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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 causes orthopnea?
Inc venous return exaccerbates pulm vasc congestion
Left heart failure
Mitral stenosis
Aortic dilation - bicuspid aortic valve - RF -

2. When do coronary arteries fill?
During diastole
Chordae rupture - GN - suppurative pericarditis - emboli
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Aortic/pulmonic stenosis and mitral/tricuspid regurg

3. What causes the murmur heard in tricuspid regurg to enhance
Crescendo - decrescendo systolic ejection murmur following ejection click
Ventricular repolarization
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
In RA return (inspiration)

4. What is the early and late lesion in rheumatic heart disease
Mitral valve prolapse
In HF
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

5. Which murmur do you hear in mitral stenosis?
Adult type aortic coarctation
Late diastolic murmur following an opening snap
Mitral>aortic>>tricuspid - high pressure valves affected most
Eccentric - concentric hypertrophy causes diastolic disfunction

6. What causes aortic regurg
2nd degree AV block - mobitz type 1
Increase intracellular Na - resulting in increased Ca
3rd degree block - pacemaker - Lyme disease
Aortic dilation - bicuspid aortic valve - RF -

7. Which lab value indicates blood viscosity?
Cystic hygroma
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
EKG
Hematocrit

8. In an anterior wall infarct - which artery is effected and which leads show Q waves
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
V fib
LAD - V1 - V4
Extracellular calcium - calcium induced calcium release

9. What is the association with wide S2 splitting?
RF
RV contraction (closed tricuspid valve bulding into atrium
Strawberry hemangioma
Pulmonic stenosis and RBBB

10. Fatal arrhythmia
V fib
Boot shaped heart
CO
Fetal right to left - neonate left to right leading to RVH and failure

11. PCWP is an estimate of...
Pulmonic stenosis and RBBB
S. epidermidis
Left atrial pressure
Glossopharyngeal to soliary nucleus of medulla

12. How are sarcomeres added in concentric hypertrophy?
Preload
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
In parallel

13. How do catecholamines increase contractility?
ASD - VSD - AV septal defect (endocardial cushion defect)
CFX
Increasing activity of Ca pump in SR
Isovolumetric contraction

14. which ethnic groups have higher association with HTN?
Septal defects - PDA - pulm art stenosis
Black > white > asian
Medullary vasomotor center senses baroreceptors and JGA
Myxoma

15. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Proportional to viscosity and inversely proportional to the radius to the 4th power
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Dec plasma proteins
Increase in Pc

16. most common heart tumor
Extracellular calcium - calcium induced calcium release
Metastasis from melanoma or lymphoma
QRS complex
Postinfarction fibrinous pericarditis

17. moncekberg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Venodilators (nitrogylcerine)
In RA return (inspiration)

18. How are the sarcomeres added in eccentric hypertrophy?
In series
CHF
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
P02

19. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Inc venous return exaccerbates pulm vasc congestion
Holosystoiic
Unstable/crescendo angina
Increase in Pc

20. EDV is also known as
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
In RA return (inspiration)
Preload
Vagus to medulla

21. What causes the CO curve to shift upwards?
Mitral valve prolapse
Pos inotropy - exercise
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Group a beta hemolytic strep

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

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23. What are the complications of atherosclerosis?
Eisenmenger's syndrome
Postinfarction fibrinous pericarditis
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Cyclophosphamide and corticosteroids

24. Central chemoreceptors do not respond directly to which parameter?
Infective endocarditis
140/90
Buerger's disease
P02

25. What is the formula for EF?
Angiosarcoma
Hematocrit
ASD
SV/ EDV

26. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Total anomalous pulmonary trunk venous return
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
7 weeks
Troponin I

27. in the JVP - What is the c wave?
Hyperlipidemia
RV contraction (closed tricuspid valve bulding into atrium
The first 4 days
Pulse pressure

28. exaggerated decrease in pulse during inspiration.

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29. Why is contractility decreased in heart failure?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
LAD
Ventricles are depolarized
Systolic dysfunction

30. 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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31. with what heart sounds do ASD usually present?
Adult type aortic coarctation
Pulmonary flow murmur and diastolic rumble
Cystic hygroma
Failure of LV to in CO during exercise

32. What is sudden cardiac death most commonly due to...
Fluid movement through capillaries
V fib arrhythima
Left sided
Sturge weber - vasculitis of caps

33. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Torsades de pointes
Posterior descending (80% off the RCA - 20% off the circumflex)
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
140/90

34. What is a normal EF
S. bovis
At least 55%
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Coarcation of aorta

35. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
LAD > RCA > circumflex
Aortic stenosis or LBBB
Torsades de pointes
Sturge weber - vasculitis of caps

36. In normal S2 splitting - which valve closes first? What increases it?
The aortic before pulmonic - inspiration increases diff
HTN - bradycardia - and respiratory depression
No
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

37. Wegener's presentation
Resting potential high K perm
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
140/90
Granuloma with giant cells

38. Mitral stenosis is most often secondary to which condition?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
RF
Atherosclerosis
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

39. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Dec P02 - inc PC02 and dec pH
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Conduction delay through AV node - nl < 200 msec
TAPVR

40. sawtooth wave

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41. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Increase - increase the chance the If are open
LAD - V1 - V4
Extracellular calcium - calcium induced calcium release
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

42. What kind of infarct show ST depression
Subendocardial
Aburpt halting of valve leaflets
Mitral stenosis
In parallel

43. Which kind of infarct show ST elevation - and/or pathologic Q waves
Angiosarcoma
Transmural
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Crescendo - decrescendo systolic ejection murmur following ejection click

44. What causes the midsystolic click
Sudden tensing of chordae tendinae
Resting potential high K perm
ANP
Non

45. What kind of dysfunction ensues in restrictive cardiomyopathy
Purkingee>atria>ventricles>AV node
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Diastolic
Vasocxn

46. What is the progression of atherosclerosis?
Myxoma
Pulse pressure
Heart - 02 extraction is always around 100%
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

47. Where is the most posterior portion of the heart and What can it cause?
Chordae rupture - GN - suppurative pericarditis - emboli
1st degree AV blodck
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

48. Which vessels account for the most total peripheral resistance
Aortic insuffic - late
Torsades de pointes
Arteriorles
PDA

49. EDV - ESV
The aortic before pulmonic - inspiration increases diff
Prinzmetal angina
CHF
Stroke volume

50. When do you see extensive coagulative necrosis in an MI
Late diastolic murmur following an opening snap
Increase in Pc
Aortic/pulmonic regurg and mitral/tricuspid stenosis
2-4 day - early coag necrosis on the first day