Kaplan -Cardiovascular

Question 1

A fluid filled neck mass (cystic hygroma), high arched palate, broad chest and pedal edema are associated with what sndrome and what two cardiovascular abnormalities?

Answer 1

Turner’s syndrome;

preductal coarctation (femoral pulse < brachial, notched ribs)
and bicuspid aortic valve

Question 2

what kinds of vessels of the circulatory system have the most blood in them when a person is at rest/ supine?

Answer 2

veins and venules

Question 3

what is the heredity of familial hypercholesterolemia

Answer 3

autosomal dominant

Question 4

what is the underlying condition associated with Libman-Sacks endocarditis

Answer 4

SLE

Question 5

how exactly is SLE diagnosed

Answer 5

at least 4 of the following 11 criteria: (RASH OR PAIN)
Rash (malar or discoid), Arthritis, Soft tissues/ serositis, Hematologic disorders (cytopenia), Oral/ nasopharyngeal ulcers, Renal disease and Raynaud’s phenomenon, Photosensitivity and Positive VDRL/RPR, Antinuclear antibodies, Immunosuppresants (treatment, not symptom), Neurologic disorders (seizures / psychosis)

Question 6

what is Wolf-Parkinson white syndrome and what drug is contraindicated in these patients

Answer 6

WPW is a pre-excitation syndrome in which bundles of Kent bypass the AV node (delta waves seen on EKG)
digoxin is contraindicated because it enhances accessory conduction pathways which can cause v. fib in WPW patients

Question 7

for vessels in parallel, what will removing one of the vessels do to resistance

Answer 7

increase resistance
(for parallel:   1/Rtotal= 1/R1 + 1/R2 + 1/R3)

Question 8

Coronary blood flow is driven by pressure changes in which part of the circulatory system? what part(s) of the ventricular cycle (isovolumetric contraction/ ejection/ isovolumetric relaxation/ filling)

Answer 8

aortic pressure drives coronary artery filling

isovolumetric contraction is associated with a sharp drop in coronary blood flow

Question 9

what are the normal values for pulmonary artery pressure and pulmonary wedge pressure

Answer 9

pulmonary artery pressure= 25/8

PCWP < 12 normally

Question 10

when Swan-Ganz catheter shows that left ventricular BP is much higher than aortic BP and you also observe a systolic murmur what disease do you suspect?
what character does the murmur have?

Answer 10

aortic stenosis

cresc. decresc. systolic ejection murmur following ejection click that is loudest at the base of the heart and radiates to the carotids

Question 11

rheumatoid arthritis is associated with which kind of cardiomyopathy and why

Answer 11

restrictive cardiomyopathy: amyloid-associated protein deposits in the myocardium leading to decreased compliance and decreased diastolic filling

Question 12

in compensated coarctation what happens to blood flow above and below the coarctation?
what happens to resistance above and below the coarctation?

Answer 12

since it is compensated blood flow must be normal above and below

pressure= flow x resistance
therefore, to maintain flow at a higher pressure (above coarctation) resistance must increase

Question 13

what does a larger vessel arteriorvenous fistula do to cardiac output

Answer 13

increases cardiac output (by roughly the same amount as the flow through the fistula)

Question 14

what are some common toxicities of digoxin

Answer 14

dysrhythmias due to increase atrioventricular conduction (such as premature ventricular contractions), nausea/ vomiting, dizziness, dyspnea, agitation, ocular disturbances (halos, scotomas, blurred vision)

Question 15

what are the histologic features of infarcted myocardium 2 days post-MI

Answer 15

on H&E stain there will be lost of neutrophils, necrosis, and contraction bands

Question 16

what are the three types of creatinine kinase and what do they measure

Answer 16

CK-MB measures myocardial damage
CK-MM measures skeletal muscle damage
CK-BB measures brain tissue damage

Question 17

in the setting of trauma with multiple injuries what kind of creatinine kinase measurement would you use to try to determine if there was cardiac contusion (hint: not simply creatinine kinase-MB)

Answer 17

CK-MB to total CK ratio (CK-MB should be greater than the other CK’s if there is a focal cardiac insult)

Question 18

which is more specific for cardiac injury CK-MB or troponin I

Answer 18

troponin I

Question 19

which better allows for determination of reinfarction, CK-MB or troponin I

Answer 19

CK-MB since it normalizes within ~3 days

Question 20

which can indicate cardiac damage AST or ALT?

Answer 20

AST; AST increase with normal ALT suggests cardiac abnormality rather than liver since AST is found in liver and heart, but ALT is only found in liver

Question 21

name some drugs that prolong QT

Answer 21

sotolol, disopyramide, procainimide, quinidine, TCA’s (“some drugs prolong Q T”)

Question 22

what joints are usually the first to be affected by gout and what blood pressure medication can cause gout

Answer 22

MTP (metatarsophalangeal) and big toe;

thiazides have gout as a side effect because they can cause hyperuricemia

Question 23

what kinds of substances are stained by a trichrome stain

Answer 23

erythrocytes=orange
muscle=red
collagen=blue

Question 24

what is the first step in atherosclerotic plaque formation

Answer 24

endothelial injury:
endothelial injury leads to release of free radicals that oxidize LDL as well as decreases in NO which is anti-atherosclerotic

Question 25

what is the most common cause of acute endocarditis

Answer 25

Staph aureus

Question 26

what is the most common valvular abnormality in IV drug users and its accompanying murmur

Answer 26

tricuspid insufficiency; holosystolic murmur heard best at the 4th intercostal space on the left parasternal border

Question 27

what is another (more descriptive) name for Churg-Strauss disease

Answer 27

eosinophilic granulomatosis with polyangitis

Question 28

what are the three clinical phases of Churg-Strauss

Answer 28

1. prodrome of allergic rhinitis or asthma
2. eosinophilic phase: eosinophilia in multiple organs
3. vasculitic phase: vasculitis of medium and small vessels, fever, malaise, weight loss

Question 29

what is Wegener’s granulomatosis, its symptoms and its characteristic autoantibody

Answer 29

granulomatosis with polyangitis: a vasculitis of small vessels that affects mainly the respiratory tract (sinusitis, rhinitis, otitis media, hemoptysis)

c-ANCA positive

Question 30

what is a lethal complication that can arise 5 days post MI?

1 month post-MI?

Answer 30

5 days post-MI ventricular wall rupture can occur

1 month post-MI ventricular aneurysm can occur due to weakened, but intact fibrosed area of myocardium

Question 31

in a patient with atrial fibrillation and ventricular tachycardia, what drug would you use to both decrease HR and decrease conduction through AV node; finally, what other effect does this drug achieve

Answer 31

digoxin stimulates the vagus nerve, decreases AV node conduction and SA node conduction

digoxin: a cardiac glycoside that directly inhibits NaK ATPase and indirectly inhibits NaCa exchanger to increase intracellular Ca and thereby increases contractility (for CHF)

Question 32

what is mean systemic filling pressure and what is a normal value

Answer 32

MSFP= the pressure within the circulatory system if the aorta and great vessels are clamped allowing pressure to redistribute throughout the system

normal MSFP is +7mmHg

Question 33

what are the indications for digoxin use

Answer 33

atrial fibrillation and mild to moderate CHF

Question 34

what kinds of drugs, when combined with digoxin can lead to new arrhythmias

Answer 34

K+ wasting diuretics because they can cause hypokalemia or hypomagnesemia (or K+ sparing diuretics can cause hyperkalemia, which also causes arrhythmia)

Question 35

stimulation of the vagus and glossopharyngeal nerves will cause the body to perceive what hemodynamic imbalance
what control center receives the impulse

Answer 35

hypertension;

nucleus solitarius

Question 36

measuring JVD serves as a proxy for what hemodynamic value

Answer 36

central venous pressure

Question 37

what cardiac abnormality can arise secondary to rheumatoid arthritis and describe it

Answer 37

amyloidosis of the heart; AA amyloid protein deposition on the heart that appears speckled pink on gross pathology and apple-green birefringence on Congo red stain

Question 38

in renal artery stenosis, what is the mechanism by which the body senses an imbalance and responds (include GFR and Na+ in your answer)

Answer 38

renal artery stenosis causes a decrease in GFR, which causes lower sodium chloride to reach the macula densa. as a result the juxtaglomerular apparatus cells secrete renin

Question 39

what kind of drug is alpha-methyldopa and what is it used for

Answer 39

alpha-methyldopa is a selective alpha2 agonist that causes decreased sympathetic outflow by stimulating alpha2 receptors
used for gestational hypertension

Question 40

what complication might you see in the lung as a result of S. aureus endocarditis?
what about in the eye?

Answer 40

pulmonary abscess (septic emboli from the heart lodge in the lungs)
Roth spots seen on fundoscopic exam

Question 41

prerenal azotemia, splenic abscess and stroke are likely to arise from endocarditis of which valve

Answer 41

mitral (these systemic lesions are more indicative of a left-sided endocarditis, as opposed to lung involvement with tricuspid endocarditis)

Question 42

what happens to the heart as a result of coarctation (what region of the heart and what phenomenon)

Answer 42

left ventricular hypertrophy

Question 43

which vessel has the greatest wall cross-sectional area to lumen cross-sectional area ratio

Answer 43

arterioles

Question 44

a high left atrial pressure at the same time point as the dicrotic notch suggests what valvular disease and what kind of murmur is it associated with

Answer 44

mitral regurgitation

associated with a holosystolic, high-pitched “blowing murmur”

Question 45

what are the normal values for total cholesterol, HDL, LDL

Answer 45

cholesterol 60 mg/dL

LDL 100-129 mg/dL

Question 46

acute pericarditis is commonly preceded by what kind of illness

Answer 46

viral URI

Question 47

what does an arteriovenous fistula do to CO and PVR

Answer 47

cardiac output increases (by roughly the flow through the arteriovenous fistula)
peripheral vascular resistance decreases

Question 48

the sphenopalatine artery (responsible for epistaxis) arises from which branch of the ECA

Answer 48

the maxillary artery

Question 49

why would an anemic patient have a wider pulse pressure

Answer 49

anemia causes an increased CO (via increased HR and SV). Increased stroke volume causes a larger difference between SBP and DBP, hence a wider pulse pressure

Question 50

there is no space between the epicardium (visceral serous pericardium) and ______; there is no space between the parietal serous pericardium and ________

Answer 50

epicardium is adherent to the heart
parietal serous pericardium is adherent to the fibrous pericardium

(thus the pericardial space is between the epicardium (visceral serous pericardium) and the parietal serous pericardium