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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. What does the atria release in response to inc blood volume and atrial pressure
ANP
Mitral and tricuspid closure
Activated histiocytes
RV failure - in venous pressure

2. What is the S2 sound?
Pos inotropy - exercise
RF
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Aortic and pulmonary closing

3. What is the classic X ray finding for tet of fallot?
Increased efferent SANS and decreased efferent PANS
Boot shaped heart
Torsades de pointes
Aortic dilation - bicuspid aortic valve - RF -

4. How are sarcomeres added in concentric hypertrophy?
In parallel
Age related calcifications or bicuspid aortic valve
Neg inotropy - HF - narcotic overdose
Myxoma

5. What causes the midsystolic click
RV failure - in venous pressure
Sudden tensing of chordae tendinae
MI
The plateau period

6. What does mitral prolapse predeispose to?
Kids
Infective endocarditis
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Unstable/crescendo angina

7. Where does coronary artery occlusion occur most commonly?
During diastole
7 weeks
LAD
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

8. What can cause mitral prolapse?
Inc venous return exaccerbates pulm vasc congestion
Myxomatous degeneration - RF - chordae rupture
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Takayasu's arteritis

9. Mitral stenosis is most often secondary to which condition?
Inc TPR and LA return (expiration)
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
RF
1st degree AV blodck

10. What is the time frame for arrhythmia risk in the evolution of MI
Cystic hygroma
Ventricles are depolarized
The first 4 days
No - no pressure gradient

11. How are the sarcomeres added in eccentric hypertrophy?
In series
Myxomatous degeneration - RF - chordae rupture
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

12. Exercise - overtransfusiion and excitiment causes and increase in...?
Chordae rupture - GN - suppurative pericarditis - emboli
Preload
CFX
Venodilators (nitrogylcerine)

13. PROVe
Fluid movement through capillaries
Babies
Crescendo - decrescendo systolic ejection murmur following ejection click
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

14. Where are pacemaker cells?
Myxoma
Tricuspid atresia - requires ASD and VSD
Subendocardial
SA and AV nodes

15. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Adult type aortic coarctation
Ischemic heart dz - mitral valve prolapse - LV dilation
Preload
...

16. What does T wave inversion indicated?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Greater ventricular EDV
Torsades de pointes
MI

17. What is the gold standard for dx of MI in the first 6 hours
Takayasu's arteritis
EKG
Conduction delay through AV node - nl < 200 msec
Viridans streptococci

18. Which organ gets the largest share of systemic cardiac output
The aortic before pulmonic - inspiration increases diff
Subendocardial
Liver
Prinzmetal angina

19. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Dilated cardiomyopathy
Afterload (proportional to peripheral resistance)
Infective endocarditis
Inc blood volume

20. clinical signs of cardiac tamponade
Late diastolic murmur following an opening snap
Dec P02 - inc PC02 and dec pH
Turners
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

21. serum marker for wegener's
C - ANCA
V fib arrhythima
Decreased
Anterosuperior displacement of the infundibular septum

22. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Conduction delay through AV node - nl < 200 msec
Kawasaki
Hypertrophied cardiomyopathy
Purkingee>atria>ventricles>AV node

23. What murmur is heard with aortic regurg?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
LAD > RCA > circumflex
During HF from microhemorrhages from inc pulm cap pressure
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

24. no change in PR interval followed by dropped beat
In series
Dec P02 - inc PC02 and dec pH
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Inc central venous pressure - inc resistance to portal flow

25. tearing chest pain radiation to the back - associated with marfan
Pulmonic stenosis and RBBB
Aortic disecction - intraluminal tear forming false lumen
Pulsus parvus and tardus - weak - can lead to syncope
Extracellular calcium - calcium induced calcium release

26. Which class of drugs decreases afterload?
The operating point of the heart
Pulsus parvus and tardus - weak - can lead to syncope
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Vasodilators - (hydrAlAzine)

27. Which channel accounts for automaticity of the SA and AV nodes?
The operating point of the heart
Atrial contraction
Polyarteritis nodosum
If sodium channel

28. What is a normal EF
Preload
At least 55%
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Preload

29. Which lab value indicates blood viscosity?
Cherry hemangioma
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Hematocrit
V fib arrhythima

30. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Rapid upstroke - voltage gated Na channels open
P02
Posterior descending (80% off the RCA - 20% off the circumflex)
Transfusion

31. exaggerated decrease in pulse during inspiration.

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32. What are aschoff bodies
Granuloma with giant cells
Mitral stenosis
Activated histiocytes
Black > white > asian

33. The 7 complications of MI

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34. What is association with fixed S2 splitting - does not increase with inspiration
Apex and anterior interventricular septum
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
ASD
Vagus to medulla

35. What are common causes of mitral regurg?
SA and AV nodes
Transmural
Decreased
Ischemic heart dz - mitral valve prolapse - LV dilation

36. If HR is too fast (V tach) what happens during diastole?
Filling is incomplete and CO falls
Inc blood volume
Buerger's disease
LAD

37. coronary artery spasm - ST elevation
Prinzmetal angina
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Pulsus parvus and tardus - weak - can lead to syncope
Coarcation of aorta

38. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Conduction delay through AV node - nl < 200 msec
Glossopharyngeal to soliary nucleus of medulla
Medullary vasomotor center senses baroreceptors and JGA
Kawasaki

39. What is indicated when CO and venous return are equal?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Liver
Rhabdomyomas
The operating point of the heart

40. fibrinous pericarditis several weeks post MI

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41. what happens to capillaries in lymphatic blockage
Turners
Fetal right to left - neonate left to right leading to RVH and failure
Inc interstitial osmotic pressure pulling fliud out of capillaries
LAD

42. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Hemorrhage
Hypertrophied cardiomyopathy
Sturge weber - vasculitis of caps

43. What do the starling forces determine
Fluid movement through capillaries
S. bovis
Proportional to viscosity and inversely proportional to the radius to the 4th power
Septal defects - PDA - pulm art stenosis

44. Which artery supplies the SA and AV nodes?
Can progess to V fib
Indomethacin closes - and pge keeps it open
Failure of LV to in CO during exercise
RCA

45. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Atrial contraction
Eccentric - concentric hypertrophy causes diastolic disfunction
ASD - VSD - AV septal defect (endocardial cushion defect)
Inc interstitial osmotic pressure pulling fliud out of capillaries

46. What is the characteristic pulse in aortic stenosis?
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Adult type aortic coarctation
Coarcation of aorta
Pulsus parvus and tardus - weak - can lead to syncope

47. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Angiosarcoma
Non
RCA

48. in the JVP - What is the v wave?
Inc TPR and LA return (expiration)
Isovolumetric contraction
Mitral and tricuspid closure
Inc RA pressure - due to filling against closed tricupsid valve

49. with what heart sounds do ASD usually present?
Rhabdomyomas
Volatage gated Ca channels
Pulmonary flow murmur and diastolic rumble
EKG

50. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
ASD
Increase - increase the chance the If are open
Adult type aortic coarctation
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD