Cardiology (Heart + Vessels)

Question 1

Sharp retrosternal chest pain, tachycardic, hypertensive., Mediastinal widening on CXR. ST depression on ECG. Diagnosis?

Answer 1

Aortic dissection

Question 2

Risk factors for aortic dissection

Answer 2

Older age (60-80, male; older in women)
collagen disorders in younger popu., (e.g. Marfans)
Inflammatory vasculitides
pre-existing aortic aneurysm`

Question 3

Glove and stocking dyasthesias, pins and needles, burning discomfort

Answer 3

Peripheral neuropathy

Question 4

Deep seated calf pain and tenderness with or without edema, color change, fever, tachycardia

Answer 4

Deep venous thrombosis

Question 5

Leg pain precipitated by exertion

Answer 5

Intermittent claudication

Question 6

Drug of choice for paroxysmal supraventricular tachycardia

Answer 6

Adenosine or Verapamil

beta blockers are second line (eg metoprolol, propanolol)

Increase vagal tone via carotid sinus massage and valsalva

Question 7

Heart lesion most likely to be problematic in pregnancy

Answer 7

mitral stenosis
The pregnancy induced increase in blood volume, cardiac output and elevation of pulse can lead to pulmonary hypertension and pulmonary edema

Question 8

Cause of “silent MI” in older and diabetic patients

Answer 8

Cardiac autonomic neuropathy

Question 9

Normal aortic systolic gradient in heart catheterisation

Answer 9

<10mmHg

If Cardiac Output is normal, a gradient >50mmHg indicates severe aortic stenosis indicated for surgery

If CO is decreased, indication of even more severe disease

Question 10

Most likely arterial injury produced by posterior dislocation of the knee

Answer 10

popliteal artery injury

Question 11

Most serious complication of atrial fibrillation

Answer 11

thromboembolism

Question 12

Necrotizing vasculitis involving medium-sized arteries usually affecting kidneys, gut, nerves, muscles often sparing the lungs

Answer 12

Polyarteritis nodosa

Question 13

Nonatherosclerotic, segmental inflammatory disease of the small and medium sized arteries, veins and nerves of the extremities

Answer 13

throboangilitis obliterans (Buerger disease)

Question 14

Most common risk factor for Buerger disease

Answer 14

Smoking, more commonly with home made cigarettes using raw tobacco

Question 15

Most common underlying causes of atrial fibrillation

Answer 15

in developed countries - IHD, thyrotoxicosis, hypertension

In developing countries - rheumatic heart disease

Question 16

Test for early diagnosis of pulmonary embolism

Answer 16

computed tomogram pulmonary angiogram (CTPA)

Question 17

Most common form of vasculitis in older adults (>50)

Answer 17

Temporal (Giant Cell) Arteritis

Question 18

Arteries usually affected by giant cell arteritis

Answer 18

branches of carotid artery particularly the temporal branch

Question 19

Flulike symptoms with joint and muscle pains in a patient with giant cell arteritis

Answer 19

polymyalgia rheumatica

Question 20

True or false: Negative biopsy will rule out giant cell arteritis

Answer 20

False; in giant cell arteritis lesions are SEGMENTAL, so a negative biopsy does not exclude disease

Question 21

Arteries usually affected by takayasu arteritis

Answer 21

branches of the aortic arch

Question 22

Organs spared in polyarteritis nodosa

Answer 22

lungs

Question 23

String of pearls appearance due to alternating areas of fibrinoid necrosis + transmural inflammation and healed fibrosis

Answer 23

polyarteritis nodosa

Question 24

Treatment of polyarteritis nodosa

Answer 24

Corticosteroids + cyclophosphamide

Question 25

Artery usually affected by kawasaki disease

Answer 25

coronary artery -- RISK FOR MI in young or aneurysm

Question 26

Treatment for Kawasaki disease

Answer 26

Aspirin and IVIG

Question 27

AHA Diagnostic criteria of Kawasaki disease

Answer 27

mnemonic - FEBRILE F - ever >5 days; PLUS 4/5 of the ff: E - nanthem: strawberry tongue , fissuring B - ulbar conjunctival injection, painless R - ash, polymorphous I - nternal organ involvement L - ymphadenopathy, nonpurulent, cervical E - xtremity changes: reddening of hands and soles progressing to membranous desquamation; transverse grooves across nails called Beau lines

Question 28

Necrotizing vasculitis involving ulceration, gangrene and autoamputation of fingers and toes

Answer 28

Buerger Disease

Question 29

vasospasm leading to discoloration

Answer 29

Raynaud phenomenon

Question 30

Necrotizing granulomatous vasculitis involving nasopharynx, lungs and kidneys

Answer 30

Wegener granulomatosis

Question 31

Vasculitis associated with increased serum c-ANCA levels

Answer 31

Wegener granulomatosis

Question 32

Treatment for Wegener granulomatosis

Answer 32

Cyclophosphamide and corticosteroids

Question 33

Necrotizing granulomatous vasculitis involving lungs and kidneys, NO nasopharyngeal involvement

Answer 33

microscopic polyangitis

Question 34

Vasculitis associated with increased serum p-ANCA levels

Answer 34

microscopic polyangitis, Churg-Strauss Syndrome to differentiate: no granulomas in MP, CS has asthma association and peripheral eosinophilia

Question 35

Treatment for microscopic polyangitis

Answer 35

Cyclophosphamide and corticosteroids

Question 36

Most common vasculitis in children

Answer 36

HSP

Question 37

Vasculitis due to IgA immune complex deposition

Answer 37

HSP

Question 38

Palpable purpura on buttocks and legs; GI pain and bleeding, Hematuria, joint pain, usually occurs after URTI

Answer 38

HSP

Question 39

atherosclerosis usually affects _______ vessels (size)

Answer 39

medium to large;

Question 40

atherosclerosis most commonly occurs in these arteries

Answer 40

abdominal aorta, coronary, popliteal, internal carotid

Question 41

4 Modifiable risk factors of atherosclerosis

Answer 41

HTN Hypercholesterolemia smoking diabetes Non-modifiable: age, gender, genetics

Question 42

Percentage of stenosis before acquiring symptoms

Answer 42

70% stenosis

Question 43

Histologic hallmark of atherosclerotic plaque embolus

Answer 43

Cholesterol clefts

Question 44

Classic end-organ damage associated with hyaline arteriolosclerosis

Answer 44

glomerular scarring -> chronic renal failure

Question 45

2 major causes of hyaline arteriolosclerosis

Answer 45

1) benign HTN | 2) Diabetes

Question 46

Narrowing of small arterioles due to proteins leaking into vessel wall

Answer 46

hyaline arteriolosclerosis | arteriolonephrosclerosis

Question 47

"Onion-skin" thickening of vessel wall

Answer 47

hyperplastic arteriolosclerosis

Question 48

Cause of hyperplastic arteriosclerosis

Answer 48

malignant hypertension

Question 49

Causes Acute Renal Failure with flea-bitten appearance (pinpoint hemorrhages)

Answer 49

hyperplastic arteriolosclerosis

Question 50

Vascular pattern of calcification on mammogram

Answer 50

Monckeberg medial calcification - non-obstructive; not clinically significant, but may be confounding in mammogram where calcification is identified

Question 51

Intimal tear allows blood to pool inside media of aorta

Answer 51

Aortic dissection

Question 52

Where does aortic dissection occur?

Answer 52

Proximal 10cm of aorta (high pressure) with pre-existing weakness of media

Question 53

Character of chest pain in aortic dissection

Answer 53

sharp, tearing, radiating to back

Question 54

Most common cause of death in aortic dissection

Answer 54

pericardial tamponade

Question 55

Classic cause of THORACIC aneurysm

Answer 55

Tertiary syphilis end-arteriris

Question 56

Most important complication of thoracic aortic aneurysm

Answer 56

Dilatation of aortic valve root resulting in aortic insufficiency others: compression of mediastinal structures, thrombosis, embolism

Question 57

Usual location of AAA

Answer 57

BELOW renal arteries, ABOVE aortic bifurcation

Question 58

Classic cause of ABDOMINAL aortic aneurysm

Answer 58

ATHEROSCLEROSIS (usually male smokers >60y with HTN)

Question 59

Major complication of AAA

Answer 59

RUPTURE; esp. when >5cm

Question 60

AAA rupture triad

Answer 60

hypotension, pulsatile abdominal mass, flank pain

Question 61

Time of ischemia that will lead to myocyte death (angina vs MI)

Answer 61

>20 mins

Question 62

3 Most common artery in MI

Answer 62

1. left anterior descending - anterior LV wall and anterior interventricular septum 2. Right coronary a. - posterior wall and posterior septum 3. left circumflex - lateral wall

Question 63

Most sensitive and specific marker for MI

Answer 63

Trop I

Question 64

Rises 2-4 hrs after infarction, Peaks at 24 hours, returns to normal 7-10 days

Answer 64

Trop I

Question 65

Rises 4-6 hrs after infarction, peaks at 24 hours, returns to normal by 72 hours

Answer 65

CK-MB - useful in diagnosis second infarction few days after first

Question 66

Treatment of MI

Answer 66

``` Aspirin/heparin Supplemental O2 Nitrates Beta blockers Ace inhibitor Fibrinolysis or angioplasty ```

Question 67

Drug class causing venous dilatation and decreased preload

Answer 67

Nitrates

Question 68

Drug class causing decreased heart rate and decreases demand for oxygen; decreased arrhythmia risk

Answer 68

B-blockers

Question 69

prevents peripheral arteriole constriction, reduces afterload;

Answer 69

ACE inhibitors

Question 70

Complications of fibrinolysis/angioplasty

Answer 70

Blood is introduced back to dead myocytes; 1) contraction band necrosis (due to Ca2+ causing contractions) 2) reperfusion injury (due to free radical injury)

Question 71

Complications <4 hours from infarction

Answer 71

No microscopic changes; Cardiogenic shock, CHF, arrhythmia

Question 72

Complication 4-24h from infarction

Answer 72

Coagulative necrosis --> damaged conductive system --> arrhythmia

Question 73

Complication 1-3 days from infarction

Answer 73

Neutrophilic stage -> inflammatory cells leak into pericardium = fibrinous pericarditis (chest pain +friction rub)

Question 74

Complication 4-7 days from infarction

Answer 74

macrophages "eat" necrotic debris = thinning and weakening of wall = RUPTURE => possible cardiac tamponade or septal shunt or mitral insufficiency (rupture of papillary ms)

Question 75

Complication months after infarction

Answer 75

fibrosis - weak wall; risk for aneurysm, mural thrombus or Dressler syndrome (formation of antibodies against pericardial antigens = autoimmune pericarditis)

Question 76

Unexpected death due to cardiac disease occurring without symptoms or <1 hour after symptoms arise, due to fatal ventricular arrhythmia

Answer 76

sudden cardiac death

Question 77

Hemosiderin-laden macrophages in alveolar air sac

Answer 77

heart failure cells (left-sided HF)

Question 78

Most common cause of right-sided heart failure

Answer 78

left-sided heart failure

Question 79

blood vessels of the lungs constrict d/t hypoxia, causing increased work for right side of heart, eventually causing failure

Answer 79

Cor pulmonale

Question 80

liver discoloration d/t cardiac cirrhosis in RSHF

Answer 80

nutmeg liver