Usmle Step 1 Dit: Cardio

Front 1

Name the 5 phases of left ventricle cardiac cycle:

Back 1

1. Isovolumetric contraction

2. Systolic ejection

3. Isovolumetric relaxation

4. Rapid filling

5. Reduced filling

Front 2

What is the isovolumetric contraction?

Back 2

The period between mitral valve closing and aortic valve opening

Front 3

What is the period of highest O2 consumption in left ventricle cardiac cycle?

Back 3

Isovolumetric contraction

Front 4

What is systolic ejection?

Back 4

Period between aortic valve opening and closing

Front 5

What is isovolumetric relaxation?

Back 5

period between aortic valve closing and mitral valve opening

Front 6

When does rapid filling occur?

Back 6

right after mitral valve opening

Front 7

when does reduced filling occur?

Back 7

just before mitral valve closing

Front 8

What makes the aortic valve open?

Back 8

the pressure in the ventricle exceeds the pressure in the aorta

Front 9

What makes the aortic valve close?

Back 9

When the pressure of the aorta exceeds pressure of ventricle

Front 10

What makes mitral valve open?

Back 10

Pressure in atrium is greater than in the ventricle

Front 11

What sounds, when heard, are ALWAYS normal?

Back 11

S1 and S2

Front 12

What sound, when heard, is considered pathological (except if its in pregnancy or children)?

Back 12

S3

Front 13

Other than in pregnant women and in children, when is S3 heard?

Back 13

Mitral regurg, CHF, dilated myocardiopathy, left to right shunt

Front 14

When you hear S4 in a patient, you suspect:

Back 14

stiff heart due to ventricular hypertrophy, aortic stenosis, chronic hypertension with left ventricle hypertrophy, post MI

Front 15

What diseases have problems with dicrotic notch? why?

Back 15

Marfan and siphilis due to decreased elasticity of aortic valce and therefor decreased dicrotic notch

Front 16

QRS complex is indicative of:

Back 16

ventricular contraction, AV valve closure

Front 17

the a wave in jugular venous pulse:

Back 17

atrial contraction

Front 18

the c wave in jugular venous pulse:

Back 18

Right ventricle contraction

Front 19

the v wave in jugular venous pulse:

Back 19

increased right atrial pressure due to filling against closed tricuspid valve

Front 20

When contractility is increased in the ventricle, what happens to SV, EF, ESV, preload?

Back 20

Increased SV, increased EF, decreased ESV, preload is not affected

Front 21

What happens to heart when there is an increase in afterload?

Back 21

Increased aortic pressure, decreased SV, increased ESV

Front 22

What happens to the heart when there is an increase in preload?

Back 22

Increased SV

Front 23

Where is normal splitting of S2 seen?

Back 23

In young patients and athletes, a slight splitting of S2 can be seen.

Front 24

Where is wide splitting seen?

Back 24

Can be seen in conditions that delay RV emptying like pulmonic stenosis, right bundle branch block

Front 25

Wide splitting on expiration:

Back 25

Never normal

Front 26

Wide splitting on inspiration:

Back 26

Might be normal

Front 27

Fixed splitting is seen in what disease? why?

Back 27

ASD (bc of left to right shunt, there is an increase in right atria and right ventricle volumes and increased flow through pulmonic valve, such that, pulmonic closure is greatly delayed)

Front 28

Parodoxical splitting is seen in what conditions?

Back 28

Conditions that delay LV emptying: aortic stenosis, left bundle branch block.

Front 29

What happens in paradoxical splitting?

Back 29

P2 and A2 switch

Front 30

Abnormal benign murmurs

Back 30

Split S1- if there are no other symptoms

Split S2 - on inspiration

Split S3 - in a patient <40

Early, quiet, systolic murmur with no other evidence of disease

Front 31

What murmurs are best heard in lateral decubitus position?

Back 31

Mitral stenosis, mitral regurg, left sided S3, left sided S4

Front 32

Where to listen in auscultation of the heart

Back 32

Aortic, pulmonic, tricuspid, mitral

APT M

Front 33

What conditions are best auscultated in aortic area?

Back 33

Systolic mumur: aortic stenosis (& radiates carotid), flow murmur, aortic valve sclerosis

Front 34

Which conditions are best auscultated in left sternal border?

Back 34

Diastolic murmurs: aortic regurg, pulmonic regurg,

systolic murmur: hypertrophic cardiomyopathy

Front 35

Which conditions are best auscultated in pulmonic area?

Back 35

Systolic ejection mumur: pulmonic stenosis, flow murmur (physiologic)

Front 36

What conditions are best auscultated in tricuspid area?

Back 36

Parasystolic murmur: Tricuspid regurg, ventricular septal defect

Diastolic murmur: Tricuspid stenosis, atrial septal defect

Front 37

What conditions are best auscultated in mitral area?

Back 37

Systolic murmur: mitral regurg

Diastolic murmur: mitral stenosis

Front 38

Which bedside maneuver has increased intensity of right heart sounds?

Back 38

Inspiration

Front 39

Which bedside maneuver has increased intensity of left heart sounds?

Back 39

Expiration

Front 40

Mitral mumur is best heard in which bedside maneuver?

Back 40

Expiration

Front 41

Tricuspid murmur is best heard in which bedside maneuver?

Back 41

Hand grip

Front 42

Hand grip bedside maneuver works by:

Back 42

Increasing systemic vascular resistance and afterload

Front 43

What conditions are best detected with hand grip maneuver?

Back 43

Mitral regurg, Aortic regurg, VSD

Front 44

Valsalva bedside maneuver works by:

Back 44

decreasing preload and afterload. Decreased venous return

Front 45

What conditions can be detected with valsalva bedside maneuver?

Back 45

Increased intensity in most murmurs but is increased in hypertrophic cardiomyopathy murmur

Front 46

Holosystolic, high pitched "blowing murmur" that is loudest at apex and radiates toward axilla. Enhanced by hand-grip and squatting.

Back 46

Mitral/tricuspid regurgitation

Front 47

What are the main causes of mitral and aortic regurg?

Back 47

Rheumatic fever, endocarditis

Front 48

Holosystolic, high pitched "blowing murmur" loudest at tricuspid area and radiates to right sternal border. Enhanced by inspiration.

Back 48

Tricuspid regurg

Front 49

Crescendo-decrescendo systolic ejection murmur. Pulses are weak and a delayed peak.

Back 49

aortic stenosis

Front 50

"Pulsus parvus et tardus"

Back 50

Aortic stenosis

Front 51

What are the main causes of aortic stenosis?

Back 51

Age related calcific aortic stenosis or bicuspid aortic valve, rheumatic fever

(also unicuspid valve and syphilis)

Front 52

Holosystolic, harsh sounding murmur, loudest at tricuspid. Accentuated with hand grip maneuver.

Back 52

VSD

Front 53

Differential diagnosis between VSD and tricuspid regurg?

Back 53

They sound a lot a like in that they are both holosystolic murmurs but VSD is most common in newborns whereas tricuspid regurg is most common in IV users.

Front 54

Late systolic crescendo murmur with midsystolic click.

Back 54

Mitral valve prolapse

Front 55

Most frequent valvular lesion?

Back 55

Mitral valve prolapse

Front 56

High pitched, blowing, early diastolic, decrescendo murmur with wide pulse pressure. Bounding strong pulses and head bobbing. Best heard left side of sternum

Back 56

Aortic regurgitation

Front 57

What are the most common causes of aortic regurg?

Back 57

Syphilis, Marfan, aortic root dilation, bicuspid aortic valve, endocarditis, rheumatic fever

Front 58

Following diastole, opening snap . Heard in the apex, lateral decubitus.

Back 58

Mitral stenosis

Front 59

What are the main causes of mitral stenosis?

Back 59

Rheumatic fever

Front 60

Chronic mitral stenosis can lead to:

Back 60

left atrial dilation

Front 61

Continuous, machine-like murmur. Loudest at S2. Best heared at left infraclavicular area

Back 61

PDA

Front 62

What are the nonvalvular heart murmurs?

Back 62

VSD, PDA

Front 63

Which murmurs are systolic?

Back 63

Mitral/tricuspid regurg, aortic stenosis, VSD, mitral valve prolapse

Front 64

Which murmurs are diastolic?

Back 64

Aortic regurg, mitral stenosis, tricuspid stenosis, pulmonic regurg

Front 65

Which murmurs are continuous?

Back 65

PDA

Front 66

What happens during phase 0 of ventricular action potential?

Back 66

Rapid upstroke and depolarization: Na+ channels open

Front 67

What happens during phase I of ventricular action potential?

Back 67

Initial repolarization: Decreased permeability to Na+ and increased permeability to K+

Front 68

What channels are inactivated and activated during phase I of ventricular action potential?

Back 68

Inactivation of voltage gated Na+ channels and voltage K gated channels open.

Front 69

What happens during phase 2 of ventricular action potential?

Back 69

plateu: Ca2+ influx tries to balance K+ efflux

Front 70

During what phase does myocyte contraction take place?

Back 70

Phase 2, Ca2+ influx

Front 71

What happens during phase 3 of ventricular action potential?

Back 71

rapid repolarization: massive K+ efflux due to opening of flow K+ channels and closing of voltage-gated Ca2+ channels

Front 72

What happens during phase 4 of ventricular action potential?

Back 72

resting potential: high K+ permeability through K+ channels

Front 73

What is the normal action potential of K+, Na+ and Ca2+?

Back 73

K+ = -75 to - 85mV

Na+ = +50mV

Ca2+ = +20mV

Front 74

When effective refractory period (ERP) increases..

Back 74

Heart heart decreases

Front 75

Phase 0 of pacemaker action potential

Back 75

opening of voltage gated Ca2+ channels, depolarization

Front 76

phase I and 2 of pacemaker action potential

Back 76

absent

Front 77

Phase 3 of pacemaker action potential

Back 77

Ca2+ channels inactivated and K+ channels activate

Front 78

Phase 4 of pacemaker action potential

Back 78

slow diastolic depolarization - membrane depolarizes slowly and conductance increases

Front 79

What accounts for automaticity of SA and AV nodes?

Back 79

Phase 4 of pacemaker action