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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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1. What is the difference between adult and infantile type aortic coarctation?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Inc blood volume

2. What are the 5 T's of cyanoitc babies
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Mean arterial pressure
Eccentric - concentric hypertrophy causes diastolic disfunction
Subendocardial

3. Which murmur is characteristic of mitral/tricuspid regurg?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Eccentric - concentric hypertrophy causes diastolic disfunction
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Holosystoiic

4. What does prolonged QT predispose to?
RV contraction (closed tricuspid valve bulding into atrium
Prinzmetal angina
Torsades de pointes
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

5. list the coronary vessels most likely to be occluded
LAD > RCA > circumflex
Polyarteritis nodosum
Left heart failure
Cherry hemangioma

6. What is the classic X ray finding for tet of fallot?
HypoK and bradycardia
Boot shaped heart
Cyclophosphamide and corticosteroids
Myxoma

7. What causes tet of fallot?
Anterosuperior displacement of the infundibular septum
Maintain blood flow to organ over wide range of perfussion pressures
Atrial contraction
Filling is incomplete and CO falls

8. What causes the early cyanosis in Tet of Fallot?
R to L shunt caused by stenoic pulmonic valve
Age related calcifications or bicuspid aortic valve
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Ventricles are depolarized

9. What is the machine like murmur? What is the heart pathology and the predisposing causes
Crescendo - decrescendo systolic ejection murmur following ejection click
Patent ductus arteriosus - congenital rubella or prematurity
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Turners

10. How does angiotensin II raise MAP
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Vasocxn
140/90
Persistant truncus arteriosus

11. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Left sided
Rhabdomyomas
Myxoma
Inc Kf - capillary perm

12. Restrictive cardiomyopathy causes
RCA
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Turners
Kids

13. What are the complications of atherosclerosis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Hypertrophied cardiomyopathy
Vasocxn - while other tissues it causes vasodilation
Holosystoiic

14. How does a patient with Tet of fallot learn to improve symptoms?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Ischemic heart dz - mitral valve prolapse - LV dilation
Cystic hygroma
Squat. Compression of femoral arteries - inc TPR - dec

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

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16. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
Late systolic crescendo murmur with a midsystolic click
Boot shaped heart
Dec plasma proteins

17. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Maintain blood flow to organ over wide range of perfussion pressures
5-10 days - macs have degraded structural components
SA and AV nodes
Fetal right to left - neonate left to right leading to RVH and failure

18. Central chemoreceptors do not respond directly to which parameter?
CFX
P02
HypoK and bradycardia
Infective endocarditis

19. What are the four most common locations for atherosclerosis?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Greater ventricular EDV
V fib
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

20. What is the progression of atherosclerosis?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
MI
Hyperlipidemia
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

21. In an EKG - What is the QT interval?
Inc blood volume
Dilation
Mechanican contraction of the ventricles
2-4 day - early coag necrosis on the first day

22. In an EKG - What is the PR interval?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Conduction delay through AV node - nl < 200 msec
Inc RA pressure - due to filling against closed tricupsid valve
Can progess to V fib

23. in the JVP - What is the a wave?
Atrial contraction
Myxoma
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Chordae rupture - GN - suppurative pericarditis - emboli

24. which heart valves are afected most in rheumatic heart diseease
Pos inotropy - exercise
Mitral>aortic>>tricuspid - high pressure valves affected most
Arteriolosclerosis in malignant hypertension
CO

25. Which bacteria can cause endocarditis from prosthetic valves?
S. epidermidis
2-4 day - early coag necrosis on the first day
RV failure - in venous pressure
Subendocardial

26. What happens in phase 2 of the cardiac ventricular action potential?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Venodilators (nitrogylcerine)
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

27. What does mitral prolapse predeispose to?
Infective endocarditis
Subendocardial
Metastasis from melanoma or lymphoma
During diastole

28. Why is there edema after burns or during infection
Inc Kf - capillary perm
Cyclophosphamide and corticosteroids
Cardiac tamponde
Neg inotropy - HF - narcotic overdose

29. disease of elastic arteries and large and medium sized muscular arteries
Atherosclerosis
...
Ventricular repolarization
Kids

30. What channels do the the pacemaker cells lack?
Fast volatge gated Na channels
Microscopic polyangiitis - like wegener's without granulomas
V fib arrhythima
Unstable/crescendo angina

31. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Ischemic heart dz - mitral valve prolapse - LV dilation
Polyarteritis nodosum
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Fast volatge gated Na channels

32. congenital heart defect in an infant with a diabetic mother?
Transposition of great vessels
QRS complex
10%
Pyogenic granuloma - associated with trauma and pregnancy

33. Which organ has ht highest blood flow per gram of tissue
Venodilators (nitrogylcerine)
Eisenmenger's syndrome
Kidney
Inc RA pressure - due to filling against closed tricupsid valve

34. What causes aortic stenosis
Mechanican contraction of the ventricles
Kids
Atherosclerosis
Age related calcifications or bicuspid aortic valve

35. What causes the ejection click in the Cres - decres murmur?
Aburpt halting of valve leaflets
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Hyperlipidemia
Pos inotropy - exercise

36. Which lab value indicates blood viscosity?
Pos inotropy - exercise
Libman - sacks endocarditis
Hematocrit
Hyperlipidemia

37. Which organ has the largest arteriovenous difference
Wolff - Parkinson white syndrome
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
MI
Heart - 02 extraction is always around 100%

38. What causes the murmur heard in tricuspid regurg to enhance
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Squat. Compression of femoral arteries - inc TPR - dec
In RA return (inspiration)
Angiosarcoma

39. sawtooth wave

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40. Which murmur do you hear in mitral stenosis?
Aburpt halting of valve leaflets
5-10 days - macs have degraded structural components
Arteriorles
Late diastolic murmur following an opening snap

41. What is the cushing triad?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Volatage gated Ca channels
HTN - bradycardia - and respiratory depression
Inc TPR and LA return (expiration)

42. tearing chest pain radiation to the back - associated with marfan
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
LAD > RCA > circumflex
Aortic disecction - intraluminal tear forming false lumen
Indomethacin closes - and pge keeps it open

43. When and why do you hear the S4 sound
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
ASD - VSD - AV septal defect (endocardial cushion defect)
Ischemic heart dz - mitral valve prolapse - LV dilation
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

44. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
LCX - I - aVL
Unstable/crescendo angina
Henoch - Schlonlein purpura
2-4 day - early coag necrosis on the first day

45. In an anterior wall infarct - which artery is effected and which leads show Q waves
LAD - V1 - V4
Hyperlipidemia
In series
Ventricular repolarization

46. What does the U wave indicated?
Group a beta hemolytic strep
HypoK and bradycardia
Venodilators (nitrogylcerine)
Mean arterial pressure

47. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Right sided
Decreases
7 weeks
Afterload (proportional to peripheral resistance)

48. What are common causes of mitral regurg?
TAPVR
Ischemic heart dz - mitral valve prolapse - LV dilation
LAD > RCA > circumflex
Hematocrit

49. What other syndrom is associated with infantile aortic coarctation
Kawasaki
TAPVR
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Turners

50. Which channel accounts for automaticity of the SA and AV nodes?
Truncus - tet of fallot
QRS complex
C - ANCA
If sodium channel