Raymond Path Cardio Exam Iii

Front 1

Abnormally dilated and tortuous veins

Back 1

Varicose veins

Front 2

Causes of varicose veins

Back 2

Prolonged increased venous pressure

Loss of vascular support

Front 3

Most common site for varicose veins

Back 3

Upper and lower leg

Front 4

Who usually gets varicose veins

Back 4

- People over 50 years old

- Women (especially in pregnancy)

- Obesity

Front 5

Do varicose veins embolize

Back 5

NO - no emboli

Front 6

S&S of varicose veins

Back 6

- Stasis of blood
- Congestion
- Thrombus
- Pain
- Edema
- Persisten stasis - stasis dermatitis, ulcerations, delayed healing

Front 7

Causes of spider angiomas

Back 7

Pregnancy

Alcoholism

Cause - ESTROGEN --> cant metabolize 17 keto acids - form more estrogen in adipose tissue

Front 8

Clinical predisposition to thrombophlebitis/phlebothrombosis

Back 8

Heart failure

Pregnancy

Obesity

Post op

Prolonged bed rest

Immobilization

Genetic hypercoagulability

Front 9

Thrombosis of deep leg veins is often accompanied by _

Back 9

Inflammation of vessel walls

Front 10

Thrombosis of deep leg veins may be clinically manifest as _

Back 10

Redness

Swelling

Tenderness

Pain of affected site

Front 11

_ important site of origin of PE

Back 11

Thrombosed deep veins of legs and pelvis

Front 12

Pregnant female presents with painful white leg - what does she have and causes?

Back 12

Plegnasia alba dolens - special variant of primary phlebothrombosis

Causes:

Pregnancy - stasis of blood - compression by gravid uterus and hypercoagulable state

Lymphatic blockage

Front 13

Superior vena caval syndrome is usually caused by _

Back 13

Pancoast tumor (Horner syndrome)
Mediastinal lymphoma

Front 14

Patient presents with headache, blurry vision and shortness of breath. PE shows dilation of veins of the head and arms and retinal vein engorgement - what does patient have

Back 14

Superior vena cava syndrome

Front 15

Inferior vena cava syndrome is caused by _

Back 15

Neoplasms of liver or kidney

Front 16

Patient presents with edema, pain of lower extremities, caput medusa, hemorrhoids and proteinuria - what does patient have

Where is it coming from?

Back 16

Inferior vena cava obstruction - thrombus from femoral or iliac vein

Front 17

Patient presents with painful subcutaneous red streaks that extend along lymphatics - diagnosis and whats common cause

Back 17

Lymphangitis - common cause are group A beta hemolytic strep

Front 18

Interstitial edema due to occlusion of lymphatic drainage

Back 18

Lymphedema

Front 19

What are the causes of secondary lymphedema

Back 19

Malignant tumors - metastasis

RADICAL MASTECTOMY

Postirradiation fibrosis

Filariasis

Front 20

What are the causes of primary lymphedema

Back 20

Simple congenital

Familial congenital

Lymphedema praecox

Front 21

Reduced blood flow in _ the major artery in the thigh can cause leg pain with exercise (intermittent claudcation) and can lead to skin ulcers, gangrene and amputations

Back 21

Femoropopliteal artery

Front 22

Major cause (90%) of ischemic heart disease

Back 22

Reduced coronary blood flow

Front 23

4 clinical manifestations of IHD

Back 23

MI

Angina

Chronic IHD with heart failure

Sudden cardiac death

Front 24

Diagnosis of chronic ischemic heart disease requires critical stenosis of

Back 24

> 75%

Front 25

Most MI, unstable angina and sudden cardiac death are precipitated by _

Back 25

Plaque disruption with overlying thrombus

Front 26

Factors causing inability of plaque to withstand mechanical stress

Back 26

Rupture/fissures

Erosion/ulceration

Hemorrhage into atheroma

Front 27

What types of plaques are vulnerable to disrupt

Back 27

Plaques with large amounts of foam cells and extracellular lipids and have thin fibrous cap

Front 28

Where there is a greates stress on plaque and fibrous cap is thinnest

Back 28

Junction of fibrous cap and normal adjacent arterial segment

Front 29

What determines strength of plaque

Back 29

Collagen

Front 30

Metalloproteinases are made by _

Back 30

Macrophages in atheroma

Front 31

Increases mechanical stress on plaque (influence)

Back 31

Adrenergic stimulation

Front 32

Most common cause of death in patients with MI and hemorrhage

Back 32

Lethal arrhythmia

Front 33

Cause of stable angina

Back 33

Decreased coronary blood flow as result of chronic stenosis atherosclerosis

Front 34

Patietn presents with complaint of chest pain that occurs with exercise, emotional stress or anything that increases heart work

Back 34

Stable angina

Front 35

Pain in stable angina is relieved by -

Back 35

Nitroglycerin or rest

Front 36

Patient presents with chest pain at rest - he states that is unrelated to his physical activity or increases in heart rate

Back 36

Prinzmetal angina

Front 37

Cause of Prinzmetal angina

Back 37

Coronary vasospasm

Front 38

What do you see on EKG of patient with Prinzmetal angina

Back 38

ST elevation

Front 39

What type of ischemia in Prinzmetal angina

Back 39

Transmural ischemia

Front 40

Treatment for prinzmetal angina

Back 40

Ca channel blockers or nitroglycerine

Front 41

Which test should NOT be done in patient with unstable angina

Back 41

Treadmill test

Front 42

What do you see on EKG of patient with unstable angina

Back 42

ST depression

Front 43

What type of ischemia in patient with unstable angina

Back 43

Subendocardial ischemia

Front 44

Patient presents with chest pain at rest that progressively getting longer -

Back 44

Unstable crescendo angina

Front 45

Cause for unstable angina

Back 45

Plaque disruption - superimposed thrombus, vasospasm

Front 46

Does unstable angina respond to any drugs

Back 46

DOES NOT respons to Ca channel blockers or nitro

Front 47

What type of necrosis is MI

Back 47

Coagulative

Front 48

This type of ischemia involves entire wall (full thickness) of myocardium - endocardium, midwall and epicardium, usually caused by atherosclerosis, plaque disruption, thrombus etc -->

Back 48

Transmural ischemia

Front 49

What do you see on EKG of transmural ischemia

Back 49

ST elevation

Front 50

Patient presents with sinus bradycardia and chest pain - which artery is responsible

Back 50

RCA

Front 51

This artery involves LV anterior free wal, apex and 2/3 of anterior septum

Back 51

LAD

Front 52

This artery supplies inferior/posterior wall of LV and RV and posterior 1/3 of septum and AV node

Back 52

RCA

Front 53

This artery supplies lateral wall of LV

Back 53

Left circumflex

Front 54

This type of ischemia occurs in least perfused area of heart, more vulnerable to ischemia - limited to 1/3 of myocardium

Back 54

Subendocardial ischemia

Front 55

What do you see on EKG of patient with subendocardial ischemia

Back 55

Depression of ST segment

Front 56

Autopsy of the heart reveals white collagenous scar -how old is infarct?

Back 56

Over 2 months

Front 57

Sequence of events in MI

Back 57

Plaque disruption --> Platelet adhesion and aggregation --> Vasospasm --> Extrinsic coagulation pathway --> total occlusion of lumen

Front 58

Reasons for non atherosclerotic induced MI

Back 58

VASOSPASM - lethal arrhythmia

EMBOLI --> LV mural thrombus, LA, paradoxical

Front 59

Coagulative necrosis occurs when after onset

Back 59

4-12 hours

Front 60

Effective way to salvage ischemic myocardium and prevent MI _

Back 60

Reestablishing coronary blood flow (reperfusion)

Front 61

3 ways of reperfusion

Back 61

Thrombolytics

PTCA

CABG

Front 62

What causes reperfusion injury

Back 62

Oxygen free radicals

Front 63

Microvascular injury and long lasting cardiac dysfuntion brought on by reperfusion

Back 63

Myocardial stunning

Front 64

Myocytes necrotic from MI and reperfusion show _

Back 64

Necrosis with contraction bands

Front 65

Patient presents with DYSPNEA and sweating. PE shows weak rapid pulse, sweating, pulmonary congestion and edema and EKG changes - diagnosis

Back 65

Acute MI

Front 66

Which LDH is normally higher and which is higher in cardiac tissue

Back 66

LDH2 normally higher than LDH1

LDH1 is in cardiac tissue

Front 67

This cardiac marker after MI rises at 2-4 hours and peak at 48 hours remain elevated for 7-10 days following MI

Back 67

Troponin I and T

Front 68

These cardiomarkers have nearly complete tissue specificity and high sensitivity

Back 68

Cardiac troponins

Front 69

This cardiac marker is excellent for re infarction

Back 69

CK MB

Front 70

This cardiac marker has sensitivity but not specificity - rises 2-4 hours following MI, peaks at 24 hours and normal within 72 hours

Back 70

CK MB

Front 71

Absence of CK for first few days and of troponin days following signifies _

Back 71

Absence of MI

Front 72

Marker to predict risk of MI in patients with angina

Back 72

CRP

Front 73

Rupture of _ is most common post MI

Back 73

LV free wall

Front 74

Rupture of _ causes hemopericaridum - tamponade

Back 74

LV free wall

Front 75

What are the risk factors for myocardial rupture

Back 75

Age >60

Female

Preexisting HTN

Lack of hypertroph

Lack of previous MI

Front 76

Patient has papillary muscle rupture and mitral regurgitation - which artery involved

Back 76

RCA

Front 77

Pericarditis during first week post MI - autoimmune or not?

Back 77

NO autoimmune

Front 78

Pericarditis 4-6 weeks autoimmune or not>

Back 78

AUTOIMMUNE

Front 79

Patient presents with chest pain, muscle aches and pain, and fever. Pain gets better when patient is leaning forward. PE reveals friction rub

Back 79

Acute pericarditis

Front 80

Patient presents with chest pain, shortness of breath and pain when breathing, fever and L shoulder pain

Back 80

Dresslers syndrome

Front 81

What type of pain would you see in someone with mitral regurgitation

Back 81

EPIGASTRIC