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Exam Compilation Flashcards

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1
Q

Single most important bedside measurement to estimate volume status. Harrison’s 19th ed page 1443

A

Jugular Venous Pressure

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2
Q

Elements of complete cardiac diagnosis. Harrison’s 19th ed page 1439

A

underlying Etiology
Anatomic abnormalities
Physiologic disturbances
Functional disability

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3
Q

NYHA Functional CLASS II. Harrison’s 19th ed page 1440

A

Slight limitation of physical activity

Ordinary activity causes symptoms

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4
Q

Defined as posterior calf pain on active dorsiflexion of the foot against resistance. Harrison’s 19th ed page 1443

A

Homan’s sign

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5
Q

Possible underlying etiologies for cardiac diagnosis. Harrison’s 19th ed page 1439

A

Congenital
Hypertensive
Ischemic
Inflammatory

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6
Q

NYHA Functional CLASS IV. Harrison’s 19th ed page 1440

A

Inability to carry out any physical activity without discomfort
Symptoms at rest

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7
Q

Abdominojugular reflex. Harrison’s 19th ed page 1444

A

Firm and consistent pressure over the right upper quadrant for at least 10 seconds

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8
Q

Possible anatomic abnormalities for cardiac diagnosis. Harrison’s 19th ed page 1440

A

Chambers involved (hypertrophied, dilated or both)
Valves affected (regurgitant or stenotic)
Pericardial involvement
Myocardial infarction

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9
Q

NYHA Functional CLASS I. Harrison’s 19th ed page 1440

A

No limitation of physical activity

No symptoms with ordinary exertion

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10
Q

Positive Abdominojugular reflex. Harrison’s 19th ed page 1444

A

Sustained rise of more than 3cm in JVP for at least 15 seconds after release of the hand

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11
Q

Possible physiologic disturbances for cardiac diagnosis. Harrison’s 19th ed page 1440

A

Arrhythmia
Congestive heart failure
Myocardial ischemia

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12
Q

NYHA Functional CLASS III. Harrison’s 19th ed page 1440

A

Marked limitation of physical activity
Less than ordinary activity causes symptoms
Asymptomatic at rest

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13
Q

Gold standard in the assessment of anatomy and physiology of the heart. Harrison’s 19th ed page 1460

A

Diagnostic cardiac catheterization and Coronary angiography

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14
Q

Causes of Reversed or Paradoxical Splitting of S2. Harrison’s 19th ed page 1447

A 
Left bundle branch block
Right ventricular pacing
Severe AS
HOCM
AMI
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15
Q

Absolute contraindications to Cardiac Catheterization. Harrison’s 19th ed page 1460

A

None

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16
Q

Relative contraindications to Cardiac Catheterization. Harrison’s 19th ed page 1460

A

Decompensated congestive heart failure
Acute renal failure
Severe chronic renal insufficiency
Bacteremia
Acute stroke
Active GI bleeding
Severe uncorrected electrolyte abnormalities
History of anaphylactic reaction to iodinated contrast agents
History of allergy/bronchospasm to aspirin

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17
Q

CHA2DS2-VASc. Harrison’s 19th ed page 1485

A 
C – CHF
H – Hypertension
A – Age  75
D – DM
S – Stroke or TIA, embolus
V – Vascular disease
A – Age 65-75
Sc - Female
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18
Q

Multifocal Atrial Tachycardia. Harrison’s 19th ed page 1485

A

3 distinct P-wave morphologies
HR 100-150bpm
Clear isoelectric intervals between P waves
Usually in chronic pulmonary disease and acute illness

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19
Q

Most common sustained arrhythmia. Harrison’s 19th ed page 1486

A

Atrial fibrillation

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20
Q

Sustained ventricular tachycardia persists longer than? Harrison’s 19th ed page 1489

A

> 30 seconds

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21
Q

Congenital Long QT syndrome Type 1 (LQTS1). Harrison’s 19th ed page 1497

A

One of the most frequent
Abnormality in K channels
Occurs during exertion, particularly swimming

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22
Q

Congenital Long QT syndrome Type 2 (LQTS2). Harrison’s 19th ed page 1497

A

One of the most frequent
Abnormality in K channels
Predisposed by sudden auditory stimuli or emotional upset

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23
Q

Congenital Long QT syndrome Type 3 (LQTS3). Harrison’s 19th ed page 1497

A

Abnormality in Na channels

Sudden death during sleep is a notable feature

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24
Q

Characteristics of chest pain that increases the likelihood of AMI. Harrison’s 19th edition page 99

A 
Radiation to the right arm or shoulder
Radiation to both arms or shoulder
Associated with exertion
Radiation to the left arm
Associated with diaphoresis
Associated with nausea and vomiting
Worse than previous angina or similar to previous MI
Described as pressure
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25
Characteristics of chest pain that decreases the likelihood of AMI. Harrison’s 19th edition page 99
``` Inframammary location Reproducible with palpation Described as sharp Described as positional Described as pleuritic ```
26
Canadian cardiovascular society classification Class I. Harrison’s 19th edition page 1581
Ordinary physical activity such as walking and climbing stairs does not cause angina. Angina present with strenuous or rapid or prolonged exertion at work or recreation
27
Canadian cardiovascular society classification Class II. Harrison’s 19th edition page 1581
Slight limitation of ordinary activity Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold or when under emotional stress or only during the few hours after awakening Walking more than two blocks on the level and climbing more than one flight of stairs at a normal pace and in normal conditions
28
Canadian cardiovascular society classification Class III. Harrison’s 19th edition page 1581
Marked limitation of ordinary physical activity. | Walking one to two blocks on the level and climbing more than one flight of stairs in normal conditions
29
Canadian cardiovascular society classification Class IV. Harrison’s 19th edition page 1581
Inability to carry on any physical activity without discomfort Anginal syndrome may be present at rest
30
First line of therapy in patients with symptomatic Idiopathic Ventricular Tachycardia. Harrison’s 19th edition page 1496
B-Adrenergic blockers
31
Important predictor of patient outcome in Heart Failure. Harrison’s 19th edition page 1501
Functional Status
32
EF of Depressed/Reduced Ejection Fraction. Harrison’s 19th edition page 1501
<40%
33
EF of Preserved Ejection Fraction. Harrison’s 19th edition page 1501
>40-50%
34
Etiologies of Preserved Ejection Fraction. Harrison’s 19th edition page 1501
Pathologic hypertrophy (hypertrophic cardiomyopathy, hypertension) Aging Restrictive cardiomyopathy (infiltrative disorders-amyloidosis, sarcoidosis; Storage disease-hemochromatosis) Fibrosis Endomyocardial disorders
35
Etiologies of high-output states of heart failure. Harrison’s 19th edition page 1501
Thyrotoxicosis Beriberi Systemic AV shunting Chronic anemia
36
Etiologies of Depressed Ejection fraction heart failure. Harrison’s 19th edition page 1501
``` Myocardial infarction Myocardial ischemia Hypertension Obstructive valvular disease Regurgitant valvular heart disease Intracardiac (left-to-right) shunting Extracardiac shunting Cor pulmonale Pulmonary vascular disorders Familial/genetic disorders Infiltrative disorders Metabolic disorders Viral Chaga’s disease Chronic brady and tachyarrhythmias ```
37
Major cause of Heart Failure in Africa and Asia. Harrison’s 19th edition page 1501
Rheumatic Heart Disease
38
Predominant cause of Heart Failure in industrialized countries and is responsible for 60-75% of cases of Heart Failure. Harrison’s 19th edition page 1501
Coronary Artery Disease
39
Major cause of Heart Failure in African and African-American Populations. Harrison’s 19th edition page 1501
Hypertension
40
Major cause of Heart Failure in South America. Harrison’s 19th edition page 1501
Chaga’s Disease
41
Frequent concomitant factor in HF in many developing nations. Harrison’s 19th edition page 1501
Anemia
42
Refers to the changes in LV mass, volume and shape. Harrison’s 19th edition page 1503
Ventricular remodeling
43
Dyspnea occurring in the recumbent position. Harrison’s 19th edition page 1503
Orthopnea
44
Alterations in LV chamber geometry in LV remodeling. Harrison’s 19th edition page 1503
LV dilation Increased LV sphericity LV wall thinning Mitral valve incompetence
45
Alterations in myocyte biology in LV remodeling. Harrison’s 19th edition page 1503
``` Excitation-contraction coupling Myosin heavy chain (fetal) gene expression B-adrenergic desensitization Hypertrophy Myocytolysis Cytoskeleton proteins ```
46
Myocardial changes in LV remodeling. Harrison’s 19th edition page 1503
``` Myocyte loss (necrosis, apoptosis, autophagy) Alterations in extracellular matrix (matrix degradation and myocardial fibrosis) ```
47
Caused by redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation with a resultant increase in pulmonary capillary pressure. Harrison’s 19th edition page 1503
Orthopnea
48
Described as increase in intensity of the holosystolic murmur of tricuspid regurgitation with inspiration. Harrison’s 19th edition page 1506
Carvallo’s sign
49
Most common cause of right sided Heart Failure. Harrison’s 19th edition page 1506
Left Heart Failure
50
Parameters are associated with worse outcomes in patients with Heart Failure. Harrison’s 19th edition page 1508
BUN > 43mg/dL SBP < 115mmHg Serum creatinine > 2.75mg/dL Elevated Troponin I
51
Useful to support clinical decision making regarding the diagnosis of Heart Failure and establishing prognosis or disease severity in chronic heart failure. Harrison’s 19th edition page 1505
B-Type natriuretic peptide (BNP) | N-terminal pro-BNP (NT-proBNP)
52
Conditions that can cause false negative result to BNP and NT-proBNP. Harrison’s 19th edition page 1505
Obesity
53
Conditions that can cause false positive result to BNP and NT-proBNP. Harrison’s 19th edition page 1505
Old Age Renal impairement Women Right HF from any cause
54
Components of Tetralogy of Fallot. Harrison’s 19th edition page 1526
Malaligned VSD Obstruction to RV outflow Aortic override of the VSD RV hypertrophy
55
Physical findings of Aortic Stenosis. Harrison’s 19th edition page 1531
``` Pulsus parvus et tardus Anacrotic “shudder” Accentuated a wave in the JVP Systolic thrill at the base of the heart to the right sternum Parodoxical splitting of S2 S3 and S4 Ejection (mid) systolic murmur ```
56
Carotid arterial pulse rises slowly to a delayed peak. Harrison’s 19th edition page 1531
Pulsus parvus et tardus
57
A palpable thrill more commonly over the left carotid arteries. Harrison’s 19th edition page 1531
Anacrotic “shudder”
58
Normal mitral valve orifice. Harrison’s 19th edition page 1539
4-6cm2
59
Mitral valve area of patients with severe MS. Harrison’s 19th edition page 1539
1-1.5cm2
60
Most common primary MALIGNANT cardiac tumor. Harrison’s 19th edition page 1577
Sarcoma
61
Most common primary cardiac tumor. Harrison’s 19th edition page 1577
Myxomas
62
Door-to-needle time. Harrison’s 19th edition page 1605
30 minutes
63
Goal of reperfusion therapy. Harrison’s 19th edition page 1605
TIMI grade 3
64
Thrombolysis in Myocardial Infarction (TIMI) Grade 0. Harrison’s 19th edition page 1605
Complete occlusion of the infarct-related artery
65
Thrombolysis in Myocardial Infarction (TIMI) Grade 1. Harrison’s 19th edition page 1605
Some penetration of the contrast material beyond the point of obstruction but without perfusion of the distal coronary bed
66
Thrombolysis in Myocardial Infarction (TIMI) Grade 2. Harrison’s 19th edition page 1605
Perfusion of the entire infarct vessel into the distal bed, but with flow that is delayed compared with normal artery
67
Thrombolysis in Myocardial Infarction (TIMI) Grade 3. Harrison’s 19th edition page 1605
Full perfusion of the infarct vessel with normal flow
68
Absolute Contraindications to the use of fibrinolytic agents. Harrison’s 19th edition page 1605
Cerebrovascular hemorrhage at any time Nonhemorrhagic stroke or other cerebrovascular event within the past year BP > 180/110 Suspicion of Aortic dissection Active internal bleeding (excluding menses)
69
Relative Contraindications to the use of fibrinolytic agents. Harrison’s 19th edition page 1605
Use of anticoagulants (INR2) Recent invasive or surgical procedure (<2 weeks) Prolonged cardiopulmonary resuscitation (>10mins) Known bleeding diasthesis Pregnancy Hemorrhagic ophthalmic condition Active peptic ulcer disease History of severe hypertension that is currently and adequately controlled Previous use of streptokinase (5 days to 2 years)
70
Most frequent complication to the use of fibrinolytics. Harrison’s 19th edition page 1605
Hemorrhage
71
Most serious complication to the use of fibrinolytics. Harrison’s 19th edition page 1605
Hemorrhagic stroke
72
Myocardial Infarction Type 1. Harrison’s 19th edition page 1602
Spontaneous myocardial infarction
73
Myocardial Infarction Type 2. Harrison’s 19th edition page 1602
Myocardial infarction secondary to an ischemic imbalance
74
Myocardial Infarction Type 3. Harrison’s 19th edition page 1602
Myocardial infarction resulting in death where biomarker values are unavailable
75
Myocardial Infarction Type 4a. Harrison’s 19th edition page 1602
Myocardial infarction related to percutaneous coronary intervention (PCI)
76
Myocardial Infarction Type 4b. Harrison’s 19th edition page 1602
Myocardial infarction related to stent thrombosis
77
Myocardial Infarction Type 5. Harrison’s 19th edition page 1602
Myocardial infarction related to coronary artery bypass grafting (CABG)
78
Killip class I. Harrison’s 19th edition page 1607
No signs of pulmonary or venous congestion
79
Killip class II. Harrison’s 19th edition page 1607
``` = Moderate heart failure Rales S3 gallop Tachypnea Signs of failure of the right side of the heart Venous congestion Hepatic congestion ```
80
Killip class III. Harrison’s 19th edition page 1607
= severe heart failure | pulmonary edema
81
Killip class IV. Harrison’s 19th edition page 1607
``` Shock with systolic pressure <90mmHg Peripheral vasoconstriction Peripheral cyanosis Mental confusion Oliguria ```
82
Symptom that confers the worst outcome in patients with Aortic Stenosis. Harrison’s 19th edition page 1532
Congestive Heart Failure
83
Treatment of choice for Acute Aortic Regurgitation. Harrison’s 19th edition page 1536
Surgery
84
Leading cause of mitral stenosis (MS). Harrison’s 19th edition page 1539
Rheumatic fever
85
Cardiac murmurs that increases when Standing and Valsalva maneuver. Harrison’s 19th edition page 1448
Systolic murmur of HCOM | Murmur of MVP
86
Mitral Valve Prolapse. Harrison’s 19th edition page 1539
More common in young women (15-30yrs) Posterior mitral leaflet is more commonly affected Murmur is increased by standing and Valsalva maneuver
87
Beck’s Triad. Harrison’s 19th edition page 1573
Hypotension Soft or absent heart sounds Elevated JVP (prominent x descent, absent y descent)
88
Most common toxin implicated in chronic dilated cardiomyopathy. Harrison’s 19th edition page 1562
Alcohol
89
Most common drugs implicated in toxic cardiomyopathy. Harrison’s 19th edition page 1562
Chemotherapy agents
90
Treatment of Constrictive Pericarditis. Harrison’s 19th edition page 1576
Pericardial Resection

Cardiology (2 decks)

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