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Cardiology

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 mitral prolapse predeispose to?
Kidney
Infective endocarditis
Ischemic heart dz - mitral valve prolapse - LV dilation
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

2. most common primary cardiac tumor in children - associated with tuberous sclerosis
Mitral valve prolapse
Apex and anterior interventricular septum
Rhabdomyomas
Increasing activity of Ca pump in SR

3. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Posterior descending (80% off the RCA - 20% off the circumflex)
Acute thrombosis of coronary artery
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Mitral valve prolapse

4. Which murmur is heard in aortic stenosis?
Troponin I
Crescendo - decrescendo systolic ejection murmur following ejection click
Left atrial pressure
Mitral>aortic>>tricuspid - high pressure valves affected most

5. Which organ has ht highest blood flow per gram of tissue
Systolic dysfunction
Kidney
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Stroke volume affected by contractility - afterload - and preload

6. Which channel accounts for automaticity of the SA and AV nodes?
Late diastolic murmur following an opening snap
If sodium channel
Stroke volume
Wolff - Parkinson white syndrome

7. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
S. aureus
LAD > RCA > circumflex
LCX - V4- V6
Pulmonic stenosis and RBBB

8. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Right sided
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
CO
Lymphangiosarcoma

9. The cause of cardiac dilation?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Greater ventricular EDV
Aortic disecction - intraluminal tear forming false lumen
Pyogenic granuloma - associated with trauma and pregnancy

10. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
Late systolic crescendo murmur with a midsystolic click
2nd degree AV block - mobitz type 1
Mechanican contraction of the ventricles
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

11. What does FAN MY SKIN On Wednesday stand for?
Group a beta hemolytic strep
Maintain blood flow to organ over wide range of perfussion pressures
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Systolic dysfunction

12. Rank the pacemakers cells
Coarcation of aorta
During HF from microhemorrhages from inc pulm cap pressure
SA>AV>bundle of His>ventricles
Libman - sacks endocarditis

13. what happens to capillaries in lymphatic blockage
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Posterior descending (80% off the RCA - 20% off the circumflex)
Inc Kf - capillary perm
Inc interstitial osmotic pressure pulling fliud out of capillaries

14. Irregularly irregular ECG - no p waves: dx and treatment
In series
Granuloma with giant cells
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Glossopharyngeal to soliary nucleus of medulla

15. Which valve is most commonly involved in bacterial endocarditis?
LAD > RCA > circumflex
Kaposi's sarcoma
Crescendo - decrescendo systolic ejection murmur following ejection click
Mitral valve

16. failure of truncus arteriosus to divide?
Aortic stenosis or LBBB
Pos inotropy - exercise
CFX
Persistant truncus arteriosus

17. Which murmur is heard with mitral prolapse?
Late systolic crescendo murmur with a midsystolic click
Fluid movement through capillaries
V fib
P02

18. Given P = QR - what factors influence resistance?
Dec P02 - inc PC02 and dec pH
Proportional to viscosity and inversely proportional to the radius to the 4th power
No - no pressure gradient
In parallel

19. When do you see extensive coagulative necrosis in an MI
Fick principle
2-4 day - early coag necrosis on the first day
7 weeks
Turners

20. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Atherosclerosis
S. bovis
Hypertrophied cardiomyopathy
Kawasaki

21. What does the atria release in response to inc blood volume and atrial pressure
ANP
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
LAD
Late diastolic murmur following an opening snap

22. Which bacteria can cause endocarditis from prosthetic valves?
Medullary vasomotor center senses baroreceptors and JGA
In parallel
S. epidermidis
No

23. How are the sarcomeres added in eccentric hypertrophy?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Hyperlipidemia
In series
CO

24. congenital heart defect in an infant with a diabetic mother?
R to L shunt caused by stenoic pulmonic valve
Dilation
Conduction delay through AV node - nl < 200 msec
Transposition of great vessels

25. The aortic arch receptors transmit along which nerve?
Hyperlipidemia
Vagus to medulla
Myxomatous degeneration - RF - chordae rupture
RCA

26. dyspnea - fatigue - edema and rales - multiple causes
CHF
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
QRS complex
CFX

27. list the coronary vessels most likely to be occluded
LAD > RCA > circumflex
Indomethacin closes - and pge keeps it open
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
SV/ EDV

28. In the cardiac cycle - which period has the highest 02 consumption?
Transfusion
Isovolumetric contraction
Pulmonic stenosis and RBBB
RV failure - in venous pressure

29. Right to left shunts are more common in babies or kids?
TAPVR
Babies
Microscopic polyangiitis - like wegener's without granulomas
Aburpt halting of valve leaflets

30. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
Atherosclerosis
RV contraction (closed tricuspid valve bulding into atrium
Subendocardial

31. How are sarcomeres added in concentric hypertrophy?
Indomethacin closes - and pge keeps it open
In parallel
Inc interstitial osmotic pressure pulling fliud out of capillaries
CO

32. What are the different etiologies of dialted cardiomyopathy
Increase - increase the chance the If are open
CHF
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
During diastole

33. What is association with fixed S2 splitting - does not increase with inspiration
LV failure - pulm venous distention transudation of fluid
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
ASD
Non

34. What constitues the upstroke in pacemaker cells?
Resting potential high K perm
Liver
Takayasu's arteritis
Volatage gated Ca channels

35. What happens in phase 2 of the cardiac ventricular action potential?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Decreases
Wolff - Parkinson white syndrome
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

36. Churg Strauss - presentation and test
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Fick principle
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Atrial contraction

37. What are common causes of mitral regurg?
2-4 day - early coag necrosis on the first day
Ischemic heart dz - mitral valve prolapse - LV dilation
Non
LAD > RCA > circumflex

38. What other syndrom is associated with infantile aortic coarctation
Turners
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Mitral valve prolapse
Mechanican contraction of the ventricles

39. Which enzymes are useful for diagnosing reinfarction
Diastolic
CK- MB
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Increase - increase the chance the If are open

40. How does aldosterone raise MAP
Inc blood volume
Aortic dilation - bicuspid aortic valve - RF -
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Fick principle

41. in the JVP - What is the c wave?
Vasocxn - while other tissues it causes vasodilation
RV contraction (closed tricuspid valve bulding into atrium
Subendocardial
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

42. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Mitral stenosis
Black > white > asian
LV failure - pulm venous distention transudation of fluid
Hypertrophied cardiomyopathy

43. Hyperplastic onion skinning
Arteriolosclerosis in malignant hypertension
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Non
Late diastolic murmur following an opening snap

44. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Arteriorles
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Dilated cardiomyopathy

45. What does hypoxia cause in the lung versus other tissues?
Fast volatge gated Na channels
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Vagus to medulla
Vasocxn - while other tissues it causes vasodilation

46. what conditions are associated with pulsus paradoxus
In RA return (inspiration)
Unstable/crescendo angina
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

47. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Unstable/crescendo angina
Late systolic crescendo murmur with a midsystolic click
S. bovis

48. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Pulse pressure
3rd degree block - pacemaker - Lyme disease
Transfusion
Fluid movement through capillaries

49. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Apex and anterior interventricular septum
5-10 days - macs have degraded structural components

50. In an inferior wall infarct - which artery is affected and which leads show Q waves
Left atrial pressure
Apex and anterior interventricular septum
Glomus tumor
RCA - II - III - aVF