Medicine (CVS) Flashcards
1
Q
ECG leads
A
12 leads in total
6 limb leads
6 chest leads
2
Q
Limb lead placement in ECG
A
6 limb leads 3 bipolar (1,2,3) 3 unipolar (aVL, aVR, aVF)
3
Q
Chest leads placement in ECG
A
V1,V2,V3,V4,V5,V6
4
Q
ECG leads with relation to cardiac wall and blood vessel.
A
V1-V4 = anterior wall, LAD
V5-V6 = anterolateral wall, LAD + LCA
Lead 1 and aVL = laterla wall, LCA
lead 2,3 and aVF = inferior wall , RCA
5
Q
Causes of + upward detection of current in aVR
A
By mistake of operator
Dextrocardia
6
Q
Cause of vibrations and thrills in ECG?
A
Anxiety
Parkinson’s disease
7
Q
Low voltage i.e. less than 15mm occurs in?
A
Obese pt. CCF pleural effusion Percardial effusion Primary hypothyroidism
8
Q
Heart rate is checked in which lead?
A
Lead 2
9
Q
Method of calculating heart rate
A
R-R wave is the key
2 methods
1. Calculate big boxes between R-R interval and divide that number from 300
Ex, 3 boxes between R-R interval
300/3 =100 beats per minute
- Calculate small boxes between R-R interval and devide that number from 1500
Ex. 10 small boxes between R-R interval
1500/10 = 150 beats per minute
10
Q
Normal cardiac axis is between what degrees?
A
-30 to +90 degrees
11
Q
Axis deviation in ECG is checked by which leads?
A
Lead 1 and 2
Or
Lead 1 and aVF
12
Q
Normal axis in ecg is shown by?
A
+ or upward deflection in lead 1 and 2 or in lead 1 and aVF
13
Q
LAD i.e. left axis deviation in ECG.
A
Lead 1 upward
Lead 2 or aVF downward
Current is more towards left axis
14
Q
Causes of Left axis deviation?
A
Chronic HTN
Left ventricular hypertrophy
Inferior wall MI
Wolf-parkinson-white syndrome (extra electrical pathway in left ventricle)
Ventricular tachycardia
Ostium primum ASD (the defect is near atrio-ventricular valve i.e. very near to left ventricle.
LBBB
15
Q
RAD i.e. right axis deviation in ECG
A
Lead 1 downward
Lead 2 or aVF upward
16
Q
Causes of right axis deviation?
A
COPD Left sided pneumothorax Right ventricular hypertrophy Anterolateral MI Pulmonary embolism RBBB
17
Q
Extreme right axis deviation in ECG?
A
Both leads downward or negative
18
Q
Boxes distribution in ECG for time and lenght
A
1 small box = 0.04sec = 1mm
1 large box = 5 small boxes= 0.2s =5mm
19
Q
How to check Left ventricular hypertrophy in ECG?
A
Vertical small boxes aVL lead should be checked
If R wave is taller than 11mm , it is ventricular hypertrophy
20
Q
MCC of left axis deviation?
A
Left ventricular hypertrophy
21
Q
MCC of right axis deviation?
A
Pulmonary hypertension
22
Q
Sokolow-LyonCriteria is used to detect which heart pathology?
A
Left ventricular hypertrophy
23
Q
Explain sokolow-LyonCriteria
A
Calculate hight of S wave in V1 and of R wave in V5 or V6. Then add them, if the sum is greater than 35 mm, LVH is present
24
Q
What is J point in ECG
A
Junction between S and T wave
25
ST elevation and depression are seen by which part of ECG?
By J point
26
ST elecation indicates MI in which heart wall?
Ant.wall MI
27
ST depression MI indicates MI in which heart wall?
Lateral / Inferior wall MI
28
How to check ST elevation and depression in ECG?
ST elevation = J point more than 2small boxes
| ST depression= J point depress more than 1 small box
29
Phases of cardiac contraction
Phase 0, rapid depolarization by Na influx
Phase 1, sodium channel closses resulting in sudden small drop
Phase 2, Ca2+ influx and K+ efflux causes a platue formation
Phase 3, K+ efflux only causes a rapid drop and repolarization
Phase 4, resting membrane potential.
30
Diagnosis of hypertensive pt.
Systolic BP morethan 140mmHg
Diastolic BP more than 90mmHg
Morning occipetal pain
Dizziness
Fatigue
Epistaxis and blurred vission in severe hypertension.
31
Drug group i.e. treatment of choice in most healthy pt. With only hypertension.
No#1 rule, life style modification
| No#2 drug, MC thiazide diuretics
32
Diuretics contraindications.
Gout (due to hyperurecemia effect)
DM (due to hyperglycemia effect)
Not safe in renal and hepatic impairement pt.
33
Mnemonics for drugs
CCB, dipine and diltiazem
ARB, losartan, sartan
B-Blockers, olol
ACEI, opril
34
Drug of choice in pt. With co-existing coronary artery disease.
B-Blockers
35
Drug of choice for hypertension in pt. With DM and heart failure.
ACEI
36
Drug of choice in elderly pt. With asthma?
CCB, dipine
37
Drug of choice in hypertensive pt. With stroke?
ACEI or ARB
38
Drugs for aggressive treatment if HTN in stroke?
All should be given IV
Labetolol
Nicardipine
Hydralazine
39
Ca2+ channel blockers work on which phase of cardiac contratility?
Phase 4
40
Endogenous lipid function.
```
Chylomicrons, carry dietry lipids
VLDL, TAGs to adipocytes
IDL, both TAGS n cholesterol
VLDL, cholesterol only
HDL, removes cholesterol from blood.
```
41
Types of hyperlipidemia.
Type 1, chylomicrons (one word)
Type 2-A, LDL (2 L)
Type 2-B, LDL n VLDL (2 L in both)
Type 3, IDL (3 digits)
Type 4, VLDL (4 Digits)
Type 5, VLDL + Chylomicron (4 digits + one word)
Full Names:
Type 1 familial hyperchylomicronemia
Type 2-A familial hypercholesterolemia
Type 2-B Familial combines mixed hyperlipidemia
Type 3 familial dysbetalipoproteinemia (also known as beta lipoprotien)
Type 4 familial hypertriglyceridemia
Type 5 familial mixed hypertriglyceridemia
42
Most common type of familial hyperlipidemia
Type 2-B, familial combined hyperlipidemia.
43
Type of hyperlipidemia which is a genetic effect.
Type 5 i.e. raised VLDL n chylomicrons
44
Type of hyperlipidemia that has highest chances of inchemic heart disease?
Type 2-A ,becz LDL has cholesterol which is main culprit.
45
Type of hyperlipidemia with no risk of coronary heart disease?
Type 1 by chylomicrons, becz dietry lipid is useless in causing disease.
46
Xanthomas occurs in which type of dyslipidemia?
| Skin nodule like irregular lesion filled with lipid
Type 3, IDL raised one, becz of their both lipid and cholesterol content.
47
Classification of dyslipidemia.
Primary or familial dyslipidemia.
| Secondary or acquired dyslipidemia.
48
Causes of secondary / acquired dyslipidemia.
```
Body related:
Pregnancy
Alcohol abuse
DM
Cushing syndrome
Chronic kidney disease
Nephrotic syndrome
Obstructive jaundice
Hypothyroidism
```
```
Drug induced:
Oral contraceptives
Thiazide diuretics
Beta Blockers
Glucocorticoids
```
49
3 classic clinical features of dyslipidemia
Premature acrus senilis: opaque ring in the corneal margin
Tendon Xanthomata: hard-non tender nodular enlargment of tendons
Xanthelasmas: Fatty deposits in eye lids
50
Most widely used diagnostic criteria for familial hypercholesterolemia.
Simmon Broome Diagnostic Criteria
51
What DNA evidence is found in simmon broome criteria?
Mutation of LDL receptors
Defective apo-B-100
Defective PCSK 9
52
Desired HDL levels in blood.
40mg/dL or more
53
Most important enzyme ascardiac marker for MI?
Troponin i
54
What is PCI or angioplasty and when it is indicated?
PCI(Percutaneous Coronary Intervention) or angioplasty is a non surgical procedure in which catheter is used to place a stent in blocked artery of heart.
And it is indicated when one vessel of heart is blocked.
55
Indication for CABG or Corronary artery bypass graft.
When 2-3 arteries of heart are blocked.
56
Time period when thrombolytic agents are most effective?
During First hour of MI
57
O2 therapy should be monitored in which type of pt.
In COPD, as it may cause hypercapnia or raised CO2 level in blood
58
Brand name of nitroglycerine i.e. used as initial home remedy for MI.
Angised
59
ECG findings in unstable angina and NSTEMI
ST-depression +or- T-wave inversion
60
Cardiac enzyme findings in unstable angina?
Cardiac enzymes are always negative in unstable angine as uptill now no cardiac injury has occured.
61
S-3 sound is heard in which pathology?
Heart failure
62
S-4 sound in which condition?
Sign of ichemia
63
MC cause of death within 1 hour of MI?
By arrhythmias
64
MC cause of death after few hours of MI?
Heart failure
65
Best initial test for confirming MI?
Repitive ECG
66
Q wave in ECG indicates which condition?
Prior infarct
67
Cardiac marker which is enzyme of choice to check re-infarct with in few days of MI
CK-MB marker
68
ST elevation in ECG indicates which type of MI
Transmural MI
69
Non ST elevation ECG indicates which type of MI?
Subendocardial injury
70
Arteries involved in MI.
Inferior wall MI: right coronary artery
Anterior wall MI: left anterior descending
Anteroseptal MI: left anterior descending artery
Posterior wall MI: posterior descending
Anterolateral wall MI: LAD and left circumflex artery.
71
MC overall cause of infective endocarditis.
Strep. viridians
72
MC organism causing infective endocarditis in IV drug users.
Staph.Aureus
73
MC cause of acute Infective endocarditis.
Staph. Aureus
74
MC cause of infective endocarditis in prothetic valve
Staph.epidermidis.
75
MC valve involved in IE.
mitral valve (becz of rich O2 blood)
76
2nd MC valve involved in IE.
Aortic valve.
77
MC Valve involved in IV drug users in IE.
Tricuspid valve.
78
types of IE
Acute n sub-acute
Acute: is more dangerous, causing more damage, and attacking a normal valve.
sub-acute: less dangerous, causing less damage and attacking already damaged valve.
79
MC organism causing acute IE.
Staph.Aureus
80
MC organism causing sub-acute IE.
Strep.viridians i.e. S.sangius and s.mitis
81
Abscesses in echocardiography is found in which type of IE?
Acute (becz of staph i.e. pyogenic bacteria)
82
some Imp findings in sub acute IE.
```
Roth spots (hemorrhage in ratina)
Oslers nodes (painful, red, raised lesions found on the hands and feet)
splinter hemorrhages (in fingers)
Janeway's lesions (painless lesions on palms and feet)
```
83
most accurate investigation for confirming IE.
Blood culture.
84
MC surgical indication in IE.
Heart failure due to valve damage.
85
treatment of penicilin (methicilin) resistant s.aureus MRSA?
vancomycin
86
treatment of penicilin (methicilin) sensitive s.aureus?
Nafcilin, oxacilin and benzyl penicilin,
| penicilin working, use it
87
Diagnostic methodology or criteria used for IE?
Duke's criteria
88
Types of EEG.
```
transthoracic echocardiograms (TTE)
transesophageal echocardiograms (TEE)
```
89
which type of EEG is more specific and sensitive in IE.
TEE i.e. tranesophageal echocardiograms
90
MC type of heart failure?
Left sided heart failure (HF)
91
Key clinical features of left sided HF.
Dyspnea (difficulty in breathing)
Orthopnea (difficulty in bleeding while lying flat)
Paroxysmal nocturnal dysnea (PND) i.e. dysnea while sleeping.
92
First cardiac sign of Left sided HF.
S3 heart sound
93
Murmur in Left sided HF.
pansystolic murmur
94
MC cause of right sided HF,
Left sided HF
| corpulmonale
95
Heart sound in left sided heart failure.
S3 heart sound.
96
Heart sound in right sided heart failure.
right sided S3 and S4 heart sound
97
Hall mark sign of right sided HF.
Pitting pedal and peritibial edema.
98
what is high-output heart failure.
Congestive heart failure with high cardiac output.
99
Causes of high-output heart failure.
severe anemia
wet beri beri (effects heart and circulatory sys)
mitral regurgitation
aortic regurgitation (becz blood always comes back)
pregnancy.
100
most common symptom of congestive heart failure.
Dyspnea on exertion.
101
best initial test for CHF
transthoracic EEG
| becz it shows the size of heart from all angels
102
cardiac neuro hormone which is marker of CHF
(BNP) brain natriuretic peptide
if elevated i.e. CHF confirm
if normal than no CHF
103
MC indication for heart transplantation
coronary artery disease and dilated cardiomyopathy.
104
MC cause of death in CHF pt.
sudden cardiac death due to ventricular arrhythmia.
105
Worst and most serious menifestation of CHF.
Acute pulmonary edema
106
loud S1 is heard in which pahology.
mitral stenosis
107
soft S1 is heard in which pahology.
heart failure and mitral regurgitation.
108
Fixed Splitting of S2 sound is heard in
ASD
109
low-pitched, early diastolic sound is heard in which condition S3
mitral regurgitation
tricuspid regurgitation
acute aortic regurgitation
becz blood comes back
110
low-pitched, late diastolic sound is heard in
| S4
LV hypertrophy
RV hypertrophy
2 hypertrophy= 4 guna taqat
111
MC cause of death in acute attack of rheumatic fever.
myocarditis
112
MC initial presentation of acute RF.
migratory polyarthritis.
113
murmur in RHD
carey coombs murmur
114
sydenham chorea is also known as
st.vitus dance
