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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. fibrous plaques and atheromas in intima of arteries
Atherosclerosis
Arteriolosclerosis in malignant hypertension
At least 55%
Torsades de pointes

2. Which murmur is heard with VSD?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
EKG
Rapid upstroke - voltage gated Na channels open
Vasocxn - while other tissues it causes vasodilation

3. Right to left shunts are more common in babies or kids?
CK- MB
Babies
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

4. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Glomus tumor
Increased SV
Transfusion
Tricuspid atresia - requires ASD and VSD

5. What masks atrial repolarization?
Myxoma
Cherry hemangioma
QRS complex
Atrial contraction

6. Where are pacemaker cells?
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
SA and AV nodes
Extracellular calcium - calcium induced calcium release
Babies

7. What 4 things drive myocardial 02 demand?
Aortic insuffic - late
Aortic disecction - intraluminal tear forming false lumen
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Pulmonary flow murmur and diastolic rumble

8. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Hypertrophied cardiomyopathy
Wegener's
Proportional to viscosity and inversely proportional to the radius to the 4th power
LV failure - pulm venous distention transudation of fluid

9. bening capillary hemangioma of elderly - does not regress
Cherry hemangioma
ANP
P02
The first 4 days

10. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Adult type aortic coarctation
Dec plasma proteins
Rhabdomyomas
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

11. congenital heart defect with marfan's
Cherry hemangioma
Vasodilators - (hydrAlAzine)
Arteriolosclerosis in malignant hypertension
Aortic insuffic - late

12. Which artery supplies the SA and AV nodes?
Dec plasma proteins
RCA
Myxoma
The plateau period

13. What is association with fixed S2 splitting - does not increase with inspiration
ASD
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
ASD - VSD - AV septal defect (endocardial cushion defect)

14. moncekberg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Gap junctions
3rd degree block - pacemaker - Lyme disease
Pulsus parvus and tardus - weak - can lead to syncope

15. What does the U wave indicated?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
HypoK and bradycardia
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Kids

16. Where does coronary artery occlusion occur most commonly?
Liver
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Infective endocarditis
LAD

17. PCWP > LV diastolic pressure
Mitral stenosis
Transposition of great vessels
Increase contractility
Babies

18. EDV is also known as
Preload
Ischemic heart dz - mitral valve prolapse - LV dilation
Torsades de pointes
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

19. Wegener's tx
Increase intracellular Na - resulting in increased Ca
Cyclophosphamide and corticosteroids
Late diastolic murmur following an opening snap
Varicose veins - thromboembolism rare

20. What do the carotid and aortic bodies respond to?
Dec P02 - inc PC02 and dec pH
Preload
In series
Holosystoiic

21. no change in PR interval followed by dropped beat
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Non
Crescendo - decrescendo systolic ejection murmur following ejection click
Wolff - Parkinson white syndrome

22. What other sign is often present with congenital long QT syndrome - why?
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Total anomalous pulmonary trunk venous return
HTN - bradycardia - and respiratory depression
Postinfarction fibrinous pericarditis

23. exaggerated decrease in pulse during inspiration.

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24. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Subendocardial - fewer collaterals and higher pressure
Right sided
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Wolff - Parkinson white syndrome

25. When during cardiac nodal cells depolarize?
Sturge weber - vasculitis of caps
Right sided
During diastole
LV failure - pulm venous distention transudation of fluid

26. Given P = QR - what factors influence resistance?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Kidney
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

27. 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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28. Which murmur do you hear in mitral stenosis?
Lower right - MC - upper right - AO - upper right AC - lower left MO
3rd degree block - pacemaker - Lyme disease
Late diastolic murmur following an opening snap
Conduction delay through AV node - nl < 200 msec

29. Left to right shunts are more common in babies or kids?
RCA
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Kids
Mechanican contraction of the ventricles

30. What is the most common cause of MI
Granuloma with giant cells
Acute thrombosis of coronary artery
PDA
Activated histiocytes

31. Mitral stenosis is most often secondary to which condition?
5-10 days - macs have degraded structural components
RF
Eisenmenger's syndrome
Postinfarction fibrinous pericarditis

32. When does extracellular calcium enter the cardiac muscle cells during contraction?
The plateau period
Black > white > asian
Fast volatge gated Na channels
Dec P02 - inc PC02 and dec pH

33. In the cardiac cycle - which period has the highest 02 consumption?
Mitral and tricuspid closure
Isovolumetric contraction
S. epidermidis
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

34. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
5-10 days - macs have degraded structural components
Polyarteritis nodosum
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

35. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Fick principle
Decrease in cAMP
Aortic disecction - intraluminal tear forming false lumen
Ventricles are depolarized

36. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Transposition of great vessels
Atherosclerosis
Decrease in activity of Na/Ca exhanger and increase in contractility

37. systolic - diastolic
LAD > RCA > circumflex
Aburpt halting of valve leaflets
Pulse pressure
Hematocrit

38. Unilateral headache - jaw claudication - impaired vision
V fib
Tempral arteritis - may cause irreversible blindness
7 weeks
Pulsus parvus and tardus - weak - can lead to syncope

39. pulseless disease - granulomatous thickening of the aortic arch and/or proximal great vessels - elev ESR - asian females > 40

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40. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Inc venous return exaccerbates pulm vasc congestion
MAP
Decreases
Varicose veins - thromboembolism rare

41. p - anca

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42. decrease stretch in baroreceptors leads to what response?
Mechanican contraction of the ventricles
Increased efferent SANS and decreased efferent PANS
Left sided
Volatage gated Ca channels

43. What causes the CO curve to shift downwards?
HTN - bradycardia - and respiratory depression
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Neg inotropy - HF - narcotic overdose
Polyarteritis nodosum

44. PROVe
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Decrease in activity of Na/Ca exhanger and increase in contractility
MI
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

45. What are the complications of atherosclerosis?
SA and AV nodes
Left atrial pressure
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Increase - increase the chance the If are open

46. What causes the murmur heard in MR to enhance?
Strawberry hemangioma
Atherosclerosis
Inc TPR and LA return (expiration)
Changes in CO as a function of preload

47. What is the cushing triad?
HTN - bradycardia - and respiratory depression
Conduction delay through AV node - nl < 200 msec
Cyclophosphamide and corticosteroids
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

48. What are the different etiologies of dialted cardiomyopathy
No
In series
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Mitral>aortic>>tricuspid - high pressure valves affected most

49. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Sturge weber - vasculitis of caps
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Transposition of great vessels
Medullary vasomotor center senses baroreceptors and JGA

50. what happens to capillaries in lymphatic blockage
Maintain blood flow to organ over wide range of perfussion pressures
MI
Kawasaki
Inc interstitial osmotic pressure pulling fliud out of capillaries