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► Med - Step 1 > Cardiovascular - First Aid > Flashcards

Cardiovascular - First Aid Flashcards

1
Q

The truncus arteriosus gives rise to…

A

the ascending aorta and pulmonary trunk.

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2
Q

The bulbus cordis gives rise to…

A

outflow track of left and right atria.

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3
Q

The primitive atria gives rise to…

A

the trabeculated part of left and right atria.

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4
Q

The primitive ventricle gives rise to…

A

the trabeculated part of the left and right ventricles.

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5
Q

The primitive pulmnoary vein gives rise to…

A

the smooth part of the left atrium.

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6
Q

The left horn of the sinus venous gives rise to the…

A

coronary sinus.

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7
Q

The right horn of the sinus venous gives rise to…

A

the smooth part of the right atrium.

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8
Q

The right common cardinal vein and right anterior cardinal vein give rise to…

A

the SVC.

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9
Q

In the vertebrate embryo, the heart is…

A

the first functional organ and it beats spontaneously by week 4.

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10
Q

In week 4 of gestation, the primitive heart tube will…

A

loop to establish left-right polarity.

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11
Q

A defect in left-right dynein can lead to..

A

dextrocardia (as seen in Kartagener).

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12
Q

The foramen ovale closes soon after….

A

birth due to increased LA pressure.

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13
Q

A patent foramen ovale is caused by…

A

failure of the septum primum and septum secundum to fuse after birth; most left untreated.

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14
Q

Patent foramen ovale can lead to…

A

paradoxical emboli (venous thromboemboli that enter the systemic arterial circulation).

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15
Q

Ventricular Septal Defect (VSD) most commonly occurs in..

A

the membranous septum.

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16
Q

Babies with VSD are…

A

acyanotic at birth due to left to right shunt.

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17
Q

Outflow tract is formed when truncus arteriosus rotates and neural crest and endocardial cell migrations lead to…

A

truncal and bulbar ridges that spiral and fuse to form the aorticopulmonary septum.

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18
Q

Conotruncal abnormalities include:

A
  1. transposition of the great vessels 2. tetralogy of fallot 3. persistent truncus arteriosus
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19
Q

The aortic and pulmonary valves are derived from…

A

endocardial cushions of the outflow tract.

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20
Q

The mitral and tricuspid valves are derived from…

A

fused endocardial cushions of the AV canal.

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21
Q

Fetal erythropoesis occurs in:

A
  1. Yolk Sac (3-8 wks) 2. Liver (6 wks - birth) 3. Spleen (10-28 wks) 4. Bone marrow (18 wks to adult)
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22
Q

Fetal Hb (HbF)

A

alpha2gamma2

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23
Q

Adult Hb (HbA)

A

alpha2beta2

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24
Q

HbF has higher affinity for oxygen due to…

A

less avid binding of 2,3-BPG. This allows HbF to extract oxygen from maternal Hb across the placenta.

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25
Q

Highest concentration of O2 in the fetal circulation is in…

A

the umbilical vein. PO2 = 30 mmHg 80% saturated w/ O2

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26
Q

Blood entering the fetus through the umbilical vein is conducted via the…

A

ductus venosus into the IVC to bypass the hepatic circulation.

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27
Q

Most highly oxygenated blood reaching the heart via the IVC is…

A

diverted through the foramen ovale and pumped out the aorta to teh head and body.

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28
Q

Deoxygenated blood entering the RA from the SVC goes:

A

RA –> RV –> main PA –> PDA –> descending aorta

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29
Q

PDA is kept open in the fetal period due to…

A

high fetal pulmonary artery resistance due partly to low O2 tension.

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30
Q

At birth, when the infant takes their first breath…

A

decreased resistance in the pulmonary circulation causes increased left atrial pressure vs. right atrial pressure clossing the foramen ovale.

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31
Q

The ductus arteriosus closes due to…

A

increase in O2 and decrease in prostaglandins (from placental separation).

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32
Q

PDA is kept open medically with…

A

PGE1 and PGE2.

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33
Q

The umbilical vein becomes the…

A

ligamentum teres hepatis contained in the falciform ligament.

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34
Q

Umbilical arteries become…

A

medial umbilical ligaments

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35
Q

ductus arteriosus becomes…

A

ligamentum arteriosum

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36
Q

ductus venosus becomes…

A

ligamentum venosum

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37
Q

foramen ovale becomes…

A

fossa ovalis

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38
Q

allantois becomes…

A

urachus-median umbilical ligament; urachal cyst or sinus is a remnant

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39
Q

Notochord becomes…

A

nucleus pulposus of intervertebral disc

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40
Q

SA and AV nodes are supplied by…

A

the RCA and infarct may cause bradycardia or heart block.

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41
Q

The acute marginal artery supplies…

A

the RV.

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42
Q

The posterior decending artery supplies…

A

the posterior third of the interventricular septum and posterior walls of ventricles.

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43
Q

The LAD supplies…

A

the anterior 2/3 of the interventricular septum, anterior papillary muslce and anterior surface of the left ventricle.

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44
Q

The left circumflex coronary artery supplies…

A

the lateral and posterior walls of the LV.

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45
Q

Right-dominant circulation

A

PDA arises from RCA

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46
Q

Left-dominant circulation

A

PDA arises from LCX

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47
Q

Coronary artery occlusion most commonly occurs in the….

A

LAD.

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48
Q

Coronary blood flow peaks in…

A

early diastole.

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49
Q

The most posterior part of the heart is…

A

the LA; enlargment can cause dysphagia or hoarseness.

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50
Q

CO =

A

SV x HR

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51
Q

MAP (mean arterial pressure) =

A

CO x TPR Also, MAP = 2/3 diastolic pressure + 1/3 diastolic pressure

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52
Q

Pulse pressure =

A

systolic pressure - diastolic pressure

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53
Q

Pulse pressure is proportional to…

A

SV and inversely proportional to arterial compliance.

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54
Q

SV =

A

EDV - ESV.

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55
Q

During the early stages of exercise, CO is maintained by…

A

increased HR and increased SV.

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56
Q

During the late stages of exercise, CO is maintained by…

A

increased HR only, the SV plateaus.

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57
Q

Diastole is preferentially shortened with…

A

increased HR leading to less filling time which decreases CO.

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58
Q

Increased pulse pressure is seen in (5):

A
  1. hyperthyroidism 2. aortic regurgitation 3. arteriosclerosis 4. obstructive sleep apnea 5. exercise
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59
Q

Decreased pulse pressure is seen in (4):

A
  1. aortic stenosis 2. cardiogenic shock 3. cardiac tamponade 4. advanced heart failure
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60
Q

Stroke volume is increased by…

A

increased contractility, increased preload and decreaed afterload.

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61
Q

Contractility increases with:

A
  1. catecholamines 2. increased intracellular calcium 3. decreased extracellular sodium 4. digitalis
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62
Q

Catecholamines increase contractility by…

A

increasing the activity of the Ca2+ pump in the SR

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63
Q

Digitalis increases contractility by…

A

blocking the Na/K pump leading to increased intracellular sodium leading to decreased Na/Ca exchange leading to increased intracellular Ca

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64
Q

Contractility decreases with (5):

A
  1. beta1-blockade (decreased cAMP) 2. heart failure with systolic dysfunciton 3. acidosis 4. hypoxia/hypercapnea 5. non-dihydropyridine Calcium channel blockers
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65
Q

Preload is approximated by..

A

ventricular EDV; it depends on venous tone and circulating blood volume.

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66
Q

Preload can be decreased with…

A

VEnodilators. (nitroglycerin)

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67
Q

Afterload is approximated by…

A

MAP.

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68
Q

The LV compensates for increased afterload by…

A

thickening to decrease wall tension.

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69
Q

Afterload is decreased with…

A

Vasodilators (Hydralazine).

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70
Q

Both preload and afterload are decreased by…

A

ACE inhibitors and ARBs.

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71
Q

Left ventricular EF is an index of…

A

ventricular contractility. Normal EF is > 55%.

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72
Q

EF is decreased in…

A

systolic heart failure and normal in diastolic heart failure.

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73
Q

Total resistance of vessels in series

A

TR = R1 + R2 + R3

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74
Q

Total resistance of vessels in parallel

A

1/TR = 1/R1 + 1/R2 + 1/R3

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75
Q

Viscosity depends mostly on…

A

hematocrit.

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76
Q

Viscosity increases in…

A

-polycythemia -hyperproteinemic states -aHereditary spherocytosis

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77
Q

Viscosity decreases in…

A

anemia.

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78
Q

Resistance is directly proportional to…

A

viscosity and vessel length and inversely proportional to the radius to the 4th power.

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79
Q

Most of the TPR is accounted for by…

A

arterioles which regulate capillary flow.

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80
Q

Positive Inotropes

A

catecholamines, digoxin

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81
Q

Negative Inotropes

A

heart failure, narcotic overdose

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82
Q

Things that increase volume, venous tone

A

fluid infusion, sympathetic activity

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83
Q

Things that decrease volume, venous tone

A

acute hemorrhage, spinal anesthesia

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84
Q

Things that increase TPR

A

vasopressors

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85
Q

Things that decrease TPR

A

exercise, AV shunt

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86
Q

S1

A

mitral and tricuspid valve closure; loudest at mitral area

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87
Q

S2

A

aortic and pulmonary valve closure; loudest at left sternal border

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88
Q

S3

A

in early diastole during rapid ventricular filling phase; associated with incresed filling pressures (MR, HCR) and is more common in dilated ventricles

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89
Q

S4

A

in late diastole; high atrial pressure; associated with ventricular hypertrophy; left atrium must push against the stiff LV wall

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90
Q

Normal splitting

A

Inspiration leads to a drop in intrathoracic pressure leading to an increase in venous return to the RV. Increased RV stroke volume leads to increased RV ejection time leading to delayed closure of the pulmonary valve.

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91
Q

Normal splitting is also contributed to by…

A

decreased pulmonary impedance.

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92
Q

Wide splitting is seen in conditions that…

A

delay RV emptying (pulmonic stenosis, right bundle branch block)

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93
Q

Fixed splitting is seen in…

A

ASD which leads to a left to right shunt which leads to increased RA and RV volumes which leads to increased flow through the pulmonic valve such that regardless of breath, pulmonic closure is greatly delayed.

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94
Q

Paradoxical splitting is seen in conditions that…

A

delay LV (aortic stenosis, left bundle branch block).

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95
Q

In paradoxical splitting, the normal order of valve closure is…

A

reversed so that P2 sound occurs before delayed A2 sound. Therefore, on inspiration, P2 closes later and moves closer to A2 (paradoxical).

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96
Q

Aortic area murmurs

A

Systolic 1. aortic stenosis 2. flow murmur 3. aortic valve sclerosis

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97
Q

Left sternal border murmurs

A

Systolic 1. Hypertrophic cardiomyopathy Diastolic 1. aortic regurgitation 2. pulmonic regurgitation

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98
Q

Pulmonic area murmurs

A

Systolic 1. pulmonic stenosis 2. flow murmur

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99
Q

Tricuspid area murmurs

A

Pansystolic 1. tricuspid regurgitation 2. VSD Diastolic 1. tricuspid stenosis 2. ASD

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100
Q

Mitral area murmurs

A

Systolic 1. mitral regurgitation Diastolic 1. mitral stenosis

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101
Q

ASD commonly presents with…

A

a pulmonary flow murmur (increased flow through the pulmonic valve) and a diastolic rumble (increased flow across the tricuspid).

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102
Q

Blood flow across the actual ASD does…

A

not cause a murmur bc there is no pressure gradient.

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103
Q

Inspiration maneuver will…

A

increase the intensity of the right heart sounds.

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104
Q

Hand grip (increases systemic vascular resistance) which will…

A

increase intensity of MR, AR, and VSD murmurs decrease the intensity of AS, hypertrophic cardiomyopathy murmurs

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105
Q

Valsalva (standing decreases venous return) will…

A

decrease intensity of most murmurs increase intensity of the hypertrophic cardiomyopathy murmur

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106
Q

Rapid squatting (increases venous return, increases preload, increases afterload)

A

decreases intensity of hypertrophic cardiomyopathy murmur increases intensity of AS murmur

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107
Q

Mitral Regurgitation murmur

A

-holosystolic, high-pitched “blowing murmur” -loudest at apex, radiates toward axilla

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108
Q

MR murmur is enhanced by…

A

maneuvers that increase TPR (squatting, hand grip).

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109
Q

MR is often due to…

A

ischemic heart disease, MVP or LV dilation.

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110
Q

Tricuspid regurgitation murmur

A

-holosystolic, high-pitched “blowing murmur” -loudest at tricuspid and radiates to the right sternal border

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111
Q

TR murmur is enhanced by…

A

maneuvers that increase RA return (inspiration).

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112
Q

TR is commonly caused by…

A

RV dilation.

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113
Q

Rheumatic fever and endocarditis can cause either…

A

MR or TR.

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114
Q

Aortic Stenosis murmur

A

-crescendo-decrescendo systolic ejection murmur -loudest at base; radiates to carotids -pulsus parvus et tardus

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115
Q

Aortic stenosis can lead to…

A

Syncope, Angina and Dyspnea on exertion

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116
Q

Aortic stenosis is often due to…

A

age-related calcific aortic stenosis or bicuspid aortic valve.

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117
Q

VSD murmur

A

-holosystolic, harsh sounding murmur -loudest at tricuspid area -accentuated with hand grip maneuver due to increased afterload

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118
Q

Mitral valve prolapse murmur

A

-late systolic crescendo murmur with midsystolic click -best heard over apex and just before S2

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119
Q

MVP can predispose to…

A

infective endocarditis.

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120
Q

MVP can be caused by…

A

myxomatous degeneration, rheumatic fever or chordae.

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121
Q

MVP occurs earlier with…

A

maneuvers that decrease venous return (standing or valsalva).

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122
Q

Aortic regurgitation murmur

A

-high pitched “blowing” early diastolic decrescendo murmur -wide pulse pressure

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123
Q

Aortic regurgitation can present with…

A

boudning pulses and head bobbing.

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124
Q

AR is often due to…

A

aortic root dilation, bicuspid aortic valve, endocarditis or rheumatic fever.

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125
Q

Aortic regurgitation murmur is increased during…

A

hand grip. Vasodilators decrease the intensity of the murmur.

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126
Q

Mitral stenosis murmur

A

-follows opening snap due to abrupt halt in leaflet motion in diastole after rapid opening due to fusion of the leaflets -delayed rumbling late diastolic murmur

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127
Q

With mitral stenosis, a decreased interval between S2 and the opening snap correlates with…

A

increased severity.

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128
Q

MS often occurs secondary to…

A

rheumatic fever. Can lead to LA dilatation.

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129
Q

MS murmur is enhanced by…

A

maneuvers that increase LA return (expiration).

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130
Q

PDA murmur

A

-continuous machine-like murmur -loudest at S2 -best heart at left infraclavicular area

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131
Q

PDA is often due to…

A

congenital rubella or prematurity.

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132
Q

T wave inversion may indicate…

A

recent MI.

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133
Q

U wave is caused by…

A

hypokalemia and bradycardia.

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134
Q

Speed of conduction

A

Purkinje > atria > ventricles > AV node

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135
Q

Pacemaker potential

A

SA > AV > bundle of His/purkinje/ventricles

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136
Q

Torsades de pointes is…

A

polymorphic ventricular tachycardia characterized by shifting sinusoidal waveforms on ECG.

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137
Q

Torsades de pointes can progress to…

A

ventricular fib.

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138
Q

A predisposing factor for Torsades is…

A

long QT interval.

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139
Q

Torsades is caused by…

A

drugs, decreased K, decreased Mg.

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140
Q

Treatment of Torsades is with…

A

magnesium sulfate.

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141
Q

Congenital long QT is an…

A

inherited disorder of myocardial repolarization typically due to ion channel defects.

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142
Q

2 types of Congenital long QT syndrome

A
  1. Romano-Ward Syndrome 2. Jervell and Lange-Nielsen Syndrome
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143
Q

Romano-Ward Syndrome features

A

-congenital long QT -autosomal dominant -pure cardiac phenotype

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144
Q

Jervell and Lange-Nielsen syndrome features

A

-congenital long QT -autosomal recessive -sensorioneural deafness

145
Q

Wolff-Parkinson-White (WPW) Syndrome is the most common type of…

A

ventricular pre-excitation syndrome. There is an abnormal fast accessory conduction pathway from the atria to ventricle that bypasses the rate-slowing AV node.

146
Q

As a result of the accessory pathway in WPW, ventricles begin to…

A

partially depolarize earlier, giving rise to the characteristic delta wave with shortened PR interval on ECG.

147
Q

WPW may result in…

A

a reentry circuit leading tosupraventricular tachycardia.

148
Q

A. fib ECG

A

no discrete P waves erratic baseline (irregularly irregular)

149
Q

A. fib can result in…

A

atrial stasis and lead to thromboembolic stroke.

150
Q

Treatment for A. fib includes…

A

rate control, anticoagulation, and possible pharmacolgical or electrical cardioversion.

151
Q

Atrial flutter is….

A

a rapid succession of identical back-to-back atrial depolarization waves. “sawtooth appearance”

152
Q

Pharmacologic conversion to sinus rhythm for atrial flutter

A

-class IA, IC or III antiarrhythmics

153
Q

Rate control for atrial flutter

A

beta-blocker or calcium channel blocker

154
Q

Definitive treatment for atrial flutter is…

A

catheter ablation

155
Q

V. fib ECG

A

completely erratic with no identifiable waves.

156
Q

V. fib will cause…

A

fatal arrhythmia w/o immediate CPR and defibrillation

157
Q

1st degree AV block

A

-PR interval prolonged (> 200 ms) -benign/asymptomatic -No treatment

158
Q

2nd degree AV block - Mobitz type I

A

-progressive lengthening of the PR interval until a beat is dropped -usually asymptomatic

159
Q

2nd degree AV block - Mobitz type II

A

-dropped beats that are not preceded by a change in the length of the PR interval -usually 2:1 per block -may progress to 3rd degree -treated with pacemaker

160
Q

3rd degree AV block

A

-atria and ventricles beat independently of each other -both P waves and QRS complexes are present (no relation to each other) -atrial rate faster than ventricular -treated with pacemaker -can be due to lyme disease

161
Q

Atrial natriuretic peptide (ANP) is released from…

A

atrial myocytes in response to increased blood pressure and atrial pressure.

162
Q

ANP causes…

A

vasodilation and decreased sodium reabsorption at the renal collecting tubule. It constricts the efferent renal arterioles and dilates the afferent arterioles via cGMP, promoting diuresis and “aldosterone escape”.

163
Q

B-type natriuretic peptide is released from..

A

ventricular myocytes in response to increased tension. It has similar physiologic action to ANP with a longer half-life.

164
Q

BNP blood test is used for diagnosing…

A

heart failure (good negative predictive value)

165
Q

Nesiritide is…

A

a recombinant form of BNP used to treat HF.

166
Q

Aortic arch receptors transmits signals via…

A

the vagus nerve to the solitary nucleus of the medulla and responds to increased bp only.

167
Q

Carotid sinus recptors transmit singals via…

A

the glossopharyngeal nerve to teh solitary nucleus of medulla. It responds to both increased and decreased blood pressure.

168
Q

Cushing Reaction

A

increased intracranial pressure constricts arterioles leading to cerebral ischemia and reflex sympathetic increase in pefusion pressure leading to increased stretch and baroreceptor mediated bradycardia.

169
Q

Peripheral chemoreceptors are stimulated by…

A

decreased PO2 (less than 60), increased PCO2 and decreased pH of blood.

170
Q

Central chemoreceptors are stimulated by…

A

changes in pH and PCO2 of brain interstiatial fluid.

171
Q

Organ with largest share of systemic CO

A

liver

172
Q

Organ with highest blood flow per gram of tissue

A

kidney

173
Q

Pulmonary capillary wedge pressure is a good approximation of…

A

left atrial pressure.

174
Q

In mitral stenosis, PCWP is…

A

greater than LV diastolic pressure.

175
Q

Factors determining autoregulation in the heart

A

-local metabolites - CO2, adenosine, NO

176
Q

Factors determining autoregulation in the brain

A

local metabolites - CO2

177
Q

Factors determing autoregulation in the kidneys

A

myogenic and tubuloglomerular feedback

178
Q

factors determining autoregulation in the lungs

A

hypoxia causes vasoconstriction

179
Q

Factors determining autoregulation in the skeletal muscle

A

lactate, adenosine, K+, H+, CO2

180
Q

factors determining autoregulation in the skin

A

sympathetic stimulation

181
Q

Kf =

A

filtration constant (capillary permeability)

182
Q

Jv (net fluid flow) =

A

(Kf)(Pnet)

183
Q

Pnet (net filtration pressure) =

A

(Pc - Pi) - (pic - pii)

184
Q

Increased capillary pressure can be caused by…

A

heart failure.

185
Q

Decreased plasma proteins can be due to…

A

nephrotic syndrome or liver failure.

186
Q

Increased capillary permeability can be caused by…

A

toxins, infxns, burns.

187
Q

Increased interstitial fluid colloid osmotic pressure can be caused by…

A

lymphatic blockage. q

188
Q

22q11 Syndrome (Digeorge) is associated with…

A

truncus arteriosus and tetralogy of fallot

189
Q

Down Syndrome is associated with…

A

ASD, VSD, and AV septal defect (endocardial cushion defect)

190
Q

Congenital rubella is associated with…

A

septal defects, PDA and pulmonary artery stenosis.

191
Q

Turner syndrome is associated with…

A

bicuspid aortic valve and coarctation.

192
Q

Marfan is associated with…

A

MVP, thoracic aortic aneurysm and dissection, and aortic regurgitation.

193
Q

The infant of a diabetic mother is at increased risk for…

A

transposition of the great vessels.

194
Q

Hypertensive emergency

A

-severe hypertension (>180/120) -acute ongoing target organ damage (papilledema, mental status changes)

195
Q

HTN predisposes to..

A

atherosclerosis, LVH, stroke, CHF, renal failure, retinopathy and aortic dissection.

196
Q

Primary HTN is related to…

A

increased CO and TPR.

197
Q

Secondary HTN is due to…

A

renal disease, including fibromuscular dysplasia (in younger pts).

198
Q

On angiogram, fibromuscular dysplasia is shown as…

A

“string of beads” of the renal artery.

199
Q

Xanthomas are…

A

plaques or nodules composed of lipid-laden histiocytes in the skin, especially the eyelids.

200
Q

Tendinous xanthoma is seen in…

A

the achilles (lipid deposit).

201
Q

Corneal arcus is…

A

lipid depsoit in the cornea that appears early in life with hypercholesterolemia. Common in elderly.

202
Q

Monckeberg Arteriosclerosis is…

A

calcification in the media of the arteries (esp radial or ulnar).

203
Q

Monckeberg arteriosclerosis shows…

A

“pipestem” arteries on x-ray.

204
Q

Monckeberg arteriosclerosis does not…

A

obstruc blood flow and intima is not involved.

205
Q

Arteriolosclerosis is either…

A

hyaline or hyperplastic.

206
Q

Hyaline arteriolosclerosis is…

A

thickening of small arteries in essential HTN or DM.

207
Q

Hyperplastic arteriolosclerosis is…

A

“onion skinning” seen in severe HTN.

208
Q

Modifiable risk factors for atherosclerosis

A

-smoking -HTN -hyperlipidemia -diabetes

209
Q

Nonmodifiable risk factors for atherosclerosis

A

-age -sex (increased in men and postmenopausal women) -FHx

210
Q

Progression of Atherosclerosis

A

endothelial cell dysfunction –> macrophage and LDL accumulation –> foam cell formation –> fatty streaks –> smooth muscle migration, proliferation and ECM deposition –> fibrous plaques –> complex atheromas

211
Q

Compolications of atherosclerosis (6)

A
  1. aneurysms 2. ischemia 3. infarcts 4. peripheral vascular disease 5. thrombus 6. emboli
212
Q

Symptoms of atherosclerosis

A

-angina -claudication

213
Q

Abdominal aortic aneurysm occurs more frequently in…

A

hypertensive male smokers older than 50.

214
Q

Abdominal aortic aneurysm is associated with..

A

atherosclerosis.

215
Q

Thoracic aortic aneurysm is associated with…

A

cystic medial degeneratio ndue to HTN or Marfan and tertiary syphilis.

216
Q

Aortic dissection is a…

A

longitudinal intraluminal tear forming a false lumen.

217
Q

Aortic disseciton is associated with…

A

HTN, bicuspid aortic valve, and inherited CT disorders.

218
Q

Aortic dissection can present with…

A

tearing chest pain, with sudden onset, radiation to the back and +/- unequal BP in arms.

219
Q

CXR of aortic dissection shows…

A

mediastinal widening.

220
Q

Aortic dissection results in…

A

pericardial tamponade, aortic rupture and death.

221
Q

Angina is usually due to…

A

ischemic myocardium secondary to coronary artery stenosis or spasm.

222
Q

Stable Angina is usually secondary to…

A

atherosclerosis.

223
Q

Stable angina presents with…

A

exertional chest pain (ST depression) that resolves with rest.

224
Q

Variant angina (Prinzmetal) occurs at rest secondary to…

A

coronary artery spasm. Tranisent ST elevation.

225
Q

Triggers of variant angina are…

A

tobacco, cocaine, triptans.

226
Q

Treat variant angina with…

A

calcium channel blockers, nitrates and smoking cessation.

227
Q

Unstable/crescendo angina is due to…

A

thrombosis with incomplete coronary artery occlusion; ST depression on ECG.

228
Q

Unstable angina presents with…

A

increased frequency/intensity of chest pain and at rest

229
Q

Coronary steal syndrome occurs…

A

distal to coronary stenosis and the vessels are maximally dilated at baseline.

230
Q

In coronary steal syndrome, administration of vasodilators (dipyridamole, regadenoson) dilates…

A

normal vessels and shunts blood toward well-perfused areas leading to decreased flow and ischemia in the poststenotic region.

231
Q

MI is most often due to…

A

acute thrombosis due to coronary artery atherosclerosis with complete occlusion of coronary artery and myocte necrosis.

232
Q

If MI is transmural, ECG will show…

A

ST elevation.

233
Q

If MI is subendocardial, ECG may show…

A

ST depressions.

234
Q

Sudden Cardiac Death is…

A

death from cardiac causes within 1 hr of onset of symptoms, most commonly due to a lethal arrhythmia.

235
Q

Sudden cardiac death is associated with…

A

CAD, cardiomyopathy and hereditary ion channelopathies.

236
Q

Chronic ischemic heart disease is…

A

progressive onset of CHF over many yrs due to chronic ischemic myocardial damage.

237
Q

Most commonly occluded arteries in MI

A

LAD > RCA > circumflex

238
Q

Cardiac troponin I rises after…

A

4 hrs and is increaesd for 7-10 days after MI. More specific than other protein markers.

239
Q

CK-MB is predominantly found in…

A

the myocardium but can also be released from skeletal muscle.

240
Q

CK-MB is useful in diagnosing…

A

reinfaction following acute MI bc levels return to normal after 48 hours.

241
Q

ECG changes of MI

A

-ST elevation (transumral) -ST depresion (subendocardial) -pathologic Q waves (old transmural)

242
Q

Anterior wall infarct (LAD) is seen in leads…

A

V1-V4.

243
Q

Anteroseptal infarct (LAD) is seen in leads…

A

V1-V2.

244
Q

Anterolateral infarct (LAD or LCX) is seen in leads…

A

V4-V6.

245
Q

Lateral wall infarct (LCX) is seen in leads…

A

I, aVL.

246
Q

Inferior wall infarct (RCA) is seen in leads…

A

II, III, aVF.

247
Q

Cardiac arrhythmia is…

A

an important cause of death before reaching the hospital; common in first few days after MI.

248
Q

Ventricular free wall rupture leads to…

A

cardiac tamponade.

249
Q

Papillary muscle rupture leads to….

A

mitral regurgitation.

250
Q

Interventricular septum ruptur leads to…

A

VSD.

251
Q

Greatest risk of wall/septum rupture and papillary muslce rupture after MI is…

A

6-14 days postinfarct.

252
Q

Greatest risk of ventricular pseudoaneurysm formation is…

A

1 wk post-infarct. It leads to decreased CO, risk of arrhtyhmia, and embolus from mural thrombus.

253
Q

Risk of postinfarction fibrinous pericarditis is greatest…

A

1-3 days post-MI.

254
Q

Dressler syndrome is…

A

an autoimmune phenomenon resulting in fibrinous pericarditis (seen several weeks post-MI).

255
Q

Dilated cardiomyopathy is often idiopathic or congenital but other causes include…

A

-Alcohol abuse -Beriberi -Coxsackie B virus myocarditis -Cocaine use -Chagas disease -Doxorubicin toxicity -hemochromatosis -peripartum cardiomyopathy

256
Q

Findings of Dilated cardiomyopathy

A

-HF -S3 -dilated heart on echocardiogram -balloon appearance of heart on CXR -systolic dysfunction (decreased EF) -eccentric hypertrophy

257
Q

Treatment of dilated cardiomyopathy

A

-Na restriction -ACE inhibitors -Beta-blockers -diuretics -digoxin -implantable carioverter defibrillator -heart transplant

258
Q

Hypertrophic cardiomyopathy is usually…

A

familial, AD and due to a beta-myosin heavy-chain mutation.

259
Q

Hypertrophic cardiomyopathy can be assocaited with…

A

Friedreich ataxia

260
Q

Hypertrophic cardiomyopathy is a cause of…

A

sudden death in young athletes due to ventricular arrhythmia.

261
Q

Findings of Hypertrophic cardiomyopathy

A

-S4 -systolic murumur -diastolic dysfunction -often septal predominance of hypertrophy -myofibrillar disarray and fibrosis

262
Q

Obstructive HCM is when…

A

the hypertrophied septum is too close to teh anterior mitral leaflet leading to outlet obstruction leadin gto dyspnea and possible syncope.

263
Q

Treatment of HCM

A

-cessation of high-intensity athletics -beta-blocker or calcium channel blocker -ICD

264
Q

Major causes of restrictive/infiltrative cardiomyopathy include…

A

sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis, Loffler syndrome and hemochromatosis.

265
Q

Loffler syndrome is…

A

endomyocardial fibrosis with a prominent eosiniophilic infiltrate.

266
Q

Restrictive cardiomyopathy leads to…

A

diastolic dysfunction. There can be low-voltage ECG despite a thick myocardium.

267
Q

CHF is a clinical syndrome of…

A

cardiac pump dysfunction. Symptoms include dyspnea, orthopnea, and fatigue. Signs include rales, JVD and pitting edema.

268
Q

Systolic dysfunction features

A

-low EF -poor contractility -often secondary to ischemic heart disease or DCM

269
Q

Diastolic dysfunction features

A

-normal EF and contractility -impaired relaxation -decreased compliance

270
Q

Right heart failure most often results from…

A

left heart failure.

271
Q

Isolated right heart failure is due to…

A

cor pulmonale.

272
Q

Drugs that decrease the mortality of CHF

A

-ACE inhibitors -beta-blockers -AngII receptor blockers -spironolactone

273
Q

In CHF, thiazides and loop diuretics are mainly used for…

A

symptomatic relief.

274
Q

Hydralazine with nitrate therapy improves…

A

both symptoms and mortality in some CHF pts.

275
Q

In pulmonary edema, an increased pulmonary venous pressure leads to…

A

pulmonary venous distention and transudation of fluid.

276
Q

Pulmonary edema has the presence of…

A

hemosiderin-laden macrophages (heart failure cells) in the lungs.

277
Q

Orthopnea is…

A

shortness of breath when supine due to increased venous return exacerbating the pulmonary congestion.

278
Q

Bacterial endocarditis presents with…

A

fever, new murmur, Roth spots, Osler nodes, Janeway lesions, anemia, and splinter hemorrhages.

279
Q

Acute bacterial endocarditis is due to…

A

S. aureus; large vegetations on previouisly normal valves.

280
Q

Subacute bacterial endocarditis is due to…

A

viridans streptococci; smaller vegetations on congenitally abnormal valves; sequela of dental procedures

281
Q

Culture negative bacterial endocarditis is most likely due to…

A

Coxiella burnetii and Bartonella.

282
Q

Endocarditis may also be nonbacterial secondary to…

A

malignancy, hypercoagulable state or lupus. *S. bovis present in colon cancer. **S. epidermidis present on prosthetic vavles.

283
Q

The most commonly involved valve in endocarditis is…

A

the mitral valve.

284
Q

Involvement of the tricuspid valve with endocarditis is associated with…

A

IV drug abuse; S. aureus, Pseudomonas and Candida.

285
Q

Complications of bacterial endocarditis

A

-chordae rupture -glomerulonephritis -suppurative pericarditis -emboli

286
Q

Rheumatic fever is a consequence of…

A

pharyngeal infection with group A beta-hemolytic streptococci.

287
Q

Rheumatic fever casues early death due to…

A

myocarditis.

288
Q

Late sequelae of rheumatic fever includes rheumatic heart disease which affects the valves in this order….

A

mitral > aortic > tricuspid. (high pressure valves are affected most)

289
Q

Early lesion of rheumatic fever is…

A

mitral valve regurgitation. Late lesion is mitral stenosis.

290
Q

Rheumatic fever is assocaited with…

A

Aschoff bodies (granuloma with giant cells) Anitschkow cells (enlarged macrophages with ovoid, wavy, rod-like nucleus) increased ASO titers

291
Q

Rheumatic fever is not a direct effect of the bacteria. It is…

A

immune mediated (type II HSR). There are antibodies to M protein that cross react with self-antigens.

292
Q

Acute pericarditis commonly presents with…

A

sharp pain, aggravated by inspiration adn relieved by sitting up or leaning forward. Friction rub.

293
Q

ECG changes of acute pericarditis include…

A

ST segment elevation and/or PR depression.

294
Q

Fibrinous acute pericarditis is caused by…

A

Dressler syndrome, uremia, radiation. Presents with a loud friction rub.

295
Q

Serous pericarditis is…

A

viral pericarditis; noninfectious inflammatory diseases

296
Q

Suppurative/purulent pericarditis

A

usually caused by bacterial infections (pneumococcus, strep)

297
Q

Cardiac tamponade is…

A

compression of the heart by fluid in the pericardium leading to decreased CO.

298
Q

Cardiac tamponade displays equibrilation of…

A

diastolic pressure in all 4 quadrants.

299
Q

Findings of cardiac tamponade

A

-Beck triad (hypotension, distended neck veins, distant heart sounds) -increased HR -pulsus paradoxus -Kussmaul sign

300
Q

ECG of cardiac tamponade shows…

A

low voltage QRS and electrical alternans

301
Q

Pulsus paradoxus is..

A

decrease in amplitude of systolic blood pressure by more than 10 mmHg during inspiration.

302
Q

Pulsus paradoxus is seen in…

A

cardiac tamponade, asthma, OSA, pericarditis and croup.

303
Q

Tertiary syphilis disrupts the vasa vasorum of the aorta with consequent…

A

atrophy of the vessel wall and dilation of the aorta and valve ring.

304
Q

Syphilitic heart disease may display…

A

calcification of the aortic root an dascending aortic arch. This leads to “tree bark” appearnce of the aorta.

305
Q

Syphilitic heart disease may result in…

A

aneurysm of the ascending aorta or aortic insufficiency.

306
Q

The most common primary cardiac tumor in adults is…

A

myxoma. 90% occur in the atria.

307
Q

Myxomas are usually described as….

A

a “ball valve” obstruction in the LA associated with multiple syncopal episodes.

308
Q

The most frequent primary cardiac tumor in children is…

A

a rhabdomyoma associated with tuberous sclerosis.

309
Q

The Kussmaul sign is…

A

increase in JVP on inspiration instead of a normal decrease.

310
Q

Increased JVP upon inspiration can occur when the negative intrathoracic pressure is not…

A

transmitted to the heart and there is impaired filling of the RV leading to backup of blood in the vena cava leading to JVD.

311
Q

Kussmaul sign may be seen with…

A

constrictive pericarditis, restrictive cardiomyopathies, and right atrial or ventricular tumors.

312
Q

The raynaud phenomenon is called Raynaud syndrome when….

A

secondary to a disease process sucha as mixed CT disorder, SLE or CREST syndrome.

313
Q

Strawberry hemangioma is a…

A

benign capillary hemangioma of infancy.

314
Q

Strawberry hemangioma appears in…

A

the first few wks of life, grows rapidly and regresses spontaneously at 5-8 yrs.

315
Q

Cherry hemangioma is…

A

a benign capillary hemangioma of the elderly. They do not regress.

316
Q

Pyogenic granulmona is…

A

a polypoid capillary hemangioma that can ulcerate and bleed.

317
Q

Pyogenic granuloma is associated with…

A

trauma and pregnancy.

318
Q

A cystic hygroma is…

A

a cavernous lymphangioma of the neck.

319
Q

Cystic hygroma is associated with..

A

Turner syndrome.

320
Q

Glomus tumor is…

A

a benign, painful, red-blue tumor under the fingernails.

321
Q

Glomus tumor arises from…

A

modified smooth muscle cells of the glomus body.

322
Q

Bacillary angiomatosis is…

A

a benign capillary skin papules found in AIDS pts.

323
Q

Bacillary angiomatosis is caused by…

A

Bartonella henselae.

324
Q

Angiosarcoma is a…

A

blood vessel malignancy typically occuring int he head, neck and breast. Usually in elderly on sun-exposed areas.

325
Q

Angiosarcoma is associated with…

A

radiation and arsenic.

326
Q

Angiosarcoma is difficult to resect due to…

A

delay in diagnosis.

327
Q

Lymphangiosarcoma is…

A

a lymphatic malignancy associated with peristent lymphedema (post-radical mastectomy).

328
Q

Kaposi sarcoma is…

A

an endothelial malignancy of the skin, but also the mouth, GI tract and respiratory tract.

329
Q

Kaposi sarcoma is associated with…

A

HHV-8 and HIV.

330
Q

Bacillary angiomatosis is often mistaken for…

A

Kaposi sarcoma and vice versa.

331
Q

Temporal (Giant Cell) Arteritis Features

A

-elderly females -unilateral headache, jaw claudication -branches of carotid a -focal granulomatous inflammation

332
Q

Temporal arteritis may lead to…

A

irreversible blindness due to ophthalmic artery occlusion.

333
Q

Temporal arteritis is asscoaited with…

A

polymyalgia rheumatica.

334
Q

Temporal arteritis is treated with…

A

high-dose corticosteroids prior to temporal artery biopsy to prevent vision loss.

335
Q

Takayasu arteritis features

A

-asian females less than 40 -pulseless disease -fever -night sweats -arthritis -myalgias -skin nodules -ocular disturbances -granulomatous thickening and narrowing of aortic arch

336
Q

Polyarteritis nodosa features

A

-young adults -Hep B -fever, weight loss, malaise, HA -abdomainal pain, melena -HTN, neurologic dysfunction, cutaneous eruptions, renal damage

337
Q

Polarteritis nodosa typically involves…

A

renal and visceral arteries (not pulmonary).

338
Q

Polarteritis nodosa is mediate by…

A

immune complex. There is transmural inflammation of the arterial wall with fibrinoid necrosa.

339
Q

On arteriogram, polyarteritis nodosa displays…

A

innumerable microaneurysms and spasm.

340
Q

Polyarteritis nodosa is treated with…

A

corticosteroids and cyclophosphamide.

341
Q

Kawasaki disease features

A

-asian children

342
Q

Kawasaki diseaes may develop…

A

coronary artery aneurysms with thrombosis leading to MI or rupture.

343
Q

Kawasaki should be treated with…

A

IV immunoglobulin and aspirin.

344
Q

Buerger disease features

A

-heavy smokers, males

345
Q

Buerger disease often also presents with..

A

raynaud phenomenon.

346
Q

Treat Buerger disease with…

A

smoking cessation.

347
Q

Wegener’s granulomatosis with polyangiitis features

A

-upper respirator tract: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis -lower respirator tract: hemoptysis, cough, dyspnea -renal: hematuria, red cell casts *PR3-ANCA/c-ANCA

348
Q

Triad of Wegener’s granulomatosis

A

-focal necrotizing vasculitis -necrotizing granulomas in the lung and upper airways -necrotizing glomerulonephritis

349
Q

CXR of Wegener’s shows…

A

large nodular densities.

350
Q

Treat Wegener’s with…

A

cyclophosphamide and corticosteroids.

351
Q

Microscopic polyangiitis is…

A

necrotizing vasculitis involving the lungs, kidneys, and skin with pauci-immune glomerulonephritis and palpable purpura.

352
Q

Microscopic polyangiitis presents similarly to…

A

granulomatosis with polyangiitis (Wegener’s) but without the nasopharyngeal involvement. No granulomas. **MPO-ANCA/p-ANCA

353
Q

Treat Microscopic polyangiitis with…

A

cyclophosphamide and corticosteroids.

354
Q

Churg-Strauss syndrome presents with…

A

asthma, sinusitis, palpable purpura and peripheral neuropathy. Can also involve the heart, GI and kidneys.

355
Q

Pathology of Churg-Strauss

A

granulomaotus, necrotizing vasculitis with eosinophilia

356
Q

Labs of Churg Strauss

A

-MPO-ANCA/p-ANCA -increased IgE

357
Q

The most common childhood systemic vasculitis is…

A

Henoch-Schonlein purpura and it often follows a URI. Associated with IgA nephropathy.

358
Q

Classic triad of Henoch-Schonlein purpura is…

A
  1. Skin (palpable purpura on buttocks/legs) 2. Arthralgias 3. GI (abdominal pain, melena, multiple lesions of the same age)
359
Q

The vasculitis of Henoch-Schonleinpurpura is secondary to…

A

IgA deposition.

► Med - Step 1 (31 decks)

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