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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. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
LV failure - pulm venous distention transudation of fluid
Heart - 02 extraction is always around 100%
Pyogenic granuloma - associated with trauma and pregnancy
Infective endocarditis

2. What are the 5 T's of cyanoitc babies
Pulse pressure
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
EKG
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

3. What does HTN predispose to?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Dilation
Anterosuperior displacement of the infundibular septum
Posterior descending (80% off the RCA - 20% off the circumflex)

4. Wegener's tx
Decreases
Cyclophosphamide and corticosteroids
RCA - II - III - aVF
Atrial contraction

5. What masks atrial repolarization?
In HF
QRS complex
SA and AV nodes
S. aureus

6. What is a normal EF
At least 55%
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
P02

7. What does autoregulation do?
Maintain blood flow to organ over wide range of perfussion pressures
10%
Vasodilators
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

8. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Pos inotropy - exercise
Inc blood volume
Dec P02 - inc PC02 and dec pH
LCX - I - aVL

9. How does acidosis affect contractility?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
EKG
Decreased
Atrial contraction

10. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Extracellular calcium - calcium induced calcium release
...
Wolff - Parkinson white syndrome
RF

11. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Mitral valve prolapse
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
5-10 days - macs have degraded structural components
Total anomalous pulmonary trunk venous return

12. Inspiration causes an increase in which sided heart sounds?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Left atrial pressure
Right sided
Indomethacin closes - and pge keeps it open

13. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Kawasaki
Venodilators (nitrogylcerine)
Inc blood volume

14. How does angiotensin II raise MAP
Vasocxn
Postinfarction fibrinous pericarditis
Purkingee>atria>ventricles>AV node
Atrial contraction

15. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Strawberry hemangioma
Purkingee>atria>ventricles>AV node
Coarcation of aorta
Truncus - tet of fallot

16. What is the S1 sound?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Glossopharyngeal to soliary nucleus of medulla
Mitral and tricuspid closure

17. What are the complications from bacterial endocarditis?
Polyarteritis nodosum
Cardiac tamponde
Kidney
Chordae rupture - GN - suppurative pericarditis - emboli

18. congenital heart defect in an infant with a diabetic mother?
Late systolic crescendo murmur with a midsystolic click
Transposition of great vessels
EKG
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

19. What is the early and late lesion in rheumatic heart disease
Mitral valve prolapse
Vasodilators
Raynaud's
Mechanican contraction of the ventricles

20. What causes the CO curve to shift upwards?
Vasodilators
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
In RA return (inspiration)
Pos inotropy - exercise

21. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
Tricuspid atresia - requires ASD and VSD
Black > white > asian
The first 4 days

22. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Angiosarcoma
Ischemic heart dz - mitral valve prolapse - LV dilation
ASD - VSD - AV septal defect (endocardial cushion defect)

23. dyspnea - fatigue - edema and rales - multiple causes
V fib arrhythima
2nd degree AV block - mobitz type 1
CHF
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

24. in the JVP - What is the a wave?
Cystic hygroma
Hematocrit
Atrial contraction
During HF from microhemorrhages from inc pulm cap pressure

25. What do patients die early from in rheumatic heart disease?
Inc interstitial osmotic pressure pulling fliud out of capillaries
Filling is incomplete and CO falls
Early deaths from myocarditis
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

26. What causes aortic stenosis
Age related calcifications or bicuspid aortic valve
HTN - bradycardia - and respiratory depression
Squat. Compression of femoral arteries - inc TPR - dec
Left sided

27. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
V fib
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Increase intracellular Na - resulting in increased Ca

28. What causes hepatomegaly?
Prinzmetal angina
Inc central venous pressure - inc resistance to portal flow
Increase intracellular Na - resulting in increased Ca
Left sided

29. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Dilation
Sturge weber - vasculitis of caps
Atherosclerosis
Cherry hemangioma

30. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Afterload (proportional to peripheral resistance)
The first 4 days
Raynaud's
Fetal right to left - neonate left to right leading to RVH and failure

31. What happens in phase 0 of the cardiac ventricular action potential?
...
Rapid upstroke - voltage gated Na channels open
Boot shaped heart
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

32. which medications are used to maintain patency or close the ductus arteriosus?
Increasing activity of Ca pump in SR
Can progess to V fib
Indomethacin closes - and pge keeps it open
Libman - sacks endocarditis

33. bening capillary hemangioma of elderly - does not regress
No
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
CHF
Cherry hemangioma

34. Unilateral headache - jaw claudication - impaired vision
Chordae rupture - GN - suppurative pericarditis - emboli
Tempral arteritis - may cause irreversible blindness
Dec plasma proteins
Left heart failure

35. Fatal arrhythmia
Adult type aortic coarctation
Boot shaped heart
V fib
Activated histiocytes

36. What causes the midsystolic click
Sudden tensing of chordae tendinae
CHF
CK- MB
Troponin I

37. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Eccentric - concentric hypertrophy causes diastolic disfunction
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Wegener's
2-4 day - early coag necrosis on the first day

38. How do catecholamines increase contractility?
Increasing activity of Ca pump in SR
The aortic before pulmonic - inspiration increases diff
LAD - V1- V2
Transposition of great vessels

39. What does FEVERSS stand for in rheumatic heart disease
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Decrease in cAMP
HTN - bradycardia - and respiratory depression

40. When do coronary arteries fill?
Viridans streptococci
LCX - V4- V6
During diastole
Pyogenic granuloma - associated with trauma and pregnancy

41. When is the scar completely formed in an MI?
Transfusion
Pyogenic granuloma - associated with trauma and pregnancy
7 weeks
Decreased

42. machine murmer
Fetal right to left - neonate left to right leading to RVH and failure
PDA
Kidney
Dressler's - autoimmune

43. What does an isoelectric ST segment indicate?
Decrease in cAMP
Eccentric - concentric hypertrophy causes diastolic disfunction
Viridans streptococci
Ventricles are depolarized

44. fibrous plaques and atheromas in intima of arteries
Pulse pressure
Atherosclerosis
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Gap junctions

45. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
RV failure - in venous pressure
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Pos inotropy - exercise
Dec plasma proteins

46. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Inc interstitial osmotic pressure pulling fliud out of capillaries
Polyarteritis nodosum
Mitral stenosis
Transposition of great vessels

47. Where are pacemaker cells?
Microscopic polyangiitis - like wegener's without granulomas
SA and AV nodes
Left sided
3rd degree block - pacemaker - Lyme disease

48. What can cause mitral prolapse?
Crescendo - decrescendo systolic ejection murmur following ejection click
Myxomatous degeneration - RF - chordae rupture
MI
Rapid upstroke - voltage gated Na channels open

49. What is the formula for EF?
Polyarteritis nodosum
SV/ EDV
Venodilators (nitrogylcerine)
Fast volatge gated Na channels

50. what happens to capillaries in lymphatic blockage
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Fluid movement through capillaries
Inc interstitial osmotic pressure pulling fliud out of capillaries
Increased SV