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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. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Atherosclerosis
Extracellular calcium - calcium induced calcium release
Hemorrhage

2. What does mitral prolapse predeispose to?
Infective endocarditis
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Vagus to medulla
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

3. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
Vasodilators - (hydrAlAzine)
Aortic dilation - bicuspid aortic valve - RF -
SV/ EDV

4. 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
Decrease in cAMP
Atherosclerosis
LCX - I - aVL

5. Right to left shunts are more common in babies or kids?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Babies
Decreased
In series

6. In an acute MI - are there any visible changes via LM in the first 2-4 hours
S. aureus
No
HypoK and bradycardia
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

7. What causes the cushing reflex and why
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
5-10 days - macs have degraded structural components
Torsades de pointes
Failure of LV to in CO during exercise

8. What do the starling forces determine
Fluid movement through capillaries
Ventricular depolarization - nl < 120 msec
In parallel
Kaposi's sarcoma

9. congenital heart defect in an infant with a diabetic mother?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Kawasaki
Transposition of great vessels
7 weeks

10. How does digitatlis increase contractility?
Vasocxn
Increase intracellular Na - resulting in increased Ca
Acute thrombosis of coronary artery
Isovolumetric contraction

11. What is the machine like murmur? What is the heart pathology and the predisposing causes
Patent ductus arteriosus - congenital rubella or prematurity
Neg inotropy - HF - narcotic overdose
5-10 days - macs have degraded structural components
Changes in CO as a function of preload

12. Central chemoreceptors do not respond directly to which parameter?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
CHF
P02
Holosystolic - harsh sounding murmur - loudest over tricuspid area

13. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
No - no pressure gradient
Troponin I
Total anomalous pulmonary trunk venous return
Increase - increase the chance the If are open

14. Why is contractility decreased in heart failure?
Cardiac tamponde
Inc RA pressure - due to filling against closed tricupsid valve
Stable angina
Systolic dysfunction

15. What do patients die early from in rheumatic heart disease?
Unstable/crescendo angina
Early deaths from myocarditis
Inc RA pressure - due to filling against closed tricupsid valve
LCX - V4- V6

16. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Maintain blood flow to organ over wide range of perfussion pressures
No
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Transfusion

17. What other syndrom is associated with infantile aortic coarctation
ASD
Stroke volume affected by contractility - afterload - and preload
Turners
Ventricular repolarization

18. The 7 complications of MI

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19. What is associated with paradoxical spliting of S2
Pulsus parvus and tardus - weak - can lead to syncope
Subendocardial
Aortic stenosis or LBBB
Posterior descending (80% off the RCA - 20% off the circumflex)

20. What supplies the posterior left ventricle?
RV contraction (closed tricuspid valve bulding into atrium
CFX
Rhabdomyomas
Aburpt halting of valve leaflets

21. no change in PR interval followed by dropped beat
CFX
Can progess to V fib
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Holosystoiic

22. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Proportional to viscosity and inversely proportional to the radius to the 4th power
5-10 days - macs have degraded structural components
Filling is incomplete and CO falls

23. What is the danger of torsades to pointes?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Unstable/crescendo angina
Can progess to V fib

24. What are the complications of atherosclerosis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
V fib arrhythima
ANP
Vasocxn

25. in the JVP - What is the v wave?
10%
Neg inotropy - HF - narcotic overdose
Inc RA pressure - due to filling against closed tricupsid valve
LCX - V4- V6

26. PROVe
Aortic insuffic - late
Age related calcifications or bicuspid aortic valve
Microscopic polyangiitis - like wegener's without granulomas
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

27. When do you find hemosiderin laden macrophages in the lungs?
Decreases
Fast volatge gated Na channels
During HF from microhemorrhages from inc pulm cap pressure
Atrial contraction

28. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Increase - increase the chance the If are open
Temporal arteritis
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Atrial contraction

29. What does autoregulation do?
...
Maintain blood flow to organ over wide range of perfussion pressures
Pyogenic granuloma - associated with trauma and pregnancy
Total anomalous pulmonary trunk venous return

30. benign cap hemangioma of infancy - spont regresses
SV/ EDV
LAD - V1 - V4
Strawberry hemangioma
Coarcation of aorta

31. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Hyperlipidemia
Late systolic crescendo murmur with a midsystolic click
LAD - V1- V2

32. If HR is too fast (V tach) what happens during diastole?
SV/ EDV
Filling is incomplete and CO falls
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Crescendo - decrescendo systolic ejection murmur following ejection click

33. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Dilated cardiomyopathy
Mean arterial pressure
LCX - I - aVL
QRS complex

34. What does FAN MY SKIN On Wednesday stand for?
CK- MB
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

35. Which area of the endocardium is especially vulnerable to infarction? Why?
Subendocardial - fewer collaterals and higher pressure
Hyperlipidemia
Wegener's
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

36. What causes the midsystolic click
Sudden tensing of chordae tendinae
Neg inotropy - HF - narcotic overdose
Squat. Compression of femoral arteries - inc TPR - dec
Transposition of great vessels

37. What do the carotid and aortic bodies respond to?
Dec P02 - inc PC02 and dec pH
Aburpt halting of valve leaflets
LV failure - pulm venous distention transudation of fluid
Preload

38. What causes the CO curve to shift upwards?
Changes in CO as a function of preload
Decrease in cAMP
Fast volatge gated Na channels
Pos inotropy - exercise

39. Churg Strauss - presentation and test
Fetal right to left - neonate left to right leading to RVH and failure
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Decreases
Mitral and tricuspid closure

40. Given P = QR - what factors influence resistance?
Preload
Proportional to viscosity and inversely proportional to the radius to the 4th power
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Increasing activity of Ca pump in SR

41. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Dilation
LAD > RCA > circumflex
Coarcation of aorta

42. Expiration causes an increase in which sided heart sounds
Left sided
Dilated cardiomyopathy
Pulsus parvus and tardus - weak - can lead to syncope
2-4 day - early coag necrosis on the first day

43. moncekberg
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Cystic hygroma
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Adult type aortic coarctation

44. Which organ has ht highest blood flow per gram of tissue
Filling is incomplete and CO falls
Kidney
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
MI

45. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Decrease in activity of Na/Ca exhanger and increase in contractility
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
TAPVR
Mitral valve

46. clinical signs of cardiac tamponade
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
RV failure - in venous pressure
1st degree AV blodck
Sturge weber - vasculitis of caps

47. What does the starling curve show?
Kidney
Changes in CO as a function of preload
Pulsus parvus and tardus - weak - can lead to syncope
Left heart failure

48. What is the classic X ray finding for tet of fallot?
Squat. Compression of femoral arteries - inc TPR - dec
If sodium channel
Subendocardial - fewer collaterals and higher pressure
Boot shaped heart

49. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
In series
Apex and anterior interventricular septum
...
Pulse pressure

50. What are the 5 T's of cyanoitc babies
Changes in CO as a function of preload
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Ischemic heart dz - mitral valve prolapse - LV dilation
Glossopharyngeal to soliary nucleus of medulla