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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. PROVe
140/90
Microscopic polyangiitis - like wegener's without granulomas
Vasodilators
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

2. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Ventricular depolarization - nl < 120 msec
Fetal right to left - neonate left to right leading to RVH and failure
Kidney
QRS complex

3. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
1st degree AV blodck
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
TAPVR
Tempral arteritis - may cause irreversible blindness

4. What is the S1 sound?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
EKG
Mitral and tricuspid closure
At least 55%

5. In what disease states is blood viscosity increased?
Dressler's - autoimmune
Pos inotropy - exercise
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
HypoK and bradycardia

6. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
140/90
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
MI
Viridans streptococci

7. How do beta blockers decrease contractility?
V fib arrhythima
Decrease in cAMP
V fib
Neg inotropy - HF - narcotic overdose

8. congenital heart defect in an infant with a diabetic mother?
Transposition of great vessels
Varicose veins - thromboembolism rare
Proportional to viscosity and inversely proportional to the radius to the 4th power
CK- MB

9. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Angiosarcoma
Inc TPR and LA return (expiration)
V fib arrhythima
MI

10. What is the characteristic pulse in aortic stenosis?
Medullary vasomotor center senses baroreceptors and JGA
Polyarteritis nodosum
7 weeks
Pulsus parvus and tardus - weak - can lead to syncope

11. What does the U wave indicated?
LCX - V4- V6
HypoK and bradycardia
Increasing activity of Ca pump in SR
Fluid movement through capillaries

12. What is the classic X ray finding for tet of fallot?
Boot shaped heart
Vasodilators
Myxoma
CK- MB

13. What is sudden cardiac death most commonly due to...
LCX - V4- V6
Atherosclerosis
Babies
V fib arrhythima

14. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Fluid movement through capillaries
Hypertrophied cardiomyopathy
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Postinfarction fibrinous pericarditis

15. Most common vasculitis affecting medium and large arteries
MI
Indomethacin closes - and pge keeps it open
Temporal arteritis
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

16. Which murmur is characteristic of mitral/tricuspid regurg?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
If sodium channel
Prinzmetal angina
Holosystoiic

17. list the coronary vessels most likely to be occluded
Dilation
LAD > RCA > circumflex
Coarcation of aorta
Increased SV

18. What is the formula for EF?
Heart - 02 extraction is always around 100%
SV/ EDV
LAD > RCA > circumflex
Truncus - tet of fallot

19. what conditions are associated with pulsus paradoxus
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Aortic disecction - intraluminal tear forming false lumen
CO
Persistant truncus arteriosus

20. Which class of drugs decreases afterload?
Rhabdomyomas
Can progess to V fib
Inc venous return exaccerbates pulm vasc congestion
Vasodilators - (hydrAlAzine)

21. What causes orthopnea?
Vasodilators - (hydrAlAzine)
Inc Kf - capillary perm
10%
Inc venous return exaccerbates pulm vasc congestion

22. What 4 things drive myocardial 02 demand?
140/90
Tricuspid atresia - requires ASD and VSD
Unstable/crescendo angina
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

23. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Glomus tumor
Anterosuperior displacement of the infundibular septum
RCA
Posterior descending (80% off the RCA - 20% off the circumflex)

24. What does autoregulation do?
Maintain blood flow to organ over wide range of perfussion pressures
Aortic disecction - intraluminal tear forming false lumen
Inc venous return exaccerbates pulm vasc congestion
Non

25. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Age related calcifications or bicuspid aortic valve
Fick principle
Hematocrit
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

26. Which two mechanisms sense decrease MAP?
Sturge weber - vasculitis of caps
Medullary vasomotor center senses baroreceptors and JGA
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
R to L shunt caused by stenoic pulmonic valve

27. What are common causes of mitral regurg?
Increase in Pc
Henoch - Schlonlein purpura
Ischemic heart dz - mitral valve prolapse - LV dilation
TAPVR

28. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
During diastole
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Myxoma

29. What causes ankle - sacral edema - jugular venous distention
Increased SV
RV failure - in venous pressure
SA>AV>bundle of His>ventricles
Eccentric - concentric hypertrophy causes diastolic disfunction

30. SV CAP means?
Heart - 02 extraction is always around 100%
Medullary vasomotor center senses baroreceptors and JGA
Volatage gated Ca channels
Stroke volume affected by contractility - afterload - and preload

31. In an anterior wall infarct - which artery is effected and which leads show Q waves
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Arteriolosclerosis in malignant hypertension
LAD - V1 - V4
Eisenmenger's syndrome

32. Which vessels account for the most total peripheral resistance
The first 4 days
Increased efferent SANS and decreased efferent PANS
Increase intracellular Na - resulting in increased Ca
Arteriorles

33. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
Crescendo - decrescendo systolic ejection murmur following ejection click
Posterior descending (80% off the RCA - 20% off the circumflex)
Henoch - Schlonlein purpura

34. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Transfusion
Liver
Aortic disecction - intraluminal tear forming false lumen
Pos inotropy - exercise

35. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Sturge weber - vasculitis of caps
Preload
RV failure - in venous pressure
Takayasu's arteritis

36. Which enzymes are useful for diagnosing reinfarction
Varicose veins - thromboembolism rare
CK- MB
Hematocrit
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

37. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Early deaths from myocarditis
No
MAP
Transmural

38. serum marker for wegener's
Pulmonic stenosis and RBBB
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
C - ANCA

39. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Gap junctions
During diastole
SV/ EDV
Hyperlipidemia

40. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Failure of LV to in CO during exercise
Lymphangiosarcoma
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Posterior descending (80% off the RCA - 20% off the circumflex)

41. When does EF decrease
In HF
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Fluid movement through capillaries
Aortic/pulmonic regurg and mitral/tricuspid stenosis

42. What causes the midsystolic click
Sudden tensing of chordae tendinae
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Vasocxn

43. exaggerated decrease in pulse during inspiration.

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44. What is the association with wide S2 splitting?
Inc RA pressure - due to filling against closed tricupsid valve
Left sided
Pulmonic stenosis and RBBB
Stroke volume affected by contractility - afterload - and preload

45. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Coarcation of aorta
Henoch - Schlonlein purpura
No - no pressure gradient
Filling is incomplete and CO falls

46. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
10%
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Yes
Wolff - Parkinson white syndrome

47. What does the LAD supply?
Transposition of great vessels
Lymphangiosarcoma
Apex and anterior interventricular septum
During diastole

48. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Troponin I
Atherosclerosis
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

49. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Microscopic polyangiitis - like wegener's without granulomas
LAD - V1- V2
Resting potential high K perm
Conduction delay through AV node - nl < 200 msec

50. What do the starling forces determine
LAD
Increase in Pc
CO
Fluid movement through capillaries