NBME CBSE EXAM 2023 (Answered)
Bulbus cordis
Smooth parts (outflow tract) of left and right ventricles
endocardial cushions
Atrial septum, membranous interventricular septum; AV and semilunar valves
neural crest
left horn of the sinus venosus
coronary sinus
posterior, sub cardinal, and supra cardinal veins
IVC
Right common cardinal vein and right anterior cardinal vein
SVC
Right horn of sinus venosus
Smooth part of right atrium (sinus venarum)
Patent foramen ovale
failure of septum primum and septum secundum to fuse after birth
Transposition of the great vessels
Tetralogy of Fallot
Persistent truncus arteriosus
Conotruncal abnormalities associated with failure of neural crest cells to migrate
ductus venosus
connects the umbilical vein to the inferior vena cava, bypassing the liver
becomes ligamentum venosum
phrenic nerve
innervates the diaphragm and pericardium
S3 heart sound
Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated
ventricles
normal in kids and pregnant women
S4 heart sound
atrial kick late diastole, right before S1
best heard at apex in LLD position
High atrial pressure.
Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)
Always abnormal
atria contract
a wave of JVP
c wave
,RV contraction (closed tricuspid valve bulging into atrium) wave of JVP
x descent
JVP wave corresponding to downward displacement of closed tricuspid valve during
rapid ventricular ejection phase
reduced or absent in tricuspid regurge
V wave
JVP wave corresponding to inc'd RA pressure due to filling against closed tricuspid
valve
y descent
JVP wave corresponding to RA emptying into RV
absent in cardiac tamponade
plusus parvus et tardus
pulses are weak with delayed peak
Aortic stenosis
PR interval
0.12-0.20 seconds
120 milliseconds
QT interval length
9 - 11 squares = .36 to .44 seconds
Hypokalemia
U wave present on ECG
Mg sulfate
for torsades de pointe, hypokalemia (can lengthen QT and cause torsades), and pre-
eclampsia (prevent seizures)
Romano-Ward syndrome
-Congenital long QT syndrome
-Autosomal dominant, pure cardiac phenotype (no deafness).
Jervell and Lange-Nielsen syndrome
-Congenital long QT syndrome
-Autosomal recessive, sensorineural deafness
Brugada syndrome
-Autosomal dominant disorder affecting Na channels most common in Asian males.
-ECG pattern of pseudo-right bundle branch block and ST elevations in V1-V3 (anterior
ventricular septum)
-inc risk of ventricular tachyarrhythmias and sudden cardiac deatgh
Prevent SCD with implantable cardioverter-defibrillator (ICD).
Wolff-Parkinson-White Syndrome
Most common type of ventriuclar pre-excitation sydnrome. Abnormal fast accessory
conduction pathway from atria to venricle bypasses the rate-slowing AV node
causing a delta wave and widening QRS with shortened PR interval. Could lead to a
reentrant circuit and suprvaventicular tachy.
, First degree AV block
- PRI >5 boxes/.20 sec (200 msec)
- Fixed but prolonged PRI
(consistent but long)
- normally get bradycardia here
second degree AV block mobitz type 2
-PR interval is constant
-atrial conduction to ventricle is intermittent: dropped QRS without increasing PR
interval length
-disease below AV node in His bundle
may progress to 3rd degree/complete AV block
Second Degree AV Block Mobitz Type 1 (wenckebach)
Progressive lengthening of pr interval leading to dropped QRS
third degree AV block
The atria and Ventricles are totally dissociated.
-So, the QRSs and the P waves have no relation to each other.
PCWP
4-12 mmHg
est of LA pressure
Williams Syndrome
a genetic condition characterized by mental retardation in most regards but surprisingly
good use of language relative to their other abilities, elfin facies
Chromosome 7
assoc with supravalvular aortic stenosis
DiGeorge Syndrome
Maldevelopment of 3 and 4 pharyngeal pouches, fascial dysmorphia, cardiac shunt
(trunks arteriosus, tetralogy of Fallot), lack of T-cells, undeveloped paracortex
Corneal arcus
Lipid deposits in the cornea. Common in the elderly, but appears earlier in life with
hypercholesterolemia
Stanford A aortic dissection
Dissection of the ascending aorta
Tx with surgery
Stanford B aortic dissection
Dissection of the descending aorta below the level o the left subclavian artery
Tx: Beta Blockers then vasodilators
Left bundle branch block
QRS> 120 msec
Deep, broad S waves in V1 and V2
Broad R waves in in V5 and V6
hypertrophic obstructive cardiomyopathy
common AD inherited heart defect of a thick septal wall
mutations in sarcomeric proteins (myosin binding protein C; Beta myosin heavy chain)
Bulbus cordis
Smooth parts (outflow tract) of left and right ventricles
endocardial cushions
Atrial septum, membranous interventricular septum; AV and semilunar valves
neural crest
left horn of the sinus venosus
coronary sinus
posterior, sub cardinal, and supra cardinal veins
IVC
Right common cardinal vein and right anterior cardinal vein
SVC
Right horn of sinus venosus
Smooth part of right atrium (sinus venarum)
Patent foramen ovale
failure of septum primum and septum secundum to fuse after birth
Transposition of the great vessels
Tetralogy of Fallot
Persistent truncus arteriosus
Conotruncal abnormalities associated with failure of neural crest cells to migrate
ductus venosus
connects the umbilical vein to the inferior vena cava, bypassing the liver
becomes ligamentum venosum
phrenic nerve
innervates the diaphragm and pericardium
S3 heart sound
Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated
ventricles
normal in kids and pregnant women
S4 heart sound
atrial kick late diastole, right before S1
best heard at apex in LLD position
High atrial pressure.
Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)
Always abnormal
atria contract
a wave of JVP
c wave
,RV contraction (closed tricuspid valve bulging into atrium) wave of JVP
x descent
JVP wave corresponding to downward displacement of closed tricuspid valve during
rapid ventricular ejection phase
reduced or absent in tricuspid regurge
V wave
JVP wave corresponding to inc'd RA pressure due to filling against closed tricuspid
valve
y descent
JVP wave corresponding to RA emptying into RV
absent in cardiac tamponade
plusus parvus et tardus
pulses are weak with delayed peak
Aortic stenosis
PR interval
0.12-0.20 seconds
120 milliseconds
QT interval length
9 - 11 squares = .36 to .44 seconds
Hypokalemia
U wave present on ECG
Mg sulfate
for torsades de pointe, hypokalemia (can lengthen QT and cause torsades), and pre-
eclampsia (prevent seizures)
Romano-Ward syndrome
-Congenital long QT syndrome
-Autosomal dominant, pure cardiac phenotype (no deafness).
Jervell and Lange-Nielsen syndrome
-Congenital long QT syndrome
-Autosomal recessive, sensorineural deafness
Brugada syndrome
-Autosomal dominant disorder affecting Na channels most common in Asian males.
-ECG pattern of pseudo-right bundle branch block and ST elevations in V1-V3 (anterior
ventricular septum)
-inc risk of ventricular tachyarrhythmias and sudden cardiac deatgh
Prevent SCD with implantable cardioverter-defibrillator (ICD).
Wolff-Parkinson-White Syndrome
Most common type of ventriuclar pre-excitation sydnrome. Abnormal fast accessory
conduction pathway from atria to venricle bypasses the rate-slowing AV node
causing a delta wave and widening QRS with shortened PR interval. Could lead to a
reentrant circuit and suprvaventicular tachy.
, First degree AV block
- PRI >5 boxes/.20 sec (200 msec)
- Fixed but prolonged PRI
(consistent but long)
- normally get bradycardia here
second degree AV block mobitz type 2
-PR interval is constant
-atrial conduction to ventricle is intermittent: dropped QRS without increasing PR
interval length
-disease below AV node in His bundle
may progress to 3rd degree/complete AV block
Second Degree AV Block Mobitz Type 1 (wenckebach)
Progressive lengthening of pr interval leading to dropped QRS
third degree AV block
The atria and Ventricles are totally dissociated.
-So, the QRSs and the P waves have no relation to each other.
PCWP
4-12 mmHg
est of LA pressure
Williams Syndrome
a genetic condition characterized by mental retardation in most regards but surprisingly
good use of language relative to their other abilities, elfin facies
Chromosome 7
assoc with supravalvular aortic stenosis
DiGeorge Syndrome
Maldevelopment of 3 and 4 pharyngeal pouches, fascial dysmorphia, cardiac shunt
(trunks arteriosus, tetralogy of Fallot), lack of T-cells, undeveloped paracortex
Corneal arcus
Lipid deposits in the cornea. Common in the elderly, but appears earlier in life with
hypercholesterolemia
Stanford A aortic dissection
Dissection of the ascending aorta
Tx with surgery
Stanford B aortic dissection
Dissection of the descending aorta below the level o the left subclavian artery
Tx: Beta Blockers then vasodilators
Left bundle branch block
QRS> 120 msec
Deep, broad S waves in V1 and V2
Broad R waves in in V5 and V6
hypertrophic obstructive cardiomyopathy
common AD inherited heart defect of a thick septal wall
mutations in sarcomeric proteins (myosin binding protein C; Beta myosin heavy chain)
