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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. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Lymphangiosarcoma
Vasodilators - (hydrAlAzine)
LCX - I - aVL
Increased efferent SANS and decreased efferent PANS

2. What is the early and late lesion in rheumatic heart disease
Pulmonary flow murmur and diastolic rumble
Lymphangiosarcoma
Mitral valve prolapse
Increase intracellular Na - resulting in increased Ca

3. The cause of dyspnea on exertion?
The operating point of the heart
Acute thrombosis of coronary artery
Activated histiocytes
Failure of LV to in CO during exercise

4. coronary artery spasm - ST elevation
3rd degree block - pacemaker - Lyme disease
Prinzmetal angina
Subendocardial
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

5. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
LAD > RCA > circumflex
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
LV failure - pulm venous distention transudation of fluid

6. What does hypoxia cause in the lung versus other tissues?
LAD > RCA > circumflex
Proportional to viscosity and inversely proportional to the radius to the 4th power
Vasocxn - while other tissues it causes vasodilation
Fetal right to left - neonate left to right leading to RVH and failure

7. In an anterolateral infarct - which artery is effected and which leads show Q waves
Fetal right to left - neonate left to right leading to RVH and failure
The operating point of the heart
Hemorrhage
LCX - V4- V6

8. friction rub - 3-5 days post MI
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Postinfarction fibrinous pericarditis
Eisenmenger's syndrome
CK- MB

9. What are the systolic heart sounds
LAD > RCA > circumflex
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Aortic dilation - bicuspid aortic valve - RF -
Sturge weber - vasculitis of caps

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

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11. The aortic arch receptors transmit along which nerve?
ASD - VSD - AV septal defect (endocardial cushion defect)
Vagus to medulla
3rd degree block - pacemaker - Lyme disease
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

12. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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13. What does TAPVR stand for
Total anomalous pulmonary trunk venous return
Atherosclerosis
In RA return (inspiration)
Metastasis from melanoma or lymphoma

14. The carotid sinus transmits along which nerve?
CHF
Venodilators (nitrogylcerine)
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Glossopharyngeal to soliary nucleus of medulla

15. Why is contractility decreased in heart failure?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Pulsus parvus and tardus - weak - can lead to syncope
Systolic dysfunction

16. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Strawberry hemangioma
V fib arrhythima
Group a beta hemolytic strep
TAPVR

17. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Angiosarcoma
Persistant truncus arteriosus
Atherosclerosis
Hypertrophied cardiomyopathy

18. What do the starling forces determine
10%
Fluid movement through capillaries
2-4 day - early coag necrosis on the first day
Myxoma

19. What cardiac change occurs in pregnancy?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
V fib
Increased SV

20. Why is there edema after burns or during infection
Tricuspid atresia - requires ASD and VSD
LAD
Inc Kf - capillary perm
Inc blood volume

21. Restrictive cardiomyopathy causes
Neg inotropy - HF - narcotic overdose
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Inc central venous pressure - inc resistance to portal flow
RV contraction (closed tricuspid valve bulding into atrium

22. no change in PR interval followed by dropped beat
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Increased SV
Eisenmenger's syndrome
Yes

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

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24. Which murmur is heard with VSD?
Increase in Pc
Kaposi's sarcoma
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Unstable/crescendo angina

25. In an EKG - What is the PR interval?
Babies
Failure of LV to in CO during exercise
Late systolic crescendo murmur with a midsystolic click
Conduction delay through AV node - nl < 200 msec

26. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
R to L shunt caused by stenoic pulmonic valve
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
3rd degree block - pacemaker - Lyme disease

27. decrease stretch in baroreceptors leads to what response?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Hemorrhage
2-4 day - early coag necrosis on the first day
Increased efferent SANS and decreased efferent PANS

28. Which organ has the largest arteriovenous difference
Lower right - MC - upper right - AO - upper right AC - lower left MO
Subendocardial - fewer collaterals and higher pressure
Heart - 02 extraction is always around 100%
Maintain blood flow to organ over wide range of perfussion pressures

29. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Non
Unstable/crescendo angina
Atrial contraction
Decrease in cAMP

30. Where does coronary artery occlusion occur most commonly?
LAD
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Transfusion
Inc interstitial osmotic pressure pulling fliud out of capillaries

31. What are anitschkow's cells
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Torsades de pointes
Gap junctions
Activated histiocytes

32. Which class of drugs decrease the murmur heard in aortic regurg?
Coarcation of aorta
Fast volatge gated Na channels
Wegener's
Vasodilators

33. How are the sarcomeres added in eccentric hypertrophy?
EKG
In series
Group a beta hemolytic strep
Hematocrit

34. What causes ankle - sacral edema - jugular venous distention
RV failure - in venous pressure
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Right sided
Squat. Compression of femoral arteries - inc TPR - dec

35. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
2nd degree AV block - mobitz type 1
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Aortic disecction - intraluminal tear forming false lumen
Kawasaki

36. Which murmur is heard with mitral prolapse?
Adult type aortic coarctation
Late systolic crescendo murmur with a midsystolic click
Apex and anterior interventricular septum
Chordae rupture - GN - suppurative pericarditis - emboli

37. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Hemorrhage
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
In RA return (inspiration)

38. What 4 things drive myocardial 02 demand?
Glossopharyngeal to soliary nucleus of medulla
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Ischemic heart dz - mitral valve prolapse - LV dilation
Transmural

39. EDV - ESV
S. bovis
Early deaths from myocarditis
Black > white > asian
Stroke volume

40. list the coronary vessels most likely to be occluded
Aortic disecction - intraluminal tear forming false lumen
LAD > RCA > circumflex
Dilation
LAD - V1 - V4

41. CO x Total peripheral resistance
Neg inotropy - HF - narcotic overdose
Conduction delay through AV node - nl < 200 msec
Mean arterial pressure
Septal defects - PDA - pulm art stenosis

42. Which vessels account for the most total peripheral resistance
Mitral stenosis
Aortic stenosis or LBBB
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Arteriorles

43. pulseless disease - granulomatous thickening of the aortic arch and/or proximal great vessels - elev ESR - asian females > 40

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44. What is a normal EF
Early deaths from myocarditis
During diastole
At least 55%
Postinfarction fibrinous pericarditis

45. congenital heart defect withdown syndrome
Rapid upstroke - voltage gated Na channels open
S. epidermidis
10%
ASD - VSD - AV septal defect (endocardial cushion defect)

46. What constitues the upstroke in pacemaker cells?
Sudden tensing of chordae tendinae
If sodium channel
Wolff - Parkinson white syndrome
Volatage gated Ca channels

47. PCWP > LV diastolic pressure
Inc RA pressure - due to filling against closed tricupsid valve
Eccentric - concentric hypertrophy causes diastolic disfunction
Mitral stenosis
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

48. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Sturge weber - vasculitis of caps
Can progess to V fib
Mean arterial pressure
Transposition of great vessels

49. Right to left shunts are more common in babies or kids?
Raynaud's
Mean arterial pressure
Prinzmetal angina
Babies

50. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Libman - sacks endocarditis
Hyperlipidemia
10%
Unstable/crescendo angina