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Cardiology

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is the progression of atherosclerosis?
Myxomatous degeneration - RF - chordae rupture
Increase contractility
7 weeks
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

2. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Arteriorles
Aortic/pulmonic stenosis and mitral/tricuspid regurg
SA and AV nodes
No

3. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Increasing activity of Ca pump in SR
Mitral and tricuspid closure
Atrial contraction
Transfusion

4. Expiration causes an increase in which sided heart sounds
HypoK and bradycardia
Hemorrhage
Left sided
Boot shaped heart

5. What happens in phase 0 of the cardiac ventricular action potential?
SA>AV>bundle of His>ventricles
Rapid upstroke - voltage gated Na channels open
Truncus - tet of fallot
Tempral arteritis - may cause irreversible blindness

6. Which murmur is heard with mitral prolapse?
Late systolic crescendo murmur with a midsystolic click
V fib arrhythima
Cyclophosphamide and corticosteroids
CHF

7. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Total anomalous pulmonary trunk venous return
Right sided
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Viridans streptococci

8. Chronic mitral stenosis can lead to what changes in size of the LA
Proportional to viscosity and inversely proportional to the radius to the 4th power
Inc blood volume
Dilation
Arteriolosclerosis in malignant hypertension

9. When and why is the S3 sound heard?
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Hematocrit
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Gap junctions

10. In an EKG - What is the PR interval?
Atherosclerosis
Conduction delay through AV node - nl < 200 msec
Late systolic crescendo murmur with a midsystolic click
Buerger's disease

11. What does prolonged QT predispose to?
Torsades de pointes
LAD > RCA > circumflex
Aortic disecction - intraluminal tear forming false lumen
Eccentric - concentric hypertrophy causes diastolic disfunction

12. Which murmur do you hear in mitral stenosis?
Raynaud's
Crescendo - decrescendo systolic ejection murmur following ejection click
Pulse pressure
Late diastolic murmur following an opening snap

13. What does FEVERSS stand for in rheumatic heart disease
Aortic and pulmonary closing
During diastole
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Adult type aortic coarctation

14. How do beta blockers decrease contractility?
RF
Greater ventricular EDV
Strawberry hemangioma
Decrease in cAMP

15. Which organ has the largest arteriovenous difference
Microscopic polyangiitis - like wegener's without granulomas
Cardiac tamponde
Heart - 02 extraction is always around 100%
Aortic stenosis or LBBB

16. Which class of drugs decrease the murmur heard in aortic regurg?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Vasodilators
Proportional to viscosity and inversely proportional to the radius to the 4th power
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

17. In an EKG - What is the QRS complex?
Increased efferent SANS and decreased efferent PANS
Cystic hygroma
Ventricular depolarization - nl < 120 msec
Arteriolosclerosis in malignant hypertension

18. How does a patient with Tet of fallot learn to improve symptoms?
Inc RA pressure - due to filling against closed tricupsid valve
Squat. Compression of femoral arteries - inc TPR - dec
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
TAPVR

19. with what heart sounds do ASD usually present?
Cardiac tamponde
Pulmonary flow murmur and diastolic rumble
Late systolic crescendo murmur with a midsystolic click
Increased SV

20. What causes the cushing reflex and why
Mitral and tricuspid closure
Subendocardial
In series
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

21. The cause of cardiac dilation?
Greater ventricular EDV
HTN - bradycardia - and respiratory depression
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

22. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Eisenmenger's syndrome
Hyperlipidemia
During diastole
Preload

23. pulseless disease - granulomatous thickening of the aortic arch and/or proximal great vessels - elev ESR - asian females > 40

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24. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Myxoma
Non
Subendocardial - fewer collaterals and higher pressure
Glossopharyngeal to soliary nucleus of medulla

25. What is the time frame for arrhythmia risk in the evolution of MI
Aortic disecction - intraluminal tear forming false lumen
Inc interstitial osmotic pressure pulling fliud out of capillaries
The first 4 days
Vasodilators - (hydrAlAzine)

26. How does digitatlis increase contractility?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Henoch - Schlonlein purpura
Increase intracellular Na - resulting in increased Ca
During diastole

27. What does increasing intracellular Ca do?
Late diastolic murmur following an opening snap
Increase contractility
Aortic dilation - bicuspid aortic valve - RF -
Infective endocarditis

28. What causes the CO curve to shift upwards?
Ischemic heart dz - mitral valve prolapse - LV dilation
Preload
Pos inotropy - exercise
Transposition of great vessels

29. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Left sided
Sturge weber - vasculitis of caps
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Raynaud's

30. What does the atria release in response to inc blood volume and atrial pressure
Myxomatous degeneration - RF - chordae rupture
ANP
Coarcation of aorta
Boot shaped heart

31. decrease stretch in baroreceptors leads to what response?
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Increased efferent SANS and decreased efferent PANS
Anterosuperior displacement of the infundibular septum
Late systolic crescendo murmur with a midsystolic click

32. In an anterior wall infarct - which artery is effected and which leads show Q waves
ANP
Glossopharyngeal to soliary nucleus of medulla
LAD - V1 - V4
Liver

33. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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34. Which bacteria causes endocarditis in the presence of colon cancer
S. bovis
Atherosclerosis
S. epidermidis
SA>AV>bundle of His>ventricles

35. What happens in phase 2 of the cardiac ventricular action potential?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Inc venous return exaccerbates pulm vasc congestion
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Pulsus parvus and tardus - weak - can lead to syncope

36. What constitues the upstroke in pacemaker cells?
If sodium channel
2-4 day - early coag necrosis on the first day
Volatage gated Ca channels
Strawberry hemangioma

37. If HR is too fast (V tach) what happens during diastole?
Filling is incomplete and CO falls
Tricuspid atresia - requires ASD and VSD
Increase in Pc
Pulse pressure

38. The carotid sinus transmits along which nerve?
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Glossopharyngeal to soliary nucleus of medulla
Gap junctions
Mitral valve prolapse

39. What does FROM JANE stand for in bacterial endocarditis?

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40. When do you find hemosiderin laden macrophages in the lungs?
During HF from microhemorrhages from inc pulm cap pressure
Viridans streptococci
Dilation
Septal defects - PDA - pulm art stenosis

41. What do the carotid and aortic bodies respond to?
Heart - 02 extraction is always around 100%
Dec P02 - inc PC02 and dec pH
Maintain blood flow to organ over wide range of perfussion pressures
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

42. in the JVP - What is the v wave?
Fast volatge gated Na channels
Purkingee>atria>ventricles>AV node
Inc RA pressure - due to filling against closed tricupsid valve
Atrial contraction

43. What happens in phase 3 of the cardiac ventricular action potential?
LV failure - pulm venous distention transudation of fluid
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
MAP
In series

44. congenital heart defect with congenital rubella
Crescendo - decrescendo systolic ejection murmur following ejection click
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Septal defects - PDA - pulm art stenosis

45. In an EKG - What is the QT interval?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Mechanican contraction of the ventricles
Pyogenic granuloma - associated with trauma and pregnancy
Filling is incomplete and CO falls

46. What is the result of not have fast sodium channels in pacemaker cells?
Tricuspid atresia - requires ASD and VSD
Increased efferent SANS and decreased efferent PANS
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
In series

47. Irregularly irregular ECG - no p waves: dx and treatment
The plateau period
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Increase intracellular Na - resulting in increased Ca
Diastolic

48. What channels do the the pacemaker cells lack?
Fast volatge gated Na channels
Varicose veins - thromboembolism rare
LAD
Proportional to viscosity and inversely proportional to the radius to the 4th power

49. p - anca

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50. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
...
LAD
CFX