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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. What does the LAD supply?
Filling is incomplete and CO falls
Non
Apex and anterior interventricular septum
EKG

2. What does FAN MY SKIN On Wednesday stand for?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Inc RA pressure - due to filling against closed tricupsid valve
Increasing activity of Ca pump in SR
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

3. PROVe
Total anomalous pulmonary trunk venous return
Boot shaped heart
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Glossopharyngeal to soliary nucleus of medulla

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

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5. What are the 5 T's of cyanoitc babies
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Persistant truncus arteriosus
Aortic dilation - bicuspid aortic valve - RF -
Atherosclerosis

6. How does acidosis affect contractility?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Decreased
HTN - bradycardia - and respiratory depression
Aortic and pulmonary closing

7. What does autoregulation do?
At least 55%
Maintain blood flow to organ over wide range of perfussion pressures
Increased SV
Left atrial pressure

8. What causes the murmur heard in MR to enhance?
Mechanican contraction of the ventricles
Lower right - MC - upper right - AO - upper right AC - lower left MO
Neg inotropy - HF - narcotic overdose
Inc TPR and LA return (expiration)

9. Which murmur is characteristic of mitral/tricuspid regurg?
Holosystoiic
Transfusion
Eisenmenger's syndrome
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

10. In what disease states is blood viscosity increased?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Medullary vasomotor center senses baroreceptors and JGA
2nd degree AV block - mobitz type 1
Liver

11. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Stable angina
MAP
Indomethacin closes - and pge keeps it open

12. In an EKG - What is the PR interval?
Liver
Tricuspid atresia - requires ASD and VSD
CK- MB
Conduction delay through AV node - nl < 200 msec

13. How do catecholamines increase contractility?
Atrial contraction
Glomus tumor
CK- MB
Increasing activity of Ca pump in SR

14. Which organ gets the largest share of systemic cardiac output
Torsades de pointes
Lower right - MC - upper right - AO - upper right AC - lower left MO
Liver
Troponin I

15. When do you find hemosiderin laden macrophages in the lungs?
During HF from microhemorrhages from inc pulm cap pressure
Lymphangiosarcoma
Inc Kf - capillary perm
...

16. What is the time frame for arrhythmia risk in the evolution of MI
RCA - II - III - aVF
Yes
Decreased
The first 4 days

17. The cause of cardiac dilation?
QRS complex
Dressler's - autoimmune
Greater ventricular EDV
Squat. Compression of femoral arteries - inc TPR - dec

18. CO x Total peripheral resistance
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Mean arterial pressure
Septal defects - PDA - pulm art stenosis
QRS complex

19. Which murmur is heard with mitral prolapse?
MAP
R to L shunt caused by stenoic pulmonic valve
CO
Late systolic crescendo murmur with a midsystolic click

20. What are the four most common locations for atherosclerosis?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Hyperlipidemia
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
V fib

21. Which bacteria can cause endocarditis from prosthetic valves?
S. epidermidis
Filling is incomplete and CO falls
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Purkingee>atria>ventricles>AV node

22. 2/3 diastolic + 1/3 systolic
RCA - II - III - aVF
Granuloma with giant cells
MAP
In parallel

23. What are aschoff bodies
Increase intracellular Na - resulting in increased Ca
CHF
Granuloma with giant cells
SA>AV>bundle of His>ventricles

24. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Postinfarction fibrinous pericarditis
Mitral and tricuspid closure
Decreases
Lower right - MC - upper right - AO - upper right AC - lower left MO

25. in the JVP - What is the a wave?
Venodilators (nitrogylcerine)
Atrial contraction
CK- MB
Buerger's disease

26. What is the gold standard for dx of MI in the first 6 hours
Aortic dilation - bicuspid aortic valve - RF -
Buerger's disease
Conduction delay through AV node - nl < 200 msec
EKG

27. What is the formula for EF?
Decrease in activity of Na/Ca exhanger and increase in contractility
SV/ EDV
Early deaths from myocarditis
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

28. Which kind of infarct show ST elevation - and/or pathologic Q waves
Metastasis from melanoma or lymphoma
Libman - sacks endocarditis
Transmural
Eccentric - concentric hypertrophy causes diastolic disfunction

29. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
In parallel
2nd degree AV block - mobitz type 1
Varicose veins - thromboembolism rare
Mitral and tricuspid closure

30. Which two mechanisms sense decrease MAP?
Maintain blood flow to organ over wide range of perfussion pressures
Medullary vasomotor center senses baroreceptors and JGA
Diastolic
R to L shunt caused by stenoic pulmonic valve

31. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Aortic stenosis or LBBB
Fetal right to left - neonate left to right leading to RVH and failure
Prinzmetal angina
Sudden tensing of chordae tendinae

32. What does FROM JANE stand for in bacterial endocarditis?

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33. Which lab value indicates blood viscosity?
Ventricles are depolarized
Arteriorles
Aortic disecction - intraluminal tear forming false lumen
Hematocrit

34. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Inc interstitial osmotic pressure pulling fliud out of capillaries
Adult type aortic coarctation
TAPVR
Vasocxn - while other tissues it causes vasodilation

35. What kind of infarct show ST depression
Lymphangiosarcoma
Inc TPR and LA return (expiration)
Subendocardial
Takayasu's arteritis

36. Inspiration causes an increase in which sided heart sounds?
HypoK and bradycardia
C - ANCA
Right sided
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

37. Which class of drugs decreases afterload?
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Vasodilators - (hydrAlAzine)
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Takayasu's arteritis

38. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Venodilators (nitrogylcerine)
Kaposi's sarcoma
RCA
Hypertrophied cardiomyopathy

39. How do beta blockers decrease contractility?
During diastole
Decrease in cAMP
Dilation
Aortic disecction - intraluminal tear forming false lumen

40. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Libman - sacks endocarditis
LCX - I - aVL
CHF
Cyclophosphamide and corticosteroids

41. The aortic arch receptors transmit along which nerve?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Fick principle
Vagus to medulla
Infective endocarditis

42. What causes the CO curve to shift upwards?
Isovolumetric contraction
Pos inotropy - exercise
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Early deaths from myocarditis

43. congenital heart defect with turner's
Extracellular calcium - calcium induced calcium release
Apex and anterior interventricular septum
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Coarcation of aorta

44. necrotizing granulomas in lung and upper airways - nectrotizing GN - small vessel vasculitis

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45. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Kidney
Torsades de pointes
No - no pressure gradient
Eisenmenger's syndrome

46. Which murmur is heard in aortic stenosis?
Takayasu's arteritis
Crescendo - decrescendo systolic ejection murmur following ejection click
LAD - V1 - V4
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

47. Expiration causes an increase in which sided heart sounds
Left sided
Mitral valve prolapse
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Late diastolic murmur following an opening snap

48. What do patients die early from in rheumatic heart disease?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Inc RA pressure - due to filling against closed tricupsid valve
Early deaths from myocarditis
Inc Kf - capillary perm

49. What other sign is often present with congenital long QT syndrome - why?
Troponin I
Myxomatous degeneration - RF - chordae rupture
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
No

50. clinical signs of cardiac tamponade
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Inc RA pressure - due to filling against closed tricupsid valve
Tempral arteritis - may cause irreversible blindness
Strawberry hemangioma