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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 are the systolic heart sounds
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Resting potential high K perm
Left heart failure
Aortic/pulmonic stenosis and mitral/tricuspid regurg

2. How does acidosis affect contractility?
Decreased
Right sided
Kawasaki
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

3. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
SA>AV>bundle of His>ventricles
Changes in CO as a function of preload
Eccentric - concentric hypertrophy causes diastolic disfunction
Metastasis from melanoma or lymphoma

4. Which murmur do you hear in mitral stenosis?
Preload
Late diastolic murmur following an opening snap
Mitral and tricuspid closure
Increase - increase the chance the If are open

5. What do patients die early from in rheumatic heart disease?
Early deaths from myocarditis
Inc central venous pressure - inc resistance to portal flow
Buerger's disease
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

6. moncekberg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Pyogenic granuloma - associated with trauma and pregnancy
Chordae rupture - GN - suppurative pericarditis - emboli
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

7. exaggerated decrease in pulse during inspiration.

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8. prolonged PR interval
Mitral valve prolapse
Aortic insuffic - late
1st degree AV blodck
Torsades de pointes

9. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Increase - increase the chance the If are open
Lower right - MC - upper right - AO - upper right AC - lower left MO
Transfusion

10. What happens in phase 0 of the cardiac ventricular action potential?
Rapid upstroke - voltage gated Na channels open
Eccentric - concentric hypertrophy causes diastolic disfunction
Mean arterial pressure
Pulmonic stenosis and RBBB

11. What does the atria release in response to inc blood volume and atrial pressure
MI
ANP
Subendocardial
Takayasu's arteritis

12. Wegener's presentation
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Cherry hemangioma
Diastolic
S. epidermidis

13. What causes the ejection click in the Cres - decres murmur?
Aburpt halting of valve leaflets
Non
Inc RA pressure - due to filling against closed tricupsid valve
Pulmonic stenosis and RBBB

14. Rank the pacemakers cells
Mechanican contraction of the ventricles
SA>AV>bundle of His>ventricles
Fetal right to left - neonate left to right leading to RVH and failure
No

15. Central chemoreceptors do not respond directly to which parameter?
Neg inotropy - HF - narcotic overdose
P02
Venodilators (nitrogylcerine)
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

16. Which murmur is heard with mitral prolapse?
Increased efferent SANS and decreased efferent PANS
Atherosclerosis
Coarcation of aorta
Late systolic crescendo murmur with a midsystolic click

17. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Truncus - tet of fallot
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Metastasis from melanoma or lymphoma
EKG

18. What is the definition of HTN?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Increase in Pc
Mitral stenosis
140/90

19. What does TAPVR stand for
Total anomalous pulmonary trunk venous return
Anterosuperior displacement of the infundibular septum
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
RV failure - in venous pressure

20. Which bacteria causes rheumatic heart disease
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Group a beta hemolytic strep
SA>AV>bundle of His>ventricles
Boot shaped heart

21. What does an isoelectric ST segment indicate?
Ventricles are depolarized
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
No
R to L shunt caused by stenoic pulmonic valve

22. MAP is also known as
Resting potential high K perm
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Afterload (proportional to peripheral resistance)
Kawasaki

23. congenital heart defect with turner's
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Coarcation of aorta
Inc blood volume

24. sawtooth wave

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25. Right to left shunts are more common in babies or kids?
Early deaths from myocarditis
Babies
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Neg inotropy - HF - narcotic overdose

26. stroke volume x HR =?
CO
Aortic and pulmonary closing
Vasodilators
Inc central venous pressure - inc resistance to portal flow

27. friction rub - 3-5 days post MI
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Pyogenic granuloma - associated with trauma and pregnancy
Postinfarction fibrinous pericarditis

28. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Left heart failure
Apex and anterior interventricular septum
Posterior descending (80% off the RCA - 20% off the circumflex)
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

29. no relation between p waves and QRS intervals - treatment and predisposing factor
Stroke volume affected by contractility - afterload - and preload
3rd degree block - pacemaker - Lyme disease
C - ANCA
ASD

30. Which organ has the largest arteriovenous difference
The plateau period
Heart - 02 extraction is always around 100%
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Increased SV

31. fibrinous pericarditis several weeks post MI

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32. What causes the murmur heard in tricuspid regurg to enhance
In RA return (inspiration)
Tempral arteritis - may cause irreversible blindness
ASD - VSD - AV septal defect (endocardial cushion defect)
Babies

33. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Purkingee>atria>ventricles>AV node
Mitral valve prolapse
No
Black > white > asian

34. In an EKG - What is the PR interval?
Conduction delay through AV node - nl < 200 msec
Lower right - MC - upper right - AO - upper right AC - lower left MO
Glomus tumor
Vasodilators - (hydrAlAzine)

35. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
During diastole
Increased SV
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
S. aureus

36. Irregularly irregular ECG - no p waves: dx and treatment
Mean arterial pressure
ASD
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Filling is incomplete and CO falls

37. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Venodilators (nitrogylcerine)
Viridans streptococci
Purkingee>atria>ventricles>AV node
V fib

38. What is the S1 sound?
Group a beta hemolytic strep
Mitral and tricuspid closure
10%
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

39. SV CAP means?
Atherosclerosis
Age related calcifications or bicuspid aortic valve
Stroke volume affected by contractility - afterload - and preload
Afterload (proportional to peripheral resistance)

40. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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41. What is the early and late lesion in rheumatic heart disease
Mitral valve prolapse
Boot shaped heart
Lower right - MC - upper right - AO - upper right AC - lower left MO
Can progess to V fib

42. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Late systolic crescendo murmur with a midsystolic click
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Increase - increase the chance the If are open
10%

43. dyspnea - fatigue - edema and rales - multiple causes
Arteriolosclerosis in malignant hypertension
CHF
Mechanican contraction of the ventricles
No

44. Inspiration causes an increase in which sided heart sounds?
In RA return (inspiration)
Cardiac tamponde
Resting potential high K perm
Right sided

45. PCWP > LV diastolic pressure
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Granuloma with giant cells
Mitral stenosis

46. How are the sarcomeres added in eccentric hypertrophy?
In series
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
LAD
During diastole

47. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Preload
The aortic before pulmonic - inspiration increases diff
Inc RA pressure - due to filling against closed tricupsid valve
Adult type aortic coarctation

48. What murmur is heard with aortic regurg?
Increased efferent SANS and decreased efferent PANS
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Group a beta hemolytic strep
Eccentric - concentric hypertrophy causes diastolic disfunction

49. When does EF decrease
In HF
Wegener's
Conduction delay through AV node - nl < 200 msec
Glossopharyngeal to soliary nucleus of medulla

50. Which kind of infarct show ST elevation - and/or pathologic Q waves
Apex and anterior interventricular septum
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Inc TPR and LA return (expiration)
Transmural