Cardiopath, Murmur, Endocarditis

Front 1

Murmurs in aortic area

Back 1

Systolic: Aortic stenosis, flow murmur, Aortic valve sclerosis

Front 2

Murmurs in left sternal border

Back 2

Diastolic: Aortic regurgitation, pulm regurgitation
Systolic: Hypertorphic cardiomyopathy

Front 3

Murmurs in pulmonic area

Back 3

Systolic ejection murmur: pulm stenosis, flow murmur

Front 4

Murmurs in tricuspid area

Back 4

Pansystolic murmur: tricuspid regurgitation, VSD
Diastolic murmur: Tricuspid stenosis, ASD*

*ASD commonly presents with pulm flow murmur (Flow through pulmonary valve) and a diastolic rumble (flow across tricuspid)

Front 5

Murmurs in Mitral area

Back 5

Systolic: mitral regurgitation
Diastolic: mitral stenosis

Front 6

Bacteria that can result in endocarditis

Back 6

S. aureus, acute, large vegetation on normal previously normal valve. most common
Viridian strep, subacute, small vegetation on abnormal valves. Often due to dental procedure
Enterococcide
Staph epidermidis (on prosthetic valve)
Strep. Bovis ( a/w colon caner)
Culture negative organisms HACEK

Front 7

Culture negative endocarditis

Back 7

HACEK
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Front 8

Complications of endocarditis

Back 8

Chordae rupture
Glomerulonephritis
supprative pericarditis
Emboli

Front 9

Bacterial endocarditis symptoms

Back 9

Bacteria FROM JANE
Fever
Roth's spots (Retina)
Osler's nodes (Painful on fingers)
Murmur
Janeway Lesions (nontender on palm and sole)
Anemia
Nail-bed hemorrhage
Emboli

Front 10

Area of fibrinoid necrosis surrounded by mononuclear and multinucleated giant cells OR granuloma with giant cells
Aschoff bodies

Back 10

Pathomnemonic for Rheumatic fever

Front 11

Diagnosis of rheumatic fever

Back 11

Group A strep + 2 Jone's Critera:
Joints (migratory polyarthritis)
Heart (pancarditis)
Nodules (Subcutaneous)
Erythema Marginatum (serpiginous skin rash)
Syndenham's chorea ( chorea of face, tongue, upper limb)

Front 12

What is pulsus paradoxus and in what disease will you see it?

Back 12

Decrease amplitude of systolic BP by 10 mmHg during inspiration. Due to exaggerated inspiration leading to decrease LV volume as RV pools more blood.

Seen in cardiac tamponade, asthma obstructie sleep apnea, and croup. (exaggerated inspiration)

Front 13

Cardiac tamponade EKG findings

Back 13

Electrical alternans. Specific but not sensitive
- alternating amplitude of QRS.

Front 14

Kussmau's sign vs Pulsus paradoxus

Back 14

Kussmau: JVD with inspiration, Decreased capacity of RV, Constricitive pericarditis> tamponade

Pulsus paradoxus: Decrease BP >10mmHg with inspiration, decreaed capacity of LV, Cardiac tamponade > pericarditis

Kussmau also seen in cardiac tumors
Pulsus paradxus also seen in Asthma, Coup, obstrutive sleep apnea.

Front 15

most common cardiac tumors in adults? in children? overall?

Back 15

Left atrium myxoma (adult)
Rhabdomyomas (kids) a/w tuberous sclerosis
Metastases (most common overall)

Front 16

IV drug use presents with chest pain, dyspnea, tachycardia and tachypnea. Dx?

Back 16

Bacterial endocarditis. Right sided bact. emboli causing PE.

Front 17

What is empircal treatment for endocarditis?

Back 17

IV vancomycin

Front 18

Eosinophilia DDx

Back 18

Atopy
Asthma
Allergies
Churg-Strauss syndrome (granulomatous vasculitis with eosinophilia, often presents with Astham young ppl)

Front 19

A kid with lower extremity palpable purpura, arthralgia of the knee, abdominal pain (melena) and recent URI. Dx?

Back 19

Henoch-Schonlein purpura.
see also IgA nephropathy and IgA immune complex

Front 20

4 yo Asian with lymphadenitis, strawberry tongue, coronary aneurysm, rash and peeling of hand and foot. Dx?

Back 20

Kawasakii's disease
Need to check coronary aneurysm. Can cause rupture and MI

Front 21

How to treat Kawasakii's disease

Back 21

High dose aspirin to prevent clot. ( Recall Reye's syndrome, this is only of the few times we do this.)
IVIG

Front 22

Treatment for Wegner's and polyarteritis nodosa

Back 22

Corticosteroid with cyclophosphamide

Front 23

Patient with hepatitis B develops a vasculitis

Back 23

Polyartertis nodosa

Front 24

vasculitis with poor pulses in extremity

Back 24

Takayasu arteritis

Front 25

Elderly female with unilateral headache and jaw claudication

Back 25

Temporal giant cell arteritis
Check ESR, if negative, rule out
check vision to prevent blindness

Front 26

What disease is associated with polymyalgia rhumatica?

Back 26

Temporal giant cell arteritis
pain and joint stiffness.

Front 27

Heavy male 40 yo with claudication and rahynaud phenomenon

Back 27

Buerger's disease (thromboangitis obliterans)