Cardiac

Question 1

Fetal Erythopoiesis from where/when?

Answer 1

Yolk sac - 3-10 weeks
Liver 6wks -birth
Spleen 15-30 wks (liver does most)
Bone marrow 22 wk to adult

Question 2

Pathway of blood in fetus?

Answer 2

Syncytiotrophoblasts to cytotrophoblasts to stroma of chorionic villus, umbilical vein to liver

Question 3

Which papillary muscle may rupture post MI?

Answer 3

One fed by RCA

Question 4

Most resistance in what vessels?

Answer 4

arterioles

Question 5

2 Formulas for CO?

Answer 5

see 253

Question 6

2 Formulas for MAP?

Answer 6

see 253

Question 7

Acidosis - affect on contractility?

Answer 7

decreases

Question 8

Myocardial O2 demand increased by?

Answer 8

increased afterload
increased contractility
increased HR
increased heart size

Question 9

Normal ejection fraction?

Answer 9

55%

Question 10

increased blood viscosity with?

Answer 10

polycythemia, hyperproteinemic states, hereditary spherocytosis

Question 11

Exercise - effect on lymph flow?

Answer 11

increased flow during exercise - increased hydrostatic pressure - increased capillary filtration - increased lymph flow

Question 12

HCM murur - loudest when?

Effect of: handgrip, valsalva, squatting

Answer 12

When less blood in LV.

decreased, increased, decreased

Question 13

MVP - is “click” closest to S1 or S2:
Increased preload
Decreased preload
Anxious

Answer 13

S2, S1, S1

click happens when at a certain LV volume (more blood means more time before it hits that level of empty). Anxiety increases HR, decreasing preload.

Question 14

heart Valves - type of tissue?

Answer 14

connective tissue

Question 15

S3 murmur suggests? normal in what pts?

Answer 15

Mitral Regurg

children and pregnant women

Question 16

S4 suggests?

Answer 16

LV hypertrophy

Question 17

Pt with sycope, angina and dyspena. Heart murmur?

Answer 17

AS

Question 18

Holosystolic murmur loudest at tricuspid area? Made louder with?

Answer 18

VSD. Handgrip

Question 19

Mumur heard best when leaning forward?

Answer 19

AR.

Question 20

Mech of SNS increasing HR?

Answer 20

increased opening of funny current in cardiac pacemakers.

Question 21

U wave caused by?

Answer 21

HypoK and bradycardia

Question 22

Order of signal transduction in heart? (speed?)

Answer 22

SA
Atria (2)
AV (4)
Bundle of His
Purkinje (1)
Ventricles (3) 

(1 = fastest)

Question 23

Pt with defects in cardiac Na/K pumps and congenital sensorineural deafness?

Answer 23

Jervell and Lange-Nielsen syndrome. Congenital long QT syndrome.

Question 24

Aortic arch receptors vs carotid sinus receptors (responds to/nerve)

Answer 24

Increased BP via vagus nerve
vs
Increased and decreased BP via CN9

Question 25

ANP - functions?

Answer 25

constricts EA and dilates AA

Question 26

1st vs 2nd (type I) vs 2nd (type II) vs 3rd heart block

Answer 26

long PR vs increasing PR until dropped P vs Randomly dropped QRS vs random P and QRS complexes

Question 27

Increased BaroR caused by? leads to?

Answer 27

increased pressure. Increased PSNS (and decreased SNS) to lower heart rate, contractility (point of Carotid massage)

Question 28

Central vs peripheral chemoreceptors?

Answer 28

stimulated by CO2 vs O2

Question 29

Circulation 1) largest share of cardiac output? 2) Higher blood flow per gram of tissue? 3) Organ with largest extraction of O2?

Answer 29

1 - liver 2 - kidney 3 - heart

Question 30

Causes of early cyanosis?

Answer 30

``` Right to Left shunts: Tetrology Transposition Truncus arteriosus Tricuspid atresia (if with ASD and VSD) TAPVR ```

Question 31

Congenital Causes of adult cyanosis.

Answer 31

ASD, VSD, PDA. Cause cyanosis after switching to become R-to-L shunts

Question 32

Boot Shaped heart on x-ray?

Answer 32

Tetralogy of fallot

Question 33

Infantile vs adult coarcation

Answer 33

before vs after ductus arteriosis

Question 34

Xanthomas - histo?

Answer 34

Multinucleated giant cells with lipids

Question 35

Corneal arcus?

Answer 35

Lipids in eyes

Question 36

Califications in blood vessels in this location does no affect blood flow?

Answer 36

Media

Question 37

Pt with DM. Likely will get disease of what vessels?

Answer 37

Arterioloes

Question 38

Arteriolosclerosis - types?

Answer 38

Hyaline - HTN/DM | Hyperplastic - Onion skinning

Question 39

Pt with plaques in vessels. Affects what vessels?

Answer 39

Atherosclerosis. Arteries

Question 40

Most common location of atherosclerosis? Complication?

Answer 40

abdominal aorta. Abdominal aneurysm

Question 41

Thoracic aortic aneurysm - causes?

Answer 41

Marfans HTN Syphilis

Question 42

Myocardial stunning?

Answer 42

gradual regaining of function post MI

Question 43

MI as cells lose energy form ishemia they release this to vasodilate. Where does it come from?

Answer 43

ATP - ADP - AMP - Adenosine (dilates)

Question 44

Evolution of MI

Answer 44

time points: 0, 4, 12, 24, 4, 12 | see 271

Question 45

Pathologic Q waves?

Answer 45

transmural infarct

Question 46

Tropoinin vs CKMB

Answer 46

peaks in 4 hours and stays elevated vs peaks in a day and dips

Question 47

MI, what can rupture (leads to?)

Answer 47

1) free wall - cardiac tamponade 2) papillary muscle - Mitral Regurg 3) Interventricular septum rupture - VSD

Question 48

Ventricular aneurysm - cause lead to?

Answer 48

arrythmia or CHF. Will not rupture

Question 49

Causes of high output cardiac failure?

Answer 49

Thiamine deficiency Graves dz AV-fistula Pagents dz

Question 50

Bacteria involved? Endocarditis vs Rheumatic fever

Answer 50

growth on values vs no bacteria on valves

Question 51

Pt with thick, calcified leaflets on mitral valves. Hx may show?

Answer 51

Rheumatic fever

Question 52

SIgns of Bacterial Endocarditis?

Answer 52

FROM JANE | Fever, roth spots, oslers, nodes, murmur, janeway lesions, anemia, nail hemorrage, emboli

Question 53

Signs on rheumatic fever?

Answer 53

FEVERSS | fever, increased ESR, valular damage, Erythema marginatum, Red-hot joints, subcutaneous nodules, Sydenham's chorea

Question 54

Pericarditis: Fibrinous vs serous vs suppurative

Answer 54

Fibrinous - dresslers/uremia Serous - viral/RA/SLE Suppurative - bacterial

Question 55

Pulsus paradoxus - seen in?

Answer 55

Cardiac tamponade, asthma, sleep apnea, croup

Question 56

Medium vessel vasculities? Risk of?

Answer 56

PAN, Kawasakis, Buerger's. Infarction

Question 57

Small vessel vasculities? Mech?

Answer 57

Type III HSR - see purpura Microscopic polyangiits, wegners, Churg-Strauss, Henoch-Schonlein purpura

Question 58

Strawberry vs cherry hemangioma?

Answer 58

infants, will regress vs elderly, will not regress

Question 59

Vessel growth seen in pregnancy?

Answer 59

Pyogenic granuloma. Hemangioma that can ulcerate and bleed