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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. Which bacteria causes rheumatic heart disease
Neg inotropy - HF - narcotic overdose
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
MI
Group a beta hemolytic strep

2. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Decrease in activity of Na/Ca exhanger and increase in contractility
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
P02
S. aureus

3. Most common vasculitis affecting medium and large arteries
Decrease in cAMP
Late diastolic murmur following an opening snap
Temporal arteritis
Early deaths from myocarditis

4. EDV - ESV
Anterosuperior displacement of the infundibular septum
Ventricles are depolarized
Stroke volume
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

5. Where does coronary artery occlusion occur most commonly?
Acute thrombosis of coronary artery
Kids
Arteriorles
LAD

6. When does EF decrease
Left sided
In HF
Granuloma with giant cells
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

7. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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8. What are the complications from bacterial endocarditis?
R to L shunt caused by stenoic pulmonic valve
Raynaud's
10%
Chordae rupture - GN - suppurative pericarditis - emboli

9. How does a patient with Tet of fallot learn to improve symptoms?
Strawberry hemangioma
Squat. Compression of femoral arteries - inc TPR - dec
Cardiac tamponde
The first 4 days

10. most common primary cardiac tumor in children - associated with tuberous sclerosis
Rhabdomyomas
Failure of LV to in CO during exercise
Decrease in cAMP
Atrial contraction

11. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
3rd degree block - pacemaker - Lyme disease
Fetal right to left - neonate left to right leading to RVH and failure
Atrial contraction
Increasing activity of Ca pump in SR

12. What happends in phase 1 of the ventricular cardiac action potential?
HypoK and bradycardia
Systolic dysfunction
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Pulsus parvus and tardus - weak - can lead to syncope

13. How does aldosterone raise MAP
Inc blood volume
EKG
Aortic/pulmonic regurg and mitral/tricuspid stenosis
In series

14. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Age related calcifications or bicuspid aortic valve
The operating point of the heart
Ischemic heart dz - mitral valve prolapse - LV dilation
Myxoma

15. What are aschoff bodies
2nd degree AV block - mobitz type 1
Kidney
Granuloma with giant cells
Infective endocarditis

16. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Stable angina
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Neg inotropy - HF - narcotic overdose
Can progess to V fib

17. Which class of drugs decreases afterload?
Filling is incomplete and CO falls
Vasodilators - (hydrAlAzine)
CHF
2nd degree AV block - mobitz type 1

18. PCWP > LV diastolic pressure
During diastole
Tricuspid atresia - requires ASD and VSD
Lower right - MC - upper right - AO - upper right AC - lower left MO
Mitral stenosis

19. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
10%
Pos inotropy - exercise
Lymphangiosarcoma
Aortic stenosis or LBBB

20. most common heart tumor
Metastasis from melanoma or lymphoma
Greater ventricular EDV
Cardiac tamponde
Infective endocarditis

21. What masks atrial repolarization?
QRS complex
Increased SV
Inc RA pressure - due to filling against closed tricupsid valve
Wolff - Parkinson white syndrome

22. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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23. How do beta blockers decrease contractility?
Mean arterial pressure
Decrease in cAMP
2-4 day - early coag necrosis on the first day
Medullary vasomotor center senses baroreceptors and JGA

24. what conditions are associated with pulsus paradoxus
CHF
V fib
Increased efferent SANS and decreased efferent PANS
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

25. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Failure of LV to in CO during exercise
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Ischemic heart dz - mitral valve prolapse - LV dilation
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

26. What kind of infarct show ST depression
Subendocardial
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Group a beta hemolytic strep

27. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Cyclophosphamide and corticosteroids
Sturge weber - vasculitis of caps
LAD - V1- V2
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

28. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Apex and anterior interventricular septum
Ventricles are depolarized

29. How are cadiac myocytes eltrically coupled?
Stroke volume affected by contractility - afterload - and preload
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Gap junctions
The operating point of the heart

30. Left to right shunts are more common in babies or kids?
Kids
Pulse pressure
Eccentric - concentric hypertrophy causes diastolic disfunction
RV failure - in venous pressure

31. How does angiotensin II raise MAP
V fib arrhythima
Failure of LV to in CO during exercise
2nd degree AV block - mobitz type 1
Vasocxn

32. Which organ gets the largest share of systemic cardiac output
During diastole
Liver
Wolff - Parkinson white syndrome
Truncus - tet of fallot

33. How are sarcomeres added in concentric hypertrophy?
C - ANCA
QRS complex
In parallel
Subendocardial - fewer collaterals and higher pressure

34. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Transposition of great vessels
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Increased SV
Unstable/crescendo angina

35. Expiration causes an increase in which sided heart sounds
Squat. Compression of femoral arteries - inc TPR - dec
RF
Left sided
Rhabdomyomas

36. Which channel accounts for automaticity of the SA and AV nodes?
ASD
SA and AV nodes
If sodium channel
Ventricles are depolarized

37. coronary artery spasm - ST elevation
Prinzmetal angina
Afterload (proportional to peripheral resistance)
Polyarteritis nodosum
3rd degree block - pacemaker - Lyme disease

38. no relation between p waves and QRS intervals - treatment and predisposing factor
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Aortic stenosis or LBBB
3rd degree block - pacemaker - Lyme disease

39. serum marker for wegener's
Arteriorles
C - ANCA
CO
Glomus tumor

40. failure of truncus arteriosus to divide?
Vasocxn - while other tissues it causes vasodilation
Persistant truncus arteriosus
Temporal arteritis
Hyperlipidemia

41. What does an isoelectric ST segment indicate?
Microscopic polyangiitis - like wegener's without granulomas
Patent ductus arteriosus - congenital rubella or prematurity
Ventricles are depolarized
Metastasis from melanoma or lymphoma

42. systolic - diastolic
Wegener's
Lymphangiosarcoma
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Pulse pressure

43. Which sympathetic receptors raise MAP
Changes in CO as a function of preload
Group a beta hemolytic strep
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
LAD - V1 - V4

44. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Sturge weber - vasculitis of caps
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Decreased
RV failure - in venous pressure

45. congenital heart defect with congenital rubella
5-10 days - macs have degraded structural components
Septal defects - PDA - pulm art stenosis
Proportional to viscosity and inversely proportional to the radius to the 4th power
Aortic stenosis or LBBB

46. What kind of dysfunction ensues in restrictive cardiomyopathy
Cystic hygroma
Conduction delay through AV node - nl < 200 msec
Heart - 02 extraction is always around 100%
Diastolic

47. What are the diastolic heart sounds?
10%
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Pulsus parvus and tardus - weak - can lead to syncope
Preload

48. The carotid sinus transmits along which nerve?
Rapid upstroke - voltage gated Na channels open
Glossopharyngeal to soliary nucleus of medulla
Stroke volume affected by contractility - afterload - and preload
Increased efferent SANS and decreased efferent PANS

49. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Libman - sacks endocarditis
Takayasu's arteritis
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Left sided

50. If HR is too fast (V tach) what happens during diastole?
Filling is incomplete and CO falls
RF
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
3rd degree block - pacemaker - Lyme disease