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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. Mitral stenosis is most often secondary to which condition?
Pulsus parvus and tardus - weak - can lead to syncope
RF
2-4 day - early coag necrosis on the first day
Prinzmetal angina

2. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Decrease in activity of Na/Ca exhanger and increase in contractility
Lower right - MC - upper right - AO - upper right AC - lower left MO
2nd degree AV block - mobitz type 1
No - no pressure gradient

3. What does T wave inversion indicated?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
MI
Stable angina
10%

4. What are the 5 T's of cyanoitc babies
Persistant truncus arteriosus
Glomus tumor
Aortic and pulmonary closing
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

5. What is associated with paradoxical spliting of S2
Aortic stenosis or LBBB
In series
Hypertrophied cardiomyopathy
Preload

6. in the JVP - What is the a wave?
Pos inotropy - exercise
Pulmonic stenosis and RBBB
Atrial contraction
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

7. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
Late systolic crescendo murmur with a midsystolic click
ANP
Late diastolic murmur following an opening snap

8. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Atrial contraction
LAD - V1- V2
Inc central venous pressure - inc resistance to portal flow

9. congenital heart defect withdown syndrome
Libman - sacks endocarditis
The first 4 days
MI
ASD - VSD - AV septal defect (endocardial cushion defect)

10. MAP is also known as
Pulmonary flow murmur and diastolic rumble
Polyarteritis nodosum
Subendocardial - fewer collaterals and higher pressure
Afterload (proportional to peripheral resistance)

11. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Persistant truncus arteriosus
Subendocardial - fewer collaterals and higher pressure
...
Pos inotropy - exercise

12. What causes orthopnea?
Hemorrhage
Inc venous return exaccerbates pulm vasc congestion
The first 4 days
Pos inotropy - exercise

13. Which bacteria can cause endocarditis from prosthetic valves?
Takayasu's arteritis
LAD - V1- V2
Mitral valve prolapse
S. epidermidis

14. When and why do you hear the S4 sound
At least 55%
HypoK and bradycardia
Sudden tensing of chordae tendinae
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

15. What is association with fixed S2 splitting - does not increase with inspiration
Volatage gated Ca channels
Apex and anterior interventricular septum
Inc venous return exaccerbates pulm vasc congestion
ASD

16. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Proportional to viscosity and inversely proportional to the radius to the 4th power
Sturge weber - vasculitis of caps
Dilated cardiomyopathy
Mitral stenosis

17. Which murmur is heard in aortic stenosis?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Eccentric - concentric hypertrophy causes diastolic disfunction
RF
Crescendo - decrescendo systolic ejection murmur following ejection click

18. Which murmur do you hear in mitral stenosis?
S. aureus
CO
Late diastolic murmur following an opening snap
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

19. moncekberg
Adult type aortic coarctation
Viridans streptococci
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
LAD - V1- V2

20. What do the starling forces determine
Aortic stenosis or LBBB
Temporal arteritis
Mechanican contraction of the ventricles
Fluid movement through capillaries

21. In an EKG - What is the PR interval?
Conduction delay through AV node - nl < 200 msec
Black > white > asian
The operating point of the heart
Hematocrit

22. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
ANP
Non
Ischemic heart dz - mitral valve prolapse - LV dilation
Proportional to viscosity and inversely proportional to the radius to the 4th power

23. What causes the early cyanosis in Tet of Fallot?
Liver
During HF from microhemorrhages from inc pulm cap pressure
R to L shunt caused by stenoic pulmonic valve
LV failure - pulm venous distention transudation of fluid

24. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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25. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
5-10 days - macs have degraded structural components
Aortic disecction - intraluminal tear forming false lumen
Angiosarcoma
Rapid upstroke - voltage gated Na channels open

26. What is the most common cause of MI
Fetal right to left - neonate left to right leading to RVH and failure
Acute thrombosis of coronary artery
The aortic before pulmonic - inspiration increases diff
Tempral arteritis - may cause irreversible blindness

27. What is the definition of HTN?
140/90
If sodium channel
Rapid upstroke - voltage gated Na channels open
Left sided

28. What are the complications from bacterial endocarditis?
V fib arrhythima
Chordae rupture - GN - suppurative pericarditis - emboli
Patent ductus arteriosus - congenital rubella or prematurity
Holosystoiic

29. What does increasing intracellular Ca do?
5-10 days - macs have degraded structural components
Late diastolic murmur following an opening snap
Group a beta hemolytic strep
Increase contractility

30. What happens in phase 0 of the cardiac ventricular action potential?
Turners
Rapid upstroke - voltage gated Na channels open
Can progess to V fib
Increase in Pc

31. What are the systolic heart sounds
Lower right - MC - upper right - AO - upper right AC - lower left MO
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Myxomatous degeneration - RF - chordae rupture

32. Left to right shunts are more common in babies or kids?
Vagus to medulla
Kids
Mitral>aortic>>tricuspid - high pressure valves affected most
CFX

33. PCWP is an estimate of...
S. epidermidis
Pulmonary flow murmur and diastolic rumble
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Left atrial pressure

34. Irregularly irregular ECG - no p waves: dx and treatment
Pulmonic stenosis and RBBB
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
ASD
Group a beta hemolytic strep

35. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Aortic disecction - intraluminal tear forming false lumen
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Subendocardial
Troponin I

36. What is the progression of atherosclerosis?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Late diastolic murmur following an opening snap
Vasodilators - (hydrAlAzine)
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

37. tearing chest pain radiation to the back - associated with marfan
Inc RA pressure - due to filling against closed tricupsid valve
Aortic disecction - intraluminal tear forming false lumen
MAP
Dec P02 - inc PC02 and dec pH

38. decrease stretch in baroreceptors leads to what response?
Increased efferent SANS and decreased efferent PANS
Aburpt halting of valve leaflets
Increase intracellular Na - resulting in increased Ca
Aortic insuffic - late

39. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Left atrial pressure
Viridans streptococci
In parallel
Boot shaped heart

40. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Cardiac tamponde
At least 55%
Vasodilators
Liver

41. Inspiration causes an increase in which sided heart sounds?
Right sided
Pulmonary flow murmur and diastolic rumble
Inc TPR and LA return (expiration)
Mitral>aortic>>tricuspid - high pressure valves affected most

42. How does aldosterone raise MAP
The operating point of the heart
Postinfarction fibrinous pericarditis
Inc blood volume
Crescendo - decrescendo systolic ejection murmur following ejection click

43. When do you find hemosiderin laden macrophages in the lungs?
Pulmonary flow murmur and diastolic rumble
2-4 day - early coag necrosis on the first day
During HF from microhemorrhages from inc pulm cap pressure
Ischemic heart dz - mitral valve prolapse - LV dilation

44. what conditions are associated with pulsus paradoxus
QRS complex
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Mitral and tricuspid closure
The first 4 days

45. most common primary cardiac tumor in children - associated with tuberous sclerosis
Rhabdomyomas
Eccentric - concentric hypertrophy causes diastolic disfunction
Acute thrombosis of coronary artery
The aortic before pulmonic - inspiration increases diff

46. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Stable angina
Decrease in cAMP
Vasocxn - while other tissues it causes vasodilation
Viridans streptococci

47. What is the S1 sound?
Black > white > asian
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Mitral and tricuspid closure
Angiosarcoma

48. How are sarcomeres added in concentric hypertrophy?
Fluid movement through capillaries
In parallel
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

49. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Isovolumetric contraction
5-10 days - macs have degraded structural components

50. What are the four most common locations for atherosclerosis?
Pulmonary flow murmur and diastolic rumble
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Inc RA pressure - due to filling against closed tricupsid valve
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa