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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 heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
ASD - VSD - AV septal defect (endocardial cushion defect)
Vasocxn
Buerger's disease

2. What causes the CO curve to shift downwards?
Neg inotropy - HF - narcotic overdose
Dilated cardiomyopathy
Late diastolic murmur following an opening snap
2nd degree AV block - mobitz type 1

3. When does extracellular calcium enter the cardiac muscle cells during contraction?
Can progess to V fib
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
The plateau period
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

4. Given P = QR - what factors influence resistance?
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Pos inotropy - exercise
Proportional to viscosity and inversely proportional to the radius to the 4th power
Increase contractility

5. What is the definition of HTN?
QRS complex
140/90
Lower right - MC - upper right - AO - upper right AC - lower left MO
Fast volatge gated Na channels

6. Irregularly irregular ECG - no p waves: dx and treatment
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Kids
Inc Kf - capillary perm

7. Which channel accounts for automaticity of the SA and AV nodes?
CO
If sodium channel
Increase intracellular Na - resulting in increased Ca
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

8. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Greater ventricular EDV
Glomus tumor
Eccentric - concentric hypertrophy causes diastolic disfunction
The operating point of the heart

9. In an EKG - What is the QRS complex?
In HF
Ventricular depolarization - nl < 120 msec
Aortic dilation - bicuspid aortic valve - RF -
S. epidermidis

10. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
Rapid upstroke - voltage gated Na channels open
Pyogenic granuloma - associated with trauma and pregnancy
2nd degree AV block - mobitz type 1
Strawberry hemangioma

11. In an EKG - What is the QT interval?
ASD - VSD - AV septal defect (endocardial cushion defect)
Vasocxn - while other tissues it causes vasodilation
Mechanican contraction of the ventricles
In HF

12. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
S. epidermidis
During HF from microhemorrhages from inc pulm cap pressure
CK- MB

13. In terms of starling forces - why does heart failure cause edema?
HypoK and bradycardia
Mitral stenosis
CK- MB
Increase in Pc

14. How does aldosterone raise MAP
Pulsus parvus and tardus - weak - can lead to syncope
Subendocardial - fewer collaterals and higher pressure
Inc blood volume
Septal defects - PDA - pulm art stenosis

15. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
Transfusion
LAD - V1 - V4
RV contraction (closed tricuspid valve bulding into atrium

16. What stimulates release of calcium from the SR?
Indomethacin closes - and pge keeps it open
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Extracellular calcium - calcium induced calcium release
1st degree AV blodck

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

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18. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Increase - increase the chance the If are open
3rd degree block - pacemaker - Lyme disease
Eccentric - concentric hypertrophy causes diastolic disfunction
Henoch - Schlonlein purpura

19. What is the classic X ray finding for tet of fallot?
Decreases
Boot shaped heart
Early deaths from myocarditis
Inc interstitial osmotic pressure pulling fliud out of capillaries

20. Which bacteria can cause endocarditis from prosthetic valves?
Cyclophosphamide and corticosteroids
Inc Kf - capillary perm
Torsades de pointes
S. epidermidis

21. What does increasing intracellular Ca do?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Mitral valve prolapse
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Increase contractility

22. How does digitatlis increase contractility?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Increase intracellular Na - resulting in increased Ca
Increase contractility
Liver

23. PCWP > LV diastolic pressure
Mitral stenosis
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Systolic dysfunction
Transposition of great vessels

24. The carotid sinus transmits along which nerve?
Torsades de pointes
Glossopharyngeal to soliary nucleus of medulla
Dec plasma proteins
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

25. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
V fib arrhythima
Raynaud's
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Unstable/crescendo angina

26. Central chemoreceptors do not respond directly to which parameter?
P02
Decreases
LCX - I - aVL
V fib

27. bening capillary hemangioma of elderly - does not regress
Cherry hemangioma
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Increased SV
Group a beta hemolytic strep

28. In an EKG - What is the T wave?
Stable angina
Increased SV
Ventricular repolarization
Increase intracellular Na - resulting in increased Ca

29. systolic - diastolic
EKG
Dilation
Crescendo - decrescendo systolic ejection murmur following ejection click
Pulse pressure

30. Which murmur is heard with VSD?
7 weeks
Holosystolic - harsh sounding murmur - loudest over tricuspid area
HypoK and bradycardia
Aortic/pulmonic stenosis and mitral/tricuspid regurg

31. What causes tet of fallot?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Anterosuperior displacement of the infundibular septum
Glomus tumor

32. What happens in phase 3 of the cardiac ventricular action potential?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Decrease in activity of Na/Ca exhanger and increase in contractility
Aortic/pulmonic stenosis and mitral/tricuspid regurg

33. What happends in phase 1 of the ventricular cardiac action potential?
The operating point of the heart
Glossopharyngeal to soliary nucleus of medulla
Liver
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

34. What kind of dysfunction ensues in restrictive cardiomyopathy
Diastolic
Left atrial pressure
Aortic disecction - intraluminal tear forming false lumen
RCA - II - III - aVF

35. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Transmural
Can progess to V fib
Changes in CO as a function of preload
Increase - increase the chance the If are open

36. What does autoregulation do?
Maintain blood flow to organ over wide range of perfussion pressures
Cyclophosphamide and corticosteroids
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Hypertrophied cardiomyopathy

37. Left to right shunts are more common in babies or kids?
Stable angina
Ischemic heart dz - mitral valve prolapse - LV dilation
Pulse pressure
Kids

38. which medications are used to maintain patency or close the ductus arteriosus?
Indomethacin closes - and pge keeps it open
Babies
140/90
Aortic and pulmonary closing

39. What masks atrial repolarization?
Late diastolic murmur following an opening snap
QRS complex
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Resting potential high K perm

40. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Varicose veins - thromboembolism rare
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Wolff - Parkinson white syndrome
Maintain blood flow to organ over wide range of perfussion pressures

41. Which vessels account for the most total peripheral resistance
Arteriorles
LAD - V1- V2
Systolic dysfunction
Myxomatous degeneration - RF - chordae rupture

42. Unilateral headache - jaw claudication - impaired vision
Tempral arteritis - may cause irreversible blindness
ASD
Liver
Coarcation of aorta

43. What cardiac change occurs in pregnancy?
Buerger's disease
Increasing activity of Ca pump in SR
Increased SV
2nd degree AV block - mobitz type 1

44. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Cardiac tamponde
Fast volatge gated Na channels
Activated histiocytes
Mitral valve

45. What is the gold standard for dx of MI in the first 6 hours
Failure of LV to in CO during exercise
Kids
EKG
In parallel

46. What is associated with paradoxical spliting of S2
Isovolumetric contraction
No
Adult type aortic coarctation
Aortic stenosis or LBBB

47. tearing chest pain radiation to the back - associated with marfan
Increased efferent SANS and decreased efferent PANS
Greater ventricular EDV
Aortic disecction - intraluminal tear forming false lumen
Hematocrit

48. What is association with fixed S2 splitting - does not increase with inspiration
Kawasaki
C - ANCA
ASD
5-10 days - macs have degraded structural components

49. In an anterolateral infarct - which artery is effected and which leads show Q waves
C - ANCA
LCX - V4- V6
V fib arrhythima
S. bovis

50. absecnce of tricuspid valve - hypoplastic RV
Tricuspid atresia - requires ASD and VSD
Mean arterial pressure
Pulsus parvus and tardus - weak - can lead to syncope
MI