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First Aid Flashcards

1
Q

Where does fetal erythropoiesis occur?

A

Yolk sac | 3-8 wks
Liver | 6 wks - birth
Spleen | 10-28 wks
Bone Marrow | 18 wks to adult

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2
Q

What is fetal hemoglobin composed of?

A

α2 γ2

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3
Q

What is adult hemoglobin composed of?

A

α2 β2

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4
Q

Why does HbF have a higher affinity for oxygen?

A

Less avid binding of 2,3-BPG (left shift)

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5
Q

Where in the fetal circulation is there the highest concentration of O2

A

Umbilical vein

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6
Q

Starting in the umbilical vein, trace the flow of O2

A

Umbilical vein → Ductus venosus → IVC → RA → foramen ovale → LA → Aorta → Body

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7
Q

In the fetal circulation, deoxygenated blood flowing into the SVC goes where?

A

RA→ RV → main PA → patent ductus arteriosus → descending aorta

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8
Q

What causes the foramen ovale to close?

A

1st breath → ↓resistance in pulmonary vasculature → LAP>RAP

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9
Q

What causes the ductus arteriosus to close?

A

↑O2 (respiration) + ↓ prostaglandins (placental separation)

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10
Q

What drug can be used to close a PDA? To keep it open?

A 
Indomethacin
PGE (E1 and E2)
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11
Q

What is the fetal structure that turns into the ligamentum teres hepatis, contained in the falciform ligament

A

Umbilical vein

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12
Q

What do the umbilical arteries become?

A

Medial umbilical ligaments

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13
Q

What does the notochord become?

A

Nucleus pulposus of intervertebral disc

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14
Q

What do the ductus arteriosus and ductus venosus become?

A

Ligamentum arteriosum and venosum

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15
Q

What does the foramen ovale become?

A

Fossa ovalis

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16
Q

What does the allantois become

A

Urachus-median umbilical ligament

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17
Q

What supplies the SA and AV nodes?

A

RCA

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18
Q

What determines whether a person has Right or Left dominant circulation? Which is more common?

A 
Right-dominant = PDA arises from RCA
Left-dominant = PDA arises from LCX
85% = right dominant
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19
Q

When does coronary blood flow peak?

A

Early Diastole

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20
Q

What symptoms can enlargement of the L atrium cause?

A

Dysphagia - presses on esophagus

Hoarseness - compression of L recurrent laryngeal n. (CNX)

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21
Q

How do you compensate CO during early exercise? Late exercise?

A

↑ HR and SV

↑ HR only - SV plateaus

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22
Q

Which phase is decreased w/ ↑ HR?

A

Diastole - decreased filling time, ↓ preload

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23
Q

What things affect Mean Arterial Pressure (MAP)?

A

CO * TPR

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24
Q

What things affect Stroke Volume?

A

SV CAP - SV increases w/
Contractility ↑
Afterload ↓
Preload ↑

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25
Q

How do you increase contractility?

A

↑ intracellular Ca

  1. Catecholamines: ↑activity of Ca pump in SR
  2. ↓extracellular Na: ↓ activity of Na/Ca exchange
  3. Digitalis: blocks Na/K pump directly - indirectly blocks Na/Ca exchange
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26
Q

Which way does the Na/Ca pump work?

A

Ca in efflux (leaving) - mostly

Uses Na gradient in

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27
Q

How do you decrease contractility?

A
  1. β1-blockade (↓cAMP)
  2. Non-dihydropyridine Ca channel blockers - diltiazem & verapamil
  3. HF w/ systolic dysfunction
  4. Acidosis
  5. Hypoxia/Hypercapnea
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28
Q

What does preload depend on?

A

Ventricular EDV - venous tone and circulating blood volume

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29
Q

What class of drugs will decrease preload?

A

Venodilators - nitroglycerin

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30
Q

What does afterload depend on?

A

MAP

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31
Q

How does the heart respond to ↑MAP?

A

LV hypertrophy

Wall tension = (Pr)/(2wall thickness)

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32
Q

What 2 classes of drugs will decrease afterload?

A

Vasodilators - hydralazine

ACEi/ARBs - ↓preload & afterload

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33
Q

How is ejection fraction calculated? What is a normal EF? When is it decreased?

A

SV/EDV
Normal ≥ 55%
Systolic HF

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34
Q

What does the starling curve show?

A

LVEDV x SV (or CO)

That changes in inotropy can cause changes in SV outside of preload

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35
Q

What is R directly proportional to? Inversely proportional?

A
  1. Viscosity and vessel length

2. r^4

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36
Q

What accounts for most of the TPR?

A

Arterioles

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37
Q

What does viscosity depend on? When might it be elevated?

A

Hematocrit

Polycythemia, hyperproteinemic states (multiple myeloma), aHereditary spherocytosis

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38
Q

When does S3 occur?

A

Early in diastole - ↑filling pressure
Mitral regurg, CHF, dilated ventricles
Normal in children and pregnant women

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39
Q

When does S4 occur?

A

End of diastole - atrial kick

High atrial pressure, ventricular hypertrophy

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40
Q

What does the a wave represent?

A

Atrial contraction

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41
Q

What does the c wave represent?

A

RV contraction - closed tricuspid valve bulges into atrium

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42
Q

What does the x descent represent?

A

Atrial relaxation - absent in tricuspid regurg

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43
Q

What does the v wave represent?

A

↑ RA pressure due to filling against closed TV

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44
Q

What does the y descent represent?

A

Blood flow from RA to RV

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45
Q

What is normal splitting?

A

A2 and P2 get farther apart w/ inspiration

↓intrathoracic pressure → ↑RV SV → ↑ RV ejection time → delayed closure of the pulmonic valve

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46
Q

When would you hear wide splitting?

A

Conditions that delay RV emptying

Pulmonic stenosis, RBB block

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47
Q

When would you hear fixed splitting?

A

ASD: L→R shunt → ↑RA and RV volumes

Pulmonic closure is delayed regardless of breath

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48
Q

When do you hear paradoxical splitting?

A

Conditions that delay LV emptying
Aortic stenosis, LBB block
P2 gets closer to A2 on inspiration (paradox)

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49
Q

What murmurs are heard during systole?

A

A/P stenosis
M/T regurgitation
VSD

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50
Q

What murmurs are heard during diastole?

A

A/P regurgitation

M/T stenosis

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51
Q

What murmur is holosystolic, high-pitched “blowing”

A

M/T regurgitation

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52
Q

How could you tell the difference between Mitral and Tricuspid Regurgitation?

A

Where you hear the murmur
Mitral: enhanced w/ squatting/hand grip (↑TPR)
Tricuspid: enhanced w/ inspiration (↑RA return)

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53
Q

What murmur is a crescendo-decrescendo systolic ejection murmur?

A

Aortic Stenosis - syncope, angina, dyspnea on exertion

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54
Q

What murmur is a holosystolic, harsh-sounding murmur?

A

VSD - tricuspid area

enhanced w/ handgrip

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55
Q

What leads show ST elevation in a lateral infarction

A

I, aVL, V5, V6

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56
Q

What leads show ST elevation in a inferior (RCA) infarction

A

II, III, avF

Recip: I, aVL

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57
Q

What leads show ST elevation in a anterior (LAD) infarction?

A

V1-V4

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58
Q

What does a high pitched “blowing” early diastolic decrescendo murmur indicate? What other symptoms are seen?

A

Aortic Regurgitation

Bounding pulses, head bobbing

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59
Q

What are causes of aortic regurgitation? (4)

A

Aortic root dilatation, bicuspid aortic valve, endocarditis, rheumatic fever

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60
Q

What does a late systolic crescendo murmur w/ midsystolic click indicate?

A

Mitral valve prolapse - click due to sudden tensing of chordae tendineae

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61
Q

What does a delayed rumbling, late diastolic murmur, following an opening snap indicate?

A

Mitral Stenosis

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62
Q

What does a continuous machine-like murmur, loudest at S2 indicate? What can cause this?

A

PDA

Congenital rubella or prematurity

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63
Q

ANP

A

Released from atrial myocytes in response to ↑BV and ↑atrial pressure
Vasodilation, ↓Na reabsorption, promotes diuresis (cGMP)

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64
Q

BNP

A

Released from ventricular myocytes in response to ↑tension

Used to diagnose HF

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65
Q

What baroreceptor responds to both ↑BP and ↓BP?

A

Carotid sinus (IX) - Aortic arch (X) only responds to ↑BP

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66
Q

Which chemoreceptors respond to ↓PO2, ↓pH and ↑PCO2?

A

Peripheral chemoreceptors - central don’t respond to PO2

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67
Q

What organ has the largest blood flow?

68
Q

What organ has the largest share of systemic CO?

69
Q

What organ has the highest BF/g of tissue?

70
Q

What organ has the largest AV O2 difference?

A

Heart - O2 extraction ~80%

↑O2 demand met w/ ↑BF — not ↑ extraction

71
Q

How does the heart autoregulate BF?

A

Local metabolites (VD) CO2, adenosine, NO

72
Q

How does the brain autoregulate?

A

Local metabolites (VD) CO2 (pH)

73
Q

How do the kidneys autoregulate BF?

A

Myogenic and tubuloglomerular feedback

74
Q

How do the lungs autoregulate BF?

A

Hypoxia ➞ Vasoconstriction

75
Q

How does skeletal muscle autoregulate BF?

A

Local metabolites: lactate, adenosine, K, H, CO2

76
Q

How does skin autoregulate?

A

Sympathetic stimulation is most important mechanism—temperature control

77
Q

What are the 5 congenital R→L shunts?

A
  1. Persistant truncus arteriosus
  2. D-transposition of great vessels
  3. Tricuspid atresia
  4. Tetralogy of Fallot
  5. Total anomalous pulmonary venous return
78
Q

What two congenital heart defects are more commonly seen with DiGeorge?

A
  1. Persistant Truncus Arteriosus

2. Tetralogy of Fallot

79
Q

Most persistant truncus atertiosus (PTA) patients have what accompanying defect?

80
Q

What do D-transposition of great vessels patients need in order to be compatible with life?

A

VSD, PDA, or patent foramen ovale

81
Q

What do patients with tricuspid atresia require?

A

ASD and VSD

82
Q

What 4 things make up the Tetralogy of Fallot?

A
  1. VSD
  2. Overriding aorta
  3. Pulmonary infundibular stenosis - prognostic
  4. RVH
83
Q

What other cardiac anomaly is associated w/ TAPVR?

A

ASD or PDA

84
Q

What are the congenital L→R shunts?

A
  1. VSD
  2. ASD
  3. PDA
85
Q

What is the most common congenital cardiac defect?

A

VSD - asymptomatic → present weeks after birth

86
Q

Where do ASDs most commonly occur?

A

90% Septum secundum

Septum primum = Down syndrome

87
Q

How does a PDA present?

A

Late cyanosis in lower extremities

88
Q

Eisenmenger Syndrome

A

Uncorrected L→R shunts will ↑pulmonary BF

  • Pulmonary HTN
  • RVH

Shunt becomes R→L
Cyanosis, clubbing, polycythemia

89
Q

Infantile coarctation of the aorta present with lower extremity cyanosis and is associated w/ what disease?

A

Turner Syndrome - Maintain PDA w/ IGE

90
Q

Adult type coarctation of the aorta results in what symptoms?

A

HTN in upper extremities
Delayed pulses in lower extremities
Notching of ribs - collateral circulation

91
Q

What cardiac defects can Down Syndrome cause?

A

ASD, VSD, AV septal defect - endocardial cushion

92
Q

What cardiac defects can congenital rubella cause?

A

Septal defects, PDA, pulmonary artery stenosis

93
Q

What cardiac defects can Turner syndrome cause?

A

Bicuspid aortic valve

Coarctation of the aorta (preductal)

94
Q

What cardiac defects can Marfan syndrome cause?

A

MVP, thoracic aortic aneurysm/dissection, aortic regurgitation

95
Q

90% of HTN is primary and related to what?

A

↑CO or ↑TPR

96
Q

What are risk factors for HTN?

A

Age, obesity, diabetes, smoking, genetics,

Black > white > asian

97
Q

Hypertensive Emergency

A

≥180/120

98
Q

What are causes of 2˚ HTN?

A
  1. Renal disease

2. Fibromuscular dysplasia

99
Q

What are 3 signs of hyperlipidemia?

A
  1. Xanthomas - lipid laden histiocytes in skin (eyelids)
  2. Tendinous xanthoma - achilles
  3. Corneal arcus
100
Q

Hyaline arteriolosclerosis is to _________________ as a hyperplastic arteriolosclerosis is to _________________.

A 
Hyaline = essential HTN or diabetes (thickening)
Hyperplastic = Severe HTN (onion-skinning)
101
Q

Monckeberg (medial calcific sclerosis)

A 
Calcification of the media of arteries (radial/ulnar)
Pipestem arteries (X-ray)
102
Q

Atherosclerosis

A

Disease of large and medium-sized muscular arteries

103
Q

What are modifiable risk factors for atherosclerosis?

A

Smoking, HTN, hyperlipidemia, diabetes

104
Q

What 3 things can trigger variant angina (prinzmetal)? How do you treat?

A

Cocaine, tobacco, triptans

Ca channel blockers, nitrates, smoking cessation

105
Q

What three things lead to sudden cardiac death?

A

Causes lethal arrhythmia i.e. v. fib - w/i 1 hr. of symptoms

  1. CAD | 70%
  2. CM
  3. Hereditary ion channelopathies
106
Q

What are the most commonly occluded coronary arteries?

A

LAD>RCA>Circumflex

107
Q

When is the greatest risk of developing a fatal arrhythmia post MI?

108
Q

When is the greatest risk of developing fibrinous pericarditis post MI?

109
Q

When is the greatest risk of developing rupture problems post MI?

A

3-14 days - Mφ

110
Q

When is the greatest risk of developing Dressler syndrome post MI?

A

Several weeks after - autoimmune fibrinous pericarditis

111
Q

Which infarct is most likely to result in mitral regurgitation?

A

Posterior Descending Artery (RCA) - Inferior

112
Q

What are the causes of Dilated CM?

A 
ABCCCD
Alcohol abuse
Wet Beriberi (B1)
Coxsackie B virus myocarditis
Cocaine use
Chagas disease
Doxorubicin toxicity
113
Q

What are findings of DCM?

A

S3, systolic dysfunction
Dilated heart on ECHO
Balloon appearance of heart on CXR

114
Q

What are findings of HCM?

A

S4, diastolic dysfunction

Obstructive: dyspnea, possible syncope

115
Q

What two CM can hemochromatosis cause?

A

Dilated and Restrictive

116
Q

What is the mutation involved in HCM? How is it inherited?

A

β-myosin heavy-chain | AD

117
Q

What are the major causes of Restrictive CM?

A

Sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis, Loffler Syndrome (eosinophils), hemochromatosis

118
Q

What two CM result in diastolic dysfunction?

A

Restrictive and Hypertrophic

119
Q

What are 3 key symptoms of left HF?

A
  1. Pulmonary edema
  2. Orthopnea
  3. Paroxysmal nocturnal dyspnea
120
Q

What are 3 key symptoms of right HF?

A
  1. Hepatomegaly - nutmeg liver
  2. Peripheral edema
  3. JVD
121
Q

What drugs are shown to ↓ mortality in CHF?

A

ACE Inhibitors, β-blockers, ARBs, Spironolactone

122
Q

What is associated w/ Aschoff bodies (granuloma w/ giant cells) containing Anitschkow cells (enlarged Mφ w/ caterpillar nucleus)?

A

Rheumatic Fever

123
Q

What are the most likely causes of Culture negative bacterial endocarditis?

A

Coxiella burnetti and Bartonella spp.

124
Q

How would acute pericarditis present?

A

Sharp pain worse w/ inspiration better when sitting up/leaning forward
Friction rub
Widespread ST elevation and/or PR depression

125
Q

Dressler syndrome, uremia and radiation will cause what type of pericarditis?

A

Fibrinous - loud friction rub

126
Q

Viral pericarditis and non-infectious inflammatory disease (SLE/RA) will cause what type of acute pericarditis?

127
Q

Bacterial infections (pneumococcus and streptococcus) will cause what type of pericarditis?

A

Suppurative/purulent

128
Q

The triad of hypotension, distended neck veins and distant heart sounds is known as the Beck Triad and is commonly seen in what?

A

Cardiac tamponade
↑HR, pulsus paradoxus, Kussmaul sign
Low voltage QRS

129
Q

What other diseases will have pulsus paradoxus?

A

≥10 mmHg drop systolic during inspiration

Cardiac tamponade, asthma, OSA, pericarditis, croup

130
Q

Tree bark appearance of the aorta is synonymous with what disease?

A

Syphilitic heart disease - vasa vasorum
Ascending Aorta Aneurysm
Aortic Arch Aneurysm
Aortic insufficiency

131
Q

What is the most common heart tumor?

A

Mets - melanoma, lymphoma

132
Q

What is the most common 1˚ cardiac tumor in adults?

A

Myxoma - 90% in atria

“ball valve” obstruction

133
Q

What is the most frequent 1˚ cardiac tumor in kids, what is it associated with?

A

Rhabdomyoma - tuberous sclerosis

134
Q

Kussmaul sign is an ↑ in JVP on inspiration (instead of a normal ↓) - what diseases is this seen in?

A

Neg. pressure not transmitted to heart

  1. Constrictive pericarditis
  2. Restrictive CM
  3. RA or RV tumors
135
Q

Raynaud disease (1˚) and Raynaud syndrome both involve a arteriolar vasospasm in response to cold temperatures - in what diseases is this found?

A
  1. SLE
  2. CREST
  3. Mixed CT disease
136
Q

Strawberry hemangioma

A

Benign capillary hemangioma of infancy

  • grows rapidly
  • regresses at 5-8 yrs
137
Q

Cherry hemangioma

A

Benign hemangioma of the elderly - does NOT regress

138
Q

Pyogenic granuloma

A

Polypoid capillary hemangioma that can ulcerate/bleed -associated w/ trauma and pregnancy

139
Q

Cystic hygroma is a cavernous lymphangioma of the neck, what is it associated with?

A

Turner Syndrome

140
Q

Glomus tumor is a benign, painful red-blue tumor under fingernails that arises from what structures?

A

Modified smooth muscle cells of glomus body

141
Q

Bacillary angiomatosis is a benign capillary skin papules found in ______ patients, that is caused by what bug?

A

AIDS

Bartonella henselae

142
Q

Angiosarcoma

A

Rare blood vessel malignancy typically occurring in the head, neck, and breast areas.
Elderly, sun exposed areas
Assoc. w/ radiation therapy and arsenic
Aggressive and difficult to resect

143
Q

What is lymphangiosarcoma, and what is a common circumstance in which it might arise?

A

Lymphatic Malignancy - associated w/ persistant lymphedema e.g. post radical mastectomy

144
Q

What is kaposi sarcoma, and what bugs is it associated with?

A

Endothelial malignancy of skin - also mouth, GI tract, respiratory tract
HHV-8 and HIV

145
Q

What two diseases belong to the large vessel-vasculitis category?

A
  1. Temporal (giant cell) arteritis

2. Takayasu arteritis

146
Q

What are symptoms of Temporal (giant cell) arteritis, who usually gets it, and what would a biopsy show?

A

Unilateral headache and jaw claudication
Elderly females
Focal granulomatous inflammation - branch of carotid

147
Q

How do you treat Temporal (giant cell) arteritis?

A

High-dose corticosteroid prior to temporal artery biopsy

148
Q

Who gets Takayasu Arteritis and what are its symptoms?

A

Young asian women

Pulseless disease, neurologic disturbances

149
Q

What is Takayasu Arteritis?

A

Graunulomatous vasculitis that involves the aortic arch at branch points

150
Q

What 3 diseases are considered medium-vessel vasculitis (muscular arteries)

A
  1. Polyarteritis Nodosa
  2. Kawasaki Disease
  3. Buerger Disease
151
Q

What is Polyarteritis Nodosa and how does it present in young adults?

A

Necrotizing vasculitis involving multiple organs NOT lungs

  1. HTN (renal artery)
  2. abdominal pain w/ melana (mesenteric artery)
  3. Neurologic disturbances
  4. Skin lesions
    * Assoc. w/ serum HBsAg
152
Q

In polyarteritis nodosa early lesions progress from transmural inflammation with fibrinoid necrosis to fibrosis with a ________________ appearance on imaging.

A

String of pearls

153
Q

How do you treat polyarteritis nodosa?

A

Corticosteroids and cyclophosphamide

154
Q

Who does Kawasaki Disease develop in and what are the symptoms?

A

Asian children < 4
Non specific: Fever, conjunctivitis, erythematous rash of soles and palms, “strawberry tongue”, and enlarged cervical LN
*viral-like

155
Q

What blood vessel is involved in Kawasaki Disease?

A

Coronary artery

-risk for aneurysm, thrombosis, MI, rupture

156
Q

How do you treat Kawasaki Disease?

A

Aspirin & IVIG

157
Q

What is Buerger disease? Who gets it?

A

Necrotizing vasculitis involving digits

Heavy male smokers <40yo

158
Q

What four diseases are considered small-vessel vasculitis?

A
  1. Granulomatosis w/ polyangiitis
  2. Microscopic polyangitis
  3. Churg-Strauss Syndrome
  4. Henoch-Schonlein purpura
159
Q

What is Churg-Strauss syndrome? What are its symptoms

A

Granulomatous necrotizing vasculitis w/ eosinophilia

Asthma, sinusitis, palpable purpura, peripheral neuropathy

160
Q

What is the most common childhood systemic vasculitis

A

Henoch-Schonlein Purpura

161
Q

How does Henoch-Schonlein Purpura present?

A

Post URI - vasculitis 2˚ to IgA complex deposition

  1. Palpable purpura on buttocks/legs
  2. Arthralgias
  3. Abdominal pain, melana
162
Q

What is the triad seen in Granulomatosis with polyangiitis?

A
  1. Focal necrotizing vasculitis
  2. Necrotizing granuloma in lung and upper airway - hemoptysis, cough, chronic sinusitis, otitis media
  3. Necrotizing glomerulonephritis - hematuria
163
Q

How do you treat Granulomatosis with polyangiitis?

A

Cyclophosphamide, corticosteroids

164
Q

What is the difference between Granulomatosis with polyangiitis and Microscopic Polyangiitis?

A

Microscopic polyangiitis doesn’t have nasopharyngeal involvement, no granulomas
MPO-ANCA/p-ANCA (anti-myeloperoxidase)

165
Q

Which 2 small vessel vasculitis have MPO-ANCA/p-ANCA?

A
  1. Microscopic polyangiitis

2. Churg Strauss syndrome

166
Q

What antibody does Granulomatosis with polyangiitis have?

A

PR3-ANCA/c-ANCA (anti-proteinase 3)

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