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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. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Troponin I
Total anomalous pulmonary trunk venous return
No - no pressure gradient

2. Hyperplastic onion skinning
Resting potential high K perm
Arteriolosclerosis in malignant hypertension
Volatage gated Ca channels
Kaposi's sarcoma

3. Rank the pacemakers cells
The operating point of the heart
Increased SV
Black > white > asian
SA>AV>bundle of His>ventricles

4. Left to right shunts are more common in babies or kids?
Kids
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
QRS complex
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

5. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Late diastolic murmur following an opening snap
2-4 day - early coag necrosis on the first day
Glomus tumor
Atherosclerosis

6. Do you see elevaged ASO titers in rheumatic heart disease
Hyperlipidemia
Yes
SA and AV nodes
Myxomatous degeneration - RF - chordae rupture

7. What is sudden cardiac death most commonly due to...
Aortic insuffic - late
Chordae rupture - GN - suppurative pericarditis - emboli
V fib arrhythima
Babies

8. What is the S2 sound?
Fick principle
Atrial contraction
Aortic and pulmonary closing
Indomethacin closes - and pge keeps it open

9. What channels do the the pacemaker cells lack?
Fast volatge gated Na channels
Inc TPR and LA return (expiration)
Subendocardial
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

10. In an anterior wall infarct - which artery is effected and which leads show Q waves
Wolff - Parkinson white syndrome
LAD - V1 - V4
Eisenmenger's syndrome
Eccentric - concentric hypertrophy causes diastolic disfunction

11. What does FEVERSS stand for in rheumatic heart disease
2nd degree AV block - mobitz type 1
Atrial contraction
Inc central venous pressure - inc resistance to portal flow
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

12. In an EKG - What is the p wave?
Vagus to medulla
Cardiac tamponde
Myxoma
Atrial contraction

13. Why is contractility decreased in heart failure?
Systolic dysfunction
Subendocardial - fewer collaterals and higher pressure
Wolff - Parkinson white syndrome
Buerger's disease

14. PCWP > LV diastolic pressure
ANP
Mitral valve
Proportional to viscosity and inversely proportional to the radius to the 4th power
Mitral stenosis

15. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
In RA return (inspiration)
Preload
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
5-10 days - macs have degraded structural components

16. 2/3 diastolic + 1/3 systolic
Late diastolic murmur following an opening snap
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
MAP
Aortic insuffic - late

17. Which artery supplies the SA and AV nodes?
RCA
SV/ EDV
Patent ductus arteriosus - congenital rubella or prematurity
Granuloma with giant cells

18. What is the early and late lesion in rheumatic heart disease
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Mitral valve prolapse
Atherosclerosis
Greater ventricular EDV

19. The cause of dyspnea on exertion?
Failure of LV to in CO during exercise
In series
Dec P02 - inc PC02 and dec pH
Persistant truncus arteriosus

20. What happens in phase 4 of the cardiac ventricular action potential?
S. bovis
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
S. aureus
Resting potential high K perm

21. What are the systolic heart sounds
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Sturge weber - vasculitis of caps
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Aortic/pulmonic stenosis and mitral/tricuspid regurg

22. Which bacteria can cause endocarditis from prosthetic valves?
S. epidermidis
Neg inotropy - HF - narcotic overdose
Vagus to medulla
Increase contractility

23. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
C - ANCA
Eccentric - concentric hypertrophy causes diastolic disfunction
Mitral>aortic>>tricuspid - high pressure valves affected most
Holosystolic - harsh sounding murmur - loudest over tricuspid area

24. In an anterolateral infarct - which artery is effected and which leads show Q waves
LCX - V4- V6
Kidney
Atrial contraction
Aortic and pulmonary closing

25. What are the complications from bacterial endocarditis?
Chordae rupture - GN - suppurative pericarditis - emboli
Resting potential high K perm
Cystic hygroma
Vasocxn

26. What causes the murmur heard in MR to enhance?
Volatage gated Ca channels
Posterior descending (80% off the RCA - 20% off the circumflex)
Greater ventricular EDV
Inc TPR and LA return (expiration)

27. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Stable angina
Microscopic polyangiitis - like wegener's without granulomas
Babies

28. Which two mechanisms sense decrease MAP?
Subendocardial - fewer collaterals and higher pressure
Medullary vasomotor center senses baroreceptors and JGA
Mitral stenosis
Inc central venous pressure - inc resistance to portal flow

29. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Anterosuperior displacement of the infundibular septum
Systolic dysfunction
Wolff - Parkinson white syndrome
Inc RA pressure - due to filling against closed tricupsid valve

30. Which bacteria causes endocarditis in the presence of colon cancer
S. bovis
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
SV/ EDV
Persistant truncus arteriosus

31. What 4 things drive myocardial 02 demand?
Late diastolic murmur following an opening snap
Inc blood volume
Sturge weber - vasculitis of caps
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

32. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Early deaths from myocarditis
Varicose veins - thromboembolism rare
Fast volatge gated Na channels
Persistant truncus arteriosus

33. most common heart tumor
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
LAD > RCA > circumflex
Sudden tensing of chordae tendinae
Metastasis from melanoma or lymphoma

34. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
LAD > RCA > circumflex
Increased efferent SANS and decreased efferent PANS
Hyperlipidemia
Non

35. What do the starling forces determine
Fluid movement through capillaries
Ventricular depolarization - nl < 120 msec
Dec P02 - inc PC02 and dec pH
PDA

36. In an inferior wall infarct - which artery is affected and which leads show Q waves
S. aureus
RCA - II - III - aVF
Cyclophosphamide and corticosteroids
Temporal arteritis

37. What are the diastolic heart sounds?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
P02
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

38. most common primary cardiac tumor in children - associated with tuberous sclerosis
Rhabdomyomas
Hematocrit
SA and AV nodes
Left sided

39. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Dec plasma proteins
RCA - II - III - aVF
Dilation
Early deaths from myocarditis

40. congenital heart defect with marfan's
Myxoma
Indomethacin closes - and pge keeps it open
Pulsus parvus and tardus - weak - can lead to syncope
Aortic insuffic - late

41. What causes the CO curve to shift downwards?
Neg inotropy - HF - narcotic overdose
Conduction delay through AV node - nl < 200 msec
No - no pressure gradient
Dec plasma proteins

42. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Mitral valve
Dressler's - autoimmune
Increase - increase the chance the If are open
Prinzmetal angina

43. systolic - diastolic
In RA return (inspiration)
Atrial contraction
Pulse pressure
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

44. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Fetal right to left - neonate left to right leading to RVH and failure
In HF
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Boot shaped heart

45. In the cardiac cycle - which period has the highest 02 consumption?
LV failure - pulm venous distention transudation of fluid
Vasocxn - while other tissues it causes vasodilation
Dilation
Isovolumetric contraction

46. What cardiac change occurs in pregnancy?
Left heart failure
Increased SV
Prinzmetal angina
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

47. in the JVP - What is the c wave?
Aburpt halting of valve leaflets
RV contraction (closed tricuspid valve bulding into atrium
RCA - II - III - aVF
Isovolumetric contraction

48. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Hemorrhage
Proportional to viscosity and inversely proportional to the radius to the 4th power
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
CO

49. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Cardiac tamponde
Atrial contraction
S. bovis
Increase contractility

50. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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