Qbank - Cardiovascular

Front 1

congenital defect - oxygen "step-up" from RA to RV? Findings?

Back 1

VSD
finding would be holosystolic murmur at left sternal border

Front 2

what sO2 would be found w/ASD? Physical exam finding?

Back 2

oxygen step up from vena cava to RA
fixed splitting of S2

Front 3

spike & dome carotid pulse upstroke?

Back 3

hypertrophic obstructive cardiomyopathy - dynamic LV outflow tract obstruction

Front 4

what happens to blood & the heart with inspiration?

Back 4

decreased thoracic pressure --> increased venous return to RIGHT heart
INCREASED PULMONARY VESSEL CAPACITY --> decreased blood return to LEFT HEART

Front 5

most important prognostic factor in tetrolagy of fallot?

Back 5

degree of pulmonic stenosis

Front 6

pulmonary infarct characteristic?

Back 6

almost always hemorrhagic, b/c of dual blood supply (would be difficult to be ischemic)

Front 7

pulmonary infarct in IV drug user?

Back 7

septic emboli from tricuspid endocarditis
s. aureus & pseudomonas are MCC in this population

Front 8

reliability vs precision

Back 8

essentially the same (contrast to accurate)

Front 9

adult homeless man
increasing fatigue exertional dyspnea
LE edema, decreased sensation over feet/legs?

Back 9

wet Beriberi - high output CHF
thiamine (B1) deficient

Front 10

verapamil effect on AV & SA node?

Back 10

slows diastolic (?) depolarization - [phase 0
calcium channel blocker]

Front 11

what drugs increase the threshold potential of cardiac pacemaker cells?

Back 11

Only class I (A-C)

Front 12

what drugs prolong repolarization of cardiac pacemakers?

Back 12

class IA, IC, III

Front 13

what drugs shorten the action potential of cardiac pacemakers?

Back 13

class IB

Front 14

carpopedal spasms soon after birth, absent thymic shadow, narrowing of the aortic arch - what dz? What embryological structure?

Back 14

DiGeorge's Syndrome
3rd & 4th PHARYNGEAL pouch
- associated w/hypoPTH from parathyroid aplasia - hypocalcemia & tetany
aortic arch abnormalities

Front 15

sildafenil and nitroglycerine together?

Back 15

nitrates + phosphodiesterase inhibitors cause cGMP accumulation
profound hypotension
absolutely contraindicated

Front 16

hypotension, JVD, distant/muffled heart sounds (& tacchycardia)

Back 16

Becks triad - cardiac tamponade
loss of palpable pulse could be due to pulsus paradoxus

Front 17

34 yo female w/progessive exertional sob & coronary sinus dilation?

Back 17

pulmonary HTN
coronary sinus communicates with RA, if RA pressure goes up can cause coronary sinus dilation

Front 18

antiarrhythmic decrease the outward flow of an ion active in the late phase of cardiac myocte action potential?

Back 18

class III - K channel blockers
ibutilide, sotalol, betyu…?, amiodarone, dofetilide

Front 19

65 yo man loses conciousness while buttoning shirt, which nerve is stimulated?

Back 19

glossopharyngeal (carotid baroreceptors
responds to both increase & decrease)
not vagus b/c that is aortic arch baroceptors (not hit by shirt buttoning), responds only to increased BP

Front 20

functional heart murmurs

Back 20

caused by acute hemodynamical changes, in absence of any structural lesions

Front 21

where is the conduction speed of cardiac action potential greatest?

Back 21

purkinje fibers > atrial myocytes > ventricular myoctes > AV node

Front 22

what is the 3rd heart sound?

Back 22

result of blood turbulence w/in ventricle during period of rapid diastolic filling
in adults most commonly occurs in the setting of cardiac failure (systolic or diastolic)

Front 23

dyspnea, cough, chest pain, malaise a few weeks post pharm tx of ventricular arrythmia?

Back 23

amiodarone toxicity (interstitial pneumonitis occuring in isolation)
check PFTs, LFTs, TFTs

Front 24

what do nitrates do to HR & SV?

Back 24

venodilate --> reduced preload & so reduced SV
compensatory increased HR

Front 25

what is nesiritide?

Back 25

recombinant BNP, used to tx decompensated LV dysfxn --> CHF
BNP activate guanylate cyclase, increase cGMP --> vasodilation, diuresis, decrease BP
COUNTERACT ENDOTHELIN, sympathetics, & AT II

Front 26

what does endothelin do to vasculature?

Back 26

vasoconstricts, increases afterload

Front 27

what is the MCC of BP 180/70 in an old man?

Back 27

ISOLATED SYSTOLIC hypertension
decrease in compliance of aorta & its proximal major branches

Front 28

what cells provide major proliferative stimuli for cellular components of atherosclerotic plaques?

Back 28

Platelets
release of PDGF by platelets adherent to areas of denuded vascular endothelium plays important role - promotes migration of SMC from media to intima & subsequent proliferation (TGF-beta is also chemotactic for SMC, but not mitogenic)

Front 29

42 yo man w/exertional dyspnea & progressive fatigue, dies, dilated LV - what caused his sx?

Back 29

decreased ventricular contraction force (NOT impaired LV filling, NOT poor compliance of ventricular walls)

Front 30

what kind of dysfxn occurs w/dilated cardiomyopathy? Hypertrophic? Restrictive?

Back 30

dilated - systolic dysfxn
hypertrophic - diastolic dysfxn
restrictive - diastolic dysfxn

Front 31

pain profile of pericarditis?

Back 31

worse on inspiration, radiates to the back (shoulder blade), alleviated partially by sitting up

Front 32

MI associated w/bradycardia?

Back 32

Inferior MI, RCA is often blocked, which supplies the SA node
tx w/atropine to counter decompensation
common side effect is increased intraocular pressure may precipate closed angle glaucoma in susceptible individuals

Front 33

on CT what might be confused for IVC at level of the renal vasculature?

Back 33

lumen of 2nd part of the duodenum, IVC is closer to vertebral bodies, lies anterior & to the right

Front 34

man dies 14 days after MI, what is found on histology?

Back 34

granulation tissue
begins 7 days following ischemia, most prominent days 10-14 post infarction

Front 35

lady w/a. fib has bradycardia & hyperkalemia, what med caused?

Back 35

Digitalis, useful for a. fib particularly in pt w/underlying systolic dysfxm
stimulates vagal input to AV node
toxicity --> fatigue, blurry vision, changes in color perception, nausea & vomiting, diarrhea, abdominal pain, headache, dizziness, confusion, delirium

Front 36

pt w/fatigue, blurry vision, changes in color perception, nausea & vomiting, diarrhea, abominal pain, headache, dizziness, confusion, delirium from drug toxicity?

Back 36

digitalis
also causes bradycardia & hyperkalemia (though worsened BY hypOkalemia)

Front 37

murmur - decreased LV wall compliance vs increased LV end diastolic pressure?

Back 37

decreased LV wall compliance = S4, hypertrophy
increased left ventricular end-diastolic pressure = S3, dilation - sign of LV failure - blood is flowing in hitting left over blood (systolic failure so blood isn't all getting pumped out)

Front 38

23 yo woman from cambodia has exertional dyspnea, dry cough
had bilateral knee swelling as a child
murmur on exam

Back 38

mitral regurg
rheumatic heart dz

Front 39

mitral regurgitation in first few decades of life?

Back 39

rheumatic heart dz
more common in undeveloped countries

Front 40

JVP wave - what does it look like, what is each point?

Back 40

2 waves, the first wave has 2 peaks, first one larger. 1st wave 1st pk = a wave = right atrial contraction
1st wave 2nd peak = C wave = bulging of tricuspid valve into RA
last wave = V wave = pressure rise as RA fills

Front 41

white area around the heart on CT?

Back 41

constrictive pericarditis - calcifications > 4 mm
clinically: slowly progressing dyspnea, peripheral edema, & ascitis

Front 42

JVP tracing finding in constrictive pericarditis?

Back 42

rapid y-descent (early diastole) that becomes both deepr & steeper during inspiraton

Front 43

MC cardiovascular lesions in Marfan's?

Back 43

Mitral valve prolapse & cystic medial degeneration of the aorta --> aortic dissection

Front 44

Why would you not use ramopril in a post-MI patient?

Back 44

ACE inhibitors are great for BP control & more in post-MI, but in patients w/severe bilateral renal atherosclerosis they can precipitate ARF
ACE is needed to maintain renal perfusion in these pts

Front 45

what do strep viridans need in order to attach to heart valves?

Back 45

preexisting valve damage --> local deposition of fibrin, allowing them to adhere (fibrin-platelet aggregates are where they most likely adhere)

Front 46

what are the 4 features of Henoch-Schonlein purpura?

Back 46

GI, Kidney, Skin, Joints --> GI tract - intermittent abdominal pain/bleeding
Renal - idential to IgA nephropathy w/mesangial proliferation & crescent formation, blood in urine
Skin - palpable purpura on buttocks
Joints - self limited migratory arthritis

Front 47

what is the pathophys of Henoch-Schonlein purpura?

Back 47

IgA mediated hypersensitivity (leukocytoclastic) vasculitis, young children, preceded by URI
abdominal pain, joint pain, LE palpable purpura, hematuria

Front 48

what is the MCC of in-hospital death due to MI?

Back 48

LV failure/cardiogenic shock
10-15% cases
2/3 of the deaths

Front 49

when post-MI does ventricular free wall rupture occur?

Back 49

3-7 days, once coagulative necrosis & neutrophil infiltration have sufficiently weakened infarcted myocardium

Front 50

what substances reduce the rate of spontaneous depolarization in cardiac pacemaker cells?

Back 50

acetylcholine & adenosine

Front 51

appetite suppressing drugs? Caused sudden death, what cardiac abnormality do you find?

Back 51

fenluramine or phentermine
find RV hypertrophy b/c they cause increased incidence of pulmonary HTN

Front 52

during strenuous exercise what is the major limiting factor for coronary blood flow?

Back 52

duraiton of diastole

Front 53

does carotid baroreceptor fireing increase or decrease w/carotid body massage?

Back 53

increase
low pressure environments result in decreased firing freq

Front 54

23 yo male w/sudden heart palpitations
HR 160 BP 110/70 - what is it? Tx?

Back 54

PSVT, carotid body massage

Front 55

65 yo pt on multiple meds for HTN presents w/disturbed color vision, anorexia, nausea, vomiting, & diarrhea - what med toxicity? What is another common toxicity not listed here?

Back 55

Digoxin (changes in color vision)
could see arrhythmia

Front 56

what is the main source of resistance in the vascular system?

Back 56

capillary beds

Front 57

MCC ventricular fibrillation in ppl < 30 yo?

Back 57

Hypertrophic cardiomyopathy

Front 58

what is the MC cardiomyopathy?

Back 58

dilated cardiomyopathy, ~90%
account for ~10-15% cases sudden cardiac death

Front 59

what class of meds reduces all cause mortality in CHF? Which one in particular?

Back 59

beta blockers
carvedilol

Front 60

hemochromatosis causes what kind of cardiomyopathy?

Back 60

dilated, pts present w/signs & sx of CHF

Front 61

concentric vs eccentric cardiac hypertrophy?

Back 61

concentric hypertrophy results from increased afterload (sarcomes added in parallel)
eccentric hypertrophy is more associated with volume/dilation (sarcomeres added in series)

Front 62

how does listening at end expiration accentuate a diastolic murmur (S3)?

Back 62

brings apex closer to chest wall

Front 63

most reliable auscultory indicator of severity of mitral stenosis?

Back 63

A2-opening snap interval
shorter the more severe the stenosis

Front 64

how does the fick principle calculate CO? (using what variables)

Back 64

CO = oxygen consumption / AV oxygen difference

Front 65

in cases of dilation, what cardiac chamber can impinge on the esophagus causing occasional dysphagia?

Back 65

Left atrium

Front 66

what is the MCC mitral stenosis?

Back 66

fibrosis of valve leaflets in chronic rheumatic heart dz (99%)

Front 67

what is the early pathogenesis of AAA?

Back 67

intimal (fatty) streak of atherosclerosis
composed of intimal lipid-filled foam cells (derived from macrophages & smooth mm cells engulfing LDL)

Front 68

coronary artery bypass grafting - use what vessel for bypassing LAD? What vessel for others?

Back 68

to bypass LAD left internal mamillary (thoracic) artery is preferred
to bypass other vessels/multiples use saphenous vein, harvested at superficial medial thigh, just below pubic tubercle

Front 69

what is the difference between myocardial stunning and hibernation?

Back 69

stunning is a less severe form of ischemia-induced reversible loss of contractile function
brief ischemic episodes (<30min) followed by reperfusion, full recovery in hours to days

reptitive episodes of stunning can result in hibernation (still reversible with reperfusion - CABG)

Front 70

in developing mitral regurgitation, if it is acute vs chronic there is a higher risk for?

Back 70

acute - marked pulmonary HTN and edema

chronic development - increase LA compliance, more prone to atrial enlargement, fibrillation, and mural thromboembolism

Front 71

how much O2 does myocardium extract from it's blood? What regulates flow?

Back 71

extracts 75-80% at rest, up to 90% at work

hypoxia and adenosine accumulation increase cardiac perfusion

also, basal vascular tone modified by NO & beta adrenergic (vasodilation), and alpha adrenergic (vasoconstriction)

Front 72

patient admitted w/unstable angina, 4 days later develops severe foot pain & right toe paleness, labs reveal platelets of 60,000 - what's going on? Tx?

Back 72

Heparin induced thrombocytopenia

leads to paradoxical thrombosis rather than bleeding, more commonly

use direct thrombin inhibitor to tx - argatroban
do NOT use either low nor high molecular weight heparain, d/c immediately!

Front 73

pulsus paradoxus - found in? describe presentation?

Back 73

acute cardiac tamponade, constrictive pericarditis, severe obstructive lung dz, restrictive cardiomyopathy

"decrease in BP > 10 mmHg on inspiration"

man comes in BP cuff at 100 can hear korotkoff sounds only during expiration
at 78 sounds are heard throughout respiratory cycle

think - when inspire are increasing return to right heart, pushing septum over towards left, b/c heart is restricted no room to compensate, diminished LV stroke volume

Front 74

joint pain and cardiac murmur?

Back 74

rheumatic heart dz

antibodies against M-prtns of certain strains of streptococci cross react w/glycoprtn antigens on heart

Front 75

what is a false aneurysm? (pseudoaneurysm)

Back 75

breach in contiinuity of all 3 layers of vessel (or heart)

blood leakage &/ hematoma forming outside vascular wall

hematoma contained w/in sac of CT surrounding original pt of arterial wall rupture

ex - leaks in anastamosis at sites of vascular grafts, postinfarction myocardial ruptures

Front 76

how are the GAS sequelae mediated w/immune system?

Back 76

Rheumatic Fever (antigen mimicry)

post-strept glomerulonephritis (immune complex deposition)

Front 77

cough syncope?

Back 77

typically in overweight males w/COPD

increased intrathoracic pressure decreases venous return to heart, decreasing CO