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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 is the characteristic pulse in aortic stenosis?
ASD - VSD - AV septal defect (endocardial cushion defect)
Lymphangiosarcoma
Pulsus parvus and tardus - weak - can lead to syncope
Atrial contraction

2. How are the sarcomeres added in eccentric hypertrophy?
Non
LCX - I - aVL
In series
Arteriorles

3. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Mitral valve
Fast volatge gated Na channels
LCX - I - aVL
Extracellular calcium - calcium induced calcium release

4. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Wolff - Parkinson white syndrome
Gap junctions
Ventricular depolarization - nl < 120 msec
Aortic and pulmonary closing

5. In the cardiac cycle - which period has the highest 02 consumption?
Isovolumetric contraction
Inc RA pressure - due to filling against closed tricupsid valve
Holosystoiic
SA and AV nodes

6. In an EKG - What is the T wave?
Mean arterial pressure
Aortic insuffic - late
Ventricular repolarization
Filling is incomplete and CO falls

7. How does angiotensin II raise MAP
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
SA and AV nodes
Vasocxn

8. list the coronary vessels most likely to be occluded
LAD > RCA > circumflex
Pyogenic granuloma - associated with trauma and pregnancy
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
V fib arrhythima

9. moncekberg
Persistant truncus arteriosus
MAP
Libman - sacks endocarditis
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

10. What can cause mitral prolapse?
Myxomatous degeneration - RF - chordae rupture
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Resting potential high K perm
Sudden tensing of chordae tendinae

11. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Inc Kf - capillary perm
Ventricles are depolarized
Angiosarcoma

12. When do coronary arteries fill?
Transfusion
Pulsus parvus and tardus - weak - can lead to syncope
Aortic and pulmonary closing
During diastole

13. serum marker for wegener's
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
C - ANCA
Neg inotropy - HF - narcotic overdose
Pyogenic granuloma - associated with trauma and pregnancy

14. polypoid capillary hemangioma that can ulcerate and bleed
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
S. epidermidis
Pyogenic granuloma - associated with trauma and pregnancy
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

15. Which class of drugs decrease preload
Cyclophosphamide and corticosteroids
Vasodilators
Varicose veins - thromboembolism rare
Venodilators (nitrogylcerine)

16. What is the machine like murmur? What is the heart pathology and the predisposing causes
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Purkingee>atria>ventricles>AV node
CHF
Patent ductus arteriosus - congenital rubella or prematurity

17. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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18. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Activated histiocytes
In series
Purkingee>atria>ventricles>AV node
Increased efferent SANS and decreased efferent PANS

19. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
No
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Hyperlipidemia
CO

20. What is the cushing triad?
10%
Boot shaped heart
Afterload (proportional to peripheral resistance)
HTN - bradycardia - and respiratory depression

21. What is the gold standard for dx of MI in the first 6 hours
EKG
Medullary vasomotor center senses baroreceptors and JGA
Arteriorles
RV failure - in venous pressure

22. What happens in phase 2 of the cardiac ventricular action potential?
Aburpt halting of valve leaflets
Ischemic heart dz - mitral valve prolapse - LV dilation
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
EKG

23. What do patients die early from in rheumatic heart disease?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Early deaths from myocarditis
Buerger's disease
MI

24. How do beta blockers decrease contractility?
Decrease in cAMP
Preload
Kids
Ventricular repolarization

25. What causes tet of fallot?
Libman - sacks endocarditis
MAP
Anterosuperior displacement of the infundibular septum
Increase - increase the chance the If are open

26. What causes the cushing reflex and why
RCA
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Ventricular depolarization - nl < 120 msec
Isovolumetric contraction

27. If HR is too fast (V tach) what happens during diastole?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Filling is incomplete and CO falls
Strawberry hemangioma
7 weeks

28. What does HTN predispose to?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Arteriorles
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

29. What causes the murmur heard in tricuspid regurg to enhance
Aortic and pulmonary closing
Vagus to medulla
In RA return (inspiration)
CK- MB

30. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
V fib
Dilated cardiomyopathy
Subendocardial
5-10 days - macs have degraded structural components

31. What are the complications of atherosclerosis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Inc blood volume
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Total anomalous pulmonary trunk venous return

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

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33. Which organ has ht highest blood flow per gram of tissue
Kidney
Myxomatous degeneration - RF - chordae rupture
Mitral>aortic>>tricuspid - high pressure valves affected most
TAPVR

34. What causes hepatomegaly?
Inc central venous pressure - inc resistance to portal flow
1st degree AV blodck
Mitral>aortic>>tricuspid - high pressure valves affected most
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

35. 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
Septal defects - PDA - pulm art stenosis
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Hemorrhage

36. What is the danger of torsades to pointes?
Can progess to V fib
ANP
2-4 day - early coag necrosis on the first day
ASD

37. friction rub - 3-5 days post MI
Mechanican contraction of the ventricles
Indomethacin closes - and pge keeps it open
Postinfarction fibrinous pericarditis
Cherry hemangioma

38. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
The operating point of the heart
Proportional to viscosity and inversely proportional to the radius to the 4th power
Wolff - Parkinson white syndrome
Libman - sacks endocarditis

39. What are anitschkow's cells
Decreases
Indomethacin closes - and pge keeps it open
Kids
Activated histiocytes

40. What channels do the the pacemaker cells lack?
Stroke volume
SA>AV>bundle of His>ventricles
Anterosuperior displacement of the infundibular septum
Fast volatge gated Na channels

41. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Resting potential high K perm
Cherry hemangioma
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Glomus tumor

42. In an anterior wall infarct - which artery is effected and which leads show Q waves
Tricuspid atresia - requires ASD and VSD
Conduction delay through AV node - nl < 200 msec
LAD - V1 - V4
SA and AV nodes

43. When and why do you hear the S4 sound
Ventricular depolarization - nl < 120 msec
Changes in CO as a function of preload
Liver
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

44. Which channel accounts for automaticity of the SA and AV nodes?
Fetal right to left - neonate left to right leading to RVH and failure
If sodium channel
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Increasing activity of Ca pump in SR

45. what percentage of HTN is secondary to renal disease?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Heart - 02 extraction is always around 100%
10%
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

46. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Polyarteritis nodosum
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Dressler's - autoimmune
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

47. In an inferior wall infarct - which artery is affected and which leads show Q waves
RCA - II - III - aVF
Infective endocarditis
Prinzmetal angina
Sturge weber - vasculitis of caps

48. What is the classic X ray finding for tet of fallot?
TAPVR
Decreased
Torsades de pointes
Boot shaped heart

49. absecnce of tricuspid valve - hypoplastic RV
Black > white > asian
Decrease in activity of Na/Ca exhanger and increase in contractility
LV failure - pulm venous distention transudation of fluid
Tricuspid atresia - requires ASD and VSD

50. What are common causes of mitral regurg?
Septal defects - PDA - pulm art stenosis
Dressler's - autoimmune
Atherosclerosis
Ischemic heart dz - mitral valve prolapse - LV dilation