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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. Where are pacemaker cells?
Systolic dysfunction
SA and AV nodes
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Stroke volume affected by contractility - afterload - and preload

2. How does angiotensin II raise MAP
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Late diastolic murmur following an opening snap
Lymphangiosarcoma
Vasocxn

3. in the JVP - What is the v wave?
Inc RA pressure - due to filling against closed tricupsid valve
Lower right - MC - upper right - AO - upper right AC - lower left MO
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

4. What causes tet of fallot?
R to L shunt caused by stenoic pulmonic valve
Anterosuperior displacement of the infundibular septum
Myxomatous degeneration - RF - chordae rupture
Purkingee>atria>ventricles>AV node

5. In an EKG - What is the QRS complex?
Eccentric - concentric hypertrophy causes diastolic disfunction
Ventricular depolarization - nl < 120 msec
Persistant truncus arteriosus
Increased SV

6. In terms of starling forces - why does heart failure cause edema?
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Increase in Pc
V fib
LAD

7. most common heart tumor
Isovolumetric contraction
Atherosclerosis
Metastasis from melanoma or lymphoma
10%

8. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
ASD
Aortic disecction - intraluminal tear forming false lumen
Postinfarction fibrinous pericarditis

9. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
V fib
Sturge weber - vasculitis of caps
Varicose veins - thromboembolism rare

10. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Fick principle
Hypertrophied cardiomyopathy
Mitral valve prolapse
Failure of LV to in CO during exercise

11. absecnce of tricuspid valve - hypoplastic RV
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Tricuspid atresia - requires ASD and VSD
Greater ventricular EDV
Arteriolosclerosis in malignant hypertension

12. which heart valves are afected most in rheumatic heart diseease
Diastolic
Kawasaki
Takayasu's arteritis
Mitral>aortic>>tricuspid - high pressure valves affected most

13. most common primary cardiac tumor in children - associated with tuberous sclerosis
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Rhabdomyomas
Can progess to V fib
Septal defects - PDA - pulm art stenosis

14. What causes ankle - sacral edema - jugular venous distention
RV failure - in venous pressure
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Pulmonary flow murmur and diastolic rumble
LV failure - pulm venous distention transudation of fluid

15. MAP is also known as
Greater ventricular EDV
Afterload (proportional to peripheral resistance)
HypoK and bradycardia
LCX - V4- V6

16. What other sign is often present with congenital long QT syndrome - why?
During HF from microhemorrhages from inc pulm cap pressure
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

17. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Hyperlipidemia
Troponin I
Apex and anterior interventricular septum

18. The 7 complications of MI

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19. What happends in phase 1 of the ventricular cardiac action potential?
Increase contractility
Prinzmetal angina
LAD
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

20. What are anitschkow's cells
Squat. Compression of femoral arteries - inc TPR - dec
CFX
Acute thrombosis of coronary artery
Activated histiocytes

21. congenital heart defect withdown syndrome
ASD - VSD - AV septal defect (endocardial cushion defect)
Hyperlipidemia
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Tempral arteritis - may cause irreversible blindness

22. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
140/90
Libman - sacks endocarditis
Fetal right to left - neonate left to right leading to RVH and failure
Aortic/pulmonic stenosis and mitral/tricuspid regurg

23. What does HTN predispose to?
Wegener's
Purkingee>atria>ventricles>AV node
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Ischemic heart dz - mitral valve prolapse - LV dilation

24. Right to left shunts are more common in babies or kids?
Medullary vasomotor center senses baroreceptors and JGA
Babies
Anterosuperior displacement of the infundibular septum
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

25. Hyperplastic onion skinning
Kids
Purkingee>atria>ventricles>AV node
Inc interstitial osmotic pressure pulling fliud out of capillaries
Arteriolosclerosis in malignant hypertension

26. In an anterior wall infarct - which artery is effected and which leads show Q waves
Increase - increase the chance the If are open
Indomethacin closes - and pge keeps it open
2nd degree AV block - mobitz type 1
LAD - V1 - V4

27. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Diastolic
CK- MB
Aortic insuffic - late
No - no pressure gradient

28. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Granuloma with giant cells
Non
ASD - VSD - AV septal defect (endocardial cushion defect)
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

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

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30. What causes the cushing reflex and why
V fib
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Increase contractility
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

31. what percentage of HTN is secondary to renal disease?
Isovolumetric contraction
Anterosuperior displacement of the infundibular septum
10%
Temporal arteritis

32. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Hypertrophied cardiomyopathy
Kidney
Mitral valve
Vasocxn

33. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Inc Kf - capillary perm
Diastolic
S. aureus
Turners

34. In an EKG - What is the PR interval?
Conduction delay through AV node - nl < 200 msec
Postinfarction fibrinous pericarditis
LCX - I - aVL
If sodium channel

35. What is the S1 sound?
Inc central venous pressure - inc resistance to portal flow
3rd degree block - pacemaker - Lyme disease
Inc TPR and LA return (expiration)
Mitral and tricuspid closure

36. What is a normal EF
Increase - increase the chance the If are open
At least 55%
RV failure - in venous pressure
Vasodilators - (hydrAlAzine)

37. What is association with fixed S2 splitting - does not increase with inspiration
SA>AV>bundle of His>ventricles
10%
ASD
RV contraction (closed tricuspid valve bulding into atrium

38. list the coronary vessels most likely to be occluded
Pulmonic stenosis and RBBB
LAD > RCA > circumflex
Aortic insuffic - late
Can progess to V fib

39. What does the U wave indicated?
HypoK and bradycardia
Fluid movement through capillaries
Mechanican contraction of the ventricles
CK- MB

40. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
ASD - VSD - AV septal defect (endocardial cushion defect)
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Adult type aortic coarctation
Kawasaki

41. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
If sodium channel
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Preload
Infective endocarditis

42. Which organ has ht highest blood flow per gram of tissue
Stable angina
Ventricular repolarization
Proportional to viscosity and inversely proportional to the radius to the 4th power
Kidney

43. What causes aortic stenosis
Babies
Age related calcifications or bicuspid aortic valve
Dec P02 - inc PC02 and dec pH
Atherosclerosis

44. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Aortic/pulmonic stenosis and mitral/tricuspid regurg
CHF
Transfusion

45. In an acute MI - are there any visible changes via LM in the first 2-4 hours
No
Pos inotropy - exercise
Inc central venous pressure - inc resistance to portal flow
In parallel

46. PROVe
Atrial contraction
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Kids

47. What causes the ejection click in the Cres - decres murmur?
Dilated cardiomyopathy
LAD - V1 - V4
Aburpt halting of valve leaflets
LCX - I - aVL

48. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Filling is incomplete and CO falls
SA and AV nodes
Torsades de pointes
Glomus tumor

49. What cardiac change occurs in pregnancy?
LAD - V1- V2
Increased SV
TAPVR
HTN - bradycardia - and respiratory depression

50. When and why do you hear the S4 sound
Isovolumetric contraction
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Increase contractility
Turners