INTERNAL MEDICINE BOARD CORRELATES Flashcards
1
Q
Most efficient extractor of oxygen from the blood
A
heart
2
Q
Intracellular junctions responsible for the cardiac syncytium
A
Gap Junctions
3
Q
Most potent vasoconstrictor
A
ADH
4
Q
Triad of Ruptured Aneurysm
A
Left flank pain
hypotension
pulsatile mass
5
Q
Diagnostic triad of Wolff-Parkinson-White (WPH) ecg pattern
A
Wide QRA Complex
Relatively SHORT PR interval
Slurring of the initial part of the QRS (Delta wave)
6
Q
3 principal features of Becks triad
A
hypotension
soft/absent heart sounds
Jugular venous distention with a prominent x descent but an absent y-descent
7
Q
major determinants of myocardial 0xygen demand (MVO2)
A
HR
Myocardial contractility
Myocardial wall tension (stress)
8
Q
triad of buergers diseases
A
claudication of affected extremity
raynauds phenomenon
migratory superficial vein thromnphlebitis
9
Q
triad of buergers diseases
A
claudication of affected extremity
raynauds phenomenon
migratory superficial vein thromnphlebitis
10
Q
virchows triad
A
stasis
vascular/endothelial damage
hypercoagulability
11
Q
Dressler Triad (Post MI pericarditis)
A
Fever
Pleuritic pain
Pericardial effusion
12
Q
drugs increases contractility
A
digoxin
dobutamine
milrinone
13
Q
drugs reduces preload
A
Diuretics
vasodilators
ace inhibitors
14
Q
Drugs reduces afterload
A
diuretics
vasodilators
ACE inhibitors
Beta blockers
15
Q
Drugs causes Causes Na excretion and reduction in blood volume
A
Diuretics
16
Q
Drugs Calcium Channel Blocker that exerts more effect in the vessels than the heart
A
Dihydropyridines
Nifedipine, Felodipine, Amlodipine
17
Q
Calcium Channel blocker that exerts more effect on the heart than the vessels
A
Nondihydropyridines
Verapamil, Diltiazem
18
Q
Decreases the work load of the heart
A
Beta-blockers
19
Q
Blocks the AT1 receptor of angiotensin II
A
ARBs
20
Q
Notorious for drug-induced cough by increasing bradykinin
A
ACE inhibitors
21
Q
Blocks aldosterone action in the collecting tubules
A
Spironolactone, Eplerenone
22
Q
Hypertension with Benign Prostatic Hyperplasia (BPH)
A
Alpha-1 antagonists (Prazosin)
23
Q
Maintenance medication for pre-eclampsia
A
Methyldopa
24
Q
Physiologic basis for normal ECG tracing
A
P-wave: atrial depolarization
QRS complex: ventricular depolarization
T wave: ventricular repolarization
25
Master pacemaker of the heart
Sinoatrial (SA) Node
26
Causes depolarization of the SA node
Calcium influx (Sodium influx will merely
bring potential closer to threshold;
however, sodium is still the determinant
of heart rate)
27
The only electrical connection between the atria and ventricles
AV node
28
Only reliable therapy for symptomatic bradycardia in the absence of extrinsic
and reversible etiologies
Permanent pacemaking
29
Most rapid conduction in the heart
His bundle and bundle branches
30
Most expeditious technique in the management of AV conduction block
Transcutaneous pacing
31
Most common arrhythmia identified during extended ECG monitoring
Atrial Premature Complexes
32
Most common sustained arrhythmia
Atrial Fibrillation
33
Most common arrhythmia post-MI
Premature Ventricular Contraction
| PVC
34
Most common lethal arrhythmia post-MI
Ventricular Fibrillation
35
Most common cause of systolic dysfunction that leads to L-sided HF
Coronary Artery Disease (CAD)
36
Most common cause of diastolic dysfunction that leads to L-sided HF
Concentric LVH due to HPN
37
Most common cause of R-sided HF
L-sided HF
38
Earliest cardinal symptom of L-sided HF
Dyspnea
39
Earliest cardinal sign of L-sided HF
L-sided S3
40
Presentation of L-sided HF
```
Dyspnea, left-sided S3, PND,
orthopnea, Mitral regurgitation,
increased Brain Natriuretic Peptide
(BNP), Siderophages (hemosiderinladen
macrophages or HF cells),
pulmonary edema (septal edema,
peribronchiolar edema)
```
41
Presentation of R-sided HF
Peripheral ankle edema (hallmark of Rsided
HF), NVE, tricuspid regurgitation,
ascites, chronic passive congestion of
the liver (nutmeg liver), cardiac cirrhosis
42
Most sensitive index of cardiac function
Ejection fraction
43
Single most important bedside measurement to estimate volume status
JVP (internal jugular vein is preferred)
44
Cardinal symptoms of HF
Fatigue and shortness of breath
45
Only pharmacologic agents that can adequately control fluid retention in
advanced HF
Diuretics
46
Major problem of Aldosterone Antagonists
Development of life-threatening
| hyperkalemia
47
Cornerstones of modern therapy for HF with a depressed EF
ACE-I/ARBs and Beta Blockers
48
Most common side effect of all vasodilating agents
Hypotension
49
Most commonly used inotropic agent for acute HF
Dobutamine
50
First choice for therapy in which modest inotropy & pressor support are
required
Dopamine
51
Most common reason for rehospitalization in HF
Failure to meet criteria for discharge
52
Most common symptom of cor pulmonale
Dyspnea
53
Murmurs that always signify structural heart disease
```
Diastolic murmurs (Grade I-II systolic
murmurs are usually benign
```
54
Leading cause of MS
Rheumatic Heart Disease
55
Pansystolic Murmur; may be due to Mitral Valve Prolapse (MVP)
Mitral Regurgitation (MR)
56
Most common cause of midsystolic murmur in an adult
Aortic Stenosis (AS)
57
Most common congenital heart valve defect
Bicuspid Aortic Valve Disease
58
Three cardinal symptoms of AS
Exertional Dyspnea
Angina Pectoris
Syncope
59
Most common pathologic process involving the pericardium
Acute Pericarditis
60
Typical pain in pericarditis
Worse when supine and relieved by
| sitting upright and leaning forward
61
Pericardial friction rub in acute pericarditis is heard not frequently at
End-expiration with patient upright and
| leaning forward
62
Three most causes of tamponade
Neoplastic disease
Idiopathic pericarditis
Renal failure
63
Most common primary malignant pericardial tumor
Mesothelioma (e.g., from asbestosis)
64
Most common primary malignant pericardial tumor
Mesothelioma (e.g., from asbestosis)
65
Most common type of primary cardiac tumor in all age groups and occurring at
all ages
Myxomas (90% are sporadic)
66
Most common tumors of the cardiac valves
Papillary Fibroelastomas
67
Most common cardiac tumors in infants and children
Rhabdomyomas
68
Almost all primary cardiac malignancies are
Sarcomas (commonly involve the right
| side of the heart)
69
Most common primary originating sites of cardiac metastases
Cancer of the breast and lung
70
Most often involved in metastasis to the heart
Pericardium > Myocardium >
| Endocardium or Cardiac Valves
71
Central role in the diagnostic evaluation of cardiac metastases and cardiac
tumors
Cardiac MRI
72
Most common form of non-penetrating cardiac injury
Myocardial contusions
73
Most common valves that rupture in non-penetrating cardiac injury
TV or MV (heralded by the development
| of a loud murmur)
74
Most serious consequence of non-penetrating injury
Myocardial rupture
75
Most serious consequence of non-penetrating injury
Myocardial rupture
76
Most common vascular deceleration injury
Rupture of the aorta
77
Most common cause of sudden death in contact sports (e.g., American
football)
Commotion Cordis
78
Most common congenital heart disease; CXR shows biventricular enlargement
& dilated left atrium; most common type is membranous
Ventricular Septal Defect (VSD)
79
Most common congenital heart disease diagnosed in adults; CXR shows
dilated right atrium and right ventricle
Atrial Septal Defect (ASD)
80
CHD with Early Cyanosis (R to L shunt)
```
Mnemonic: All CHDs that start with “T”:
Tetralogy of Fallot (TOF)
Tricuspid Atresia
Truncus Arteriosus
Total Anomalous Pulmonary
Venous Connection (TAPVC)
Transposition of the Great
Arteries (TGA)
```
81
CHD with Late Cyanosis (L to R shunt)
ASD, VSD, PDA, AVSD
82
CHD associated with Congenital Rubella Syndrome; “continuous machinery
like murmur”; needs indomethacin to close and PGE1 to remain open
Patent Ductus Arteriosus (PDA)
83
CHD associated with Turner’s Syndrome
Preductal Coarctation of the Aorta
| CoA
84
CHD associated with Down Syndrome
ASD, Endocardial Cushion Defect
85
CHD associated with Marfan Syndrome
MVP, Aortic Dissection
86
CHD associated with offspring of diabetic moms
TGA
87
CXR shows boot-shaped heart (Coeur en Sabot); Components: subpulmonic
stenosis (main determinant of severity), RVH, VSD, overriding of the aorta
TOF
88
CXR shows egg-shaped silhouette or egg-on-its-side appearance
TGA
89
CXR shows snowman sign/cottage-loaf heart
TAPVC
90
CXR shows figure of 3 sign
CoA (rib-notching is seen in the adult or
| post-ductal form)
91
Most common underlying cause of myocardial ischemia and injury
Obstruction of coronary arteries by
| atherosclerosis
92
Most common cause of anterior chest musculoskeletal pain
Costochondral and chondrosternal
| syndromes
93
Major cause of death and premature disability in developed societies
Atherosclerosis
94
Represents the initial lesion of atherosclerosis
Fatty Streak
95
Major features of metabolic syndrome
```
Central obesity
Hyperglycemia
Hypertriglyceridemia
Hypertension
Low HDL cholesterol
```
96
Age when lipid screening should start (based on current ATP III guidelines)
All adults > 20 years (fasting lipid
profile: total cholesterol, triglycerides,
LDL and HDL) repeated every 5 years
97
First maneuver to achieve LDL goal
Therapeutic lifestyle changes (TLC)
98
Ultimately causes the gravest complications of atherosclerosis
Thrombosis
99
Key feature of the metabolic syndrome
Central adiposity
100
Most accepted & unifying hypothesis to describe pathophysiology of metabolic
syndrome
Insulin resistance
101
Driving force behind the metabolic syndrome
Obesity
102
Primary approach to metabolic syndrome
```
Weight reduction (caloric restriction:
most important component)
```
103
Drug of choice to lower LDL
HMG-CoA reductase inhibitors (Statins)
104
Drug of choice to lower fasting TG
Fibrates
105
Only currently available drug with predictable HDL-raising properties
Nicotinic acid
106
Most common cause of myocardial ischemia
Atherosclerotic disease of epicardial
| coronary artery
107
Major site of atherosclerotic disease
```
Epicardial arteries (most common: Left
Anterior Descending Artery)
```
108
Sites of predilection for atherosclerotic plaques to develop due to increased
turbulence
Branch points in the epicardial arteries
109
Time frame for reversible damage in myocardium
<20 minutes for total occlusion in the
| absence of collaterals
110
Route of administration where absorption of nitrates is most rapid and
complete
Sublingual/through mucus membranes
111
Most common pathophysiologic cause of unstable angina
Plaque rupture or erosion with
| superimposed non occlusive thrombus
112
Only absolute contraindications to nitrate use
Hypotension
Sildenafil or other drugs in that class in
previous 24-48 hours
113
Most common artery involved in focal spasms of Prinzmetal angina
Right Coronary Artery
114
Type of necrosis seen in MI
```
Coagulation Necrosis (preserved
architecture, faded details)
```
115
Time frame where gross changes in MI occur
12 hours after the onset of symptoms
116
Color changes in MI
```
Mottling: 4 hours
Bright yellow: 1 wk
Surrounding red granulation tissue: 2
weeks
Gray-white scar: 2 months
```
117
Fibrinous Pericarditis (bread & butter pericarditis) post-MI
Dressler’s Syndrome
118
Myocardial rupture post-MI occurs in patients who are
1st time MI patients (cardiac scar in
| those with previous MI prevents rupture)
119
Pivotal diagnostic and triage tool because it is at the center of the decision
pathway for management in STEMI
12-Lead ECG
120
Most common presenting complaint in STEMI
Chest pain
121
Preferred biochemical markers for MI
Cardiac-Specific Troponin T & Cardiac-
| Specific Troponin I
