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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. Where does coronary artery occlusion occur most commonly?
LAD
Infective endocarditis
Pulmonic stenosis and RBBB
Pyogenic granuloma - associated with trauma and pregnancy

2. What is the definition of HTN?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Apex and anterior interventricular septum
Posterior descending (80% off the RCA - 20% off the circumflex)
140/90

3. Expiration causes an increase in which sided heart sounds
Mitral valve prolapse
Aortic and pulmonary closing
CO
Left sided

4. What does FEVERSS stand for in rheumatic heart disease
LAD - V1 - V4
Mitral valve
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

5. Exercise - overtransfusiion and excitiment causes and increase in...?
Volatage gated Ca channels
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Preload
Increased efferent SANS and decreased efferent PANS

6. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Varicose veins - thromboembolism rare
Indomethacin closes - and pge keeps it open
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
MI

7. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Left heart failure
Adult type aortic coarctation
Resting potential high K perm
Activated histiocytes

8. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Myxoma
Kawasaki
Aortic and pulmonary closing

9. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Ventricular depolarization - nl < 120 msec
Turners
Aortic insuffic - late
Troponin I

10. How are cadiac myocytes eltrically coupled?
Glomus tumor
Prinzmetal angina
Gap junctions
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

11. What constitues the upstroke in pacemaker cells?
Microscopic polyangiitis - like wegener's without granulomas
Volatage gated Ca channels
Lymphangiosarcoma
R to L shunt caused by stenoic pulmonic valve

12. What causes the ejection click in the Cres - decres murmur?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Aburpt halting of valve leaflets
Takayasu's arteritis
Infective endocarditis

13. Do you see elevaged ASO titers in rheumatic heart disease
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Yes
Henoch - Schlonlein purpura
LAD - V1- V2

14. machine murmer
Inc Kf - capillary perm
PDA
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Tricuspid atresia - requires ASD and VSD

15. Most common vasculitis affecting medium and large arteries
Sudden tensing of chordae tendinae
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Inc blood volume
Temporal arteritis

16. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Stroke volume affected by contractility - afterload - and preload
Buerger's disease
No - no pressure gradient

17. systolic - diastolic
Inc blood volume
P02
Pulse pressure
PDA

18. What causes the midsystolic click
Sudden tensing of chordae tendinae
Increasing activity of Ca pump in SR
RV contraction (closed tricuspid valve bulding into atrium
Resting potential high K perm

19. What causes the murmur heard in MR to enhance?
Activated histiocytes
Dilated cardiomyopathy
Aortic dilation - bicuspid aortic valve - RF -
Inc TPR and LA return (expiration)

20. Which valve is commonly involved in bacterial endocarditis from IV drug use and Which bacteria are most common?

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21. Right to left shunts are more common in babies or kids?
7 weeks
Babies
Medullary vasomotor center senses baroreceptors and JGA
Diastolic

22. What is the most common cause of right heart failure
MAP
No - no pressure gradient
Atherosclerosis
Left heart failure

23. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Tempral arteritis - may cause irreversible blindness
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
LAD - V1- V2
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

24. In an EKG - What is the QRS complex?
Purkingee>atria>ventricles>AV node
MI
Ventricular depolarization - nl < 120 msec
Left atrial pressure

25. What causes aortic regurg
Extracellular calcium - calcium induced calcium release
Subendocardial
Eisenmenger's syndrome
Aortic dilation - bicuspid aortic valve - RF -

26. Wegener's tx
Cyclophosphamide and corticosteroids
Decrease in activity of Na/Ca exhanger and increase in contractility
Vagus to medulla
QRS complex

27. congenital heart defect with turner's
Coarcation of aorta
Transposition of great vessels
SA>AV>bundle of His>ventricles
Granuloma with giant cells

28. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Left heart failure
Torsades de pointes
LCX - I - aVL
RF

29. Restrictive cardiomyopathy causes
Dec P02 - inc PC02 and dec pH
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Eisenmenger's syndrome
Adult type aortic coarctation

30. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Mitral>aortic>>tricuspid - high pressure valves affected most
Extracellular calcium - calcium induced calcium release
Viridans streptococci
Cyclophosphamide and corticosteroids

31. In an EKG - What is the p wave?
Atrial contraction
CFX
No - no pressure gradient
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

32. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Sturge weber - vasculitis of caps
Dressler's - autoimmune
Late systolic crescendo murmur with a midsystolic click
Dec plasma proteins

33. congenital heart defect with marfan's
Viridans streptococci
Aortic insuffic - late
Torsades de pointes
Failure of LV to in CO during exercise

34. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Sudden tensing of chordae tendinae
Atrial contraction
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Posterior descending (80% off the RCA - 20% off the circumflex)

35. in the JVP - What is the v wave?
Black > white > asian
Inc blood volume
7 weeks
Inc RA pressure - due to filling against closed tricupsid valve

36. Which class of drugs decreases afterload?
Buerger's disease
The operating point of the heart
2nd degree AV block - mobitz type 1
Vasodilators - (hydrAlAzine)

37. What is the machine like murmur? What is the heart pathology and the predisposing causes
2nd degree AV block - mobitz type 1
Patent ductus arteriosus - congenital rubella or prematurity
Isovolumetric contraction
Heart - 02 extraction is always around 100%

38. sawtooth wave

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39. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Inc central venous pressure - inc resistance to portal flow
The aortic before pulmonic - inspiration increases diff
Libman - sacks endocarditis
Proportional to viscosity and inversely proportional to the radius to the 4th power

40. What masks atrial repolarization?
Increase contractility
QRS complex
Fick principle
Mechanican contraction of the ventricles

41. absecnce of tricuspid valve - hypoplastic RV
Vasodilators - (hydrAlAzine)
RCA - II - III - aVF
Sudden tensing of chordae tendinae
Tricuspid atresia - requires ASD and VSD

42. What causes the CO curve to shift downwards?
Neg inotropy - HF - narcotic overdose
Resting potential high K perm
V fib
2-4 day - early coag necrosis on the first day

43. Unilateral headache - jaw claudication - impaired vision
Tempral arteritis - may cause irreversible blindness
RCA - II - III - aVF
Preload
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

44. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Henoch - Schlonlein purpura
Troponin I
Torsades de pointes
Fast volatge gated Na channels

45. Chronic mitral stenosis can lead to what changes in size of the LA
Kids
Dilation
Holosystoiic
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

46. What are the 5 T's of cyanoitc babies
HTN - bradycardia - and respiratory depression
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Ischemic heart dz - mitral valve prolapse - LV dilation

47. What are the systolic heart sounds
Glossopharyngeal to soliary nucleus of medulla
Myxomatous degeneration - RF - chordae rupture
Aortic/pulmonic stenosis and mitral/tricuspid regurg
During diastole

48. Given P = QR - what factors influence resistance?
Dressler's - autoimmune
Resting potential high K perm
Proportional to viscosity and inversely proportional to the radius to the 4th power
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

49. What causes aortic stenosis
Age related calcifications or bicuspid aortic valve
Atherosclerosis
Late systolic crescendo murmur with a midsystolic click
Atrial contraction

50. MAP is also known as
Ischemic heart dz - mitral valve prolapse - LV dilation
Henoch - Schlonlein purpura
Afterload (proportional to peripheral resistance)
RCA - II - III - aVF