Flashcards in UWorld Cardiology Deck (66)
Sterile, non-destructive vegetations on heart valves found on autopsy in a patient with a previous hx of MI is most similar to what condition in its pathogenesis?
Trousseau Syndrome - migratory thrombophlebitis due to tumour-released procoagulants
What is pulsus paradoxus?
A drop in arterial BP of more than 10 mmHg on inspiration. It is usually found in
What clinical findings do you expect in cardiac tamponade?
Pulsus paradoxus, arterial hTN
What is beri-beri a deficiency of?
Vitamin B1 (thiamine)
Gram-positive cocci that are catalase negative and grow in hypertonic saline and bile and cause endocarditis are what bacteria and associated with what procedure?
Where is the GSV harvested for CABG procedures?
Just inferolateral to the pubic tubercle
What mechanism is responsible for the rapid decrease of cytosolic Ca right before relaxation of cardiac muscle cells?
Na/Ca exchange mechanism
What are the symptoms of and how do you use to treat a B-blocker overdose
Low cardiac output leading to hTN, bradycardia. Treat with glucagon, which increases cAMP (and consequently intracellular Ca) in cardiac myocytes
What physiological state results from a PE?
Respiratory alkalosis because of hyperventilation driven by hypoxemia - aka you blow off too much CO2
What is the best indicator of severity for MR?
Presence of an audible S3
What class of drug should you use to counteract the paradoxical increase in myocardial demand from using nitrates?
B-blockers, as it counteracts catecholamines released by the perceived hTN from vasodilation by nitrates
Which anti-arrhythmic drug has the highest selectivity for ischemic myocardium?
Lidocaine (amiodarone, if available)
What are the hallmarks of Turner Syndrome?
Short, thick neck, shortened fourth metacarpals, short stature, broad chest, and bicuspid aortic valve
What valvular abnormality is commonly associated with Turner Syndrome?
Bicuspid aortic valve (and coarctation of aorta, too)
What is the primary type of collagen in mature scars?
An echo that shows an aorta lying anterior and to the right of the pulmonary artery is diagnostic of what condition?
TGA results from the failure of what embryological process?
A double blind study is to prevent what kind of bias?
What process most likely preceded a heavily calcified aortic valve with no significant PMH?
Cellular necrosis leading to dystrophic calcification in normocalcemic conditions!
What effect does selective B1 selective antagonists like metoprolol have in the treatment of HTN?
Decrease cardiac output and block renin release from kidneys.
What condition does a patient with recurrent severe nosebleeds and pink spider-like lesions on his oral and nasal mucosa, face, and arms?
Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasias)
What is the major limiting factor for coronary blood flow during strenuous exercise?
Duration of diastole b/c most of coronary blood flow happens during diastole.
Repetitive ischemia of cardiac myocytes or persistent hypoperfusion can result in what chronic but reversible condition and how can it be reversed?
Hibernating myocardium, reversed by reperfusion of the area
What part of the heart is closest to the left sternal border at the 4th intercostal space?
What do you expect to hear on auscultation for a VSD?
Harsh sounding holosystolic murmur
What is the law of conservation of mass?
V1A1 = V2A2
What is supine hypotension syndrome?
Pregnant uterus compresses IVC in pregnant women when they lie down, decrease VR, and causes hypotension
Moderate increases in capillary fluid transudation can be offset by compensatory increase in what mechanism?
Tissue lymphatic drainage
Which arteries does polyarteritis nodosa spare?
What is the triad of features in granulomatosis with polyangiitis?
1) Focal necrotizing vasculitis
2) Necrotizing granulomas in lung and upper airway
3) Necrotizng glomerulonephritis
String of pearls appearance of blood vessels points towards what disease?
How do you treat GCA?
High dose corticosteroids
What is Buerger disease associated with?
What's involved in Wegener's? (Granulomatosis with polyangiitis)
Nose, lung, kidney
How do you distinguish Churg-Strauss from microscopic polyangiitis, given that they are both p-ANCA positive?
Granulomas, eosinophilia, asthma in CS
What is Henoch-Schonlein Purpura classically associated with?
How does Angiotensin II increase blood pressure?
1) Contracting arteriolar smooth muscle
2) Promotes aldosterone
What are the 4 key modifiable risk factors for atherosclerosis?
What are the two causes of hyaline arteriosclerosis?
Benign HTN and DM
What arteriosclerotic condition should you think about in patients with benign HTN and DM?
Where do abdominal aortic aneurysms typically occur?
Below the renal arteries but above the aortic bifurcation
What are thoracic aortic aneurysms classically associated with?
What do you do to treat a hemangioma in a kid?
Nothing. Usually self resolves.
What condition is most commonly associated with a VSD?
Fetal alcohol syndrome
What condition is most commonly associated with an ASD?
What condition is most commonly associated with a PDA?
What condition is most commonly associated with a TGA?
What is Dressler syndrome?
AI condition resulting in fibrinous pericarditis 6-8 weeks post-MI.
What are the physical signs of reperfusion injury in the heart?
Transient myocardial ischemia causes myocardial cells to increase in size due to what effect?
Intracellular Ca accumulation
What fetal heart condition do you worry about in a mother with diabetes?
What is standard therapy for heart failure?
ACEi, digoxin, diuretic + spironolactone
8 year old boy with AMI, lab shows increased methionine level. What amino acid is essential and what is the underlying mech?
Cystine. Dx: Homocystinuria, can't convert homocysteine to cystathionone.
How do you avoid infectious complications from a central catheter?
Wash your hands before you place it...
Right side face and right arm swelling, engorgement of subC veins on R. side of face. Where's the obstruction?
What two parts of the heart cause obstruction in HCM?
Mitral valve cusp and LV septum
What are the most important local factors regulating blood flow in the zone of autoregulation?
Adenosine and NO
What is the order of cardiac conduction velocity?
Purkinje, Atria, Ventricles, AV node
(Park At Ventura Avenue)
What do you see in the lungs in LHF?
Heart failure cells with hemosiderin in them
What determines the significance of ToF?
What pathway does ANP and BNP act through?
Ventricular septum with sigmoid shape, decreased ventricular chamber size, and brown perinuclear cytoplasmic inclusions. Cause?
What is the biochemical endpoint of nitrate therapy?
Decreased IC Ca and dephosphorylated myosin
Where do the leads of a biventricular pacemaker go?
RA, RV, and finally, if 3rd lead, in coronary sinus (AV groove)
Why is skeletal muscle resistant to CCBs?
Because it doesn't depend on influx of external Ca