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Cardiology

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Answer 50 questions in 15 minutes.
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1. How does digitatlis increase contractility?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
LAD - V1 - V4
Left heart failure
Increase intracellular Na - resulting in increased Ca

2. When during cardiac nodal cells depolarize?
Left heart failure
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
During diastole

3. fibrous plaques and atheromas in intima of arteries
LCX - I - aVL
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Pyogenic granuloma - associated with trauma and pregnancy
Atherosclerosis

4. coronary artery spasm - ST elevation
Prinzmetal angina
V fib
Mitral>aortic>>tricuspid - high pressure valves affected most
The plateau period

5. What happens in phase 0 of the cardiac ventricular action potential?
Rhabdomyomas
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Diastolic
Rapid upstroke - voltage gated Na channels open

6. Wegener's presentation
Indomethacin closes - and pge keeps it open
Fetal right to left - neonate left to right leading to RVH and failure
Transposition of great vessels
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

7. What is associated with paradoxical spliting of S2
Pulmonary flow murmur and diastolic rumble
Aortic stenosis or LBBB
Patent ductus arteriosus - congenital rubella or prematurity
Sturge weber - vasculitis of caps

8. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Strawberry hemangioma
LV failure - pulm venous distention transudation of fluid
Kaposi's sarcoma
Myxomatous degeneration - RF - chordae rupture

9. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
CHF
Indomethacin closes - and pge keeps it open
Dilated cardiomyopathy
Libman - sacks endocarditis

10. What is the difference between adult and infantile type aortic coarctation?
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Mitral>aortic>>tricuspid - high pressure valves affected most
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

11. In an EKG - What is the QT interval?
Pulmonary flow murmur and diastolic rumble
1st degree AV blodck
Mechanican contraction of the ventricles
Decrease in cAMP

12. What causes tet of fallot?
Sturge weber - vasculitis of caps
Anterosuperior displacement of the infundibular septum
S. aureus
Failure of LV to in CO during exercise

13. with what heart sounds do ASD usually present?
Neg inotropy - HF - narcotic overdose
Microscopic polyangiitis - like wegener's without granulomas
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Pulmonary flow murmur and diastolic rumble

14. When is the scar completely formed in an MI?
LAD > RCA > circumflex
7 weeks
Cardiac tamponde
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

15. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Arteriolosclerosis in malignant hypertension
Increase contractility
Dec plasma proteins
Right sided

16. What do the starling forces determine
Neg inotropy - HF - narcotic overdose
Aortic stenosis or LBBB
Fluid movement through capillaries
V fib arrhythima

17. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
Stable angina
2nd degree AV block - mobitz type 1
Greater ventricular EDV
ASD - VSD - AV septal defect (endocardial cushion defect)

18. What are the diastolic heart sounds?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Decreases
LAD
MAP

19. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Increase intracellular Na - resulting in increased Ca
Mechanican contraction of the ventricles

20. What is the S1 sound?
Black > white > asian
Raynaud's
Mitral and tricuspid closure
Hemorrhage

21. in the JVP - What is the a wave?
Takayasu's arteritis
During HF from microhemorrhages from inc pulm cap pressure
Atrial contraction
Hematocrit

22. Which enzymes are useful for diagnosing reinfarction
RCA - II - III - aVF
Glossopharyngeal to soliary nucleus of medulla
CK- MB
Aortic disecction - intraluminal tear forming false lumen

23. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Neg inotropy - HF - narcotic overdose
CHF
Hemorrhage
Rhabdomyomas

24. PCWP > LV diastolic pressure
Mitral stenosis
Inc TPR and LA return (expiration)
Rhabdomyomas
Late systolic crescendo murmur with a midsystolic click

25. dyspnea - fatigue - edema and rales - multiple causes
Volatage gated Ca channels
Takayasu's arteritis
Stroke volume
CHF

26. What happens in phase 3 of the cardiac ventricular action potential?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
3rd degree block - pacemaker - Lyme disease
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
S. epidermidis

27. What is the classic X ray finding for tet of fallot?
RV contraction (closed tricuspid valve bulding into atrium
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Boot shaped heart
Myxoma

28. congenital heart defect with congenital rubella
Inc Kf - capillary perm
Septal defects - PDA - pulm art stenosis
SA and AV nodes
7 weeks

29. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
R to L shunt caused by stenoic pulmonic valve
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Myxomatous degeneration - RF - chordae rupture

30. most common primary cardiac tumor in children - associated with tuberous sclerosis
Volatage gated Ca channels
CK- MB
Rhabdomyomas
Pyogenic granuloma - associated with trauma and pregnancy

31. If HR is too fast (V tach) what happens during diastole?
Filling is incomplete and CO falls
Purkingee>atria>ventricles>AV node
Wolff - Parkinson white syndrome
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

32. What does FAN MY SKIN On Wednesday stand for?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Kidney
Angiosarcoma

33. list the coronary vessels most likely to be occluded
Dec plasma proteins
Indomethacin closes - and pge keeps it open
Fluid movement through capillaries
LAD > RCA > circumflex

34. Which artery supplies the SA and AV nodes?
Transposition of great vessels
RCA
LAD
Non

35. Which two mechanisms sense decrease MAP?
Decrease in activity of Na/Ca exhanger and increase in contractility
In series
Medullary vasomotor center senses baroreceptors and JGA
Aortic/pulmonic stenosis and mitral/tricuspid regurg

36. What does the atria release in response to inc blood volume and atrial pressure
Mitral valve prolapse
Myxoma
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
ANP

37. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Mitral valve prolapse
RV failure - in venous pressure
Non
2-4 day - early coag necrosis on the first day

38. What causes the early cyanosis in Tet of Fallot?
Truncus - tet of fallot
Left sided
Fast volatge gated Na channels
R to L shunt caused by stenoic pulmonic valve

39. what percentage of HTN is secondary to renal disease?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Atherosclerosis
10%
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

40. What constitues the upstroke in pacemaker cells?
RV contraction (closed tricuspid valve bulding into atrium
Volatage gated Ca channels
Changes in CO as a function of preload
SV/ EDV

41. When and why do you hear the S4 sound
Mitral and tricuspid closure
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
P02
Septal defects - PDA - pulm art stenosis

42. Which valve is commonly involved in bacterial endocarditis from IV drug use and Which bacteria are most common?

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43. Which murmur is characteristic of mitral/tricuspid regurg?
Conduction delay through AV node - nl < 200 msec
Holosystoiic
CO
C - ANCA

44. fibrinous pericarditis several weeks post MI

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45. Which lab value indicates blood viscosity?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Squat. Compression of femoral arteries - inc TPR - dec
Hematocrit
Rhabdomyomas

46. In an EKG - What is the T wave?
Ventricular repolarization
Mechanican contraction of the ventricles
Sturge weber - vasculitis of caps
Age related calcifications or bicuspid aortic valve

47. sawtooth wave

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48. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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49. What happens in phase 2 of the cardiac ventricular action potential?
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Aburpt halting of valve leaflets
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Decreased

50. What are the 5 T's of cyanoitc babies
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Kawasaki
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Temporal arteritis

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