Platinum: CARDIOLOGY

Question 1

Most efficient extractor of oxygen from the blood

Answer 1

Heart

Question 2

Intracellular junctions responsible for the cardiac syncytium

Answer 2

Gap junctions

Question 3

Substance that dilates upstream blood vessels

Answer 3

Endothelium-Derived Relaxing Factor (EDRF) aka Nitric Oxide (NO)

Question 4

Most potent vasoconstrictor

Answer 4

ADH (can increase levels of Endothelin-1)

Question 5

An increase in venous return will increase the HR

Answer 5

Bainbridge Reflex

Question 6

An increase in venous return will increase the stroke volume, Basis: stretching of cardiac sarcomeres will increase contraction

Answer 6

Frank-Starling Mechanism

Question 7

Hypertension, irregular respiration and bradycardia

Due to activation of:
1. CNS ischemic response
2. Baroreceptor reflex in increased ICP

Answer 7

Cushing Reflex

Question 8

Formula for BP based on Ohm’s Law

Answer 8

BP = CO x Total Peripheral Resistance (TPR) = (HR x Stroke Volume) x TPR TPR is synonymous with Systemic Vascular Resistance and increases when arterioles vasoconstricted

Question 9

Normal pressure at various parts of the adult circulation

Answer 9

Large Arteries: <120/80 mmHg

Systemic Capillaries: 17 mmHg

Vena Cava: 0 mmHg

Pulmonary Artery: 25/8 mmHg

Pulmonary Capillaries: 7 mmHg

Question 10

Abdominojugular Reflux

Answer 10

At least 10 second pressure over the upper abdomen (RUQ)

Positive responses rise of >3 cm in JVP for at least 10-15 sec after release of the hand

Question 11

Carvallo’s Sign

Answer 11

Pansystolic murmur of tricuspid regurgitation

Louder during inspiration and diminishes during forced expiration’s

Question 12

Graham Steell Murmur

Answer 12

High-pitched, diastolic, decrescendo blowing murmur along the left sternal border

Due to dilation of the pulmonary valve ring

Occurs in mitral valve disease and severe pulmonary hypertension

Question 13

Murmur of aortic stenosis may be transmitted downward and to the apex

May be confused with the systolic murmur of mitral regurgitation

Answer 13

Gallavardin Effect

Question 14

Apical pulse is reduced and may retract in systole in constrictive pericarditis

Answer 14

Broadbent’s Sign

Question 15

Peripheral Signs in Aortic Regurgitation

Answer 15

Corrigan’s Pulse
Quincke’s Pulse
Traube’s Sign
Duroziez Sign

Question 16

A rapidly rising “water-hammer” pulse that collapses suddenly as arterial pressure falls rapidly during late systole and diastole

Seen in aortic regurgitation

Answer 16

Corrigan’s Pulse

Question 17

Capillary pulsations manifest as alternate flushing and paling of the skin while pressure is applied to the tip of the nail

Seen in aortic regurgitation

Answer 17

Quincke’s Pulse

Question 18

A blooming “pistol-shot” sound heard over the femoral arteries

Seen in aortic regurgitation

Answer 18

Traube’s Sign

Question 19

To-and-fro murmur audible if the femoral artery stethoscope, seen in aortic regurgitation

Answer 19

Duroziez Sign

Question 20

Major noninvasive marker of increased CV morbidity / mortality risk

Answer 20

Left Ventricular Hypertrophy (LVH)

Question 21

Cornerstone in the diagnosis of acute and chronic ischemic heart disease

Answer 21

Electrocardiogram (ECG)

Question 22

Ideal imaging modality for cardiac emergencies

Answer 22

2D echocardiography

Question 23

Gold standard for imaging valve morphology and motion, detection of pericardial effusion and cardiac tamponade, and assessment of LV cavity size, systolic function, and wall thickness

Answer 23

2D echocardiography

Question 24

Gold standard for assessing LV mass & volumes

Answer 24

MRI

Question 25

Imaging modalities of choice for the evaluation of suspected aortic aneurysm or aortic dissection, and in distinguishing between restrictive cardiomyopathy & constrictive pericarditis

Answer 25

CT scan and MRI

Question 26

Gold standard in assessing the anatomy & physiology of the heart & associated vasculature

Answer 26

Cardiac catheterization and coronary angiography

Question 27

Triad of Ruptured Aneurysm

Answer 27

Left flank pain Hypotension Pulsatile mass

Question 28

Diagnostic Triad of Wolff-Parkinson-White (WPW) ECG Pattern

Answer 28

*Relatively short PR interval *Wide QRS complex *Slurring of the initial part of the QRS complex (delta wave)

Question 29

Triad of chronic renal failure in ECG

Answer 29

*Peaked T waves (hyperkalemia) *Long QT due to ST segment lengthening (hypocalcemia) *LVH (systemic hypertension)

Question 30

Three principal features of tamponade (Beck’s Triad)

Answer 30

*Hypotension *Soft / absent heart sounds *Jugular venous distention with a prominent x-descent but an absent y-descent

Question 31

Plaques that have caused fatal thromboses tend to have

Answer 31

*Thin fibrous caps *Relatively large lipid cores *High content of macrophages

Question 32

Major determinants of myocardial O2 demand (MVO2)

Answer 32

*Heart rate *Myocardial contractility *Myocardial wall tension (stress)

Question 33

Triad of Buerger’s disease

Answer 33

MR.C loves Burgers *Migratory superficial vein thrombophlebitis *Raynaud’s phenomenon *Claudication of the affected extremity

Question 34

Virchow’s Triad

Answer 34

Stasis Vascular/endothelial damage Hypercoagulability

Question 35

Dressler’s Triad (post-MI pericarditis)

Answer 35

*Fever *Pleuritic pain *Pericardial effusion

Question 36

HF: Increases Contractility

Answer 36

Digoxin1 Dobutamine2 Milrinone2

Question 37

HF: Reduces Preload

Answer 37

Diuretics (e.g. furosemide)1 Vasodilators (e.g., nitrates, hydralazine) ACE inhibitors/ARBs3

Question 38

HF: Reduces Afterload

Answer 38

Diuretics (e.g., furosemide)1 Vasodilators (e.g., nitrates, hydralazine) ACE inhibitors/ARBs3 Beta blockers (e.g., metoprolol succinate, bisoprolol, carvedilol)3

Question 39

Binds to activated sodium channels and blocks the flow of sodium ions into the cardiac myocyte (Prolongs action potential) Atrial fibrillation Atrial flutter Ventricular tachycardia

Answer 39

HF: IA Quinidine, Procainamide, Disopyramide

Question 40

Binds to both activated and inactivated sodium channels and blocks the flow of sodium ions in the cardiac myocyte (Shortens action potential) Post-ischemic arrhythmia, Ventricular fibrillation, Ventricular tachycardia

Answer 40

HF: IB Lidocaine, Tocainide, Mexiletine