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Flashcards in UWorld Cardiology Deck (66):
1

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

2

What is pulsus paradoxus?

A drop in arterial BP of more than 10 mmHg on inspiration. It is usually found in

3

What clinical findings do you expect in cardiac tamponade?

Pulsus paradoxus, arterial hTN

4

What is beri-beri a deficiency of?

Vitamin B1 (thiamine)

5

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?

Enterococcus, cystoscopy

6

Where is the GSV harvested for CABG procedures?

Just inferolateral to the pubic tubercle

7

What mechanism is responsible for the rapid decrease of cytosolic Ca right before relaxation of cardiac muscle cells?

Na/Ca exchange mechanism

8

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

9

What physiological state results from a PE?

Respiratory alkalosis because of hyperventilation driven by hypoxemia - aka you blow off too much CO2

10

What is the best indicator of severity for MR?

Presence of an audible S3

11

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

12

Which anti-arrhythmic drug has the highest selectivity for ischemic myocardium?

Lidocaine (amiodarone, if available)

13

What are the hallmarks of Turner Syndrome?

Short, thick neck, shortened fourth metacarpals, short stature, broad chest, and bicuspid aortic valve

14

What valvular abnormality is commonly associated with Turner Syndrome?

Bicuspid aortic valve (and coarctation of aorta, too)

15

What is the primary type of collagen in mature scars?

Type 1

16

An echo that shows an aorta lying anterior and to the right of the pulmonary artery is diagnostic of what condition?

TGA

17

TGA results from the failure of what embryological process?

Septation

18

A double blind study is to prevent what kind of bias?

Observer bias

19

What process most likely preceded a heavily calcified aortic valve with no significant PMH?

Cellular necrosis leading to dystrophic calcification in normocalcemic conditions!

20

What effect does selective B1 selective antagonists like metoprolol have in the treatment of HTN?

Decrease cardiac output and block renin release from kidneys.

21

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)

22

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.

23

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

24

What part of the heart is closest to the left sternal border at the 4th intercostal space?

RV

25

What do you expect to hear on auscultation for a VSD?

Harsh sounding holosystolic murmur

26

What is the law of conservation of mass?

V1A1 = V2A2

27

What is supine hypotension syndrome?

Pregnant uterus compresses IVC in pregnant women when they lie down, decrease VR, and causes hypotension

28

Moderate increases in capillary fluid transudation can be offset by compensatory increase in what mechanism?

Tissue lymphatic drainage

29

Which arteries does polyarteritis nodosa spare?

Pulmonary

30

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

31

String of pearls appearance of blood vessels points towards what disease?

Polyarteritis nodosa

32

How do you treat GCA?

High dose corticosteroids

33

What is Buerger disease associated with?

Smoking

34

What's involved in Wegener's? (Granulomatosis with polyangiitis)

Nose, lung, kidney

35

How do you distinguish Churg-Strauss from microscopic polyangiitis, given that they are both p-ANCA positive?

Granulomas, eosinophilia, asthma in CS

36

What is Henoch-Schonlein Purpura classically associated with?

IgA nephropathy

37

How does Angiotensin II increase blood pressure?

1) Contracting arteriolar smooth muscle
2) Promotes aldosterone

38

What are the 4 key modifiable risk factors for atherosclerosis?

1) Smoking
2) HTN
3) Hyperlipidemia
4) Diabetes

39

What are the two causes of hyaline arteriosclerosis?

Benign HTN and DM

40

What arteriosclerotic condition should you think about in patients with benign HTN and DM?

Hyaline arteriosclerosis

41

Where do abdominal aortic aneurysms typically occur?

Below the renal arteries but above the aortic bifurcation

42

What are thoracic aortic aneurysms classically associated with?

3 syphilis

43

What do you do to treat a hemangioma in a kid?

Nothing. Usually self resolves.

44

What condition is most commonly associated with a VSD?

Fetal alcohol syndrome

45

What condition is most commonly associated with an ASD?

Down Syndrome

46

What condition is most commonly associated with a PDA?

Congenital Rubella

47

What condition is most commonly associated with a TGA?

Maternal diabetes

48

What is Dressler syndrome?

AI condition resulting in fibrinous pericarditis 6-8 weeks post-MI.

49

What are the physical signs of reperfusion injury in the heart?

Contraction bands

50

Transient myocardial ischemia causes myocardial cells to increase in size due to what effect?

Intracellular Ca accumulation

51

What fetal heart condition do you worry about in a mother with diabetes?

TGA

52

What is standard therapy for heart failure?

ACEi, digoxin, diuretic + spironolactone

53

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.

54

How do you avoid infectious complications from a central catheter?

Wash your hands before you place it...

55

Right side face and right arm swelling, engorgement of subC veins on R. side of face. Where's the obstruction?

Brachiocephalic vein

56

What two parts of the heart cause obstruction in HCM?

Mitral valve cusp and LV septum

57

What are the most important local factors regulating blood flow in the zone of autoregulation?

Adenosine and NO

58

What is the order of cardiac conduction velocity?

Purkinje, Atria, Ventricles, AV node
(Park At Ventura Avenue)

59

What do you see in the lungs in LHF?

Heart failure cells with hemosiderin in them

60

What determines the significance of ToF?

Pulm Stenosis

61

What pathway does ANP and BNP act through?

cGMP

62

Ventricular septum with sigmoid shape, decreased ventricular chamber size, and brown perinuclear cytoplasmic inclusions. Cause?

Old age

63

What is the biochemical endpoint of nitrate therapy?

Decreased IC Ca and dephosphorylated myosin

64

Where do the leads of a biventricular pacemaker go?

RA, RV, and finally, if 3rd lead, in coronary sinus (AV groove)

65

Why is skeletal muscle resistant to CCBs?

Because it doesn't depend on influx of external Ca

66

What cells are responsible for creating the fibrous cap of collagen and ECM in atherosclerosis?

Vascular smooth muscle cells