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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. The 7 complications of MI

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2. Inspiration causes an increase in which sided heart sounds?
Right sided
Septal defects - PDA - pulm art stenosis
No
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

3. Which channel accounts for automaticity of the SA and AV nodes?
If sodium channel
ASD
Pos inotropy - exercise
Right sided

4. If HR is too fast (V tach) what happens during diastole?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Filling is incomplete and CO falls
Atrial contraction
S. aureus

5. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
RF
Hematocrit
Lower right - MC - upper right - AO - upper right AC - lower left MO

6. What kind of dysfunction ensues in restrictive cardiomyopathy
Troponin I
Persistant truncus arteriosus
Henoch - Schlonlein purpura
Diastolic

7. What is the result of not have fast sodium channels in pacemaker cells?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Unstable/crescendo angina
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Anterosuperior displacement of the infundibular septum

8. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
V fib
Stable angina
Mechanican contraction of the ventricles
Decreased

9. Which bacteria causes endocarditis in the presence of colon cancer
Libman - sacks endocarditis
Aortic insuffic - late
S. bovis
Aortic disecction - intraluminal tear forming false lumen

10. necrotizing granulomas in lung and upper airways - nectrotizing GN - small vessel vasculitis

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11. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Filling is incomplete and CO falls
Increasing activity of Ca pump in SR

12. What is the cushing triad?
Angiosarcoma
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
HTN - bradycardia - and respiratory depression
2-4 day - early coag necrosis on the first day

13. Expiration causes an increase in which sided heart sounds
If sodium channel
Left sided
Prinzmetal angina
Aortic insuffic - late

14. What cardiac change occurs in pregnancy?
LV failure - pulm venous distention transudation of fluid
Increased SV
Ventricles are depolarized
...

15. Which lab value indicates blood viscosity?
During diastole
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Hematocrit

16. What causes the cushing reflex and why
RV failure - in venous pressure
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
The first 4 days

17. What is the S1 sound?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Inc RA pressure - due to filling against closed tricupsid valve
Mitral and tricuspid closure
Myxomatous degeneration - RF - chordae rupture

18. Given P = QR - what factors influence resistance?
Angiosarcoma
SA>AV>bundle of His>ventricles
Proportional to viscosity and inversely proportional to the radius to the 4th power
Henoch - Schlonlein purpura

19. What can cause mitral prolapse?
Dilation
Kaposi's sarcoma
Eccentric - concentric hypertrophy causes diastolic disfunction
Myxomatous degeneration - RF - chordae rupture

20. 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
Pos inotropy - exercise
Fluid movement through capillaries
Preload

21. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Pulmonic stenosis and RBBB
Adult type aortic coarctation
Myxomatous degeneration - RF - chordae rupture
Cardiac tamponde

22. prolonged PR interval
CO
SV/ EDV
Greater ventricular EDV
1st degree AV blodck

23. Which murmur is heard in aortic stenosis?
Crescendo - decrescendo systolic ejection murmur following ejection click
In RA return (inspiration)
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

24. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Left sided
Hyperlipidemia
Gap junctions
Strawberry hemangioma

25. decrease stretch in baroreceptors leads to what response?
Increased efferent SANS and decreased efferent PANS
Vasocxn
Age related calcifications or bicuspid aortic valve
Hyperlipidemia

26. What is indicated when CO and venous return are equal?
S. aureus
Microscopic polyangiitis - like wegener's without granulomas
The operating point of the heart
During diastole

27. moncekberg
RV failure - in venous pressure
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Coarcation of aorta
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

28. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
P02
Fetal right to left - neonate left to right leading to RVH and failure
Libman - sacks endocarditis
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

29. How does angiotensin II raise MAP
Babies
Vasocxn
Turners
The plateau period

30. What is association with fixed S2 splitting - does not increase with inspiration
Aortic stenosis or LBBB
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
ASD
Troponin I

31. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Maintain blood flow to organ over wide range of perfussion pressures
Arteriolosclerosis in malignant hypertension
Strawberry hemangioma
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

32. Which kind of infarct show ST elevation - and/or pathologic Q waves
Non
Transmural
10%
Right sided

33. What does increasing intracellular Ca do?
Increase contractility
1st degree AV blodck
Aortic insuffic - late
Vasocxn - while other tissues it causes vasodilation

34. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Mitral valve
R to L shunt caused by stenoic pulmonic valve
LAD > RCA > circumflex
Non

35. When do you see extensive coagulative necrosis in an MI
V fib arrhythima
P02
Black > white > asian
2-4 day - early coag necrosis on the first day

36. How does aldosterone raise MAP
Inc blood volume
Cardiac tamponde
LCX - I - aVL
Stroke volume

37. What does FAN MY SKIN On Wednesday stand for?
Microscopic polyangiitis - like wegener's without granulomas
Mitral valve prolapse
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Late diastolic murmur following an opening snap

38. Do you see elevaged ASO titers in rheumatic heart disease
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Viridans streptococci
Yes
During diastole

39. When and why is the S3 sound heard?
Atrial contraction
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

40. in the JVP - What is the c wave?
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Stroke volume affected by contractility - afterload - and preload
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
RV contraction (closed tricuspid valve bulding into atrium

41. How do beta blockers decrease contractility?
Anterosuperior displacement of the infundibular septum
Decrease in cAMP
Group a beta hemolytic strep
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

42. Which organ gets the largest share of systemic cardiac output
Liver
Fluid movement through capillaries
Ischemic heart dz - mitral valve prolapse - LV dilation
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

43. Which sympathetic receptors raise MAP
3rd degree block - pacemaker - Lyme disease
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Pulsus parvus and tardus - weak - can lead to syncope
10%

44. systolic - diastolic
At least 55%
Pulse pressure
Wolff - Parkinson white syndrome
Inc RA pressure - due to filling against closed tricupsid valve

45. What masks atrial repolarization?
Heart - 02 extraction is always around 100%
Mitral valve
Unstable/crescendo angina
QRS complex

46. In terms of starling forces - why does heart failure cause edema?
Increase in Pc
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Mitral valve prolapse
Filling is incomplete and CO falls

47. Where does coronary artery occlusion occur most commonly?
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
C - ANCA
LAD
Right sided

48. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
Fluid movement through capillaries
Mitral valve
S. bovis

49. What are the different etiologies of dialted cardiomyopathy
Age related calcifications or bicuspid aortic valve
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
2nd degree AV block - mobitz type 1
LCX - V4- V6

50. Most common vasculitis affecting medium and large arteries
Temporal arteritis
Dressler's - autoimmune
Indomethacin closes - and pge keeps it open
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction