Cardiovascular

Front 1

Telangiectasia
(2)

Back 1

1. Arteriovenous malformation in small vessels
2. Dilated vessels on skin and mucous membrane.

Front 2

Hereditary hemorrhagic Telangiectasia
(4)

Back 2

1. Osler-Weber-Rendu Syndrome
2. Autosomal-dominant
3. Nosebleeds
4. Skin Discolorations.

Front 3

Hypertension
Risk Factors
(5)

Back 3

1. Increases with age
2. Obesity
3. Diabetes
4. Smoking
5. Genetics

Front 4

Hypertension
Features
(2)

Back 4

1. 90% of hypertension is related to increased CO or TRP
2. 10% due to renal disease.

Front 5

Hypertension
Predispose to
(7)

Back 5

1. Atherosclerosis
2. LVH
3. Stroke
4. CHF
5. Renal Failure
6. Retinopathy
7. Aortic Dissection

Front 6

Atheromas

Back 6

Plaque in blood vessel walls

Front 7

Xanthomas

Back 7

Plaques or nodules composed of lipid-laden histiocytes in the skin

Front 8

Xanthelasma

Back 8

Xanthomas in the eyelids

Front 9

Tendinous xanthomas

Back 9

Lipid deposit in tendon, especially achilles

Front 10

Corneal arcus

Back 10

Lipid deposit in cornea

Front 11

Monckeberg
(3)

Back 11

1.Calcification in the media of the arteries
2. Mainly in the radial and ulnar arteries
3. Does not obstruct flow

Front 12

Arteriolosclerosis
(2)

Back 12

1. Hyaline thickening of small arteries in essential hypertension
2. Hyperplastic "onion skinning" in malignant hypertension

Front 13

Aortic Dissection
(3)

Back 13

1. Longitudinal intraluminal tear forming a false lumen
2. False lumen occupies most of the descending aorta
3. Can result in aortic rupture and death

Front 14

Aortic Dissection
CXR

Back 14

Shows mediastinal widening

Front 15

Aortic Dissection
Associated with...
(2)

Back 15

1. Hypertension
2. Cystic medial necrosis (component of Marfan's syndrome

Front 16

Atherosclerosis

Back 16

Fibrous plaque and atheromas form in the intima of elastic arteries and large and medium-sized muscular arteries

Front 17

Atherosclerosis
Risk Factors
(5)

Back 17

1. Smoking
2. Hypertension
3. Hyperlipidemia
4. Diabetes Mellitus
5. Family history

Front 18

Atherosclerosis
Progression
(7)

Back 18

(1) Endothelial cell dysfunction -> (2) macrophage and LDL accumulation -> (3) foam cell formation -> (4) fatty streaks -> (5) smooth muscle cell migration (involves PDGF and FGF-beta) -> (6) fibrous plaque -> (7) complex atheromas

Front 19

Atherosclerosis
Complications
(6)

Back 19

1. Aneurysms
2. Ischemia
3. Infarct
4. Peripheral vascular disease
5. Thrombus
6. Emboli

Front 20

Atherosclerosis
Location
(4)

Back 20

(1)Abdominal Aorta > (2) coronary artery > (3) popliteal artery > (4) carotid artery

Front 21

Atherosclerosis
Symptoms
(2)

Back 21

1. Angina
2. Claudication

Front 22

Ischemic Hear Disease
Possible Manifestations
(4)

Back 22

1. Angina
2. Myocardial Infarct
3. Sudden Cardiac Death
4. Chronic ischemic heart disease

Front 23

Angina

Back 23

CAD narrowing > 75%

Front 24

Stable angina
(3)

Back 24

1. Retrosternal chest pain on exertion
2. Mostly secondary to atherosclerosis
3. ST depression on ECG

Front 25

Prinzmetal's variant angina
(2)

Back 25

1. Occurs secondary to coronary artery spasm
2. ST elevation on ECG

Front 26

Unstable/crescendo angina
(3)

Back 26

1. Worsening chest pain
2. Thrombosis but no necrosis
3. ST depression on ECG

Front 27

Myocardial infarction
(2)

Back 27

1. Acute thrombosis due to coronary artery atherosclerosis
2. Results in myocyte necrosis

Front 28

Sudden cardiac death
(2)

Back 28

1. Death from cardiac causes within 1 hour of onset of symptoms
2. Most commonly due to lethal arrhythmia

Front 29

Chronic ischemic heart disease

Back 29

Progressive onset of CHF over many years due to chronic ischemic myocardial damage

Front 30

Red Infarct
(5)

Back 30

1. Infarcts occur in loose tissues with collaterals such as...
2. Liver
3. Lungs
4. Intestine
5. Or following reperfusion

Front 31

Pale Infarct
(4)

Back 31

1. Occurs in solid tissues with single blood supply such as ...
2. Heart
3. Kidney
4. Spleen

Front 32

Myocardial Infarct
Symptoms
(8)

Back 32

1. Diaphoresis
2. Nausea
3. Vomiting
4. Severe retrosternal pain
5. Pain in left arm and/or jaw
6. Shortness of breath
7. Fatigue
8. Adrenergic symptoms

Front 33

Evolution of MI
First Day
(5)

Back 33

1. No visible change by light microscopy in first 2-4 hours
2. Contraction bands visible after 1-2 hours
3. Early necrosis after 4 hours
4. Contents of necrotic cells released in to bloodstream
5. Beginning of neutrophil emigration

Front 34

Evolution of MI
2 to 4 Days
(5)

Back 34

1. Risk of arrhythmia
2. Tissue surrounding infarct shows acute inflammation
3. Hyperemia
4. Neutrophil emigration
5. Extensive coagulative necrosis

Front 35

Evolution of MI
5-10 Days
(5)

Back 35

1. Risk for free wall rupture
2. Tamponade
3. Papillary muscle rupture
4. Ventricular septal rupture
5. Hyperemic border

Front 36

Evolution of MI
7 weeks
(3)

Back 36

1. Recanalized artery
2. Risk for ventricular aneurysm
3. Contracted scar complete

Front 37

Diagnosis of MI
(2)

Back 37

1. In first 6 hours ECG
2. Cardiac troponin I rises after 4 hours and is elevated for 7-10 days

Front 38

CK-MB

Back 38

Is mostly found in myocardium but can also be released from skeletal muscles

Front 39

AST

Back 39

Is nonspecific and can be found in cardiac, liver and skeletal muscles

Front 40

Transmural infarct
(3)

Back 40

1. Increased necrosis
2. Affects entire wall
3. ST elevation on ECG

Front 41

Subendocardial infarct
(3)

Back 41

1. Due to ischemic necrosis of < 50% of ventricle wall
2. Subendocardium especially vulnerable to ischemia
3. ST depression on ECG due to fewer collaterals and higher pressure

Front 42

MI Complications
(7)

Back 42

1. Cardiac arrhythmia
2. LV failure and pulmonary edema
3. Cardiogenic shock
4. Ventricular free wall rupture
5. Aneurysm formation
6. Fibrinous pericarditis
7. Dressler's syndrome

Front 43

Ventricular free wall rupture can lead to...
(3)

Back 43

1. Cardiac tamponaded
2. Papillary muscle rupture
3. Interventricular septal rupture

Front 44

Papillary muscle rupture can cause

Back 44

Severe mitral regurgitation

Front 45

Interventricular septal rupture can lead to...

Back 45

VSD

Front 46

MI Complications
Aneurysm formation
(3)

Back 46

1. Decreased CO
2. Risk of arrhythmia
3. Embolus from mural thrombus

Front 47

MI Complications
Fibrinous pericarditis

Back 47

Friction rub 3-5 days post-MI

Front 48

MI Complications
Dressler's syndrome

Back 48

Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post-MI

Front 49

Dilated Cardiomyopathy
Etiologies
(7)

Back 49

1. Alcohol abuse
2. Beriberi
3. Coxsackie B virus myocarditis
4. Chronic Cocaine use
5. Chagas' disease
6. Doxorubicin toxicity
7. Peripartum cardiomyopathy

Front 50

Dilated Cardiomyopathy
Findings
(4)

Back 50

1. S3 sound
2. Dilated heart on ultrasound
3. Balloon shaped on chest x-ray
4. Systolic dysfunction

Front 51

Hypertrophic cardiomyopathy
Dysfunctions
(2)

Back 51

1. Hypertrophied IV septum is too close to mitral valve leaflet, leading to outflow tract obstruction
2. Diastolic dysfunction

Front 52

Hypertrophic cardiomyopathy
Most common cause

Back 52

50% cases are autosomal dominant

Front 53

Hypertrophic Cardiomyopathy
Findings
(4)

Back 53

1. Normal-sized heart
2. S4 sound
3. Apical impulses
4. Systolic murmur

Front 54

Restrictive Cardiomyopathy
(5)

Back 54

1. Sarcoidosis
2. Amyloidosis
3. Postradiation fibrosis
4. Endocardial fibroelastosis
5.Hemochromotosis

Front 55

Endocardial fibroelastosis

Back 55

Thick fibroelastic tissue in endocardium of young children

Front 56

Restrictive Cadiomyopathy
Dysfunction

Back 56

Diastolic dysfunction

Front 57

CHF
Abnormality: Dyspnea on exertion
Cause...

Back 57

Failure of LV output to increase during exercise

Front 58

CHF
Abnormality: Cardiac dilation
Results in...

Back 58

Greater ventricular EDV

Front 59

CHF
Abnormality:Pulmonary edema, Paroxysmal nocturnal dyspnea
Cause...
(4)

Back 59

(1) LV failure -> (2) Increased pulmonary venous pressure -> (3) pulmonary venous distension and transudation of fluid.
4. Presence of hemosiderin-laden macrophages in the lung.

Front 60

CHF
Abnormality: Orthopnea
Cause...

Back 60

Increased venous return in supine position exacerbates pulmonary vascular congestion

Front 61

CHF
Abnormality: Nutmeg liver
Cause...
(2)

Back 61

(1) Increased central venous pressure -> (2) Increased resistance to portal flow

Front 62

CHF
Abnormality: Ankle and sacral edema
Cause...
(3)

Back 62

(1) RV failure -> (2) Increased venous pressure -> (3) Fluid transudation

Front 63

CHF
Abnormality: JVD
Cause...
(2)

Back 63

(1) Right heart failure -> (2) Increased venous pressure.

Front 64

Deep venous thrombosis
(3)

Back 64

Virchow's Triad
1. Stasis
2. Hypercoagulability
3. Endothelial damage

Front 65

Bacterial Endocarditis
FROM JANE

Back 65

Fever
Roth's spots
Oslers modes
Murmur
Janeway lessions
Anemia
Nail-bed hemorrhage
Emboli

Front 66

Osler's Nodes

Back 66

Tender raised lesions on fingers or toe pads

Front 67

Janeway lesions

Back 67

Small erythematous lesions on palm or sole

Front 68

Roth's spots

Back 68

Round white spots on retina surrounded by hemorrhage

Front 69

Bacterial endocarditis
Acute
(4)

Back 69

1. S. Aureus
2. High Virulence
3. Large vegetations on previously normal valve
4. Rapid onset

Front 70

Bacterial endocarditis
Subacute
(4)

Back 70

1. Viridans streptococcus
2. Smaller vegetations on congenitally abnormal or diseased valve.
3. Sequela of dental procedures
4. More insidious onset

Front 71

S. Bovis is present in...

Back 71

Colon cancer

Front 72

S. epidermidis is present on...

Back 72

Prosthetic valves

Front 73

Libman-Sacks endocarditis
(2)

Back 73

1. Verrucous, sterile vegetations occur on both sides of the valve
2. Seen in lupus

Front 74

Rheumatic heart disease
FEVERSS

Back 74

Fever
Erythema marginatum
Valvular damage (vegetation and fibrosis)
ESR Increase
Red-hot joints (migratory polyarhritis)
Subcutaneous nodules (Aschoff bodies)
St. Vitus' dance (chorea)

Front 75

Rheumatic fever is a consequence of...

Back 75

Pharyngeal infection with group A Beta-hemolytic streptococci

Front 76

Order of heart valves affected by rheumatic fever
(3)

Back 76

Mitral >> Aortic >> Tricuspid

Front 77

Rheumatic fever is associated with
(3)

Back 77

1. Aschoff bodies
2. Anitschkow's cells
3. Elevated ASO titers

Front 78

Immune mediated rheumatic fever is a...

Back 78

Type II hypersensitivity reaction

Front 79

Cardiac tamponade
(3)

Back 79

1. Compression of heart by fluid in the pericardium
2. Leads to decreased CO
3. Equilibration of diastolic pressures in all 4 chambers

Front 80

Cardiac tamponade
Findings
(5)

Back 80

1. Hypotension
2. JVD
3. Distant heart sound
4. Increased HR
5. Pulsus paradoxus

Front 81

Pulsus Paradoxus
(Kussmaul's pulse)

Back 81

Decrease in amplitude of pulse during inspiration

Front 82

Pulsus Paradoxus
(Kussmaul's pulse)
Found in...
(5)

Back 82

1. Severe cardiac tamponade
2. Asthma
3. Obstructive sleep apnea
4. Pericarditis
5. Croup

Front 83

Serous Pericaditis
(4)

Back 83

1. SLE
2. Rheumatoid arthritis
3. Viral infection
4. Uremia

Front 84

Fibrinous Pericarditis
(3)

Back 84

1. Uremia
2. Dessler's syndrome
3. Rheumatic fever

Front 85

Hemorrhagic Pericarditis
(2)

Back 85

1. TB
2. Malignancy (e.g. melanoma)

Front 86

Pericarditis
Findings
(5)

Back 86

1. Pericardial pain
2. Friction rub
3. Pulsus paradoxus
4. Distant heart sound
5. ST elevation in multiple leads

Front 87

Syphilitic heart disease
(9)

Back 87

1. Disrupts vasa vasorum of aorta
2. Dilation of aorta
3. Dilation of valve ring
4. Calcification of aortic root
5. Calcification of Ascending aortic arch
6. Tree bark appearance of the aorta
7. Aneurysm of ascending aorta
8. Aneurysm of aortic arch
9. Aortic valve incompetence

Front 88

Types of cardiac tumor
(2)

Back 88

1. Myxomas
2. Rhabdomyomas

Front 89

Myxomas
(4)

Back 89

1. 90% occur in the atria (mostly LA)
2. Most common 1st cardiac tumor in adults
3. Ball-valve obstruction in LA
4. Associated with snycopal episodes

Front 90

Rhabdomyomas
(2)

Back 90

1. Most frequent 1st degree cardiac tumor in children
2. Associated with tuberous sclerosis

Front 91

Most common metastatic heart tumors
(2)

Back 91

1. Melanoma
2. Lymphoma

Front 92

Cardiac tumor sign

Back 92

Kussmual's sign: Increase in jugular venous pressure on inspiration

Front 93

Raynaud's Disease
(3)

Back 93

1. Decreased blood flow to the skin due to arteriolar vasospasm in response to cold temperature or emotional stress.
2. Most often in fingers and toes
3. Affects small vessels

Front 94

When is Raynaud's disease called raynaud's phenomenon
(3)

Back 94

When it is secondary to
1. a mixed connective disease
2. SLE
3. CREST Syndrome

Front 95

Wegner's granulomatosis
Characteristics
(4)

Back 95

1. Necrotizing vasculitis
2. Necrotizing granulomas in the lung and upper airway
3. Necrotizing glomerulonephritis
4. Affects small vessels

Front 96

Wegner's granulomatosis
Symptoms
(8)

Back 96

1. Perforation of nasal septum
2. Chronic sinusitis
3. Otitis media
4. Mastoiditis
5. Cough
6. Dyspnea
7. Hemoptysis
8. Hematuria

Front 97

Wegner's granulomatosis
Findings
(4)

Back 97

1. c-ANCA is a strong marker of disease
2. Chest X-ray may reveal large nodular densities
3. Hematuria
4. Red cell cast

Front 98

Wegner's granulomatosis
Treatment
(2)

Back 98

1. Cyclophosphamide
2. Corticosteroids

Front 99

ANCA positive vasculitides
(4)

Back 99

1. Microscopic polyangiitis
2. Pauci-immune crescentric glomerulonephritis
3. Churg-Strauss syndrome
4. All of the above affect small vessels

Front 100

Microscopic polyangiitis
(2)

Back 100

1. Like Wegener's but lacks granulomas
2. p-ANCA

Front 101

1st Degree pauci-immune crescentric glomerulonephritis
(2)

Back 101

1. Vasculitis limited to kidney
2. Paucity of antibodies

Front 102

Churg-Strauss syndrome
(6)

Back 102

1. Granulomatous vasculitis with eosinophilia
2. Lungs
3. Heart
4. Kidney
5. Skin
6. Nerves

Front 103

Sturge-Weber disease
(4)

Back 103

1.Congenital vascular disorder that affects capillary-sized blood vessels
2. Port-wine stain on face
3. Leptomeningeal angiomatosis
4. Intracerebral AVM

Front 104

Henoch-Schonlein purpura
(11)

Back 104

1. Most common form of childhood systemic vasculitis
2. Skin rash on buttocks and legs (palpable purpura)
3. Arthralgia
4. Intestinal Hemorrhage
5. Abdominal Pain
6. Melena
7. Follows URI
8. IgA immune complexes
9. IgA nephropathy
10. Multiple lesions of the same age
11. Affects small vessels

Front 105

Henoch-Shonlein purpura
Common Triad

Back 105

1. Skin
2. Joints
3. GI

Front 106

Buerger's disease
Characteristics
(6)

Back 106

1. Also know as thromboangitis obliterans
2. Idiopathic,
3. Segmental,
4. Thrombosing vasculitis
5. Affects small and medium vessels
6. Seen in heavy smokers

Front 107

Buerger's disease
Symptoms
(6)

Back 107

1. Intermittent claudication
2. Superficial nodular phlebitis
3. Raynaud's phenomenon
4. Severe pain in affected parts
5. May lead to gangrene
6. and autoamputation of digits

Front 108

Buerger's disease
Treatment

Back 108

Smoking cessation

Front 109

Kawasaki disease
Characteristics
(4)

Back 109

1. Acute, self-limiting disease of infants/kids.
2. Strong association with asians
3. Necrotizing vasculitis of small/medium sized vessels
4. May develop coronary aneurysms

Front 110

Kawasaki disease
Symptoms
(4)

Back 110

1. Fever
2. Congested conjunctiva
3. Strawberry tongue
4. Lymphadenitis

Front 111

Polyarteritis nodosa
Characteristics
(3)

Back 111

1. Necrotizing immune complex inflammation of medium-sized muscular arteries
2. Typically involves renal and visceral vessels
3. Lesions are of different ages

Front 112

Polyarteritis nodosa
Symptoms
(10)

Back 112

1. Fever
2. Weight loss
3. Malaise
4. Myalgia
5. Melena
6. Headache
7. Hypertension
8. Neurologic dysfunction
9. Cutaneous eruptions
10.Abdominal pain

Front 113

Polyarteritis nodosa
Findings
(3)

Back 113

1. Hepatitis B seropositivity in 30% of patients
2. Multiple aneurysms
3. Constriction on arteriogram

Front 114

Polyarteritis nodosa
Treatment
(2)

Back 114

1. Cyclophosphamide
2. Corticosteroids

Front 115

Takayasu's arteritis
(4)

Back 115

1. Pulseless disease
2. Granulomatous thickening of aortic arch and/or proximal vessels
3. Increased ESR
4. Affects asain females < 40 years old

Front 116

Takayasu's arteritis
FAN MY SKIN On Wednesday

Back 116

Fever
Arthritis
Night Sweats
MYalgia
SKIN nodules
Ocular disturbances
Weak pulses in upper extremities.

Front 117

Temporal arteritis
Characteristics
(5)

Back 117

1.Most common vasculitis that affects medium and large arteries
2. Usually branches of carotid artery
3. Focal, granulomatous inflamation
4. Affects elderly females
5. Giant cell arteritis

Front 118

Temporal arteritis
Symptoms
(4)

Back 118

1. Unilateral headache
2. Jaw claudication
3. Impaired vision
4. Occlusion of opthalmic artery

Front 119

Temporal arteritis
Findings
(3)

Back 119

1. Increased ESR
2. Half of patients have systemic involvement
3. and polymyalgia rheumatica

Front 120

Temporal arteritis
Treatment

Back 120

High dose steroids

Front 121

Increase contractility
(7)

Back 121

1. Catecholamines
2. Increase activity of Ca pump in SR
3. Increase intracellular calcium
4. Decrease extracellular sodium
5. Decreases activity of Na/Ca exchange
6. Digitalis
7. Increases intracellular Na, resulting in increased Ca

Front 122

Decrease Contractility
(5)

Back 122

1. Beta 1 blockade
2. Heart failure
3. Acidosis
4. Hypoxia/hypercapnia
5. Non-Dihdyropryridine Ca channel blockers

Front 123

What is SV affected by?
(3)

Back 123

1. Increase in Contactlility
2. Decrease in Afterload
3. Incrase in Preload

Front 124

Preload is equal to?

Back 124

Ventricular EDV

Front 125

Afterload is equal to?
(2)

Back 125

1. Mean arterial pressure
2. Proportional to peripheral resistance

Front 126

EF =

Back 126

SV/EDV

Front 127

EF is an index of?

Back 127

Ventricular contractility

Front 128

EF is normally

Back 128

Greater than or equal to 55%

Front 129

CO =
(2)

Back 129

1. SV x HR
2. Rate of O2 consumption/ (Arterial O2 content - Venous O2 content)

Front 130

MAP =

Back 130

2/3 diastolic pressure + 1/3 systolic pressure

Front 131

Pulse pressure =

Back 131

systolic pressure - diastolic pressure

Front 132

Pulse pressure is proportional to?

Back 132

SV

Front 133

SV =

Back 133

CO/HR = EDV - ESV

Front 134

Auscultation of the heart
Aortic area
(4)

Back 134

1.Systolic murmur
2. Aortic murmur
3. Aortic valve sclerosis
4. Flow murmur

Front 135

Auscultation of the heart
Left sternal border
Diastolic murmur
(2)

Back 135

1. Aortic regurgitation
2. Pulmonic regurgitation

Front 136

Auscultation of the heart
Left sternal border
Systolic murmur

Back 136

Hypertrophic cardiomyopathy

Front 137

Auscultation of the heart
Pulmonic Area
(3)

Back 137

1. Systolic ejection murmur
2. Pulmonic stenosis
3. Flow murmur

Front 138

Auscultation of the heart
Tricuspid Area
Pansystolic murmur
(2)

Back 138

1. Tricuspid regurgitation
2. VSD

Front 139

Auscultation of the heart
Tricuspid Area
Diastolic murmur
(2)

Back 139

1. Tricuspid stenosis
2. ASD

Front 140

Auscultation of the heart
Mitral Area
Systolic

Back 140

Mitral regurgitation

Front 141

Auscultation of the heart
Mitral Area
Diastolic

Back 141

Mitral stenosis

Front 142

Structures inside carotid sheath
(3)

Back 142

1. Internal jugular Vein (Lateral)
2. Common carotid Artery (Medial)
3. Vagus Nerve (Posterior

Front 143

Phases of left Ventricle
(5)

Back 143

1. Isovolumetric contraction
2. Systolic ejection
3. Isovolumetric relaxation
4. Rapid filling
5. Reduced filling

Front 144

Isovolumetric contraction
(2)

Back 144

1. Period between mitral valve closure and aoritc valve opening
2. Period of highest O2 consumption

Front 145

Systolic ejection

Back 145

Period between aoritc valve opening and closing

Front 146

Isovolumetric relaxation

Back 146

Period between aortic valve closing and mitral valve opening

Front 147

Rapid filling

Back 147

Period just after mitral valve opening

Front 148

Reduced filling

Back 148

Period just before mitral valve clusre

Front 149

Heart sound
S1
(2)

Back 149

1.Mitral and tricuspid valve closure
2. Loudest at mitral area

Front 150

Heart sound
S2
(2)

Back 150

1. Aortic and pulmonary valve closure
2. Loudest at left sternal border

Front 151

Heart sound
S3
(4)

Back 151

1. In early diastole during rapid ventricular filling phase
2. Associated with increased filling pressures
3. Common in dilated in ventricles
4. Normal in children

Front 152

Heart sound
S4
(5)

Back 152

1. Atrial kick
2. In late diastole
3. High atrial pressure
4. Associated with ventricular hypertrophy
5. Left atrium must push against stiff LV wall

Front 153

Types of jugular venous pulse
(3)

Back 153

1. a wave
2. c wave
3. v wave

Front 154

Jugular venous pulse
a wave

Back 154

Atrial contraction

Front 155

Jugular venous pulse
c wave
(2)

Back 155

1. RV contraction
2. Tricuspid valve bulging into atrium

Front 156

Jugular venous pulse
v wave

Back 156

Increase atrial pressure due to filling against closed tricuspid valve

Front 157

Heart Sound
S2 splitting
(2)

Back 157

1. Aortic valve closes before pulmonic
2. Inspiration increases difference

Front 158

Normal splitting
(3)

Back 158

1. Inspiration leads to drop intrathoracic pressure, which increases capacity of pulmonary circulation
2. Pulmonic valve closes later to accommodate more blood entering lungs
3. Aortic valve closes earlier because of decreased return to left heart

Front 159

Wide splitting
(5)

Back 159

1. Seen in conditions that delay RV emptying
2. Pulmonic stenosis
3. Right bundle branch block
4. Delay in RV emptying causes delayed pulmonic sound regardless of breath
5. An exaggeration of normal splitting

Front 160

Fixed splitting
(3)

Back 160

1. Seen in ASD
2. Leads to left-to-right shunt
3. Therefore increases flow though pulmonic valve such that regardless of breath;
4. Pulmonic closure is greatly delayed

Front 161

Paradoxical splitting
(5)

Back 161

1. Seen in conditions that delay LV emptying
2. Aortic stenosis
3. Left bundle branch block
4. Normal order of valve closure is reversed so that P2 sound occurs before delayed A2 sound
5. Therefore on inspiration, the later P2 and earlier A2 sounds move closer to one another, "paradoxically" eliminating the split

Front 162

Types of holosystolic, high-pitched "blowing murmur"
(2)

Back 162

1. Mitral regurgitation
2. Tricuspid regurgitation

Front 163

Causes of mitral regurgitation
(4)

Back 163

1. Ischemic heart disease
2. LV dilation
3. Mitral valve prolapse
4. Rheumatic fever

Front 164

Mitral regurgitation is loudest at?

Back 164

Apex and radiates toward axilla

Front 165

Causes of tricuspid regurgitation
(3)

Back 165

1. RV dilation
2. Endocarditis
3. Rheumatic fever

Front 166

Tricuspid regurgitation is loudest at?

Back 166

Tricuspid area and radiates to right sternal boarder

Front 167

Heart murmur
Aortic stenosis
(4)

Back 167

1. Crescendo-decrescendo systolic ejection murmur
2. Following ejection click
3. Pulsus parvus ed tardus
4. LV >> aortic pressure during systole

Front 168

Aortic stenosis can lead to?

Back 168

syncope

Front 169

Cause of aortic stenosis

Back 169

Often due to age-related calcific aoritc stenosis

Front 170

Heart murmur
VSD

Back 170

Holosystolic, harsh-sounding murmur

Front 171

VSD is loudest at?

Back 171

Tricuspid area

Front 172

Aortic stenosis is loudest at?

Back 172

Aortic area and radiates to carotid/apex

Front 173

Heart sound
Mitral Valve Prolapse

Back 173

1. Late systolic murmur
2. With midsystolic click

Front 174

What is the most frequent valvular lesion?

Back 174

MVP

Front 175

MVP is loudest at?

Back 175

S2

Front 176

MVP can predispose to?

Back 176

Infective endocarditis

Front 177

Heart Sound
Aortic regurgitation
(2)

Back 177

1. Immediate high-pitched "blowing" diastolic murmur
2. Wide pulse pressure when chronic

Front 178

Causes of aortic regurgitation
(3)

Back 178

1. Aortic root dilation
2. Bicuspid aortic valve
3. Rheumatic fever

Front 179

Heart sound
Mitral stenosis
(3)

Back 179

1.Follows opening snap
2. Delayed rumbling late diastolic murmur
3. LA >> LV pressure during diastole

Front 180

Cause of Mitral stenosis

Back 180

Often secondary to rheumatic fever

Front 181

Heart Sound
PDA

Back 181

Continuous machine-like murmur

Front 182

PDA is loudest at times of?

Back 182

S2

Front 183

Why do heart sounds due to valvular lesion increase in intensity on inspiration when defect is on the right side?

Back 183

Because more blood flows into RA

Front 184

Why do heart sounds due to valvular lesion increase in intensity on expiration when defect is on the left side?

Back 184

Because more blood flows in to LA

Front 185

Ventricular action potential
Phase 0
(2)

Back 185

1. Rapid upstroke
2. Voltage-gated Na channels open

Front 186

Ventricular action potential
Phase 1
(3)

Back 186

1. Initial repolarization
2. Inactivation of voltage-gated Na channels
3. Voltage-gated K channels begin to open

Front 187

Ventricular action potential
Phase 2
(3)

Back 187

1. Plateau
2. Ca influx through voltage-gated Ca channels balances K efflux
3. Ca influx trigger Ca release from SR and myocyte contraction

Front 188

Ventricular action potential
Phase 3
(3)

Back 188

1. Rapid repolarization
2. Massive K efflux due to opening of voltage-gated slow K channels
3. And closure of voltage-gated Ca channels

Front 189

Ventricular action potential
Phase 4
(2)

Back 189

1. Resting potential
2. High K permeability through K channels

Front 190

Pacemaker action potential
Phase 0
(5)

Back 190

1. Upstroke
2. Opening of voltage-gated Ca channels
3. These cells lack voltage-gated Na channels
4. Results in slow conduction velocity that is used by the AV node
5. To prolong transmission from the atria to ventricles

Front 191

Pacemaker action potential
Phase 2

Back 191

Plateau absent

Front 192

Pacemaker action potential
Phase 3
(3)

Back 192

1. Inactivation of Ca channels
2. Increased activation of K channels
3. Leads to increased K efflux

Front 193

Pacemaker action potential
Phase 4
(4)

Back 193

1. Slow diastolic depolarization
2. Membrane potential spontaneously depolarizes
3. As Na conductance increases
4. Accounts for automaticity of Sa and AV node

Front 194

What does the slope of phase 4 in the SA node determine?

Back 194

HR

Front 195

How do ACh effect Phase 4?
(2)

Back 195

1. Decreases diastolic depolarization
2. Decreases HR

Front 196

How do catecholamines effect Phase 4?
(2)

Back 196

1. Increase diastolic depolarization
2. Increase HR

Front 197

What effect does sympathetic stimulation have on Phase 4?

Back 197

It increases the chance that If channels are open

Front 198

Torsades de pointes
(4)

Back 198

1. Ventricular tachycardia
2. Shifting sinusoidal waveforms on ECG
3. Can progress to V-fib
4. Anything that prolongs QT interval

Front 199

Wolff-Parkinson-White syndrome
(5)

Back 199

1. Accessory conduction pathway from atria to ventricle, bypassing AV node
2. Bundle of Kent
3. Ventricles begin to partially depolarize earlier
4. Delta wave on ECG
5. May lead to reentry current leading to supraventricular tachycardia

Front 200

Right-to-left shunts
(5)

Back 200

1. Tetralogy of Fallots
2. Transposition of great vessels
3. Truncus arteriosus
4. Tricuspid atresia
5. Total Anomalous Pulmonary Venous Return

Front 201

Left-to-right shunts
(3)

Back 201

1. VSD
2. ASD
3. PDA

Front 202

What is the most common congenital cardiac anomaly?

Back 202

VSD

Front 203

Frequency of left-to-right shunts

Back 203

VSD > ASD > PDA

Front 204

Eisenmenger's syndrome
(5)

Back 204

1.Pulmonary hypertension due to uncorrected VSD, ASD, or PDA.
2. Shunt reverses from L -> R to R -> L
3. Causes late cyanosis
4. Clubbing
5. and polycythemia

Front 205

Tetralogy of Fallot
(6)

Back 205

1. Pulmonary stenosis
2. RVH
3. Overriding aorta
4. VSD
5. Early cyanosis caused by R -> L shunt across VSD
6. Cyanotic spells

Front 206

What causes Tetralogy of Fallot?

Back 206

Caused by anterosuperior displacement of the infundibular septum

Front 207

Atrial fibrillation
(2)

Back 207

1. Chaotic erratic baseline (irregularly irregular)
2. No discrete P waves between irregularly spaced QRS complexes

Front 208

What do you treat atrial fibrillation with?

Back 208

Warfarin (Coumadin)

Front 209

What can atrial fibrillation lead to?
(2)

Back 209

1. Atrial stasis
2. Stroke

Front 210

Atrial flutter
(2)

Back 210

1. Rapid succession of identical, back to back atrial depolarization waves
2. Accounts for Sawtooth appearance

Front 211

How do you treat atrial flutter?
(4)

Back 211

1. Convert to sinus rhythm using antiarrhythmics
2. Class IA,
3. Class IC,
4. or Class III

Front 212

AV Block
1st degree
(2)

Back 212

1. The PR interval is prolonged >200msec
2. Asymptomatic

Front 213

AV Block
2nd degree
(4)

Back 213

1. Mobitz type I (Wenckebach)
2. Progressive lengthening of the PR interval until a beat is "dropped"
3. a P wave not followed by QRS
4. Usually asymptomatic

Front 214

AV Block
Mobitz type II
(4)

Back 214

1. Dropped beats that are bot preceded by a change in the length of the PR interval
2. 2:1 block
3. 2 P waves to 1 QRS
4. May progress to 3rd degree block

Front 215

AV Block
3rd degree (complete)
(3)

Back 215

1. Atria and ventricles beat independently of each other
2. P waves bear no relation to the QRS complexes
3. Atrial rate is faster than the ventricular rate

Front 216

What can cause 3rd degree AV block

Back 216

Lyme disease

Front 217

How do you treat 3rd degree AV block

Back 217

Pace maker

Front 218

Ventricular Fibrillation
(2)

Back 218

1. complete erratic rhythm with no identifiable waves
2. Fatal

Front 219

Aortic arch transmit via...

Back 219

Vagus nerve to medulla

Front 220

Aortic arch responds to...

Back 220

Increase in BP

Front 221

Carotid sinus transmits via...

Back 221

Glossopharyngeal nerve to medulla

Front 222

Carotid sinus responds to...

Back 222

An increase or decrease in BP

Front 223

Baroreceptors:
Hypotension
(10)

Back 223

(1) Decreased aterial pressure -> (2) decreased stretch -> (3) decreased afferent baroreceptor firing -> (4) increased efferent sympathetic firing -> (5) decreased efferent parasympathetic stimulation -> (6) vasoconstriction -> (7) increased HR -> (8) increased contractility -> (9) -> increased BP
10. Important response to severe hemorrhage

Front 224

Baroreceptors:
Carotid massage
(4)

Back 224

1. Increased pressure on carotid artery -> (2) increased stretch -> (3) increased afferent baroreceptor firing -> (4) decreased HR

Front 225

Chemoreceptors:
Peripheral
(3)

Back 225

Carotid and aortic bodies respond to
1. Decrease in PO2 < 60 mmHg
2. Increase in PCO2
3. Decrease in pH of blood

Front 226

Chemoreceptors:
Central respond to changes in...
(2)

Back 226

Brain insterstitual fluid
1. pH
2. PCO2

Front 227

Chemoreceptors:
Central
Cushing reaction
(4)

Back 227

(1) Increase intracranial pressure constricts arterioles -> (2) cerebral ischemia -> (3) hypertension -> (4) reflex bradycardia

Front 228

Largest share of systemic cardiac output?

Back 228

Liver

Front 229

Highest blood flow per gram of tissue?

Back 229

Kidney

Front 230

Largest arteriovenous O2 difference?

Back 230

Heart

Front 231

How is O2 demand of the heart met?

Back 231

Increased coronary blood flow

Front 232

Factors determining autoregulation of
Heart
(3)

Back 232

1. O2
2. Adenosine
3. NO

Front 233

Factors determining autoregulation of
Brain
(2)

Back 233

1. pH
2. CO2

Front 234

Factors determining autoregulation of
Kidney
(2)

Back 234

1. Myogenic
2. Tubuloglomerular

Front 235

Factors determining autoregulation of
Lungs

Back 235

Hypoxia causes vasoconstriction

Front 236

Factors determining autoregulation of
Skeletal muscle
(3)

Back 236

1. Adenosine
2. K
3. Lactate

Front 237

Factors determining autoregulation of
Skin

Back 237

Sympathetic stimulation

Front 238

Starling forces
Capillary pressure

Back 238

Pushes fluid out of capillary

Front 239

Starling forces
Interstitial fluid pressure

Back 239

Pushes fluid into capillary

Front 240

Starling forces
Plasma colloid osmotic pressure

Back 240

Pulls fluid into capillary

Front 241

Starling forces
Interstitial fluid colloid pressure

Back 241

Pulls fluid out of capillary

Front 242

Net filtration pressure =

Back 242

[(capillary pressure - interstitial fluid pressure) - (plasma colloid osmotic pressure) - (interstitial fluid colloid pressure)

Front 243

Net fluid flow =

Back 243

(Pnet)(Kf)

Front 244

Kf =
(2)

Back 244

1. Filtration fraction
2. Capillary permeability

Front 245

Causes of edema
Increased capillary pressure

Back 245

Heart failure

Front 246

Causes of edema
Decreased plasma proteins
(2)

Back 246

1. Nephrotic syndrome
2. Liver failure

Front 247

Causes of edema
Increased capillary permeability
(3)

Back 247

1. Toxins
2. Infections
3. Burns

Front 248

Causes of edema
Increased interstitial fluid colloid osmotic pressure

Back 248

Lymphatic blockage

Front 249

Transposition of great vessels
(3)

Back 249

1. Aorta leaves RV anterior
2. Pulmonary trunk leaves LV posterior
3. Not compatible with life unless a shunt is present

Front 250

Coarctation of the aorta
Infantile type

Back 250

Aortic stenosis proximal to insertion of DA

Front 251

Coarctation of the aorta
(5)

Back 251

1. Stenosis distal to DA
2. Notching of ribs
3. Hypertension in upper extremities
4. Weak pulses in lower extremities
5. Can result in aoritc regurgitation

Front 252

PDA
Fetal period
(2)

Back 252

1. Shunt is right to left
2. Normal

Front 253

PDA
Neonatal period
(3)

Back 253

1. Left to right shunt
2. RVH and failure
3. Abnormal

Front 254

Congenital cardiac defect(s) associated with
22q11
(2)

Back 254

1. Truncus arteriosus
2. Tetralogy of Fallot

Front 255

Congenital cardiac defect(s) associated with
Down syndrome
(4)

Back 255

1. ASD
2. VSD
3. AV septal defect
4. endocardial cushion defect

Front 256

Congenital cardiac defect(s) associated with
Congential rubella
(3)

Back 256

1. Septal defects
2. PDA
3. Pulmonary artery stenosis

Front 257

Congenital cardiac defect(s) associated with
Turner's syndrome

Back 257

Coarctation of the aorta

Front 258

Congenital cardiac defect(s) associated with
Marfan's syndrome
(2)

Back 258

1. Aortic insufficiency
2. Late complucation

Front 259

Congenital cardiac defect(s) associated with
Offspring of diabetic mother

Back 259

Transposition of great vessels

Front 260

Truncus arteriosus gives rise to...

Back 260

1. Ascending aorta
2. Pulmonary trunk

Front 261

Bulbus cordis gives rise to...

Back 261

Smooth parts (outflow tracts) of left and right ventricle

Front 262

Primitive ventricle gives rise to...

Back 262

Trabeculated parts of left and right ventricle

Front 263

Primitve atria gives rise to...

Back 263

Trabeculated left and right atrium

Front 264

Left horn of sinus venosus gives rise to...

Back 264

Coronary sinus

Front 265

Right horn of sinus venosus gives rise to...

Back 265

Smooth part of right atrium

Front 266

Right common cardinal vein and right anterior cardinal vein give rise to...

Back 266

SVC

Front 267

Fetal erythropoiesis
Yolk sac

Back 267

3-8 weeks

Front 268

Fetal erythropoiesis
Liver

Back 268

6-30 weeks

Front 269

Fetal erythropoiesis
Spleen

Back 269

9-28 weeks

Front 270

Fetal erythropoiesis
Bone marrow

Back 270

28 weeks and onward

Front 271

Fetal-postnatal derivatives
Umbilical vein

Back 271

Ligamentum teres hepatis

Front 272

Fetal-postnatal derivatives
UmbiLical arteries

Back 272

mediaL umbilical ligaments

Front 273

Fetal-postnatal derivatives
Ductus arteriosus

Back 273

ligamentum arteriosum

Front 274

Fetal-postnatal derivatives
Ductus venosus

Back 274

ligamentum vensum

Front 275

Fetal-postnatal derivatives
Foramen ovale

Back 275

Fossa ovalis

Front 276

Fetal-postnatal derivatives
AllaNtois

Back 276

urachus - mediaN umbilical ligament

Front 277

Fetal-postnatal derivatives
Notochord

Back 277

nucleus pulposus

Front 278

The urachus is part of the...

Back 278

allantoic duct between the bladder and the umbilicus

Front 279

Fetal circulation
Blood entering the fetus goes through...
(4)

Back 279

the (1) umbilical vein (2) is conducted via the ductus venosus (3) into the IVC (4) to bypass the hepatic circulation

Front 280

Fetal circulation
Most oxygenated blood reaching the heart via the...
(4)

Back 280

(1) IVC (2) is diverted through foramen ovale (3) and pumped out the aorta (4) into the head and body

Front 281

Fetal circulation
Deoxygenated blood from the...
(4)

Back 281

(1) SVC (2) is expelled into the pulmonary artery (3) and ductus arteriosus (4) to the lower body

Front 282

Fetal circulation
What happens when and infant takes a breathe at birth?
(3)

Back 282

(1) Decrease resistance in pulmonary vasculature causes (2) increase in left atrial pressure vs. right atrial pressure
3. Foramen ovale closes

Front 283

Aortic arch derivatives
1st

Back 283

Part of MAXillary artery

Front 284

Aortic arch derivatives
2nd
(2)

Back 284

1. Stapedial
2. Hyoid artery

Front 285

Aortic arch derivatives
3rd
(2)

Back 285

1. Common Carotid artery
2. Proximal part of internal carotid artery

Front 286

Aortic arch derivatives
4th
(3)

Back 286

1. Left = aortic arch
2. Right = Proximal part of right subclavian artery
3. systemic

Front 287

Aortic arch derivatives
6th
(2)

Back 287

1. Proximal part of pulmonary arteries
2. Left only = Ductus arteriosus