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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. How does aldosterone raise MAP
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
If sodium channel
Unstable/crescendo angina
Inc blood volume

2. What causes the murmur heard in tricuspid regurg to enhance
In RA return (inspiration)
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Myxomatous degeneration - RF - chordae rupture
No - no pressure gradient

3. What happens in phase 0 of the cardiac ventricular action potential?
Septal defects - PDA - pulm art stenosis
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Rapid upstroke - voltage gated Na channels open
3rd degree block - pacemaker - Lyme disease

4. In an EKG - What is the p wave?
Atrial contraction
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Subendocardial
Transfusion

5. In an anterior wall infarct - which artery is effected and which leads show Q waves
Inc venous return exaccerbates pulm vasc congestion
LAD - V1 - V4
ASD
Postinfarction fibrinous pericarditis

6. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
S. bovis
Pulse pressure
Kawasaki
RF

7. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Vasodilators - (hydrAlAzine)
...
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

8. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
LAD - V1- V2
Mitral and tricuspid closure
Aortic disecction - intraluminal tear forming false lumen

9. When is the scar completely formed in an MI?
Decreased
Kidney
7 weeks
Chordae rupture - GN - suppurative pericarditis - emboli

10. In an inferior wall infarct - which artery is affected and which leads show Q waves
Fluid movement through capillaries
RCA - II - III - aVF
In RA return (inspiration)
Hemorrhage

11. Wegener's tx
Kids
Cyclophosphamide and corticosteroids
Prinzmetal angina
Strawberry hemangioma

12. prolonged PR interval
1st degree AV blodck
Cystic hygroma
CFX
Decreases

13. What is sudden cardiac death most commonly due to...
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Liver
Increased efferent SANS and decreased efferent PANS
V fib arrhythima

14. What does HTN predispose to?
Left atrial pressure
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
S. aureus
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

15. What does the U wave indicated?
HypoK and bradycardia
Pos inotropy - exercise
If sodium channel
Inc Kf - capillary perm

16. What is the classic X ray finding for tet of fallot?
Boot shaped heart
TAPVR
Heart - 02 extraction is always around 100%
Mitral>aortic>>tricuspid - high pressure valves affected most

17. Churg Strauss - presentation and test
Myxomatous degeneration - RF - chordae rupture
Kids
Chordae rupture - GN - suppurative pericarditis - emboli
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

18. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Left heart failure
S. bovis
TAPVR
5-10 days - macs have degraded structural components

19. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Can progess to V fib
...
Torsades de pointes
Decreases

20. How are sarcomeres added in concentric hypertrophy?
Temporal arteritis
In parallel
RCA
Lower right - MC - upper right - AO - upper right AC - lower left MO

21. What does FEVERSS stand for in rheumatic heart disease
Yes
LAD - V1 - V4
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

22. disease of elastic arteries and large and medium sized muscular arteries
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Changes in CO as a function of preload
Atherosclerosis
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

23. In an anterolateral infarct - which artery is effected and which leads show Q waves
Sudden tensing of chordae tendinae
LCX - V4- V6
Greater ventricular EDV
Henoch - Schlonlein purpura

24. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Left heart failure
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Aortic dilation - bicuspid aortic valve - RF -
Dec plasma proteins

25. What causes the midsystolic click
Sudden tensing of chordae tendinae
Pyogenic granuloma - associated with trauma and pregnancy
Turners
Diastolic

26. congenital heart defect with congenital rubella
Inc blood volume
CFX
Septal defects - PDA - pulm art stenosis
In series

27. The carotid sinus transmits along which nerve?
Glossopharyngeal to soliary nucleus of medulla
Fick principle
During diastole
Indomethacin closes - and pge keeps it open

28. Which murmur is heard with mitral prolapse?
Late systolic crescendo murmur with a midsystolic click
PDA
Acute thrombosis of coronary artery
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

29. What does mitral prolapse predeispose to?
Infective endocarditis
Heart - 02 extraction is always around 100%
Tricuspid atresia - requires ASD and VSD
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

30. What causes the CO curve to shift upwards?
Purkingee>atria>ventricles>AV node
Right sided
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Pos inotropy - exercise

31. What causes hepatomegaly?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Inc central venous pressure - inc resistance to portal flow
S. epidermidis
Atherosclerosis

32. Which two mechanisms sense decrease MAP?
Diastolic
Late systolic crescendo murmur with a midsystolic click
Medullary vasomotor center senses baroreceptors and JGA
Libman - sacks endocarditis

33. Which enzymes are useful for diagnosing reinfarction
Arteriorles
Vasodilators
CK- MB
Mechanican contraction of the ventricles

34. What happens in phase 4 of the cardiac ventricular action potential?
Posterior descending (80% off the RCA - 20% off the circumflex)
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Resting potential high K perm
The plateau period

35. What does FROM JANE stand for in bacterial endocarditis?

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36. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Metastasis from melanoma or lymphoma
Dilated cardiomyopathy
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Myxoma

37. What causes the murmur heard in MR to enhance?
No - no pressure gradient
Age related calcifications or bicuspid aortic valve
Decrease in cAMP
Inc TPR and LA return (expiration)

38. How does angiotensin II raise MAP
S. bovis
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Vasocxn

39. When and why is the S3 sound heard?
Atherosclerosis
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Cyclophosphamide and corticosteroids
Raynaud's

40. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Adult type aortic coarctation
Diastolic
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Henoch - Schlonlein purpura

41. What are anitschkow's cells
If sodium channel
Mitral and tricuspid closure
Activated histiocytes
Sturge weber - vasculitis of caps

42. EDV is also known as
Preload
ASD - VSD - AV septal defect (endocardial cushion defect)
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

43. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
ASD
Vasodilators
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

44. What do the starling forces determine
Lower right - MC - upper right - AO - upper right AC - lower left MO
3rd degree block - pacemaker - Lyme disease
MAP
Fluid movement through capillaries

45. 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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46. Where does coronary artery occlusion occur most commonly?
Volatage gated Ca channels
LCX - V4- V6
LAD
Sudden tensing of chordae tendinae

47. congenital heart defect with 22q11
Atrial contraction
Truncus - tet of fallot
Glossopharyngeal to soliary nucleus of medulla
7 weeks

48. In an EKG - What is the PR interval?
Dec plasma proteins
Conduction delay through AV node - nl < 200 msec
Resting potential high K perm
Sudden tensing of chordae tendinae

49. When do you find hemosiderin laden macrophages in the lungs?
2nd degree AV block - mobitz type 1
During HF from microhemorrhages from inc pulm cap pressure
Boot shaped heart
The aortic before pulmonic - inspiration increases diff

50. with what heart sounds do ASD usually present?
Preload
Granuloma with giant cells
Troponin I
Pulmonary flow murmur and diastolic rumble