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Cardiology

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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. Do you see elevaged ASO titers in rheumatic heart disease
1st degree AV blodck
Yes
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
HTN - bradycardia - and respiratory depression

2. What does T wave inversion indicated?
Resting potential high K perm
MI
Aortic disecction - intraluminal tear forming false lumen
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

3. what conditions are associated with pulsus paradoxus
Glomus tumor
Late diastolic murmur following an opening snap
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

4. Why is contractility decreased in heart failure?
During diastole
Systolic dysfunction
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
CO

5. In an EKG - What is the PR interval?
Increase in Pc
Libman - sacks endocarditis
Conduction delay through AV node - nl < 200 msec
Decreases

6. What are the four most common locations for atherosclerosis?
Atherosclerosis
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
MI
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

7. Where is the most posterior portion of the heart and What can it cause?
Pulse pressure
Diastolic
Liver
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

8. In an EKG - What is the T wave?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Yes
Ventricular repolarization
Kawasaki

9. What is the difference between adult and infantile type aortic coarctation?
Transmural
No - no pressure gradient
LAD > RCA > circumflex
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

10. PCWP is an estimate of...
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Coarcation of aorta
Vagus to medulla
Left atrial pressure

11. Churg Strauss - presentation and test
Afterload (proportional to peripheral resistance)
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

12. what percentage of HTN is secondary to renal disease?
Buerger's disease
Inc interstitial osmotic pressure pulling fliud out of capillaries
Aortic dilation - bicuspid aortic valve - RF -
10%

13. Which lab value indicates blood viscosity?
Hematocrit
SA>AV>bundle of His>ventricles
Myxoma
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

14. What are the complications of atherosclerosis?
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
C - ANCA
Adult type aortic coarctation
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

15. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
RCA - II - III - aVF
Maintain blood flow to organ over wide range of perfussion pressures
MI
Fetal right to left - neonate left to right leading to RVH and failure

16. Central chemoreceptors do not respond directly to which parameter?
HypoK and bradycardia
In series
Venodilators (nitrogylcerine)
P02

17. absecnce of tricuspid valve - hypoplastic RV
Acute thrombosis of coronary artery
Aortic stenosis or LBBB
Tricuspid atresia - requires ASD and VSD
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

18. What causes the murmur heard in tricuspid regurg to enhance
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Arteriolosclerosis in malignant hypertension
Inc venous return exaccerbates pulm vasc congestion
In RA return (inspiration)

19. Which valve is most commonly involved in bacterial endocarditis?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
LAD > RCA > circumflex
Mitral valve
No - no pressure gradient

20. What do the starling forces determine
Fast volatge gated Na channels
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Increase in Pc
Fluid movement through capillaries

21. What happens with a decrease of extracellular Na
Decrease in activity of Na/Ca exhanger and increase in contractility
Age related calcifications or bicuspid aortic valve
Dilated cardiomyopathy
Volatage gated Ca channels

22. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Myxoma
Stroke volume
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Pulmonary flow murmur and diastolic rumble

23. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2nd degree AV block - mobitz type 1
Neg inotropy - HF - narcotic overdose
Cardiac tamponde
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

24. polypoid capillary hemangioma that can ulcerate and bleed
Can progess to V fib
Total anomalous pulmonary trunk venous return
Liver
Pyogenic granuloma - associated with trauma and pregnancy

25. What happens in phase 2 of the cardiac ventricular action potential?
Purkingee>atria>ventricles>AV node
Atrial contraction
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
QRS complex

26. What channels do the the pacemaker cells lack?
Myxomatous degeneration - RF - chordae rupture
Mechanican contraction of the ventricles
LAD - V1- V2
Fast volatge gated Na channels

27. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Dressler's - autoimmune
Stable angina
Henoch - Schlonlein purpura
Early deaths from myocarditis

28. Why is there edema after burns or during infection
Inc RA pressure - due to filling against closed tricupsid valve
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Fetal right to left - neonate left to right leading to RVH and failure
Inc Kf - capillary perm

29. Rank the pacemakers cells
SA>AV>bundle of His>ventricles
Lower right - MC - upper right - AO - upper right AC - lower left MO
Fick principle
S. epidermidis

30. stroke volume x HR =?
Atherosclerosis
CO
Lower right - MC - upper right - AO - upper right AC - lower left MO
Cherry hemangioma

31. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Increase in Pc
Unstable/crescendo angina
Decrease in activity of Na/Ca exhanger and increase in contractility

32. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
RCA
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
MI

33. When does EF decrease
Late diastolic murmur following an opening snap
MAP
In HF
QRS complex

34. In terms of starling forces - why does heart failure cause edema?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Increase contractility
Increase in Pc
Atrial contraction

35. Restrictive cardiomyopathy causes
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Postinfarction fibrinous pericarditis
PDA
The first 4 days

36. benign cap hemangioma of infancy - spont regresses
Patent ductus arteriosus - congenital rubella or prematurity
Vasocxn - while other tissues it causes vasodilation
Strawberry hemangioma
Indomethacin closes - and pge keeps it open

37. How are the sarcomeres added in eccentric hypertrophy?
Inc interstitial osmotic pressure pulling fliud out of capillaries
5-10 days - macs have degraded structural components
In series
The plateau period

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

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39. When is the scar completely formed in an MI?
Wegener's
During diastole
7 weeks
Angiosarcoma

40. What is the result of not have fast sodium channels in pacemaker cells?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Henoch - Schlonlein purpura
Raynaud's

41. Which sympathetic receptors raise MAP
140/90
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Subendocardial - fewer collaterals and higher pressure

42. What does HTN predispose to?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Fluid movement through capillaries
LCX - V4- V6
Transfusion

43. What is the classic X ray finding for tet of fallot?
Boot shaped heart
Yes
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Acute thrombosis of coronary artery

44. What does the U wave indicated?
HypoK and bradycardia
Myxomatous degeneration - RF - chordae rupture
Strawberry hemangioma
Fluid movement through capillaries

45. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
5-10 days - macs have degraded structural components
The operating point of the heart
Decreases

46. In an acute MI - are there any visible changes via LM in the first 2-4 hours
SV/ EDV
Can progess to V fib
No
Crescendo - decrescendo systolic ejection murmur following ejection click

47. What causes the cushing reflex and why
Kids
Mitral>aortic>>tricuspid - high pressure valves affected most
Afterload (proportional to peripheral resistance)
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

48. What causes the murmur heard in MR to enhance?
Mean arterial pressure
Inc TPR and LA return (expiration)
Volatage gated Ca channels
Yes

49. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Decreased
Cardiac tamponde
Henoch - Schlonlein purpura
Adult type aortic coarctation

50. serum marker for wegener's
Mitral and tricuspid closure
C - ANCA
Mean arterial pressure
Pulmonary flow murmur and diastolic rumble