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Cardiology

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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 result of not have fast sodium channels in pacemaker cells?
Mitral and tricuspid closure
Glomus tumor
PDA
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

2. What does the atria release in response to inc blood volume and atrial pressure
ANP
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
EKG
Fetal right to left - neonate left to right leading to RVH and failure

3. Which bacteria causes endocarditis in the presence of colon cancer
Inc venous return exaccerbates pulm vasc congestion
Chordae rupture - GN - suppurative pericarditis - emboli
Fick principle
S. bovis

4. What 4 things drive myocardial 02 demand?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
If sodium channel
Chordae rupture - GN - suppurative pericarditis - emboli
Truncus - tet of fallot

5. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Squat. Compression of femoral arteries - inc TPR - dec
ASD
Polyarteritis nodosum
Decreases

6. Hyperplastic onion skinning
Arteriolosclerosis in malignant hypertension
Atrial contraction
At least 55%
Squat. Compression of femoral arteries - inc TPR - dec

7. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2nd degree AV block - mobitz type 1
If sodium channel
Kids
Inc Kf - capillary perm

8. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
No
MI
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Buerger's disease

9. What happens in phase 4 of the cardiac ventricular action potential?
Resting potential high K perm
No - no pressure gradient
Isovolumetric contraction
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

10. What happends in phase 1 of the ventricular cardiac action potential?
Raynaud's
ANP
Can progess to V fib
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

11. most common primary cardiac tumor in children - associated with tuberous sclerosis
Troponin I
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Arteriolosclerosis in malignant hypertension
Rhabdomyomas

12. Which vessels account for the most total peripheral resistance
Apex and anterior interventricular septum
Dec P02 - inc PC02 and dec pH
Mitral valve
Arteriorles

13. which medications are used to maintain patency or close the ductus arteriosus?
Eisenmenger's syndrome
Indomethacin closes - and pge keeps it open
Sturge weber - vasculitis of caps
Septal defects - PDA - pulm art stenosis

14. What is the S1 sound?
140/90
During HF from microhemorrhages from inc pulm cap pressure
Mitral and tricuspid closure
Maintain blood flow to organ over wide range of perfussion pressures

15. What kind of infarct show ST depression
Subendocardial
If sodium channel
Libman - sacks endocarditis
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

16. When and why do you hear the S4 sound
CO
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Fetal right to left - neonate left to right leading to RVH and failure
Rapid upstroke - voltage gated Na channels open

17. absecnce of tricuspid valve - hypoplastic RV
Fick principle
Polyarteritis nodosum
Tricuspid atresia - requires ASD and VSD
Aortic and pulmonary closing

18. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Changes in CO as a function of preload
Increase in Pc
Can progess to V fib
Polyarteritis nodosum

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

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20. How are the sarcomeres added in eccentric hypertrophy?
In series
Can progess to V fib
Volatage gated Ca channels
Kidney

21. machine murmer
Varicose veins - thromboembolism rare
Changes in CO as a function of preload
PDA
Late systolic crescendo murmur with a midsystolic click

22. clinical signs of cardiac tamponade
Decrease in cAMP
In parallel
EKG
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

23. How do catecholamines increase contractility?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
LAD - V1- V2
Increasing activity of Ca pump in SR
Turners

24. congenital heart defect withdown syndrome
Lymphangiosarcoma
ASD - VSD - AV septal defect (endocardial cushion defect)
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Atrial contraction

25. What causes the CO curve to shift upwards?
Pos inotropy - exercise
Infective endocarditis
Preload
Gap junctions

26. In an EKG - What is the QRS complex?
Ventricular depolarization - nl < 120 msec
Decrease in activity of Na/Ca exhanger and increase in contractility
Squat. Compression of femoral arteries - inc TPR - dec
Mitral stenosis

27. When do you find hemosiderin laden macrophages in the lungs?
Non
Transfusion
During HF from microhemorrhages from inc pulm cap pressure
Eisenmenger's syndrome

28. Given P = QR - what factors influence resistance?
CO
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Proportional to viscosity and inversely proportional to the radius to the 4th power
In HF

29. failure of truncus arteriosus to divide?
MI
Inc central venous pressure - inc resistance to portal flow
Preload
Persistant truncus arteriosus

30. What channels do the the pacemaker cells lack?
Preload
Aortic disecction - intraluminal tear forming false lumen
Fast volatge gated Na channels
Hematocrit

31. dyspnea - fatigue - edema and rales - multiple causes
CHF
Infective endocarditis
SA and AV nodes
RCA - II - III - aVF

32. What does TAPVR stand for
Unstable/crescendo angina
Granuloma with giant cells
Increased SV
Total anomalous pulmonary trunk venous return

33. CO x Total peripheral resistance
3rd degree block - pacemaker - Lyme disease
ASD
Dec plasma proteins
Mean arterial pressure

34. How does angiotensin II raise MAP
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
C - ANCA
Vasocxn
R to L shunt caused by stenoic pulmonic valve

35. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Atrial contraction
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Proportional to viscosity and inversely proportional to the radius to the 4th power
Mitral valve prolapse

36. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Kawasaki
Hemorrhage
Fick principle
ANP

37. PROVe
HypoK and bradycardia
Hemorrhage
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

38. prolonged PR interval
LCX - I - aVL
Acute thrombosis of coronary artery
Aortic insuffic - late
1st degree AV blodck

39. What does T wave inversion indicated?
Glossopharyngeal to soliary nucleus of medulla
5-10 days - macs have degraded structural components
MI
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

40. What is the most common cause of MI
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Acute thrombosis of coronary artery
The plateau period
V fib

41. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Mitral stenosis
Myxoma
Hematocrit
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

42. In an EKG - What is the T wave?
Varicose veins - thromboembolism rare
Boot shaped heart
Ventricular repolarization
Arteriorles

43. What does FAN MY SKIN On Wednesday stand for?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
EKG
PDA
Ischemic heart dz - mitral valve prolapse - LV dilation

44. no relation between p waves and QRS intervals - treatment and predisposing factor
Aburpt halting of valve leaflets
3rd degree block - pacemaker - Lyme disease
During diastole
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

45. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Stable angina
Adult type aortic coarctation
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
EKG

46. In an EKG - What is the p wave?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Increase in Pc
Posterior descending (80% off the RCA - 20% off the circumflex)
Atrial contraction

47. What murmur is heard with aortic regurg?
LCX - V4- V6
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
S. bovis
Decrease in cAMP

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

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49. What does prolonged QT predispose to?
Liver
Late systolic crescendo murmur with a midsystolic click
3rd degree block - pacemaker - Lyme disease
Torsades de pointes

50. What other sign is often present with congenital long QT syndrome - why?
C - ANCA
Inc TPR and LA return (expiration)
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

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