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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. Where is the most posterior portion of the heart and What can it cause?
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Posterior descending (80% off the RCA - 20% off the circumflex)
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Heart - 02 extraction is always around 100%

2. Why is contractility decreased in heart failure?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Systolic dysfunction
No - no pressure gradient
Atherosclerosis

3. The 7 complications of MI

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4. 2/3 diastolic + 1/3 systolic
Venodilators (nitrogylcerine)
MAP
Pulmonic stenosis and RBBB
Increased efferent SANS and decreased efferent PANS

5. polypoid capillary hemangioma that can ulcerate and bleed
Pyogenic granuloma - associated with trauma and pregnancy
ASD - VSD - AV septal defect (endocardial cushion defect)
3rd degree block - pacemaker - Lyme disease
Atrial contraction

6. Which bacteria causes rheumatic heart disease
Volatage gated Ca channels
Group a beta hemolytic strep
TAPVR
Extracellular calcium - calcium induced calcium release

7. Exercise - overtransfusiion and excitiment causes and increase in...?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
At least 55%
Preload
Libman - sacks endocarditis

8. What causes the CO curve to shift upwards?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Patent ductus arteriosus - congenital rubella or prematurity
Increased efferent SANS and decreased efferent PANS
Pos inotropy - exercise

9. dyspnea - fatigue - edema and rales - multiple causes
Changes in CO as a function of preload
S. epidermidis
C - ANCA
CHF

10. fibrinous pericarditis several weeks post MI

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11. What other syndrom is associated with infantile aortic coarctation
Turners
Vasocxn
The aortic before pulmonic - inspiration increases diff
Yes

12. When does extracellular calcium enter the cardiac muscle cells during contraction?
Apex and anterior interventricular septum
Glomus tumor
The plateau period
Granuloma with giant cells

13. disease of elastic arteries and large and medium sized muscular arteries
Atherosclerosis
Kaposi's sarcoma
Inc central venous pressure - inc resistance to portal flow
In parallel

14. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Babies
Stroke volume
Black > white > asian
LV failure - pulm venous distention transudation of fluid

15. Which channel accounts for automaticity of the SA and AV nodes?
Decrease in cAMP
If sodium channel
Mitral>aortic>>tricuspid - high pressure valves affected most
Myxoma

16. The carotid sinus transmits along which nerve?
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Glossopharyngeal to soliary nucleus of medulla
Pulmonic stenosis and RBBB
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

17. Which sympathetic receptors raise MAP
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Unstable/crescendo angina
The aortic before pulmonic - inspiration increases diff
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

18. EDV is also known as
Preload
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Mitral valve

19. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Atrial contraction
...
Late diastolic murmur following an opening snap
P02

20. Hyperplastic onion skinning
In series
Arteriolosclerosis in malignant hypertension
Resting potential high K perm
No - no pressure gradient

21. What causes the murmur heard in tricuspid regurg to enhance
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Pyogenic granuloma - associated with trauma and pregnancy
In RA return (inspiration)
Atherosclerosis

22. which medications are used to maintain patency or close the ductus arteriosus?
Left atrial pressure
MI
RCA
Indomethacin closes - and pge keeps it open

23. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Fetal right to left - neonate left to right leading to RVH and failure
V fib
Truncus - tet of fallot
Hypertrophied cardiomyopathy

24. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Aortic disecction - intraluminal tear forming false lumen
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Inc interstitial osmotic pressure pulling fliud out of capillaries
Increase - increase the chance the If are open

25. Why is there edema after burns or during infection
Chordae rupture - GN - suppurative pericarditis - emboli
Medullary vasomotor center senses baroreceptors and JGA
QRS complex
Inc Kf - capillary perm

26. serum marker for wegener's
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Unstable/crescendo angina
2nd degree AV block - mobitz type 1
C - ANCA

27. What is associated with paradoxical spliting of S2
Wegener's
Posterior descending (80% off the RCA - 20% off the circumflex)
QRS complex
Aortic stenosis or LBBB

28. in the JVP - What is the c wave?
RV contraction (closed tricuspid valve bulding into atrium
RV failure - in venous pressure
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
1st degree AV blodck

29. What are the four most common locations for atherosclerosis?
Group a beta hemolytic strep
Stroke volume affected by contractility - afterload - and preload
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Tricuspid atresia - requires ASD and VSD

30. What is indicated when CO and venous return are equal?
The operating point of the heart
Truncus - tet of fallot
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Stable angina

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

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32. What is association with fixed S2 splitting - does not increase with inspiration
ASD
Transposition of great vessels
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Age related calcifications or bicuspid aortic valve

33. What does TAPVR stand for
Glomus tumor
Total anomalous pulmonary trunk venous return
Increase - increase the chance the If are open
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

34. congenital heart defect with turner's
Can progess to V fib
Coarcation of aorta
Stable angina
Pulse pressure

35. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Indomethacin closes - and pge keeps it open
Polyarteritis nodosum
P02
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

36. Fatal arrhythmia
V fib
5-10 days - macs have degraded structural components
Troponin I
Subendocardial - fewer collaterals and higher pressure

37. congenital heart defect with 22q11
EKG
Cyclophosphamide and corticosteroids
Mitral and tricuspid closure
Truncus - tet of fallot

38. What masks atrial repolarization?
QRS complex
Changes in CO as a function of preload
V fib arrhythima
RV contraction (closed tricuspid valve bulding into atrium

39. What is the S2 sound?
Transfusion
Dec plasma proteins
Increase - increase the chance the If are open
Aortic and pulmonary closing

40. Which two mechanisms sense decrease MAP?
Greater ventricular EDV
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Aortic disecction - intraluminal tear forming false lumen
Medullary vasomotor center senses baroreceptors and JGA

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

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42. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
5-10 days - macs have degraded structural components
Takayasu's arteritis
Torsades de pointes
TAPVR

43. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kawasaki
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
During diastole

44. When do you see extensive coagulative necrosis in an MI
The plateau period
2-4 day - early coag necrosis on the first day
CFX
Age related calcifications or bicuspid aortic valve

45. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Persistant truncus arteriosus
Hyperlipidemia
RCA - II - III - aVF
Early deaths from myocarditis

46. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
LAD
Aortic disecction - intraluminal tear forming false lumen
Medullary vasomotor center senses baroreceptors and JGA
Adult type aortic coarctation

47. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Hemorrhage
Black > white > asian
Acute thrombosis of coronary artery
Stroke volume affected by contractility - afterload - and preload

48. with what heart sounds do ASD usually present?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Pulmonary flow murmur and diastolic rumble
Hypertrophied cardiomyopathy

49. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Adult type aortic coarctation
Myxoma
Vasodilators
Fick principle

50. In an EKG - What is the QRS complex?
Afterload (proportional to peripheral resistance)
Ventricular depolarization - nl < 120 msec
Can progess to V fib
Tempral arteritis - may cause irreversible blindness