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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 enzymes are useful for diagnosing reinfarction
During diastole
Postinfarction fibrinous pericarditis
Transmural
CK- MB

2. What causes hepatomegaly?
Inc central venous pressure - inc resistance to portal flow
Granuloma with giant cells
Decreases
The plateau period

3. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Vasodilators - (hydrAlAzine)
No
Kidney

4. What causes the CO curve to shift downwards?
Transfusion
...
Neg inotropy - HF - narcotic overdose
Inc interstitial osmotic pressure pulling fliud out of capillaries

5. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
QRS complex
Decreases
Pos inotropy - exercise
Persistant truncus arteriosus

6. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Inc Kf - capillary perm
Non
Pyogenic granuloma - associated with trauma and pregnancy
R to L shunt caused by stenoic pulmonic valve

7. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Fetal right to left - neonate left to right leading to RVH and failure
Increase - increase the chance the If are open
Chordae rupture - GN - suppurative pericarditis - emboli
Viridans streptococci

8. machine murmer
Holosystoiic
Left sided
PDA
Black > white > asian

9. PCWP > LV diastolic pressure
Babies
Anterosuperior displacement of the infundibular septum
Mitral stenosis
Increasing activity of Ca pump in SR

10. The 7 complications of MI

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11. When do coronary arteries fill?
Group a beta hemolytic strep
Conduction delay through AV node - nl < 200 msec
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
During diastole

12. clinical signs of cardiac tamponade
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Rapid upstroke - voltage gated Na channels open
Changes in CO as a function of preload
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

13. Fatal arrhythmia
140/90
V fib
5-10 days - macs have degraded structural components
Preload

14. In an EKG - What is the p wave?
Increase in Pc
Atrial contraction
Inc TPR and LA return (expiration)
Turners

15. What is the cushing triad?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
RF
HTN - bradycardia - and respiratory depression
In series

16. How does digitatlis increase contractility?
Increase intracellular Na - resulting in increased Ca
Aortic dilation - bicuspid aortic valve - RF -
At least 55%
MI

17. most common primary cardiac tumor in children - associated with tuberous sclerosis
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Rhabdomyomas
Late diastolic murmur following an opening snap
S. epidermidis

18. What do patients die early from in rheumatic heart disease?
Extracellular calcium - calcium induced calcium release
MI
HypoK and bradycardia
Early deaths from myocarditis

19. What is the association with wide S2 splitting?
Pulmonic stenosis and RBBB
TAPVR
Pyogenic granuloma - associated with trauma and pregnancy
Yes

20. What is the progression of atherosclerosis?
Aortic stenosis or LBBB
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Eisenmenger's syndrome
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

21. What causes the midsystolic click
Troponin I
Sudden tensing of chordae tendinae
Stroke volume affected by contractility - afterload - and preload
Increase intracellular Na - resulting in increased Ca

22. What is the danger of torsades to pointes?
Can progess to V fib
Turners
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
HypoK and bradycardia

23. What murmur is heard with aortic regurg?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Sturge weber - vasculitis of caps
Black > white > asian

24. What is the difference between adult and infantile type aortic coarctation?
Polyarteritis nodosum
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
V fib arrhythima
Prinzmetal angina

25. bening capillary hemangioma of elderly - does not regress
RF
Decrease in activity of Na/Ca exhanger and increase in contractility
Cherry hemangioma
Conduction delay through AV node - nl < 200 msec

26. decrease stretch in baroreceptors leads to what response?
Troponin I
Increased efferent SANS and decreased efferent PANS
In HF
Resting potential high K perm

27. What is the formula for EF?
SV/ EDV
Aortic insuffic - late
ASD - VSD - AV septal defect (endocardial cushion defect)
Cardiac tamponde

28. tearing chest pain radiation to the back - associated with marfan
Aortic stenosis or LBBB
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Sudden tensing of chordae tendinae
Aortic disecction - intraluminal tear forming false lumen

29. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
SA>AV>bundle of His>ventricles
Dec plasma proteins
V fib
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

30. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Vasodilators
ANP
Turners
LAD - V1- V2

31. sawtooth wave

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32. Which murmur is heard in aortic stenosis?
Inc blood volume
Transmural
Hypertrophied cardiomyopathy
Crescendo - decrescendo systolic ejection murmur following ejection click

33. What are the different etiologies of dialted cardiomyopathy
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Sturge weber - vasculitis of caps
MI
RV contraction (closed tricuspid valve bulding into atrium

34. What is the time frame for arrhythmia risk in the evolution of MI
Mitral>aortic>>tricuspid - high pressure valves affected most
Prinzmetal angina
LCX - V4- V6
The first 4 days

35. In terms of starling forces - why does heart failure cause edema?
Increase in Pc
LAD > RCA > circumflex
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Cardiac tamponde

36. 2/3 diastolic + 1/3 systolic
Decreased
Ventricles are depolarized
MAP
Stroke volume affected by contractility - afterload - and preload

37. What causes aortic stenosis
Crescendo - decrescendo systolic ejection murmur following ejection click
Age related calcifications or bicuspid aortic valve
Left heart failure
Pulse pressure

38. The aortic arch receptors transmit along which nerve?
Vagus to medulla
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
LAD
Heart - 02 extraction is always around 100%

39. What channels do the the pacemaker cells lack?
Angiosarcoma
Fast volatge gated Na channels
Adult type aortic coarctation
Ventricles are depolarized

40. Why is there edema after burns or during infection
Aburpt halting of valve leaflets
Inc Kf - capillary perm
Stroke volume
Glomus tumor

41. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Torsades de pointes
Lower right - MC - upper right - AO - upper right AC - lower left MO
C - ANCA
Increase contractility

42. What does HTN predispose to?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Crescendo - decrescendo systolic ejection murmur following ejection click
Rhabdomyomas
Gap junctions

43. What is association with fixed S2 splitting - does not increase with inspiration
Aortic/pulmonic stenosis and mitral/tricuspid regurg
ASD
Posterior descending (80% off the RCA - 20% off the circumflex)
Libman - sacks endocarditis

44. Where are pacemaker cells?
PDA
Changes in CO as a function of preload
SA and AV nodes
Group a beta hemolytic strep

45. What are aschoff bodies
Prinzmetal angina
Afterload (proportional to peripheral resistance)
Arteriolosclerosis in malignant hypertension
Granuloma with giant cells

46. 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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47. Which organ gets the largest share of systemic cardiac output
Liver
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Atrial contraction
Left atrial pressure

48. What causes aortic regurg
Aortic dilation - bicuspid aortic valve - RF -
Coarcation of aorta
Proportional to viscosity and inversely proportional to the radius to the 4th power
Cyclophosphamide and corticosteroids

49. Wegener's presentation
Stable angina
Dressler's - autoimmune
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Babies

50. What are the four most common locations for atherosclerosis?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Arteriolosclerosis in malignant hypertension
During diastole
Myxomatous degeneration - RF - chordae rupture