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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. Which organ has the largest arteriovenous difference
Hypertrophied cardiomyopathy
Heart - 02 extraction is always around 100%
Ventricles are depolarized
During diastole

2. What do patients die early from in rheumatic heart disease?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Early deaths from myocarditis
Adult type aortic coarctation
Atrial contraction

3. PROVe
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Aortic stenosis or LBBB
Hypertrophied cardiomyopathy
Stroke volume affected by contractility - afterload - and preload

4. What 4 things drive myocardial 02 demand?
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Metastasis from melanoma or lymphoma
LAD - V1 - V4

5. Which enzymes are useful for diagnosing reinfarction
Subendocardial - fewer collaterals and higher pressure
Stroke volume
Vasocxn - while other tissues it causes vasodilation
CK- MB

6. what happens to capillaries in lymphatic blockage
S. bovis
SV/ EDV
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Inc interstitial osmotic pressure pulling fliud out of capillaries

7. Left to right shunts are more common in babies or kids?
Increase in Pc
Aortic and pulmonary closing
Kids
Inc TPR and LA return (expiration)

8. 2/3 diastolic + 1/3 systolic
MAP
TAPVR
Lymphangiosarcoma
3rd degree block - pacemaker - Lyme disease

9. Which artery supplies the SA and AV nodes?
RCA
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Hemorrhage
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

10. congenital heart defect with congenital rubella
Persistant truncus arteriosus
Increase in Pc
Septal defects - PDA - pulm art stenosis
Decreased

11. What does an isoelectric ST segment indicate?
2-4 day - early coag necrosis on the first day
The plateau period
Chordae rupture - GN - suppurative pericarditis - emboli
Ventricles are depolarized

12. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
C - ANCA
Angiosarcoma
V fib
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

13. congenital heart defect in an infant with a diabetic mother?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Transposition of great vessels
Apex and anterior interventricular septum

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

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15. machine murmer
LCX - I - aVL
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
PDA
During HF from microhemorrhages from inc pulm cap pressure

16. Where does coronary artery occlusion occur most commonly?
Atrial contraction
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
LAD

17. The carotid sinus transmits along which nerve?
Acute thrombosis of coronary artery
MI
Glossopharyngeal to soliary nucleus of medulla
Preload

18. Wegener's tx
Metastasis from melanoma or lymphoma
Cyclophosphamide and corticosteroids
Polyarteritis nodosum
Strawberry hemangioma

19. Which murmur is heard with mitral prolapse?
Inc blood volume
Late systolic crescendo murmur with a midsystolic click
Pos inotropy - exercise
Fast volatge gated Na channels

20. Expiration causes an increase in which sided heart sounds
Eisenmenger's syndrome
Left sided
Temporal arteritis
Kawasaki

21. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Decreases
Vagus to medulla
Eccentric - concentric hypertrophy causes diastolic disfunction
Holosystoiic

22. What causes ankle - sacral edema - jugular venous distention
Hyperlipidemia
RV failure - in venous pressure
Heart - 02 extraction is always around 100%
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

23. CO x Total peripheral resistance
Late systolic crescendo murmur with a midsystolic click
During diastole
Mean arterial pressure
Greater ventricular EDV

24. How does digitatlis increase contractility?
Increase intracellular Na - resulting in increased Ca
Ventricles are depolarized
Eisenmenger's syndrome
Vasocxn - while other tissues it causes vasodilation

25. Which channel accounts for automaticity of the SA and AV nodes?
If sodium channel
Dilation
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Eccentric - concentric hypertrophy causes diastolic disfunction

26. What happens in phase 0 of the cardiac ventricular action potential?
Rapid upstroke - voltage gated Na channels open
Conduction delay through AV node - nl < 200 msec
CO
Filling is incomplete and CO falls

27. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Wolff - Parkinson white syndrome
MI
Atrial contraction
Stroke volume affected by contractility - afterload - and preload

28. Right to left shunts are more common in babies or kids?
Varicose veins - thromboembolism rare
Aortic stenosis or LBBB
Pulmonary flow murmur and diastolic rumble
Babies

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

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30. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LCX - I - aVL
Right sided
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
S. aureus

31. How are cadiac myocytes eltrically coupled?
Gap junctions
The aortic before pulmonic - inspiration increases diff
LCX - V4- V6
Varicose veins - thromboembolism rare

32. What causes the murmur heard in MR to enhance?
Inc TPR and LA return (expiration)
ASD - VSD - AV septal defect (endocardial cushion defect)
Fick principle
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

33. In an inferior wall infarct - which artery is affected and which leads show Q waves
RCA - II - III - aVF
SA>AV>bundle of His>ventricles
C - ANCA
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

34. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
LAD - V1- V2
Kawasaki
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

35. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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36. When does EF decrease
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Gap junctions
In HF
Kids

37. What is the result of not have fast sodium channels in pacemaker cells?
Arteriorles
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

38. What are aschoff bodies
Filling is incomplete and CO falls
Wolff - Parkinson white syndrome
Transmural
Granuloma with giant cells

39. 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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40. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Fluid movement through capillaries
...
Mitral and tricuspid closure
Atrial contraction

41. Where are pacemaker cells?
Ventricular repolarization
RCA - II - III - aVF
SA and AV nodes
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

42. Which lab value indicates blood viscosity?
Decreases
Aortic stenosis or LBBB
Ventricles are depolarized
Hematocrit

43. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Total anomalous pulmonary trunk venous return
...
Increase - increase the chance the If are open
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

44. What does FEVERSS stand for in rheumatic heart disease
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Vasocxn - while other tissues it causes vasodilation
Acute thrombosis of coronary artery
Cherry hemangioma

45. When do coronary arteries fill?
During diastole
Aortic dilation - bicuspid aortic valve - RF -
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Inc interstitial osmotic pressure pulling fliud out of capillaries

46. What happends in phase 1 of the ventricular cardiac action potential?
In RA return (inspiration)
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Eccentric - concentric hypertrophy causes diastolic disfunction
Afterload (proportional to peripheral resistance)

47. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
Boot shaped heart
Stroke volume affected by contractility - afterload - and preload
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

48. What are the complications from bacterial endocarditis?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Black > white > asian
CFX
Chordae rupture - GN - suppurative pericarditis - emboli

49. In what disease states is blood viscosity increased?
Buerger's disease
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
SV/ EDV
Aortic/pulmonic regurg and mitral/tricuspid stenosis

50. When during cardiac nodal cells depolarize?
During diastole
Sturge weber - vasculitis of caps
Dilation
Increase intracellular Na - resulting in increased Ca