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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. Right to left shunts are more common in babies or kids?
P02
CK- MB
Babies
Inc central venous pressure - inc resistance to portal flow

2. What causes hepatomegaly?
Anterosuperior displacement of the infundibular septum
Metastasis from melanoma or lymphoma
Inc central venous pressure - inc resistance to portal flow
CFX

3. 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
Unstable/crescendo angina
Prinzmetal angina
In HF

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

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5. In an EKG - What is the PR interval?
Sturge weber - vasculitis of caps
Conduction delay through AV node - nl < 200 msec
During diastole
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

6. In an anterolateral infarct - which artery is effected and which leads show Q waves
10%
Failure of LV to in CO during exercise
Systolic dysfunction
LCX - V4- V6

7. What does increasing intracellular Ca do?
Increase contractility
Gap junctions
Atrial contraction
Ventricular repolarization

8. Chronic mitral stenosis can lead to what changes in size of the LA
Maintain blood flow to organ over wide range of perfussion pressures
P02
Dilation
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

9. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Lymphangiosarcoma
Ischemic heart dz - mitral valve prolapse - LV dilation
R to L shunt caused by stenoic pulmonic valve
Decreases

10. Which class of drugs decrease preload
Indomethacin closes - and pge keeps it open
Ventricular depolarization - nl < 120 msec
Venodilators (nitrogylcerine)
Mitral and tricuspid closure

11. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Turners
Left sided
Extracellular calcium - calcium induced calcium release
Viridans streptococci

12. which ethnic groups have higher association with HTN?
Strawberry hemangioma
Black > white > asian
Tempral arteritis - may cause irreversible blindness
MI

13. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Wolff - Parkinson white syndrome
Indomethacin closes - and pge keeps it open
HypoK and bradycardia
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

14. What is the classic X ray finding for tet of fallot?
Aortic dilation - bicuspid aortic valve - RF -
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Boot shaped heart
Atherosclerosis

15. Which lab value indicates blood viscosity?
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Mitral valve
Pulsus parvus and tardus - weak - can lead to syncope
Hematocrit

16. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Right sided
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Mitral stenosis
Dec plasma proteins

17. What can cause mitral prolapse?
Myxomatous degeneration - RF - chordae rupture
Infective endocarditis
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Adult type aortic coarctation

18. What does an isoelectric ST segment indicate?
Ventricles are depolarized
Posterior descending (80% off the RCA - 20% off the circumflex)
...
Mitral>aortic>>tricuspid - high pressure valves affected most

19. When do you find hemosiderin laden macrophages in the lungs?
In HF
Aortic dilation - bicuspid aortic valve - RF -
LAD - V1- V2
During HF from microhemorrhages from inc pulm cap pressure

20. What is the progression of atherosclerosis?
Infective endocarditis
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
LAD

21. congenital heart defect in an infant with a diabetic mother?
Vasodilators
Black > white > asian
Mitral>aortic>>tricuspid - high pressure valves affected most
Transposition of great vessels

22. Which bacteria causes rheumatic heart disease
Posterior descending (80% off the RCA - 20% off the circumflex)
Group a beta hemolytic strep
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Prinzmetal angina

23. polypoid capillary hemangioma that can ulcerate and bleed
Pyogenic granuloma - associated with trauma and pregnancy
Posterior descending (80% off the RCA - 20% off the circumflex)
Atrial contraction
Increase - increase the chance the If are open

24. What kind of infarct show ST depression
Pulmonary flow murmur and diastolic rumble
Pulmonic stenosis and RBBB
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Subendocardial

25. What is the most common cause of MI
Hemorrhage
Acute thrombosis of coronary artery
Ventricles are depolarized
In RA return (inspiration)

26. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Boot shaped heart
Eccentric - concentric hypertrophy causes diastolic disfunction
Varicose veins - thromboembolism rare
Left sided

27. The carotid sinus transmits along which nerve?
SA>AV>bundle of His>ventricles
Glossopharyngeal to soliary nucleus of medulla
Group a beta hemolytic strep
Septal defects - PDA - pulm art stenosis

28. fibrinous pericarditis several weeks post MI

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29. In an anterior wall infarct - which artery is effected and which leads show Q waves
Prinzmetal angina
Maintain blood flow to organ over wide range of perfussion pressures
LAD - V1 - V4
Eccentric - concentric hypertrophy causes diastolic disfunction

30. absecnce of tricuspid valve - hypoplastic RV
Babies
Isovolumetric contraction
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Tricuspid atresia - requires ASD and VSD

31. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
No - no pressure gradient
Aortic disecction - intraluminal tear forming false lumen
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

32. What is a normal EF
Wolff - Parkinson white syndrome
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
CHF
At least 55%

33. What cardiac change occurs in pregnancy?
Increased SV
Atherosclerosis
Sturge weber - vasculitis of caps
2nd degree AV block - mobitz type 1

34. Which murmur do you hear in mitral stenosis?
Late diastolic murmur following an opening snap
Cyclophosphamide and corticosteroids
Afterload (proportional to peripheral resistance)
Aortic/pulmonic stenosis and mitral/tricuspid regurg

35. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Total anomalous pulmonary trunk venous return
Group a beta hemolytic strep
Chordae rupture - GN - suppurative pericarditis - emboli
Glomus tumor

36. Rank the pacemakers cells
Sudden tensing of chordae tendinae
Cyclophosphamide and corticosteroids
Increase intracellular Na - resulting in increased Ca
SA>AV>bundle of His>ventricles

37. What is indicated when CO and venous return are equal?
Aortic disecction - intraluminal tear forming false lumen
Inc Kf - capillary perm
The operating point of the heart
Mitral valve

38. exaggerated decrease in pulse during inspiration.

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39. Where is the most posterior portion of the heart and What can it cause?
Pulse pressure
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

40. Which murmur is heard with mitral prolapse?
Sturge weber - vasculitis of caps
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Late systolic crescendo murmur with a midsystolic click
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

41. prolonged PR interval
Hemorrhage
1st degree AV blodck
Greater ventricular EDV
Mitral valve prolapse

42. What is the difference between adult and infantile type aortic coarctation?
Libman - sacks endocarditis
Torsades de pointes
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
R to L shunt caused by stenoic pulmonic valve

43. In the cardiac cycle - which period has the highest 02 consumption?
Isovolumetric contraction
Granuloma with giant cells
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Viridans streptococci

44. CO x Total peripheral resistance
Eisenmenger's syndrome
Subendocardial
Mitral stenosis
Mean arterial pressure

45. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Cardiac tamponde
Mitral stenosis
Decrease in activity of Na/Ca exhanger and increase in contractility
Increase in Pc

46. How are the sarcomeres added in eccentric hypertrophy?
In series
Vagus to medulla
Inc TPR and LA return (expiration)
Left heart failure

47. Which class of drugs decrease the murmur heard in aortic regurg?
1st degree AV blodck
Apex and anterior interventricular septum
Vasodilators
Vagus to medulla

48. clinical signs of cardiac tamponade
Decrease in cAMP
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Wolff - Parkinson white syndrome

49. stroke volume x HR =?
The operating point of the heart
In series
Chordae rupture - GN - suppurative pericarditis - emboli
CO

50. fibrous plaques and atheromas in intima of arteries
Atherosclerosis
Dec P02 - inc PC02 and dec pH
Left sided
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys