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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. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
LAD - V1- V2
Right sided
Decreases
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

2. 2/3 diastolic + 1/3 systolic
RCA - II - III - aVF
Lower right - MC - upper right - AO - upper right AC - lower left MO
S. aureus
MAP

3. What channels do the the pacemaker cells lack?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
No
Fast volatge gated Na channels
Unstable/crescendo angina

4. What is the machine like murmur? What is the heart pathology and the predisposing causes
Failure of LV to in CO during exercise
Patent ductus arteriosus - congenital rubella or prematurity
Decreased
Truncus - tet of fallot

5. list the coronary vessels most likely to be occluded
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Arteriorles
Eisenmenger's syndrome
LAD > RCA > circumflex

6. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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7. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
S. aureus
Postinfarction fibrinous pericarditis
Maintain blood flow to organ over wide range of perfussion pressures
In RA return (inspiration)

8. What are the diastolic heart sounds?
Preload
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Arteriorles
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

9. When during cardiac nodal cells depolarize?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
During diastole
Late diastolic murmur following an opening snap
Cystic hygroma

10. no relation between p waves and QRS intervals - treatment and predisposing factor
3rd degree block - pacemaker - Lyme disease
No
140/90
Increase in Pc

11. When do you see extensive coagulative necrosis in an MI
HypoK and bradycardia
Mitral valve prolapse
Systolic dysfunction
2-4 day - early coag necrosis on the first day

12. What are the different etiologies of dialted cardiomyopathy
Squat. Compression of femoral arteries - inc TPR - dec
Eisenmenger's syndrome
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

13. What is the S1 sound?
Inc interstitial osmotic pressure pulling fliud out of capillaries
3rd degree block - pacemaker - Lyme disease
Inc venous return exaccerbates pulm vasc congestion
Mitral and tricuspid closure

14. When do you find hemosiderin laden macrophages in the lungs?
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
ASD
During HF from microhemorrhages from inc pulm cap pressure
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

15. What causes ankle - sacral edema - jugular venous distention
No - no pressure gradient
...
RV failure - in venous pressure
Babies

16. bening capillary hemangioma of elderly - does not regress
Cherry hemangioma
Ventricular depolarization - nl < 120 msec
Medullary vasomotor center senses baroreceptors and JGA
CO

17. Irregularly irregular ECG - no p waves: dx and treatment
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
3rd degree block - pacemaker - Lyme disease
Volatage gated Ca channels
Hemorrhage

18. In the cardiac cycle - which period has the highest 02 consumption?
Aortic and pulmonary closing
Atrial contraction
Isovolumetric contraction
Hemorrhage

19. What is the formula for EF?
SV/ EDV
Yes
CFX
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

20. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Atrial contraction
Glomus tumor
LAD - V1 - V4
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

21. Which bacteria can cause endocarditis from prosthetic valves?
Activated histiocytes
S. epidermidis
Dressler's - autoimmune
P02

22. In what disease states is blood viscosity increased?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Metastasis from melanoma or lymphoma
Transmural

23. What does the starling curve show?
Atrial contraction
Aortic disecction - intraluminal tear forming false lumen
In parallel
Changes in CO as a function of preload

24. Why is contractility decreased in heart failure?
Vasocxn - while other tissues it causes vasodilation
Transfusion
Gap junctions
Systolic dysfunction

25. When and why do you hear the S4 sound
Mitral and tricuspid closure
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
RV failure - in venous pressure
5-10 days - macs have degraded structural components

26. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Mean arterial pressure
MI
Varicose veins - thromboembolism rare
In series

27. most common heart tumor
Coarcation of aorta
Metastasis from melanoma or lymphoma
Septal defects - PDA - pulm art stenosis
Increasing activity of Ca pump in SR

28. What is the gold standard for dx of MI in the first 6 hours
Increase - increase the chance the If are open
Sturge weber - vasculitis of caps
Granuloma with giant cells
EKG

29. What are the complications of atherosclerosis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Fluid movement through capillaries
Vagus to medulla
Babies

30. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
S. epidermidis
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Dec plasma proteins

31. with what heart sounds do ASD usually present?
Aortic dilation - bicuspid aortic valve - RF -
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Vasocxn
Pulmonary flow murmur and diastolic rumble

32. which heart valves are afected most in rheumatic heart diseease
Fick principle
Mitral>aortic>>tricuspid - high pressure valves affected most
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Takayasu's arteritis

33. Wegener's tx
Total anomalous pulmonary trunk venous return
Pulmonary flow murmur and diastolic rumble
Cyclophosphamide and corticosteroids
Cardiac tamponde

34. What does TAPVR stand for
Total anomalous pulmonary trunk venous return
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Left sided
Temporal arteritis

35. Which area of the endocardium is especially vulnerable to infarction? Why?
Prinzmetal angina
Arteriolosclerosis in malignant hypertension
Granuloma with giant cells
Subendocardial - fewer collaterals and higher pressure

36. Rank the pacemakers cells
SA>AV>bundle of His>ventricles
Dec P02 - inc PC02 and dec pH
...
Cystic hygroma

37. What does FAN MY SKIN On Wednesday stand for?
Inc central venous pressure - inc resistance to portal flow
Decrease in activity of Na/Ca exhanger and increase in contractility
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
The operating point of the heart

38. coronary artery spasm - ST elevation
Increase - increase the chance the If are open
Prinzmetal angina
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Pulse pressure

39. What is the association with wide S2 splitting?
2-4 day - early coag necrosis on the first day
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Pulmonic stenosis and RBBB
Resting potential high K perm

40. In terms of starling forces - why does heart failure cause edema?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Increase in Pc
Heart - 02 extraction is always around 100%
Left sided

41. 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 and pulmonary closing
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Left sided

42. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Transfusion
Infective endocarditis
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
EKG

43. What causes the cushing reflex and why
Dilated cardiomyopathy
PDA
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
V fib

44. The carotid sinus transmits along which nerve?
Subendocardial - fewer collaterals and higher pressure
Glossopharyngeal to soliary nucleus of medulla
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
HypoK and bradycardia

45. decrease stretch in baroreceptors leads to what response?
Failure of LV to in CO during exercise
Metastasis from melanoma or lymphoma
Rapid upstroke - voltage gated Na channels open
Increased efferent SANS and decreased efferent PANS

46. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
RCA - II - III - aVF
Stroke volume affected by contractility - afterload - and preload

47. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Kawasaki
LAD - V1- V2
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

48. Which vessels account for the most total peripheral resistance
MAP
Conduction delay through AV node - nl < 200 msec
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Arteriorles

49. How does digitatlis increase contractility?
Fetal right to left - neonate left to right leading to RVH and failure
Greater ventricular EDV
Increase intracellular Na - resulting in increased Ca
Vasocxn - while other tissues it causes vasodilation

50. What does FROM JANE stand for in bacterial endocarditis?

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