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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. fibrinous pericarditis several weeks post MI

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2. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Lymphangiosarcoma
LCX - V4- V6
LCX - I - aVL
EKG

3. In an EKG - What is the QRS complex?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Turners
Ventricular depolarization - nl < 120 msec
Myxomatous degeneration - RF - chordae rupture

4. fibrous plaques and atheromas in intima of arteries
Fast volatge gated Na channels
Mitral valve prolapse
Viridans streptococci
Atherosclerosis

5. Which murmur do you hear in mitral stenosis?
Decrease in cAMP
Heart - 02 extraction is always around 100%
2-4 day - early coag necrosis on the first day
Late diastolic murmur following an opening snap

6. in the JVP - What is the c wave?
V fib
RV contraction (closed tricuspid valve bulding into atrium
At least 55%
Indomethacin closes - and pge keeps it open

7. What causes the cushing reflex and why
Hematocrit
No
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

8. in the JVP - What is the a wave?
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Atrial contraction
RCA - II - III - aVF
LV failure - pulm venous distention transudation of fluid

9. moncekberg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Pulmonic stenosis and RBBB
Kawasaki
Maintain blood flow to organ over wide range of perfussion pressures

10. What can cause mitral prolapse?
Myxomatous degeneration - RF - chordae rupture
Aortic and pulmonary closing
2-4 day - early coag necrosis on the first day
Aburpt halting of valve leaflets

11. in the JVP - What is the v wave?
Granuloma with giant cells
RF
Inc RA pressure - due to filling against closed tricupsid valve
Atherosclerosis

12. When do you see extensive coagulative necrosis in an MI
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Rapid upstroke - voltage gated Na channels open
Arteriolosclerosis in malignant hypertension
2-4 day - early coag necrosis on the first day

13. What are the complications of atherosclerosis?
Takayasu's arteritis
Right sided
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

14. When does EF decrease
Kidney
SV/ EDV
In HF
RV failure - in venous pressure

15. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2nd degree AV block - mobitz type 1
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
CO
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

16. Which vessels account for the most total peripheral resistance
Mitral stenosis
Non
Arteriorles
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

17. prolonged PR interval
1st degree AV blodck
Persistant truncus arteriosus
...
Aortic insuffic - late

18. PCWP is an estimate of...
10%
Aortic stenosis or LBBB
Left atrial pressure
Temporal arteritis

19. sawtooth wave

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20. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
S. aureus
Diastolic

21. disease of elastic arteries and large and medium sized muscular arteries
Fast volatge gated Na channels
Atherosclerosis
ASD
Extracellular calcium - calcium induced calcium release

22. Which artery supplies the SA and AV nodes?
Persistant truncus arteriosus
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Maintain blood flow to organ over wide range of perfussion pressures
RCA

23. In normal S2 splitting - which valve closes first? What increases it?
Libman - sacks endocarditis
RCA
The aortic before pulmonic - inspiration increases diff
Age related calcifications or bicuspid aortic valve

24. What stimulates release of calcium from the SR?
LV failure - pulm venous distention transudation of fluid
Extracellular calcium - calcium induced calcium release
Ventricles are depolarized
Tricuspid atresia - requires ASD and VSD

25. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
MAP
Stable angina
Indomethacin closes - and pge keeps it open
Coarcation of aorta

26. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
RCA
Fetal right to left - neonate left to right leading to RVH and failure
Mitral valve
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

27. no change in PR interval followed by dropped beat
Coarcation of aorta
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Pulmonary flow murmur and diastolic rumble

28. tearing chest pain radiation to the back - associated with marfan
LCX - I - aVL
Aortic disecction - intraluminal tear forming false lumen
Failure of LV to in CO during exercise
Hypertrophied cardiomyopathy

29. Irregularly irregular ECG - no p waves: dx and treatment
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Coarcation of aorta
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Neg inotropy - HF - narcotic overdose

30. polypoid capillary hemangioma that can ulcerate and bleed
Pyogenic granuloma - associated with trauma and pregnancy
The operating point of the heart
LAD - V1 - V4
No

31. Chronic mitral stenosis can lead to what changes in size of the LA
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Liver
Transfusion
Dilation

32. with what heart sounds do ASD usually present?
Heart - 02 extraction is always around 100%
Tempral arteritis - may cause irreversible blindness
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Pulmonary flow murmur and diastolic rumble

33. What are anitschkow's cells
Babies
Activated histiocytes
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

34. Which kind of infarct show ST elevation - and/or pathologic Q waves
Turners
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Transmural
LV failure - pulm venous distention transudation of fluid

35. which heart valves are afected most in rheumatic heart diseease
Fast volatge gated Na channels
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Pyogenic granuloma - associated with trauma and pregnancy
Mitral>aortic>>tricuspid - high pressure valves affected most

36. How do catecholamines increase contractility?
7 weeks
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Increasing activity of Ca pump in SR

37. EDV - ESV
P02
Stroke volume
Failure of LV to in CO during exercise
2-4 day - early coag necrosis on the first day

38. What do patients die early from in rheumatic heart disease?
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Early deaths from myocarditis
Kawasaki

39. coronary artery spasm - ST elevation
QRS complex
Prinzmetal angina
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

40. Which area of the endocardium is especially vulnerable to infarction? Why?
Subendocardial - fewer collaterals and higher pressure
C - ANCA
Wegener's
R to L shunt caused by stenoic pulmonic valve

41. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
RCA
Non
Troponin I
In RA return (inspiration)

42. In an anterolateral infarct - which artery is effected and which leads show Q waves
Granuloma with giant cells
LCX - V4- V6
LCX - I - aVL
S. aureus

43. stroke volume x HR =?
Hemorrhage
Fetal right to left - neonate left to right leading to RVH and failure
EKG
CO

44. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Failure of LV to in CO during exercise
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Eccentric - concentric hypertrophy causes diastolic disfunction

45. What is the cushing triad?
HTN - bradycardia - and respiratory depression
ASD - VSD - AV septal defect (endocardial cushion defect)
Left atrial pressure
Ischemic heart dz - mitral valve prolapse - LV dilation

46. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
MI
Hyperlipidemia
Cyclophosphamide and corticosteroids
Hematocrit

47. What constitues the upstroke in pacemaker cells?
Pyogenic granuloma - associated with trauma and pregnancy
Group a beta hemolytic strep
Volatage gated Ca channels
Myxoma

48. How does aldosterone raise MAP
Inc blood volume
Ischemic heart dz - mitral valve prolapse - LV dilation
Dec plasma proteins
Adult type aortic coarctation

49. What does the atria release in response to inc blood volume and atrial pressure
Venodilators (nitrogylcerine)
Hyperlipidemia
ANP
PDA

50. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
MAP
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Systolic dysfunction
Temporal arteritis