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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. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Left heart failure
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Venodilators (nitrogylcerine)

2. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Venodilators (nitrogylcerine)
The operating point of the heart

3. which heart valves are afected most in rheumatic heart diseease
Filling is incomplete and CO falls
Mitral>aortic>>tricuspid - high pressure valves affected most
CO
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

4. What does the atria release in response to inc blood volume and atrial pressure
Left heart failure
Aortic and pulmonary closing
ANP
Persistant truncus arteriosus

5. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Lower right - MC - upper right - AO - upper right AC - lower left MO
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
LCX - V4- V6
Dec plasma proteins

6. What is the result of not have fast sodium channels in pacemaker cells?
SV/ EDV
Patent ductus arteriosus - congenital rubella or prematurity
Rapid upstroke - voltage gated Na channels open
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

7. Inspiration causes an increase in which sided heart sounds?
If sodium channel
Kawasaki
Right sided
1st degree AV blodck

8. in the JVP - What is the v wave?
Fast volatge gated Na channels
Inc RA pressure - due to filling against closed tricupsid valve
Turners
Medullary vasomotor center senses baroreceptors and JGA

9. How are the sarcomeres added in eccentric hypertrophy?
Fast volatge gated Na channels
Transposition of great vessels
In series
LCX - I - aVL

10. What causes aortic regurg
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Aortic dilation - bicuspid aortic valve - RF -
Vasodilators - (hydrAlAzine)
LAD - V1 - V4

11. What happens with a decrease of extracellular Na
Decrease in activity of Na/Ca exhanger and increase in contractility
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Proportional to viscosity and inversely proportional to the radius to the 4th power
In RA return (inspiration)

12. polypoid capillary hemangioma that can ulcerate and bleed
SA and AV nodes
Strawberry hemangioma
Pyogenic granuloma - associated with trauma and pregnancy
Inc RA pressure - due to filling against closed tricupsid valve

13. What is the cushing triad?
HTN - bradycardia - and respiratory depression
Cherry hemangioma
Tempral arteritis - may cause irreversible blindness
In RA return (inspiration)

14. When does extracellular calcium enter the cardiac muscle cells during contraction?
Proportional to viscosity and inversely proportional to the radius to the 4th power
CFX
Fetal right to left - neonate left to right leading to RVH and failure
The plateau period

15. What does T wave inversion indicated?
CO
MI
Subendocardial - fewer collaterals and higher pressure
Cystic hygroma

16. Which bacteria can cause endocarditis from prosthetic valves?
Systolic dysfunction
C - ANCA
Tricuspid atresia - requires ASD and VSD
S. epidermidis

17. What causes the CO curve to shift downwards?
Rapid upstroke - voltage gated Na channels open
Neg inotropy - HF - narcotic overdose
Liver
Viridans streptococci

18. What are the complications of atherosclerosis?
Filling is incomplete and CO falls
LAD - V1- V2
7 weeks
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

19. How are sarcomeres added in concentric hypertrophy?
In parallel
S. bovis
Stroke volume
Mitral stenosis

20. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
CFX
In RA return (inspiration)
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Stable angina

21. What happens in phase 2 of the cardiac ventricular action potential?
Cardiac tamponde
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
2-4 day - early coag necrosis on the first day
The plateau period

22. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Dilated cardiomyopathy
V fib
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Fick principle

23. Restrictive cardiomyopathy causes
MI
Microscopic polyangiitis - like wegener's without granulomas
Wolff - Parkinson white syndrome
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

24. decrease stretch in baroreceptors leads to what response?
The first 4 days
Libman - sacks endocarditis
Increased efferent SANS and decreased efferent PANS
Crescendo - decrescendo systolic ejection murmur following ejection click

25. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LCX - I - aVL
Fetal right to left - neonate left to right leading to RVH and failure
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

26. What do the starling forces determine
No
Fluid movement through capillaries
Postinfarction fibrinous pericarditis
Mechanican contraction of the ventricles

27. Exercise - overtransfusiion and excitiment causes and increase in...?
Preload
CK- MB
Mitral>aortic>>tricuspid - high pressure valves affected most
Transmural

28. When does EF decrease
Viridans streptococci
In HF
No
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

29. What can cause mitral prolapse?
Pulmonic stenosis and RBBB
Myxomatous degeneration - RF - chordae rupture
Cystic hygroma
Atherosclerosis

30. Rank the pacemakers cells
Conduction delay through AV node - nl < 200 msec
SA>AV>bundle of His>ventricles
Mitral>aortic>>tricuspid - high pressure valves affected most
In HF

31. What are the four most common locations for atherosclerosis?
Hypertrophied cardiomyopathy
Fetal right to left - neonate left to right leading to RVH and failure
Subendocardial
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

32. Which bacteria causes endocarditis in the presence of colon cancer
Metastasis from melanoma or lymphoma
Preload
Vasodilators - (hydrAlAzine)
S. bovis

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

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34. What supplies the posterior left ventricle?
In RA return (inspiration)
CFX
The plateau period
Increased efferent SANS and decreased efferent PANS

35. How do catecholamines increase contractility?
Increase intracellular Na - resulting in increased Ca
Ventricular depolarization - nl < 120 msec
Increasing activity of Ca pump in SR
Mechanican contraction of the ventricles

36. What 4 things drive myocardial 02 demand?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Non
RF
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

37. What do the carotid and aortic bodies respond to?
Gap junctions
Pulmonary flow murmur and diastolic rumble
Dec P02 - inc PC02 and dec pH
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

38. When do you find hemosiderin laden macrophages in the lungs?
Fetal right to left - neonate left to right leading to RVH and failure
Inc TPR and LA return (expiration)
During HF from microhemorrhages from inc pulm cap pressure
Angiosarcoma

39. cavernous lymphangioma of the neck - associated with turner's
The operating point of the heart
Cystic hygroma
No - no pressure gradient
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

40. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
...
Persistant truncus arteriosus
Adult type aortic coarctation
Sturge weber - vasculitis of caps

41. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Turners
Babies
Cardiac tamponde
5-10 days - macs have degraded structural components

42. Which kind of infarct show ST elevation - and/or pathologic Q waves
Transmural
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
ASD
Septal defects - PDA - pulm art stenosis

43. which medications are used to maintain patency or close the ductus arteriosus?
Mechanican contraction of the ventricles
Henoch - Schlonlein purpura
Atherosclerosis
Indomethacin closes - and pge keeps it open

44. what percentage of HTN is secondary to renal disease?
Inc TPR and LA return (expiration)
Aortic stenosis or LBBB
Maintain blood flow to organ over wide range of perfussion pressures
10%

45. What is the gold standard for dx of MI in the first 6 hours
The operating point of the heart
Infective endocarditis
EKG
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

46. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
In series
Anterosuperior displacement of the infundibular septum
Troponin I

47. What is the definition of HTN?
Tempral arteritis - may cause irreversible blindness
MI
140/90
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

48. What causes the midsystolic click
R to L shunt caused by stenoic pulmonic valve
Decreases
Sudden tensing of chordae tendinae
Hypertrophied cardiomyopathy

49. clinical signs of cardiac tamponade
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Cherry hemangioma
Eccentric - concentric hypertrophy causes diastolic disfunction
LAD

50. What is the machine like murmur? What is the heart pathology and the predisposing causes
10%
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Patent ductus arteriosus - congenital rubella or prematurity
RCA - II - III - aVF