct NO release causing increased cGMP

cyanide toxicity

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16
Q

what channel does dihydropyridine calcium blockers target?

A

L-type voltage gated Ca++ channels

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17
Q

apart from holosystolic MR murmur, which is the best aucultatory finding indicating severity of disease?

A

S3 gallop - reflects degree of left ventricular volume overload.

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18
Q

How long can myocardial ischaemia continue before damage is irreversible?

A

30 mins

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19
Q

following MI, what histological changes are apparent between 1 - 5 days? (2)

A

contraction band necrosis neutrophil infiltrate

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20
Q

what percentage of medium size artery must be stenosed to yield end-organ complication?

A

70%

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21
Q

tuncus arteriosus gives rise to

A

ascending aorta and pulmonary trunk

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22
Q

2 most common causes of aortic dissection

A
  1. HTN (older)
  2. connective tissue disorder (Marfan & ED, younger)
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23
Q

only organ spared by polyarteritis nodosa

A

lung

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24
Q

which drugs help close and maintain ductus arteriosus?

A

close - indomethacin

maintian - PGE1 and PGE2

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25
Q

3 complicaton of thoracic aneurysm

A
  1. aortic regurgitation 2. thrombosis/embolism 3. compression of mediastinal structures
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26
Q

define type B aortic dissection

A

aortic dissection exclusively involving the thoracic aorta

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27
Q

equation for EF

LVEF becomes symptomatic at?

A

(EDV-ESV)/EDV

‘what has been ejected’/’what was in there to begin with’

around 40% LVEF begin to experience symptoms

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28
Q

what is the reaction catalysed by eNOS?

A

Arginine + O2 –> NO + citrulline

increased cytosolic Ca++ activates eNOS; NO activates guanylyl cyclase to make cGMP

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29
Q

What process produces an S3 heart sound?

A

S3 occurs early in diastole as blood flows against a stiffened left ventricle

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30
Q

clinical features of HOCM (3)

A
  1. decreased CO (LV cannot fill in diastole) 2. sudden death due to ventricular arrhythmia (young athlete, sudden death) 3. syncope with exercise
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31
Q

mutation in what protein gives rise to hypertrophic cardiomyopathy? mode of inheritance?

A

sarcomere autosomal dominant

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32
Q

TCA Rx

A

as soon as confirmed elevated ESR start IV corticosteroids to prevent blindness

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33
Q

what cell types provides the major proliferative stimulus for cellular component of atheroma?

what does this activate?

A

platelets - PDGF and TGF-beta

SMC migration from media to intima and proliferation, interstitial collagen production

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34
Q

blood in umbilical vein has PO2 of?

A

30 mmHg

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35
Q

what is the electrocardial adverse effect of type IA antiarrythmics?

A

prolonged QT, torsades de points

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36
Q

in traumatic deceleration injury, what part of the aorta is likely to dissect/rupture?

A

aortic isthimus, where the aorta is held stationary by the ligamentus arteriosus

just after the left sebclavian artery leaves at the top of the descending aorta

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37
Q

in which portion of the developing heart is a VSD most likely to occur?

A

membranous intraventricular septum

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38
Q

hyaline arterioloscelrosis - aetiology (2)

A

benign HTN diabetes (non-enzymatic glycosylation)

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39
Q

what are the class IA antiarrythmics?

A

quinidine, procainamide, disopyramide

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40
Q

following MI, what histological changes are apparent between 4 - 12 hours? (4)

A

early coagulation necrosis oedema haemorrhage wavy fibers

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41
Q

congenital RFs for cerebral aneurysm (4)

A
  1. coarctation of aorta 2. PCKD 3. connective tissue disorder (Elhers-Danlos) 4. AV malformation
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42
Q

what is supplied by LCX?

A

lateral and posterior walls of left ventricle

papillary muscle

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43
Q

primitive ventricle gives rise to

A

trabeculated part of left and right ventricles

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44
Q

kawasaki disease main vessel involvement

A

coronary artery

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45
Q

what is a co-dominant circulation?

A

posterior descending/interventricular artery arrises from both the RCA and the LCX

7%

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46
Q

how does hydralazine work?

A

increase cGMP leading to smooth muscle relaxation

preferential vasodilatory action on arterioles > veins, reduces afterload

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47
Q

Brugada syndrome

  • inheritance
  • EKG findings
  • protein affected
  • major complication
  • Rx
A
  • AD
  • psuedo-RBBB & ST segment elevation in V1-3.
  • myocardial sodium channelopathy
  • sudden cardiac death from ventricular tachyarrhythmia
  • implantable cardiac defib
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48
Q

Acute Rheumatic fever symptoms JONES

A

J - joint arthritis O - ‘heart’ = pancarditis N - nodules E - erythema marginatum S - Sydenham’s chorea

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49
Q

most common causative organism for bacterial endocarditis

A

strep viridans

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50
Q

TCA epidemiology

A

old adults (>50 y/o) females

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51
Q

complications of aortic stenosis (3)

A
  1. concentric left ventricular hypertrophy 2. angina and syncope with exercise 3. haemolytic anaemia (schistocytes)
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52
Q

in lung histology, haemosiderin laden macrophages reflect what underlying process?

A

left heart failure increase pulmonary capillary pressure compromise of blood-gas barrier and extravasation of erythrocytes phagocytosis by resident alverolar macrophages and conversion to haemosiderin

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53
Q

is anteriolateral or posteriomedial papillary muscle rupture more likely? why?

A

posteriomedial - receives only blood from the posterior descending/interventricular artery

anteriolateral papillary muscles have dual blood supply from LAD and LCx

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54
Q

how can you best heard S3 and why?

A

at end expiration in the left lateral decubitus position

reduces lung volume and brings the left heart closest to the chest wall. Also increases pulmonary venous return to heart by closing small vessels in the lung

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55
Q

which ion channel is only responsible for the rate of action potential firing from pacemaker cells?

i.e. no inotropic or lusitropic effect

what drug can be used to target this?

A

funny sodium channels

more open - slower refractory period, more closed - longer refractory period

refractory period ==> length of diastole

ivabradine

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56
Q

what are the steps in the pathogenesis of infective endocarditis? (4)

A
  1. disruption of normal endocardial surface
  2. fibrin deposition and nidus formation
  3. microoganisms colonise the nidus, further coagulation
  4. macroscopic vegiation formation from RBCs, neutrophils, platelets and microorganisms
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57
Q

ST elevation in V3-4

A

distal LAD

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58
Q

what are the side effects of amiodarone?

A

pulmonary fibrosis

blue/grey skin deposits

hepatotoxicity

hypo-/hyper-thyroidism (amIODarone)

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59
Q

in Tet of Falot, what is the factor determining symptom severity?

A

degree of pulmonary artery outflow obstruction

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60
Q

TCA is associated with another condition?

A

polymyalgia rheumatica - proximal myalgia and weakness

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61
Q

difference between acute and sub acute bacterial endocarditis?

A

acute - staph aureus, large vegitations that destroy the valve subacute - smaller vegitations that do not destroy the valve

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62
Q

Ortner syndrome

A

mitral stenosis causing dilation of the left atrium and subsequent impingement on the left recurrent laryngeal nerve, resulting in hoarsness

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63
Q

hyaline arterioloscelrosis - complication

A

glomerular scarring –> CKD shrunken kidney

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64
Q

what structure of the primitive heart is defective in Tet of Fallot?

A

infundibular septum, part of conal septum

due to failure of migration of neural crest cells

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65
Q

4 complication of atherosclerosis

A
  1. stenosis 2. thrombosis 3. embolism 4. aneurysm
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66
Q

layers of arterial wall inside to out - major component of each

A

intima - endothelium media - smooth muscle adventitia - connective tissue

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67
Q

CK-MB is useful in what setting? why?

A

reinfarction Troponin I remains elevated after first MI, whereas CK-MB is cleared within 72 hours (versus 7 - 10 days)

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68
Q

what is the coronary steal phenomenon? what drugs cause it?

A

paradoxically, in MI coronary vasodilators divert blood to the low resistance vessels, reducing collateral arteriolar flow to the myocardium distal to any blockage.

dipyridamole, adenosine

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69
Q

3 groups of patients that get Kaposi sarcoma

A
  1. older, eastern European male - tumour localised to skin 2. transplant patient 3. AIDS
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70
Q

what is milrinione and when is it used?

A

PDE3 inhibitor allowing cAMP accumulation in tissues

vasculature = vasodilation

heart = positive inotropy and chronotropy

use in decompensated HF short-term

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71
Q

pathology - HTN causing aortic dissection

A

vasa vasorum deliver oxygen to media/adventitia of large veseel HTN induces hyaline arteriolosclerosis in VV VV become stenotic weakening of aorta SM wall

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72
Q

which organisms cause endocarditis with negative blood cultures? (5)

A

HACEK haemophilus actinobacillus cardiobacterium Eikenella Kingella

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73
Q

immediate management of TOGA in newborn?

A

identify the other malformation that allows mixing of blood and maintain it

TOGA is incompatible with life without PFO, PDA etc.

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74
Q

postnatal derivatives:

ductus arteriosus

A

ligamentum arteriosum

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75
Q

what are the pressures of the heart?

RA, RV, PA, LA, LV, root of aorta

A

RA <5

RV 25/5

PA 25/10

LA <10

LV 120/10

aortic root 120/80

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76
Q

when is Mg++ useful as an antiarrhythmic?

A

torsades de points and digoxin toxicity

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77
Q

Tet of Fallot typical ausculatation findings?

A

harsh, systolic ejection murmur over mid-to-left sternal border

RVOT obstruction

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78
Q

5 causes of restrictive cardiomyopathy

A
  1. amyloidosis 2. sarcoidosis 3. haemochromatosis 4. endocardial fibroelastosis 5. Loeffler syndrome
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79
Q

inspiratory splitting of S2

A

patent ductus arteriosus

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80
Q

complication of MI in 1st day (3)

A
  1. cardiogenic shock 2. congestive heart failure 3. arrhythmia (most common)
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81
Q

major mechanism of GTN

A

VENOUS dilatation, decrease preload to heart, decrease oxygen requirement

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82
Q

what vessels do the fourth aortic arch contribute to?

A

true aortic arch and subclavian arteries

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83
Q

complication of MI in 1st month (3)

A

aneurysm, mural thrombus, Dressler syndrome (AI pericarditis 6-8 week following infarction)

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84
Q

primitive atrium gives rise to

A

trabeculated part of left and right atria

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85
Q

what does phentolamine do?

A

non-specific alpha 1/2 blocker with no beta blocker effect

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86
Q

what Ca channel blocker do you use in hypertensive emergeny?

A

nicardipine, clevidipine

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87
Q

primitive pulmonary vein gives rise to

A

smooth part of left atrium

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88
Q

Churg-Strauss histopath

A

necrotizing granuloma (c/o microsocpic polyangiitis) eosinophils (assoc Asthma)

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89
Q

following MI, what histological changes are apparent between 12 - 24 hours? (2)

A

coagulation necrosis contraction band necrosis

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90
Q

describe the process of septation of the atria in 7 steps

A
  1. septum primum, foramen primum
  2. foramen secundum
  3. septrum secundum
  4. foramen ovale
  5. septum primum expands
  6. fusion of septa secundum (rostral) and primum (caudal)
  7. closure of FO with increasing LA pressure at birth
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91
Q

what antiarrythmic drug gives luminous phenomena/visual brightness as adverse effect?

A

ivabridine

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92
Q

major risk factor for Buerger disease

A

smoking

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93
Q

in the setting of AF, where in the heart are clots likely to form?

A

left atrial appendage

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94
Q

what is Ebstein’s anomaly?

A

downward displacement of the tricuspid valve allowing regurgitant flow from RV to RA and right heart failure

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95
Q

aetiology of S3 (3)

A
  1. athletic left atrium pushing blood against healthy left ventricle 2. low ventricular compliance 3. high end-diastolic LV volume (overfilled)
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96
Q

what are the two vessels that can supply the SAN?

A

right coronary (60%)

left circumflex (40%)

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97
Q

ARF - histo features of myocarditis (4)

A

Ashoff bodies - foci of chronic inflammation - containing: Anitschkow cells - histiocytes with long, slender nuclei (caterpillar)

Giant cells

fibrinoid material

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98
Q

blowing, loud, holosystolic murmur at left mid sternal border

A

small VSD audible at days 4 - 10 of life

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99
Q

what is the effect of adenosine on the heart?

A

prolongs phase 4 of cardiac action potential by activating A1 receptor, reducing the rate of action potentials and lengthening diastole

A1 receptor activates outward K+ channels and blocks inward Ca++ channels

slows sinus rate and increases AV nodal conduction delay - used in pSVT to terminate tachyarrhythmia

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100
Q

borders of the femoral triangle

A

superior - inguinal ligament

lateral - sartorius

medial - adductor longus

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101
Q

where does the thoracic duct entre the thorax?

A

through diaphragm at T12 through aortic hiatus

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102
Q

what is the mechanism of ivabridine?

when do you use it?

A

slows funny Na+ current, negative chronotropy without inotropic effect

reduces cardiac O2 consumption

chronic stable angina in people who do not tolerate beta-blockers

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103
Q

ST depression in V1-3 with tall R waves

A

posterior, so opposite changes to electrical activity in anterior leads

posterior descending/interventrical artery

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104
Q

blood supply to the retina starting from the common carotid..

A

common carotid, internal carotid, opthalmic, retnal (within the optic nerve)

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105
Q

how do you treat hypertension in pregnancy? (not pre-eclampsia)

A

hydralazine, methyldopa, labetolol, nifedipine

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106
Q

micoscopis polyangiitis blood finding

A

pANCA

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107
Q

what is the main electolyte disturbance with digoxin toxicity?

A

hyperkalaemia

108
Q

what is supplied by the posterior descending/interventricular artery? (4)

A

AV node

posterior 1/3rd interventricular septum

posterior walls of ventricles

posterior papillary muscles

109
Q

postnatal derivatives:

ductus venosus

A

ligamentum venosum

110
Q

constipation and heart block/AV node supression suggests what class of drug?

A

non-DHPR blockers - diltiazem and verapamil

111
Q

what is the equation of Fick principle?

A

cardiac output = Rate of oxygen consumption/ateriovenous oxygen content difference

112
Q

when used with a statin, which other lipid lowering agent increases the risk of rhabomyolysis/CK increase?

A

niacin or fibrates

esp gemfibrozil - which impairs the hepatic clearance of statins

113
Q

how quickly following myocardial ischaemia does contraction stop?

A

60 seconds

114
Q

what is monday disease?

A

industrial exposure to nitrates, tolerance during the week

loss of tolerance over the weekend, return on Monday

features: dizziness, tachycardia, headache

115
Q

key lab finding in TCA

A

Elevated ESR (>100)

116
Q

What is lipofuscin? organs? what patients?

A

yellow-brown, granular perinuclear pigment lipid polymers and protein-phospholipid complex seen in heart and liver of aging/cachectic/malnourished patients

117
Q

what is nimodipine used for?

A

cerebral vasospasm prophylaxis in SAH

118
Q

what happens to the foetal circulation on first breath?

A
  1. negative intrathoracic pressure, decrease pulmonary arterial resistance
  2. increase in LA:RA pressure ratio, closure of FO
  3. increase PaO2 and reduction in circulating maternal prostaglands (separation of placenta)
  4. closure of ductus arteriosus
119
Q

which are the partial beta-agonists?

A

pindolol and acebutolol

120
Q

bulbus cordis gives rise to

A

outflow tracts of left and right ventricles

121
Q

how does fendolopam work?

A

D1 agonist - coronary/peripheral/renal vasodialiton

drop in BP and increase natriuresis

122
Q

what enzyme catalyses the primary breakdown pathway for natriuretic peptides?

what type of enyzme is this?

A

Neprilysin

Metalloprotease

.. inhibition of this would lead to increased BNP/ANP, which are opposers of RAAS and is beneficial in the setting of heart failure unresponsive to ACE inhibitors/ARB

123
Q

postnatal derivatives:

notochord

A

nucleus pulposus

124
Q

which type of Ca++ channel blockers result in constipation and hyperPRL?

A

NDHPR blockers - diltiazem/verapamil

125
Q

ST elevation in V1/2

A

proximal LAD

126
Q

which vessel does atherosclerosis most commonly affect?

A

abdominal aorta

127
Q

mechanism of action of clopidogrel, pasugrel, ticlopidine

A

P2Y12 ADP-receptor inhibitor that stops the expression of GpIIb/IIIa

128
Q

what is the clinical use of type 1B antiarrythmics?

A

preventing post MI tachyarrythmia or digitalis-induced arrythmia

129
Q

what nerve innervates the pericardium?

A

phrenic nerve, pain referred to shoulder

130
Q

what medication alters the effect of adenosine?

A

caffiene and theophylline

adenosine receptor antagonists

131
Q

which vessels involved in large-vessel vasculitis?

A

aorta and major branches

132
Q

which valvular disorder increases risk of infective endocarditis?

A

mitral valve prolapse

133
Q

hyperplastic arteriolosclerosis - aetiology

A

malignant HTN

134
Q

Takayasu vessels

A

aortic arch at the point of the branching vessels

135
Q

Chrug-Strauss blood results

A

pANCA

136
Q

a varicocele is a dilatation of what blood vessels?

A

pampiniform plexus

usually from compression/stasis of left spermatic/gonadal vein

137
Q

middle meningeal artery is a branch of what atery?

A

maxillary, which is a terminal branch of external carotid

138
Q

phosphorylation of myosin light chain give what response in vessels?

A

contraction

NO –> cGMP –> MLC phosphatase –> dephosphorylation –> relaxation

139
Q

what are the side effects of quinidine?

A

chinchonism - headache/tinnitus

140
Q

PDA best heard where?

A

left infraclavicular area

141
Q

GDM assoication with which congential cardiac malformations?

A
  1. VSD 2. truncus arteriosus
142
Q

what are the contraindications of class IC antiarrythmics?

A

post MI or structural heart disease

only used for pSVTs (including AF)

143
Q

what nerve is associated with 1st pharyngeal arch?

A

trigeminal (V)

144
Q

Takayasu Rx

A

corticosteroids

145
Q

Jervell and Lange-Nielsen syndrome 2 features protein affected? major complication

A

bilateral sensorineural hearing loss, congenital long QT voltage-gates K+ channel ventricular arrhythmia (TdP or VFib)

146
Q

blood supply of SA and AVN

A

right coronary artery

147
Q

which organism is associated with endocarditis in patients wtih underlying colorectal carcinoma?

A

strep bovis

148
Q

what is the mechanism of adenosine as antiarrhythmic?

A

increases extracellular K+, hyperpolarising the cell

decreases intracelluar Ca++, decreases AV node conduction

short half life = 15 sec

149
Q

TCA vessels and associated symptoms (2 arteries, 3 symptoms)

A

temporal (headache) opthalmic (visual disturbance/blindness) jaw claudication

150
Q

split S2 that does not change with inhalation

A

atrial septal defect with left to right shunting

151
Q

polyarteritis nodosa Rx

A

corticosteroids and cyclophosphamide fatal if not treated

152
Q

Churg-Strauss site affected

A

lung and heart

153
Q

3 abnormalitis of the heart associated with failure of the neural crest cell migration

A
  1. TOGA
  2. Tetralogy of Fallot
  3. Truncus arteriosus
154
Q

what is phenoxybenzamine and when it is used?

A

irreversible competitive inhibitor at alpha 1 and 2 receptors

used mainly for phaeochromocytoma

155
Q

Raising the threshold potential of cardiac myocytes is the mechanism of action for what class of antiarrhythmic drugs?

A

type I (sodium channel blockers)

156
Q

what structures does the thoracic duct drain?

A

lymph from whole left sie of body

all regions inferior to umbilicus

entire GI tract

157
Q

what nerve is associated with the 2nd pharyngeal arch?

A

facial (VII)

158
Q

what proportion of people have a right dominant circulation?

A

85%

159
Q

treatment of MI

A

MONA BASH morphine oxygen nitrates aspirin beta-blocker, ACE inhibitor, statin, heparin

160
Q

2 causes of RAS

A
  1. atherosclerosis 2. fibromuscular dysplasia (young female)
161
Q

3 conditions underlying nonbacterial thrombotic endocarditis

A
  1. APL syndrome, SLE (Leibman-Sacks) 2. adenocarcinoma of viceral organs (mucin/cytokine production) 3. DIC in sepsis
162
Q

RFs for spontaneous intracranial haemorrhage (3)

A
  1. cerebral aneurysm 2. arteriovenous malformation 3. sympathomimetic drug abuse (cocaine)
163
Q

what is the difference in vasodilation between hydralazine and nitrates?

A

hydralazine - arterioles > veins (decrease afterload)

nitrates - veins >> arterioles (increase afterload)

164
Q

polyarteritis nodosa histopath findings (3)

A

transmural inflammation resulting in aneurysm

whole vessel wall fibrinoid necrosis

‘string of pearls’ appearance of resulting fibrotic nodules

165
Q

which type of calcium channel blocker affects the heart? which the vasculature?

A

dihydropiridine = vascular smooth muscle

non-dihydropyridine (diltiazem, verapamil) = heart

166
Q

doxorubicin causes what cardiomyopathy?

A

dilated cardiomyopathy

167
Q

Nonmodifiable RFs for atherosclerosis (3)

A

Age - older Sex - male Genetics - FHx

168
Q

what nerve is associated with the 6th pharygeal arch?

A

recurrent laryngeal branch of vagus (X)

169
Q

macroscopic changes to the aging heart 4

A
  1. decreased LV cavity size
  2. sigmoid septum
  3. decreased base to apex length
  4. increased intersitial connective tissue/myocardial atrophy
170
Q

what is the order of sodium channel binding strength for class 1 antiarrhythmics?

A

1C > 1A > 1B

the stronger binding strength, slower the drug comes off the channel when bound.
so 1C shows greatest use-dependence, as they accumulate best over multiple cardiac cycles

171
Q

following MI, what histological changes are apparent between 2 weeks and 2 months? (1)

A

scar formation/collagen deposit

172
Q

1 major RF for TAA

A

tertiary syphilis - endarteritis of aortic vasa vasorum

173
Q

what is the LVEDP, LVEDV and LVEF in isolated diastolic HF?

Examples of diastolic HF?

A

increased, normal, normal

HOCM, hypertrophy 2ary to hypertension, amyloidosis, stiff ventricular wall 2ary to MI scarring

174
Q

what are the class III antiarrythmics?

(4)

A

K+ channel blockers

amiodarone, ibutilide, dofetilide, sotalol (AIDS)

175
Q

what vessels do the sixth aortic arch contribute to?

A

pulmonary arteries and ductus arteriosus

176
Q

great saphenous vein runs on what aspect of the leg and where does it end?

A

medial aspect

acess: proximal anterior aspect of thigh, 3-4 cm inferolateral to pubic tubercle

joins the femoral vien at the femoral triangle

177
Q

endocardial cushion gives rise to (3)

A
  1. atrial septum
  2. membranous intraventricular septum
  3. AV and semilunar valves
178
Q

Romano-Ward syndrome clinical features protein affected major complication

A

only long QT syndrome - no sensorineural hearing loss c/o Jervell and Lange-Nielsen syndrome voltage-dependent K+ channel in myocardium sudden cardiac death from ventricular arrhythmia

179
Q

Buerger disease clinical features

A

ulceration/gangene autoamputation of fingers and toes

180
Q

most common cardiac malformation with Down syndrome?

A

complete atrioventricular canal defect - ostium primum ASD - VSD - single atrioventricular valve

181
Q

HSP histopath (1)

A

IgA immune complex deposition

182
Q

HSP clinical findings (3 signs, 1 history)

A
  • palpable purpura on buttocks and legs
  • GI pain/bleeding
  • IgA nephropathy (haematuria)

history - URTI

183
Q

mechanism of AT-II (2)

A

direct contraction of alveolar smooth muscle

promoting secretion of adrenal aldosterone -> Na resorbtion in DCT

184
Q

microscopic poylangiits sites affected

A

lung and kidney c/o WG - no nasopharynx

185
Q

what does the third aortic arch give rise to?

A

common carotids

proximal internal carotids

186
Q

what is the mechanism of niacin flushing side effects?

A

prostaglandin mediated

can administer aspirin 30-60 mins before to reduce s/e’s

187
Q

polyarteritis nodosa serology

A

Hep B surface antigen (HbSAg)

188
Q

2 major RFs for aoritc regurgitation

A
  1. aortic root dilitation (so murmur best heard on right sternal border instead) 2. bicuspid aortic valve
189
Q

Takayasu arteritis epidemiolody

A

adult <50 y/o - young asian female

190
Q

what embryonic structures give rise to the superior vena cava?

A

right common cardinal vein and right anterior cardinal vein

191
Q

when platelets bind vWF from the basement membrane (adhesion), what factors are release and what are their function? (3)

A
  1. Ca2+ to promote coagulation cascade
  2. ADP - activates P2Y12 receptor to stimulate externalisation of GpIIb/IIIa
  3. TXA2 - platelet aggregation
192
Q

Buerger disease Rx

A

smoking cessation

193
Q

what is supplied by the right marginal artery

A

right ventricle

194
Q

2 blood tests confirming group A beta-haemolytic Strep infection

A

positive ASO or anti-DNase B titre

195
Q

function of ductus venosus?

A

shunts oxygenated blood from umbilical vein to IVC, bypassing the hepatic criculation

196
Q

what do you usually give with hydralazine? why?

A

beta-blocker - prevent reflex tachycardia

197
Q

following MI, what histological changes are apparent in the myocardium between 0 - 4 hours? (1)

A

minimal change

198
Q

How do type IV antiarrhythmic drugs work?

examples? indication?

A

inhibition of slow T-type inward Ca++ channels at pacemaker cells

Verapamil, diltiazem

recurrent nodal tachyarrhythmias (pSVT etc..)

199
Q

postnatal derivatives:

umbilical arteries

A

medial umbilical ligaments

200
Q

function of the foramen ovale?

A

allows passage of blood from RA to LA, allowing most oxygenated blood in foetal circulation to bypass the lungs and be delivered to head and body

201
Q

complication of MI 1st week (4)

A

fibrinous pericarditis (neutrophils) rupture of ventricular free wall, tamponade rupture of intraventricular septum, left to right shunt cordae tendinae rupture, mitral insufficiency

202
Q

what nerve is associated with the 3rd pharyngeal arch?

A

glossopharyngeal (IX)

203
Q

2 types of arteriolosclerosis

A
  1. hyaline 2. hypertrophic
204
Q

HSP Rx

A

usually self limited treat with steroids if very severe

205
Q

location and supply of SA node

A

at the junction of the SVC and RA

supplied by right coronary artery

206
Q

after 2 weeks of statin therapy what is a common complication?

A

myalgia, rhabdomyolysis and myoglobinuria

207
Q

why is there right atrial collapse in cardiac tamponade?

A

rostral displacement of pericardial fluid as the right ventricle expands, putting inward pressure at the top of the heart that collapses the atrium

208
Q

what smooth muscle relaxant causes compensatory tachycardia and fluid retention?

A

hydralazine

209
Q

location and supply of the AV node?

A

right atrium near the septal cusp of the trisuspid valve/orifice of cornonary sinus

supplied by posterior descending/interventricular artery

210
Q

right horn of the sinus venosus gives rise to

A

smooth part of right atrium (sinus venarum)

211
Q

1 major RF for AAA

A

atherosclerosis - oxygen diffusion barrier

212
Q

into what structure does the thoracic duct drain?

A

left subclavian vein, near its junction with internal jugular vein

213
Q

histologic findings in HOCM

A

myofiber hypertrophy with disarray

214
Q

modifiable RFs for atherosclerosis (4)

A

HTN, smoking, DM, hypercholesterolaemia

215
Q

what are the four classes of antiarrythmics?

A

1 - sodium channel block

2 - beta-blocker

3 - potassium channel block

4 - calcium channel block

216
Q

2 non-CVS syptoms of left atrial enlargement?

A

dysphagia (compression of distal oesophagus)

hoarsness (compression of left RLN)

217
Q

postnatal derivatives:

umbilical vein

A

ligamentum teres hepaticus (round ligament)

contained within the falciform ligament

218
Q

complications of fibrinolysis (2) at a tissue level (i.e. NOT haemorrhagic stroke etc)

A
  1. contraction band necrosis (Ca return to tissue) 2. reperfusion injury (oxygen forming free radicals)
219
Q

what is the ristocetin test? if +ve what is the differential diagnosis?

A

Ristocetin - promotes platelet adhesion by binding vWF to GpIb

if ristocetin does not promote platelet plug formation then either vWF or GpIb are missing

this is von Willebrand disease and Bernard-Soulier syndrome

220
Q

RAS major distinct findings (2)

A
  1. increased plasma Renin 2. unilateral renal atrophy
221
Q

an uncorrected ASD leads to…

A

increased blood flow through the pulmonary artery tunica media hypertrophy increase RV afterload right heart hypertrophy Eisenmenger syndrome

222
Q

intimal hyperplasia and fibrosis, medial hypertrophy and formation of capillary tufts refers to which pathology? epidemiology?

A

pulmonary arterial hypertension women, 20 - 40

223
Q

Libman-Sacks define, association, complication

A

sterile endocarditis due to vegitations association with SLE

vegitations arise in mitral valve, leading to mitral regurg

224
Q

temporal artery biopsy findings (4)

A

inflamed vessel wall giant cells present intimal fibrosis granulomatous vasculitis

225
Q

postnatal derivatives:

allantois (urachus)

A

median umbilical ligament

226
Q

WG histology (vessel wall) (3)

A

large necrotizing granuloma adjacent necrotizing vasculitis giant cells & epithelioid histiocytes (hallmark of granuloma)

227
Q

left horn of sinus venosus gives rise to

A

coronary sinus

228
Q

what chemicals are released in the coronary vessels during exercise to promote adequate blood supply?

A

nitric oxide and adenosine

229
Q

which are the cardioselective beta blockers?

A

selective for beta 1 - metoprolol, atenolol, bisoprolol, nebivolol

230
Q

what are 3 effects of ANP/BNP physiologically?

A
  1. stop Renin production
  2. efferent arteriolar vasoconstriction, increasing GFR
  3. natriuresis, decreasing circulating volume
231
Q

what is a right-dominant circulation?

A

posterior descenting/interventricular artery arises from the right coronary artery

85%

232
Q

what does vWF bind to?

A

subendothelial collagen and platelet GpIb (adhesion)

233
Q

what are 4 determinants of myocardial oxygen consumption?

A

EDV, BP, HR, contractility

234
Q

define type A aortic dissection

A

any aortic dissection involving the ascending aorta

235
Q

ST elevation in II, III and aVF

A

inferior, RCA

236
Q

Prinzmetal pattern of angina

A

episodic chest pain unrelated to exercise

237
Q

what is the antedote for digoxin?

A

slowly correcting K+, Mg++, anti-digoxin Fab fragments

238
Q

what is a left-dominant circulation?

A

posterior descending/interventricular artery arises from left circumflex artery

8%

239
Q

explain subclavian steal syndrome

A

significant stenosis of left subclavian artery proximal to bifurcation of left vertebral artery

poor LVA pressure

diversion of flow from contralateral vertebral artery at level of basilar artery, ‘steal’

retrograde flow down LVA, vestibulobasilar insufficiency = dizziness, vertigo, drop attacks

240
Q

what are the three main neurohormonal mechanisms activated during congestive heart failure?

A
  1. sympathetic autonomic nervous system
  2. RAAS
  3. ADH
241
Q

migratory throbophlebitis is associated with which condition?

A

visceral adenocarcinoma (pancreas, colon and lung) secretion of thromboplastin-like substance causing hypercoagulability

242
Q

WG symptoms

A

nasopharynx = sinusitis and NP ulceration lung = haemoptysis kidney = RPGN - haematuria

243
Q

which vessels are involved in medium-vessel vasculitis?

A

muscular arteries supplying organs (muscular defines medium sized vessels)

244
Q

hyperplastic arteriolosclerosis - complications (3)

A

fibrinoid necrosis end-organ necrosis AKI - flea-bitten appearance of micro-haemorrhage

245
Q

what is the action of dobutamine?

A

pure beta1-adrenoceptor agonist

  1. positive inotropy
  2. weaky positive chronotropy
  3. vasodilation
246
Q

what is the mechanism of TXA2 in promoting platelet aggregation?

A

two-fold

  1. increases expression of GpIIb/IIIa
  2. vasoconstriction, decrease blood flow
247
Q

Takayasu clinical findings

A

visual and neurologic disturbance weak/absent pulses elevated ESR

248
Q

major risk factor for lymphangiosarcoma? from which cells does this cancer develop? benign or malignant?

A

persistent lymphoedema, as after mastectomy w/ axillary clearance lymphatic endothelium malignant

249
Q

Wegener granulomatosis - sites affected

A

nasopharynx, lung, kidneys

250
Q

what are the antiarrhythmic drugs that prolong QT? which one has the least chance of causing TdP?

A

ones that prolong the overal duration of ventricular action potential

class Ia and III

amiodarone

251
Q

following MI, what histological changes are apparent between 5 - 10 days? (1)

A

macrophage phagocytosis

252
Q

internal iliac gives rise to 4 arteries…

A
  1. inferior gluteal
  2. superior gluteal
  3. obturator
  4. lateral sacral
253
Q

what nerve is associated with the 4th pharyngeal arch?

A

superior laryngeal nerve of vagus (X)

254
Q

hyaline arterioloscelrosis - histology findings

A

protein seen as pink hyaline in thick vessel wall

255
Q

which organism colonises prothetic heart valves?

A

staph epidermis

256
Q

hyaline arterioloscelrosis - caused by?

A

protein leaking into vascular wall –> vessel thickening

257
Q

hyperplastic arteriolosclerosis - pathoG histology

A

onion-skin appearance

258
Q

what is the innominate vein?

what vessels join, in what order, to make up this structure?

A

right brachiocephalic vien

right subclavian vein joined first by external jugular, then by internal jugular

right lymphatic duct also drains into right brachiocephalic

259
Q

following MI, what histological changes are apparent between 10 - 14 days? (2)

A

granulation tissue neovascularisation

260
Q

postnatal derivatives:

foramen ovale

A

fossa ovalis

261
Q

microscopic polyangiitis Rx

A

cyclophosphamide and corticosteroids

262
Q

what are 3 contraindications for nitrates?

A

HOCM (worsens outflow tract obstruction)

right ventricular infarction (reduces preload, hence decreases CO)

PDE inhibitors (synergism increases hypotension risk)

263
Q

which vessels are involved in small-vessel vasculitis?

A

arterioles, capillaries, venuoles

264
Q

ST elevation in I and aVL

A

Lateral - LCx

265
Q

what 2 types of medication can lead to erectile dysfunction?

A

SSRIs and sympathetic blockers

266
Q

PathoG - myxomatous degeneration of valve leaflets

A

mitral valve prolapse

267
Q

WG Rx

A

cyclophosphamide relapse are common

USMLE S1 (16 decks)

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