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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. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
S. epidermidis
Inc RA pressure - due to filling against closed tricupsid valve
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

2. What causes the CO curve to shift upwards?
Age related calcifications or bicuspid aortic valve
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Infective endocarditis
Pos inotropy - exercise

3. in the JVP - What is the c wave?
Inc Kf - capillary perm
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
The aortic before pulmonic - inspiration increases diff
RV contraction (closed tricuspid valve bulding into atrium

4. absecnce of tricuspid valve - hypoplastic RV
Kidney
SA>AV>bundle of His>ventricles
Cyclophosphamide and corticosteroids
Tricuspid atresia - requires ASD and VSD

5. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Conduction delay through AV node - nl < 200 msec
Cardiac tamponde
During HF from microhemorrhages from inc pulm cap pressure
Decrease in activity of Na/Ca exhanger and increase in contractility

6. congenital heart defect with turner's
Coarcation of aorta
Dec P02 - inc PC02 and dec pH
C - ANCA
The operating point of the heart

7. What does an isoelectric ST segment indicate?
Ventricles are depolarized
Decreased
Ischemic heart dz - mitral valve prolapse - LV dilation
Transfusion

8. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Acute thrombosis of coronary artery
No
MI
Polyarteritis nodosum

9. What is association with fixed S2 splitting - does not increase with inspiration
ASD
LAD - V1 - V4
During diastole
Greater ventricular EDV

10. Which class of drugs decreases afterload?
Left atrial pressure
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Libman - sacks endocarditis
Vasodilators - (hydrAlAzine)

11. Which murmur is heard with VSD?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Mitral and tricuspid closure
SA and AV nodes

12. Unilateral headache - jaw claudication - impaired vision
Inc Kf - capillary perm
Pulmonary flow murmur and diastolic rumble
Tempral arteritis - may cause irreversible blindness
Pulsus parvus and tardus - weak - can lead to syncope

13. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Myxoma
In parallel
Troponin I

14. dyspnea - fatigue - edema and rales - multiple causes
Wegener's
CHF
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Diastolic

15. congenital heart defect with congenital rubella
Early deaths from myocarditis
MI
Babies
Septal defects - PDA - pulm art stenosis

16. EDV is also known as
Inc interstitial osmotic pressure pulling fliud out of capillaries
Adult type aortic coarctation
C - ANCA
Preload

17. What causes the midsystolic click
Pyogenic granuloma - associated with trauma and pregnancy
Unstable/crescendo angina
Eccentric - concentric hypertrophy causes diastolic disfunction
Sudden tensing of chordae tendinae

18. In an anterior wall infarct - which artery is effected and which leads show Q waves
Lymphangiosarcoma
LAD - V1 - V4
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
During HF from microhemorrhages from inc pulm cap pressure

19. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
LV failure - pulm venous distention transudation of fluid
RCA - II - III - aVF
ASD - VSD - AV septal defect (endocardial cushion defect)

20. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Arteriorles
Holosystoiic
Aburpt halting of valve leaflets
Glomus tumor

21. which heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Pulmonary flow murmur and diastolic rumble
Squat. Compression of femoral arteries - inc TPR - dec

22. How do beta blockers decrease contractility?
Dilation
Temporal arteritis
Proportional to viscosity and inversely proportional to the radius to the 4th power
Decrease in cAMP

23. What does prolonged QT predispose to?
Torsades de pointes
Decrease in activity of Na/Ca exhanger and increase in contractility
CFX
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

24. Where are pacemaker cells?
Kawasaki
Troponin I
S. bovis
SA and AV nodes

25. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Glomus tumor
Dilation
Adult type aortic coarctation
2nd degree AV block - mobitz type 1

26. Do you see elevaged ASO titers in rheumatic heart disease
Pulse pressure
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Yes
TAPVR

27. Restrictive cardiomyopathy causes
Filling is incomplete and CO falls
Fetal right to left - neonate left to right leading to RVH and failure
The operating point of the heart
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

28. What masks atrial repolarization?
QRS complex
Pulse pressure
LAD > RCA > circumflex
Sturge weber - vasculitis of caps

29. polypoid capillary hemangioma that can ulcerate and bleed
Pyogenic granuloma - associated with trauma and pregnancy
Greater ventricular EDV
Granuloma with giant cells
Non

30. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Fast volatge gated Na channels
Anterosuperior displacement of the infundibular septum
Tricuspid atresia - requires ASD and VSD
Hyperlipidemia

31. What causes aortic stenosis
Kids
Maintain blood flow to organ over wide range of perfussion pressures
Age related calcifications or bicuspid aortic valve
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

32. What other sign is often present with congenital long QT syndrome - why?
Tricuspid atresia - requires ASD and VSD
Aburpt halting of valve leaflets
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Kidney

33. Which two mechanisms sense decrease MAP?
Truncus - tet of fallot
Medullary vasomotor center senses baroreceptors and JGA
Early deaths from myocarditis
CFX

34. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
At least 55%
Transfusion
Black > white > asian

35. failure of truncus arteriosus to divide?
Persistant truncus arteriosus
LCX - I - aVL
CFX
HTN - bradycardia - and respiratory depression

36. What causes the murmur heard in tricuspid regurg to enhance
In RA return (inspiration)
Vagus to medulla
EKG
Late diastolic murmur following an opening snap

37. What causes tet of fallot?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Venodilators (nitrogylcerine)
Anterosuperior displacement of the infundibular septum

38. What channels do the the pacemaker cells lack?
Pulmonary flow murmur and diastolic rumble
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Fast volatge gated Na channels

39. most common primary cardiac tumor in children - associated with tuberous sclerosis
Stroke volume
Rhabdomyomas
Eccentric - concentric hypertrophy causes diastolic disfunction
Apex and anterior interventricular septum

40. What does T wave inversion indicated?
MI
Heart - 02 extraction is always around 100%
Increased SV
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

41. exaggerated decrease in pulse during inspiration.

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42. with what heart sounds do ASD usually present?
Angiosarcoma
Pulmonary flow murmur and diastolic rumble
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
During diastole

43. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
During diastole
Temporal arteritis
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

44. What does the LAD supply?
Turners
140/90
Apex and anterior interventricular septum
Prinzmetal angina

45. The cause of cardiac dilation?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Greater ventricular EDV
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Late systolic crescendo murmur with a midsystolic click

46. machine murmer
Pyogenic granuloma - associated with trauma and pregnancy
Infective endocarditis
Inc venous return exaccerbates pulm vasc congestion
PDA

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

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48. What is the S1 sound?
Increased efferent SANS and decreased efferent PANS
Pulsus parvus and tardus - weak - can lead to syncope
Mitral and tricuspid closure
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

49. Which lab value indicates blood viscosity?
Hematocrit
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Greater ventricular EDV
V fib

50. What causes the CO curve to shift downwards?
Pulsus parvus and tardus - weak - can lead to syncope
HypoK and bradycardia
Neg inotropy - HF - narcotic overdose
Stable angina