QBank Cards Flashcards

0
Q

Which vessels have the most effective oxygen extraction in the body?

A

The coronary arteries. Therefore, the coronary sinus has the lowest oxygen content of any vessel.

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1
Q

What heart sound is consistent with HF? How can it be accentuated?

A

S3, listening at end expiration in the lateral decubitus position when heart is closest to the chest wall due to dec lung volume

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2
Q

What are the holosystolic murmurs? Which one is heard at the lower left border and increases with inspiration?

A

Tricuspid regurg, mitral regurg, VSD

  • LLSB is tricuspid.
  • Inspiration causes inc venous return to R heart > L heart.
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3
Q

What’s the pathophys of PE?

A

Hypoperfusion of lung parenchyma causes hypoxemia which stimulates respiration -> hyperventilation and respiratory alkalosis. Inc pH, reduced PaCO2, low PO2

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4
Q

What effect does phenylephrine have on TPR?

A

It increases sympathetic tone, increasing TPR (both CO and venous return are decreased)

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5
Q

What effect does an AV fistula have TPR?

A

It decreases TPR acutely. Chronically, the SNS and kidney will compensate and cause mean systemic pressure.

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6
Q

What effect does anaphylaxis have on venous return?

A

Widespread venous and arteriolar dilatation with fluid third spacing, drops venous return

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7
Q

What murmur causes bounding peripheral pulses and carotid pulsations with head-bobbing?

A

Aortic regurg: large pulse pressure causes abrupt dissenting and quick collapse
- de Musset sign: head bobbing due to momentum transfer from head to neck

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8
Q

What is the effect of verapamil?

A

Calcium channels actually contribute to the latter part of diastolic depolarization. By blocking them in the SA and AV node, depolarization is slowed.
It also decreased the amt of Ca available in cardiomyocytes

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9
Q

What effect does nitroprusside have on the pressure volume loop?

A

Nitroprusside is a short-acting vasodilator of both arteries and veins. It decreases preload and after load.

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10
Q

What happens to systemic vascular resistance during exercise?

A

Overall, there is a decrease because even though there’s contraction of arterioles in all tissues except muscles, there is local vasodilation in muscles from adenosine, K+, ATP, CO2, and lactate. Blood flow to systemic organs doesn’t change.

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11
Q

What is the effect of carotid sinus massage?

A

It increases the baroreceptor firing rate causing increased parasympathetic discharge to slow HR by slowing conduction at the AV node.

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12
Q

What is the order of cardiac tissue velocity?

A

Fastest first: Purkinje system (2.2 m/sec), atrial muscle (1.1), ventricular muscle (0.3), and AV node (0.5)

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13
Q

What’s the compensatory response to CHF? How does it actually negatively affect the heart?

A

CHF causes decreased CO, which is detected as low BP.
-increases sympathetic activity
-stimulation of RAAS
-release of ADH
Excessive vasoconstriction increases after load and reduces CO, fluid retention is caused by dec renal perfusion. Renin and angiotensin also cause fluid retention leading to peripheral edema and pulmonary congestion. This all causes cardiac remodeling

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14
Q

What is the effect of adenosine on the cardiac pacemaker action potential?

A

It activates K+ channels and prolongs K+ flow, causing a longer negative potential and it inhibits L-type Ca2+ channels making it longer to reach threshold. Overall, HR is decrease

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15
Q

What’s the normal pressure range for each heart chamber?

A

RA- 0-8, RV: 4-25, PA: 9-25, LA: 2-12, LV: 9-130, Aorta: 70-130

16
Q

How can you tell the severity of mitral regurg on PE?

A

The presence of an S3 sound from increased rate of LV filling from regurgitate flow

17
Q

Which cardiac defect is correlated with each genetic syndrome: Down, DiGeorge, Friedreich ataxia, Kartagener, Marfan, TS, Turner

A

Down: endocardium cushion defects (regurgitate AV valves, Latium primum ASD)
DiGeorge- ToF, interrupted aortic arch
FA: hypertrophic cardiomyopathy
Kartagener: situs inversus
Marfan: cystic medial necrosis (dissection, aneurysm), MVP
TS: valve obstruction from rhabdomyoma
Turner: aortic coarctation, bicuspid aortic valve

18
Q

What is increased left atrial pressure during systole? What about diastole?

A

Mitral regurg; mitral stenosis

19
Q

What is cystic medial degeneration?

A

Myxomatous changes in the media of large arteries caused by elastic tissue fragmentation.

20
Q

What develops incorrectly in DiGeorge’s syndrome?

A

The third and fourth pharyngeal pouch causing thymal aplasia and aortic abnormalities.

21
Q

When is cardiac ventricular expression of natriuretic peptides increased?

A

With hypertrophy. Think: BBP is used to diagnose CHF

22
Q

When is an S4 pathologic in adults? Young adults? What is the sound caused by?

A

It can be benign in older adults due to decreased ventricular compliance. If it becomes louder, then it’s the sound of blood from atrium hitting a pathologically stiff ventricle due to restrictive cardiomyopathy or LVH
-young adults, pathologic

23
Q

What test differentiates strep from staph?

A

Catalase test. Strep is catalase positive. Staph is catalase negative.

24
Q

What differentiates staph aureus from other forms of staph? Which staph ferments mannitol? Which is novobiocin resistant?

A

Coagulase test. Staph aureus (mannitol fermenting) is coagulase positive. S. Epidermis, haemolyticus, and saprophyticus (novobiocin resistant) are all negative.

25
Q

What genetic disease presents with premature atherosclerosis, ectopia lentis, osteoporosis, MR?

A

Homocystinuria-can have increased levels of methionine from deficiency of cystathionine beta synthetase to convert homocysteine into cystine

26
Q

Half life equation? Maintenance dose? Loading dose?

A

Vd x0.7/CL
Cp x CL/[Bioavailability fraction=1 if IV]
Vd x Cp/[Bioavailability fraction]

27
Q

What is an S3 caused by? When is it normal? Abnormal?

A

Heard during rapid filling of ventricles during diastole
Normal: children, YA, pregnancy
Abnormal: restrictive cardiomyopathy, HF, high output state

28
Q

Migratory thrombophlebitis should trigger what diagnosis? Pathophys?

A

Paraneoplastic syndrome (Trousseau’s) from pancreatic, colon, or lung adenocarcinoma, which make a thromboplastin-like substance

29
Q

What is the histology of the final stage of MI healing?

A

Collage nous scar, made from type I collagen. Granulation tissue is type III collagen.