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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. How do beta blockers decrease contractility?
Decrease in cAMP
No - no pressure gradient
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
In HF

2. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Wolff - Parkinson white syndrome
Lower right - MC - upper right - AO - upper right AC - lower left MO
No - no pressure gradient
7 weeks

3. Where are pacemaker cells?
1st degree AV blodck
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
QRS complex
SA and AV nodes

4. When and why is the S3 sound heard?
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Pos inotropy - exercise
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Inc venous return exaccerbates pulm vasc congestion

5. polypoid capillary hemangioma that can ulcerate and bleed
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Atrial contraction
Systolic dysfunction
Pyogenic granuloma - associated with trauma and pregnancy

6. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Temporal arteritis
Adult type aortic coarctation
Maintain blood flow to organ over wide range of perfussion pressures
Granuloma with giant cells

7. most common heart tumor
Tempral arteritis - may cause irreversible blindness
Heart - 02 extraction is always around 100%
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Metastasis from melanoma or lymphoma

8. What causes the early cyanosis in Tet of Fallot?
Resting potential high K perm
Filling is incomplete and CO falls
R to L shunt caused by stenoic pulmonic valve
Heart - 02 extraction is always around 100%

9. what percentage of HTN is secondary to renal disease?
Sudden tensing of chordae tendinae
10%
Ventricles are depolarized
Troponin I

10. Exercise - overtransfusiion and excitiment causes and increase in...?
Apex and anterior interventricular septum
Preload
MI
Coarcation of aorta

11. Which murmur is characteristic of mitral/tricuspid regurg?
2-4 day - early coag necrosis on the first day
Holosystoiic
In RA return (inspiration)
Mitral>aortic>>tricuspid - high pressure valves affected most

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

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13. with what heart sounds do ASD usually present?
Black > white > asian
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Pulmonary flow murmur and diastolic rumble
Kawasaki

14. Which organ has ht highest blood flow per gram of tissue
Buerger's disease
7 weeks
SA and AV nodes
Kidney

15. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Preload
Metastasis from melanoma or lymphoma
Aortic dilation - bicuspid aortic valve - RF -

16. sawtooth wave

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17. dyspnea - fatigue - edema and rales - multiple causes
In series
Mitral stenosis
CHF
Microscopic polyangiitis - like wegener's without granulomas

18. What causes the midsystolic click
Sudden tensing of chordae tendinae
Inc blood volume
Tempral arteritis - may cause irreversible blindness
Decrease in activity of Na/Ca exhanger and increase in contractility

19. What cardiac change occurs in pregnancy?
Mean arterial pressure
Systolic dysfunction
During diastole
Increased SV

20. What causes aortic stenosis
Hemorrhage
Age related calcifications or bicuspid aortic valve
Fast volatge gated Na channels
Subendocardial - fewer collaterals and higher pressure

21. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
LAD - V1 - V4
Medullary vasomotor center senses baroreceptors and JGA
Rhabdomyomas

22. 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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23. What does the U wave indicated?
Vagus to medulla
PDA
Subendocardial
HypoK and bradycardia

24. Why is there edema after burns or during infection
Kawasaki
Venodilators (nitrogylcerine)
Cyclophosphamide and corticosteroids
Inc Kf - capillary perm

25. What is the S2 sound?
Failure of LV to in CO during exercise
Gap junctions
Aortic and pulmonary closing
Vagus to medulla

26. What does autoregulation do?
Maintain blood flow to organ over wide range of perfussion pressures
Activated histiocytes
Polyarteritis nodosum
Increase in Pc

27. When does extracellular calcium enter the cardiac muscle cells during contraction?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
The plateau period
Dec plasma proteins

28. What other syndrom is associated with infantile aortic coarctation
Adult type aortic coarctation
Mitral and tricuspid closure
Turners
MI

29. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Unstable/crescendo angina
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
LCX - I - aVL

30. What causes the murmur heard in tricuspid regurg to enhance
Buerger's disease
Takayasu's arteritis
In RA return (inspiration)
Resting potential high K perm

31. What happens with a decrease of extracellular Na
Hypertrophied cardiomyopathy
10%
Decrease in activity of Na/Ca exhanger and increase in contractility
LAD > RCA > circumflex

32. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Late diastolic murmur following an opening snap
Hypertrophied cardiomyopathy
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Late systolic crescendo murmur with a midsystolic click

33. How are the sarcomeres added in eccentric hypertrophy?
In series
Viridans streptococci
PDA
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

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
Acute thrombosis of coronary artery
Increasing activity of Ca pump in SR
Angiosarcoma
Polyarteritis nodosum

35. systolic - diastolic
Hypertrophied cardiomyopathy
Sudden tensing of chordae tendinae
Pulse pressure
Black > white > asian

36. MAP is also known as
V fib
Left atrial pressure
Afterload (proportional to peripheral resistance)
CHF

37. Which class of drugs decrease preload
Mechanican contraction of the ventricles
Venodilators (nitrogylcerine)
Inc TPR and LA return (expiration)
Failure of LV to in CO during exercise

38. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Arteriolosclerosis in malignant hypertension
Troponin I
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
S. aureus

39. in the JVP - What is the c wave?
Fluid movement through capillaries
Glomus tumor
RV contraction (closed tricuspid valve bulding into atrium
Cardiac tamponde

40. friction rub - 3-5 days post MI
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Postinfarction fibrinous pericarditis
Turners
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

41. In an anterolateral infarct - which artery is effected and which leads show Q waves
Can progess to V fib
LCX - V4- V6
Squat. Compression of femoral arteries - inc TPR - dec
At least 55%

42. Do you see elevaged ASO titers in rheumatic heart disease
2nd degree AV block - mobitz type 1
Subendocardial
Yes
Dressler's - autoimmune

43. exaggerated decrease in pulse during inspiration.

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44. Why is contractility decreased in heart failure?
Stroke volume affected by contractility - afterload - and preload
Infective endocarditis
LAD
Systolic dysfunction

45. What is the S1 sound?
Pulse pressure
S. epidermidis
Mitral and tricuspid closure
Boot shaped heart

46. What is the gold standard for dx of MI in the first 6 hours
Indomethacin closes - and pge keeps it open
EKG
Aortic disecction - intraluminal tear forming false lumen
In HF

47. What are the different etiologies of dialted cardiomyopathy
Can progess to V fib
Kidney
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Rhabdomyomas

48. no relation between p waves and QRS intervals - treatment and predisposing factor
Mean arterial pressure
3rd degree block - pacemaker - Lyme disease
The operating point of the heart
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

49. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Henoch - Schlonlein purpura
Preload
Cyclophosphamide and corticosteroids
No - no pressure gradient

50. bening capillary hemangioma of elderly - does not regress
Extracellular calcium - calcium induced calcium release
S. aureus
Holosystoiic
Cherry hemangioma