Cardiology

Front 1

A biphasic waveform is recorded in a lead when the depolarization moves in what direction to the lead

Back 1

Perpendicular to the lead in question

Front 2

Sequence of normal cardiac activation:

Back 2

1: SA node

2: Sinus wave

3: AV node delay

4: QRS

Front 3

Normal ventricular depolarization is recorded by leads

Back 3

aVF and aVL

Front 4

ST segment from where to where?

Back 4

Finish of S to start of T

Front 5

PR interval from where to where?

Back 5

Start to start

Front 6

QT intervalfrom where to where?

Back 6

Start to finish

Front 7

Voltage in one vertical box?

Back 7

0.1 mV

Front 8

Time in one horizontal box?

Back 8

40ms

Front 9

Rate determination quick step sequence:

Back 9

300-150-100-75-60-50

Front 10

Normal PR interval

Back 10

0.12-0.20 sec (3-5 boxes x 0.04ms)

Front 11

Decreased PR interval pathogenesis?

Back 11

Preexcitation syndrom or Junctional rhythm

Front 12

Increase PR interval?

Back 12

First degree AV block.

Front 13

Rapid QT interval assessment:

Back 13

QT < (R-R)/2; if HR 60-100 bpm

Front 14

Long QT intervals may predispose patients to?

Back 14

Lethal cardiac rhythm disturbances.

Front 15

Conditions that shorten QT interval:

Back 15

Hypercalcemia and Tachycardia

Front 16

Conditions that lengthen QT interval:

Back 16

Hypocalcemia, hypokalemia, hypomagnesia, myocardial ischemia, certian anti-arrhythmic drugs

Front 17

Axis deviation trick for RAD and LAD:

Back 17

RAD = lead I negative (with or without lead II negative)

LAD = only lead II negative, not lead I

Front 18

RA enlargement by ECG:

Back 18

P height >2.5 in lead II

Front 19

LA enlagement by ECG:

Back 19

negative P in V1 >1mm wide and deep.

Front 20

QRS abnormalities include:

Back 20

Ventricular hypertrophy, bundle branch blocks, pathologic Q waves

Front 21

Right ventricular hypertrophy by ECG:

Back 21

V1 and V2 recrod greater than normal upward deflections (R>S)

Right Axis Deviation

Front 22

Left ventricular hypertrophy by ECG:

Back 22

V5 and V6 record greater than normal upward deflections

V1 and V2 demonstrate deeper than normal S waves

Left axis deviations

Front 23

In bundle branch blocks, ventricle rely on what for electrical activity?

Back 23

Slow myocyte to myocyte spread

Front 24

Normal QRS duration

Back 24

< 0.1s

Front 25

Complete bundle branch block QRS duration

Back 25

>0.12s (3 boxes x 0.04s)

Front 26

Bunny ears (RSR') in V1-V3

Back 26

RBBB

Front 27

Bunny ears in I, aVL, V5, V6

Back 27

LBBB

Front 28

Prominent S in V6

Back 28

RBBB

Front 29

Absent R and prominent S in V1

Back 29

LBBB

Front 30

What are fascicular blocks?

Back 30

Conduction is impaired in just one of the two fascicles (subdivisions) of a bundle branch.

Front 31

Main ECG finding of fascicular blocks?

Back 31

Altered mean ECG axis

Front 32

What is permanent evidence of an old trans-mural infaction?

Back 32

Pathological Q waves

Front 33

Pathological Q waves develop in the leads overlying infacted tissues because...

Back 33

Necrotic muscle does not general electrical forces and currents are picked up from healthy tissue on opposite region of ventricle.

Front 34

Physiological Q waves...

Back 34

Small in leads V6 and aVL (<0.04sec and <25% QRS height)

Front 35

QRS that are >1 square and>25% QRS height are...

Back 35

Pathological

Front 36

Pathological Q waves in:

V1/V2

V3/V4

II/III/aVF

I/V5/V6/aVL/

Significy what localization of infaction and typically which coronary artery involved?

Back 36

Antero septal; LAD

Antero apical; LAD distal

Inferior; RCA

Antero lateral; CFX

Front 37

ECG findings of pericarditis?

Back 37

Diffuse ST segment elevation in most leads except aVR and V1 - inflammation of adjacent myocardium

PR segment depression - abnormal atrial repolarization

Front 38

ST segment and T wave abnormalities are typically induced by:

Back 38

Transient MI

Acute ST segment elevation MI (STEMI)

Acute non-ST segment elevation MI (NSTEMI)

Front 39

ST depression and T wave inversion indicative of

Back 39

MI

Front 40

T wave inversion and deeper Q wave indicative of

Back 40

Day 1-2 STEMI

Front 41

ST elevation is indicative of:

Back 41

Acute STEMI

Front 42

ST elevation with decreased R wave accompanied with Q wave and T wave inversion is indicative of

Back 42

Hours into acute STEMI

Front 43

ST normalization and inverted T wave is indicative of:

Back 43

Days after STEMI

Front 44

If no Q waves develop in ST segment depression with/without T wave inversion, what is likely cause?

Back 44

Partial occlusive thrombus in Acute NSTEMI

Front 45

Other causes of ST/T abnormalities:

Back 45

Digoxin therapy, Hyperkalemia, Hypokalemia, Hyper-/Hypocalcemia

Front 46

What is Parvus tardis and it is typical of what valvular disease?

Back 46

Diminished uupstroke and late peaking of this upstroke of cartoid; Aortic stenosis

Front 47

What fashion should one perform a cardiac exam?

Back 47

Centripetal

Front 48

Components of examinations:

Back 48

Inspection

BP

Arterial pulse

Respiratory rate

Jugular venous pulsation

Carotid Pulsation

Palpation of eart

Auscultation of Heart

Front 49

Cyanosis develops at what oxygen pressure?

Back 49

~<75-85%

Front 50

Three subcategories of Xanthomata with what HD association?:

Back 50

Tenedinous - Stony hard, masses on extensor tendons of fingers, Achilles, and plantar tendons; familial hypercholesterolemia

Tuberous - Palms, soles, knees, elbows, and hands; primary biliairy cirrhosis

Eruptive - Yellowish papules on an erythematous base on buttocks, abdomen, back, face and arms.; hypertriglyceridemia

Front 51

Osler's nodes are...

Back 51

Painful lesions on the tufts of the fingers and toes from immune complex deposition.

Front 52

Janeway lesions are...

Back 52

Non-painful, small erythematous macular lesions on the palms and soles from septic emboli/microabcesses.

Front 53

Osler's nodes and Janeway lesions are indicative of...

Back 53

Infective endocarditis.

Front 54

Where are splinter hemorrhages found, describe their appearance, and where they arise from.

Back 54

Nail beds; small reddish-brown lines; clots migrating from affected heart valve into various parts of body.

Front 55

Where is Lichtstein's sign found, describe its appearance, and where it arises from.

Back 55

Earlobe; oblique creases; over 50 years of age with significant coronary disease.

Front 56

Where is xanthelasma found, describe its appearance, and where it arises from.

Back 56

Eyes; yellowish plaques on eyelids; slightly associated with dyslipidemia

Front 57

Where is Arcus senilis found, describe its appearance, and where it arises from.

Back 57

Eyes; arcus seen in patients younger than 40 years of age; suspect dyslipidemia

Front 58

Where is palatal petechiae found, describe its appearance, and where it arises from.

Back 58

Mouth; red lesions; endocarditis

Front 59

Where is pectus excavatum found, describe its appearance, and where it arises from.

Back 59

Chest; Caved in; Marfan's and mitral valve prolapse

Front 60

Where is pectus carinatum found, describe its appearance, and where it arises from.

Back 60

Chest; pigeon breast; Marfan's

Front 61

Short statute, cubitus valgus, and medial deviation of the forearm are indicative of...

Back 61

Turner's syndrome.

Front 62

Long slender fingers are associated with:

Back 62

Marfan's

Front 63

Prevalence of hypertension in Canada:

Back 63

22%

Front 64

Width and length of inflatable bladder should be what percentage of the upper arm circumference?

Back 64

40% and 80%

Front 65

Lower border of cuff should be how high above antecubital crease?

Back 65

2.5cm

Front 66

Brachial artery should be at what level?

Back 66

Heart level

Front 67

Determining systolic BP by palpation avoids the error caused by what?

Back 67

Ausculatory gap - silent interval that may be present between systolic and diastolic pressures.

Front 68

Which part of stethoscope do you use for BP and why?

Back 68

Bell; Korotkoff sounds are low pitched

Front 69

At what speed do you deflate the cuff when measuring BP

Back 69

2-3 mm Hg/s

Front 70

Causes of falsely high BP:

Back 70

Patient related: caffeine, drug, stress

Instrument related: cuff too small

Procedure: Cuff too loose, brachial artery lower than heart

Front 71

White coat syndrome is:

Back 71

Phenomenon by which patients exhibit elevated BP in clinical settings possibly due to anxiety

Front 72

What to do if irregular heart rhythm?

Back 72

Use stethoscope at cardiac apex and check if irregularity varies with respiration or if early beats appear in a basically regular pattern.

Front 73

Normal respiratory rate:

Back 73

20 bpm

Front 74

Orthostatic hypotention is:

Back 74

When systolic BP drops >20 mm Hg and diastolic BP drops >10 mm Hg

Front 75

Causes of orthostatic hypotension

Back 75

Drugs, blood loss, prolonged bed rest, ANS disease

Front 76

IJV is preferred over EJV because:

Back 76

EJV is valved and not in direct line with the SVC/RA

Front 77

JVP provides an index of...

Back 77

Right heart pressures and cardiac function

Front 78

JVP reflects...

Back 78

RA pressure and therefore central venous pressure, and RV end-diastolic pressure.

Front 79

JVP positioning:

Back 79

Start at 30 degrees.

Front 80

JVP positioning if anticipating hypovolemia:

Back 80

0 degrees

Front 81

What impedes JVP assessment?

Back 81

Large neck.

Excessive accessory muscle use.

Front 82

Kussmaul signs are and indicate what?

Back 82

A rise (or failure to decrease) in the height of the JVP with inspiration

Significant RV diastolic disfunction/lack of RV compliance (e.g. constrictive pericarditis, restrictive cardiomyopathy, PE, RV infaction).

Front 83

The carotid pulse provides information on:

Back 83

Cardiac function, stenosis or regurgitation of aortic valve.

Front 84

Carotid pulse measuring technique:

Back 84

Head elevated to 30 degrees.

Standing slightly behind on right side.

Carotid is medial to steronmastoid at cricoid cartilage level

Use finers on lower third of neck and increase pressure to maximal pulsation, then slowly decrease until sensing arterial pressure and contour.

Front 85

What to assess during Carotid pulse measuring:

Back 85

Amplitude, contour (speed of upstroke, duration, speed of downstroke), variations in amplitude, Humming vibrations, bruits (murmur-like sounds)

Front 86

Diaphragm is good for:

Back 86

High pitched sounds: S1, S2, murmurs of AR/MR, mid-systolic clicks, ejection sound, opening snap, pericardial friction rubs

Front 87

Bell is good for:

Back 87

Low pitched sounds: S3, S4, mitral stenosis.

Front 88

Sitting leaning forward after full exhalation is good for finding:

Back 88

Soft decrescendo diastolic murmur of aortic insufficiency.

Front 89

Right ventricular area palpations done in what position and where?

Back 89

Supine at 30 degrees

Tip of fingers on L 3,4,5 ICS during end expiration

Front 90

High amplitude only for RV area palpation is a sign of:

Back 90

Chronic RV volume overload

Front 91

High amplitude and duration for RV area palpation is a sign of:

Back 91

Chronnic RV pressure overload.

Front 92

What kind of overload condition is Aortic stenosis, why is this, and what heart sound do we also hear?

Back 92

Pressure; because LV hypertrophies and requires to increase pressure way higher than PAo; S4

Front 93

Aortic stenosis is rare in young patients except in the event of:

Back 93

Bicuspid aortic valves

Front 94

Aortic stenosis murmur type and timing:

Back 94

Systolic ejection murmur; Between S1 and S2 but closer to S2

Front 95

Narrow QRS rules out what pacemaker?

Back 95

Ventricle as origin of beat which instead would be wide

Front 96

Nodal pacemaker with have what kind of PR interval?

Back 96

Short or non existant

Front 97

Afib has what rhythm?

Back 97

Irregular with no pattern

Front 98

Vfi has what kind of QRS complexes?

Back 98

No QRS

Front 99

Regular rhythm with normal PR usually has pacemaker as

Back 99

SA node

Front 100

Not sinus rhythm if

Back 100

P waves are inverted.

Front 101

What kind of and when is aortic regurgitation murmur heard?

Back 101

High pitched early decrescendo; Disatole

Murmur is shorter in acute AoR

Front 102

What system overload is Aortic regurgitation?

Back 102

Both pressure and volume overload.

Front 103

What heart sounds can be heard in Aortic regurgitation?

Back 103

Both S3 (volume) and S4 (pressure)

Front 104

Common cause of Mitral stenosis

Back 104

Rheumatic fever leading to Rheumatic HD

Front 105

Prolonged atrial emptying is suggestive of what:

Back 105

Mitral stenosis

Front 106

Mild vs sever mitral stenosis murmurs:

Back 106

Mild - at start of diastole then goes away when pressure gradient comes down, with return at atrial kick. Opening snap.

Severe - LA pressure stays elevated, murmur lasts throughout all of diastole, but louder during pre-systole because of atrial kick. Shorter duration between OS and A2 of mitral valve

Front 107

Opening snap is suggestive of what valve disease?

Back 107

Mitral stenosis

Front 108

Most common cause of chronic mitral regurgitation is:

Back 108

Mitral valve prolapse.

Front 109

What system overload diseass is mitral regurgitation?

Back 109

Volume overload condition - blood from LV enters LA, LA in turns tries to refill LV.

Front 110

Does Mitral regurgitation increase pre-, afterload, neither or both?

Back 110

Only preload increase, severe cases have afterload decrease.

Front 111

What kind of murmur is associated with Mitral regurgitation?

Back 111

Pansystolic.