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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. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Troponin I
Polyarteritis nodosum
Ischemic heart dz - mitral valve prolapse - LV dilation
Ventricles are depolarized

2. bening capillary hemangioma of elderly - does not regress
Kaposi's sarcoma
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Rapid upstroke - voltage gated Na channels open
Cherry hemangioma

3. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Proportional to viscosity and inversely proportional to the radius to the 4th power
CO
5-10 days - macs have degraded structural components
2-4 day - early coag necrosis on the first day

4. Right to left shunts are more common in babies or kids?
Mitral valve prolapse
Proportional to viscosity and inversely proportional to the radius to the 4th power
Babies
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

5. How are sarcomeres added in concentric hypertrophy?
In parallel
MI
Inc interstitial osmotic pressure pulling fliud out of capillaries
Polyarteritis nodosum

6. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Eccentric - concentric hypertrophy causes diastolic disfunction
Non
Kawasaki
Vagus to medulla

7. When and why do you hear the S4 sound
Left atrial pressure
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Anterosuperior displacement of the infundibular septum
Stroke volume affected by contractility - afterload - and preload

8. What does FEVERSS stand for in rheumatic heart disease
Subendocardial
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Temporal arteritis
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

9. sawtooth wave

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10. What are the complications of atherosclerosis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Vasocxn - while other tissues it causes vasodilation
Maintain blood flow to organ over wide range of perfussion pressures
Black > white > asian

11. moncekberg
Neg inotropy - HF - narcotic overdose
Mitral valve prolapse
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Aortic and pulmonary closing

12. Why is there edema after burns or during infection
Inc Kf - capillary perm
In RA return (inspiration)
ASD - VSD - AV septal defect (endocardial cushion defect)
Increased efferent SANS and decreased efferent PANS

13. Which murmur do you hear in mitral stenosis?
Vasodilators
Increase in Pc
Non
Late diastolic murmur following an opening snap

14. When during cardiac nodal cells depolarize?
During diastole
Granuloma with giant cells
Eisenmenger's syndrome
Inc TPR and LA return (expiration)

15. In an EKG - What is the QT interval?
Decreases
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Sudden tensing of chordae tendinae
Mechanican contraction of the ventricles

16. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Glossopharyngeal to soliary nucleus of medulla
Late diastolic murmur following an opening snap
Failure of LV to in CO during exercise
Viridans streptococci

17. In an EKG - What is the QRS complex?
Age related calcifications or bicuspid aortic valve
Ventricular depolarization - nl < 120 msec
LAD
7 weeks

18. In an anterior wall infarct - which artery is effected and which leads show Q waves
LAD - V1 - V4
Inc central venous pressure - inc resistance to portal flow
V fib
Ventricles are depolarized

19. Restrictive cardiomyopathy causes
Increasing activity of Ca pump in SR
Ventricular depolarization - nl < 120 msec
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Vasocxn - while other tissues it causes vasodilation

20. What happens in phase 4 of the cardiac ventricular action potential?
Resting potential high K perm
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Inc RA pressure - due to filling against closed tricupsid valve
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

21. In an EKG - What is the T wave?
Ventricular repolarization
Viridans streptococci
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Transfusion

22. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Stable angina
Transfusion
Arteriolosclerosis in malignant hypertension
Microscopic polyangiitis - like wegener's without granulomas

23. What is the result of not have fast sodium channels in pacemaker cells?
Venodilators (nitrogylcerine)
Age related calcifications or bicuspid aortic valve
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Truncus - tet of fallot

24. 2/3 diastolic + 1/3 systolic
Temporal arteritis
Inc central venous pressure - inc resistance to portal flow
Aburpt halting of valve leaflets
MAP

25. What is the machine like murmur? What is the heart pathology and the predisposing causes
RF
Henoch - Schlonlein purpura
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Patent ductus arteriosus - congenital rubella or prematurity

26. Left to right shunts are more common in babies or kids?
PDA
Ventricles are depolarized
Adult type aortic coarctation
Kids

27. what conditions are associated with pulsus paradoxus
In series
Rapid upstroke - voltage gated Na channels open
The first 4 days
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

28. What does the atria release in response to inc blood volume and atrial pressure
In series
Subendocardial - fewer collaterals and higher pressure
ANP
Inc interstitial osmotic pressure pulling fliud out of capillaries

29. What cardiac change occurs in pregnancy?
Late diastolic murmur following an opening snap
Increased SV
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Buerger's disease

30. What is the formula for EF?
Vasocxn - while other tissues it causes vasodilation
SV/ EDV
Eisenmenger's syndrome
Purkingee>atria>ventricles>AV node

31. What causes the CO curve to shift upwards?
Unstable/crescendo angina
Hemorrhage
Pos inotropy - exercise
Fluid movement through capillaries

32. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Arteriolosclerosis in malignant hypertension
Wolff - Parkinson white syndrome
Activated histiocytes
Inc central venous pressure - inc resistance to portal flow

33. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
C - ANCA
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

34. What is the difference between adult and infantile type aortic coarctation?
Varicose veins - thromboembolism rare
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
EKG
Transposition of great vessels

35. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
No - no pressure gradient
Pos inotropy - exercise
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Mitral stenosis

36. What is the characteristic pulse in aortic stenosis?
Heart - 02 extraction is always around 100%
Infective endocarditis
Pulsus parvus and tardus - weak - can lead to syncope
Non

37. necrotizing granulomas in lung and upper airways - nectrotizing GN - small vessel vasculitis

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38. PROVe
Hyperlipidemia
Raynaud's
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

39. What is a normal EF
At least 55%
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Rhabdomyomas
Anterosuperior displacement of the infundibular septum

40. polypoid capillary hemangioma that can ulcerate and bleed
Glomus tumor
Septal defects - PDA - pulm art stenosis
Increase - increase the chance the If are open
Pyogenic granuloma - associated with trauma and pregnancy

41. What is associated with paradoxical spliting of S2
Adult type aortic coarctation
Aortic stenosis or LBBB
Late systolic crescendo murmur with a midsystolic click
Total anomalous pulmonary trunk venous return

42. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Patent ductus arteriosus - congenital rubella or prematurity
MI
Decreases
Subendocardial

43. In normal S2 splitting - which valve closes first? What increases it?
LAD - V1 - V4
Sturge weber - vasculitis of caps
The aortic before pulmonic - inspiration increases diff
Turners

44. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
In HF
Hyperlipidemia
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

45. in the JVP - What is the c wave?
Failure of LV to in CO during exercise
RV contraction (closed tricuspid valve bulding into atrium
Cardiac tamponde
Mitral and tricuspid closure

46. what happens to capillaries in lymphatic blockage
Squat. Compression of femoral arteries - inc TPR - dec
Stroke volume affected by contractility - afterload - and preload
Inc interstitial osmotic pressure pulling fliud out of capillaries
Right sided

47. clinical signs of cardiac tamponade
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Postinfarction fibrinous pericarditis
5-10 days - macs have degraded structural components

48. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Mechanican contraction of the ventricles
1st degree AV blodck
Lymphangiosarcoma
Aortic stenosis or LBBB

49. How does digitatlis increase contractility?
Increase intracellular Na - resulting in increased Ca
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Proportional to viscosity and inversely proportional to the radius to the 4th power
Left heart failure

50. Which kind of infarct show ST elevation - and/or pathologic Q waves
Transmural
Anterosuperior displacement of the infundibular septum
SA>AV>bundle of His>ventricles
Inc RA pressure - due to filling against closed tricupsid valve