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Cardiology

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. Which class of drugs decreases afterload?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Vasodilators - (hydrAlAzine)
Preload
Aortic dilation - bicuspid aortic valve - RF -

2. If HR is too fast (V tach) what happens during diastole?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Filling is incomplete and CO falls
Age related calcifications or bicuspid aortic valve

3. What is the early and late lesion in rheumatic heart disease
Mitral valve prolapse
Dec plasma proteins
The aortic before pulmonic - inspiration increases diff
Aortic and pulmonary closing

4. The carotid sinus transmits along which nerve?
Henoch - Schlonlein purpura
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Glossopharyngeal to soliary nucleus of medulla
Infective endocarditis

5. What is associated with paradoxical spliting of S2
Proportional to viscosity and inversely proportional to the radius to the 4th power
Babies
Eccentric - concentric hypertrophy causes diastolic disfunction
Aortic stenosis or LBBB

6. What causes the cushing reflex and why
Yes
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Lower right - MC - upper right - AO - upper right AC - lower left MO

7. PROVe
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
10%
In RA return (inspiration)
Dilated cardiomyopathy

8. What do the starling forces determine
Raynaud's
3rd degree block - pacemaker - Lyme disease
Fluid movement through capillaries
Anterosuperior displacement of the infundibular septum

9. in the JVP - What is the v wave?
Increase contractility
Boot shaped heart
Inc RA pressure - due to filling against closed tricupsid valve
Persistant truncus arteriosus

10. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
During diastole
Mitral and tricuspid closure
Mean arterial pressure

11. Where is the most posterior portion of the heart and What can it cause?
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Left sided
Kidney

12. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Tricuspid atresia - requires ASD and VSD
Mechanican contraction of the ventricles
5-10 days - macs have degraded structural components
Inc venous return exaccerbates pulm vasc congestion

13. Which bacteria can cause endocarditis from prosthetic valves?
Inc Kf - capillary perm
S. epidermidis
SA and AV nodes
Vasocxn - while other tissues it causes vasodilation

14. congenital heart defect in an infant with a diabetic mother?
In RA return (inspiration)
Left heart failure
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Transposition of great vessels

15. The 7 complications of MI

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16. Which murmur is characteristic of mitral/tricuspid regurg?
Wegener's
Holosystoiic
Mechanican contraction of the ventricles
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

17. SV CAP means?
Stroke volume affected by contractility - afterload - and preload
P02
Metastasis from melanoma or lymphoma
Apex and anterior interventricular septum

18. What does the LAD supply?
Polyarteritis nodosum
Apex and anterior interventricular septum
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Afterload (proportional to peripheral resistance)

19. What constitues the upstroke in pacemaker cells?
Adult type aortic coarctation
No
The aortic before pulmonic - inspiration increases diff
Volatage gated Ca channels

20. Chronic mitral stenosis can lead to what changes in size of the LA
Dilation
MAP
LAD
Aburpt halting of valve leaflets

21. fibrinous pericarditis several weeks post MI

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22. Irregularly irregular ECG - no p waves: dx and treatment
Hypertrophied cardiomyopathy
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Prinzmetal angina

23. Left to right shunts are more common in babies or kids?
Tempral arteritis - may cause irreversible blindness
Hemorrhage
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Kids

24. moncekberg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Vasocxn
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
HTN - bradycardia - and respiratory depression

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

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26. coronary artery spasm - ST elevation
Lower right - MC - upper right - AO - upper right AC - lower left MO
Prinzmetal angina
Mitral valve prolapse
Varicose veins - thromboembolism rare

27. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
2-4 day - early coag necrosis on the first day
V fib arrhythima
In series
Stable angina

28. Which two mechanisms sense decrease MAP?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Medullary vasomotor center senses baroreceptors and JGA
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
10%

29. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Dilation
Acute thrombosis of coronary artery
Lymphangiosarcoma

30. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Group a beta hemolytic strep
Unstable/crescendo angina
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
During HF from microhemorrhages from inc pulm cap pressure

31. In an EKG - What is the T wave?
Ventricles are depolarized
Proportional to viscosity and inversely proportional to the radius to the 4th power
RCA - II - III - aVF
Ventricular repolarization

32. What happens in phase 3 of the cardiac ventricular action potential?
Inc interstitial osmotic pressure pulling fliud out of capillaries
Transmural
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Transfusion

33. What are the complications from bacterial endocarditis?
Aortic dilation - bicuspid aortic valve - RF -
TAPVR
Inc blood volume
Chordae rupture - GN - suppurative pericarditis - emboli

34. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Pulsus parvus and tardus - weak - can lead to syncope
Decrease in activity of Na/Ca exhanger and increase in contractility
Increase contractility
TAPVR

35. absecnce of tricuspid valve - hypoplastic RV
Increased efferent SANS and decreased efferent PANS
Ventricular repolarization
Polyarteritis nodosum
Tricuspid atresia - requires ASD and VSD

36. Why is there edema after burns or during infection
RF
Inc Kf - capillary perm
Dilated cardiomyopathy
Cyclophosphamide and corticosteroids

37. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Transfusion
Mechanican contraction of the ventricles
Postinfarction fibrinous pericarditis
Pos inotropy - exercise

38. p - anca

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39. in the JVP - What is the a wave?
C - ANCA
Left sided
140/90
Atrial contraction

40. Mitral stenosis is most often secondary to which condition?
Mitral valve
Non
Fast volatge gated Na channels
RF

41. Which class of drugs decrease preload
Venodilators (nitrogylcerine)
Decreased
Cardiac tamponde
Dilated cardiomyopathy

42. Wegener's presentation
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Greater ventricular EDV
Troponin I
MI

43. machine murmer
Aortic and pulmonary closing
PDA
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Inc venous return exaccerbates pulm vasc congestion

44. What is the gold standard for dx of MI in the first 6 hours
Myxomatous degeneration - RF - chordae rupture
Changes in CO as a function of preload
EKG
C - ANCA

45. When do you find hemosiderin laden macrophages in the lungs?
Henoch - Schlonlein purpura
Age related calcifications or bicuspid aortic valve
Decrease in cAMP
During HF from microhemorrhages from inc pulm cap pressure

46. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Increased efferent SANS and decreased efferent PANS
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Sturge weber - vasculitis of caps
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

47. What causes the CO curve to shift upwards?
1st degree AV blodck
CHF
Pos inotropy - exercise
RV failure - in venous pressure

48. What causes orthopnea?
5-10 days - macs have degraded structural components
Inc venous return exaccerbates pulm vasc congestion
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Volatage gated Ca channels

49. What are the 5 T's of cyanoitc babies
Septal defects - PDA - pulm art stenosis
MI
Kids
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

50. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Truncus - tet of fallot
Decrease in activity of Na/Ca exhanger and increase in contractility
Changes in CO as a function of preload
Non

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