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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. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Glomus tumor
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
LCX - I - aVL
Eccentric - concentric hypertrophy causes diastolic disfunction

2. what conditions are associated with pulsus paradoxus
HypoK and bradycardia
RV contraction (closed tricuspid valve bulding into atrium
Boot shaped heart
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

3. clinical signs of cardiac tamponade
S. epidermidis
Preload
Atherosclerosis
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

4. Hyperplastic onion skinning
If sodium channel
Stroke volume
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Arteriolosclerosis in malignant hypertension

5. What are the different etiologies of dialted cardiomyopathy
Aortic dilation - bicuspid aortic valve - RF -
Failure of LV to in CO during exercise
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
S. epidermidis

6. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Hemorrhage
Gap junctions
Tempral arteritis - may cause irreversible blindness
MI

7. Which murmur is heard in aortic stenosis?
Microscopic polyangiitis - like wegener's without granulomas
Troponin I
The plateau period
Crescendo - decrescendo systolic ejection murmur following ejection click

8. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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9. What is the gold standard for dx of MI in the first 6 hours
Kids
No
Buerger's disease
EKG

10. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Filling is incomplete and CO falls
No
Fick principle
Lower right - MC - upper right - AO - upper right AC - lower left MO

11. If HR is too fast (V tach) what happens during diastole?
Filling is incomplete and CO falls
ASD - VSD - AV septal defect (endocardial cushion defect)
Inc blood volume
Posterior descending (80% off the RCA - 20% off the circumflex)

12. What are the diastolic heart sounds?
Subendocardial - fewer collaterals and higher pressure
Sudden tensing of chordae tendinae
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Increase contractility

13. What are the four most common locations for atherosclerosis?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Gap junctions
Filling is incomplete and CO falls
Age related calcifications or bicuspid aortic valve

14. MAP is also known as
Afterload (proportional to peripheral resistance)
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Arteriolosclerosis in malignant hypertension
10%

15. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
Dressler's - autoimmune
Dilated cardiomyopathy
Vasodilators - (hydrAlAzine)

16. What are the 5 T's of cyanoitc babies
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Patent ductus arteriosus - congenital rubella or prematurity
Extracellular calcium - calcium induced calcium release
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

17. What happens in phase 4 of the cardiac ventricular action potential?
7 weeks
Inc TPR and LA return (expiration)
Fluid movement through capillaries
Resting potential high K perm

18. Which lab value indicates blood viscosity?
Hematocrit
Vasodilators
Purkingee>atria>ventricles>AV node
CO

19. What other syndrom is associated with infantile aortic coarctation
10%
ASD - VSD - AV septal defect (endocardial cushion defect)
Turners
Apex and anterior interventricular septum

20. What does hypoxia cause in the lung versus other tissues?
LCX - I - aVL
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Vasocxn - while other tissues it causes vasodilation
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

21. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Vasodilators
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Yes

22. benign - painful - red - blue tumor under fingernails from smooth muscle cells
V fib
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Atrial contraction
Glomus tumor

23. sawtooth wave

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24. In an EKG - What is the QRS complex?
Viridans streptococci
Greater ventricular EDV
Persistant truncus arteriosus
Ventricular depolarization - nl < 120 msec

25. What is the machine like murmur? What is the heart pathology and the predisposing causes
140/90
Venodilators (nitrogylcerine)
Atrial contraction
Patent ductus arteriosus - congenital rubella or prematurity

26. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Atrial contraction
Sturge weber - vasculitis of caps
Vasocxn
Tempral arteritis - may cause irreversible blindness

27. The cause of dyspnea on exertion?
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
The operating point of the heart
Failure of LV to in CO during exercise
Vasodilators - (hydrAlAzine)

28. How are the sarcomeres added in eccentric hypertrophy?
Stable angina
V fib
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
In series

29. What is the characteristic pulse in aortic stenosis?
Rhabdomyomas
Diastolic
Pulsus parvus and tardus - weak - can lead to syncope
The aortic before pulmonic - inspiration increases diff

30. Rank the pacemakers cells
3rd degree block - pacemaker - Lyme disease
CFX
SA>AV>bundle of His>ventricles
Early deaths from myocarditis

31. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
V fib
Maintain blood flow to organ over wide range of perfussion pressures
LAD > RCA > circumflex
LV failure - pulm venous distention transudation of fluid

32. The 7 complications of MI

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33. What channels do the the pacemaker cells lack?
Vasocxn
Fast volatge gated Na channels
Cystic hygroma
Mitral stenosis

34. What is indicated when CO and venous return are equal?
Neg inotropy - HF - narcotic overdose
Patent ductus arteriosus - congenital rubella or prematurity
Resting potential high K perm
The operating point of the heart

35. What causes the cushing reflex and why
Subendocardial - fewer collaterals and higher pressure
Kaposi's sarcoma
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Mitral and tricuspid closure

36. Most common vasculitis affecting medium and large arteries
Kidney
Aortic insuffic - late
HTN - bradycardia - and respiratory depression
Temporal arteritis

37. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
HypoK and bradycardia
At least 55%
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Cardiac tamponde

38. Which organ gets the largest share of systemic cardiac output
Raynaud's
Subendocardial - fewer collaterals and higher pressure
Liver
Dec P02 - inc PC02 and dec pH

39. What causes aortic stenosis
Age related calcifications or bicuspid aortic valve
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Metastasis from melanoma or lymphoma

40. What do the carotid and aortic bodies respond to?
Rapid upstroke - voltage gated Na channels open
Inc blood volume
Dec P02 - inc PC02 and dec pH
Fetal right to left - neonate left to right leading to RVH and failure

41. Which area of the endocardium is especially vulnerable to infarction? Why?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Maintain blood flow to organ over wide range of perfussion pressures
SA>AV>bundle of His>ventricles
Subendocardial - fewer collaterals and higher pressure

42. Which murmur do you hear in mitral stenosis?
Late diastolic murmur following an opening snap
Mitral and tricuspid closure
During diastole
1st degree AV blodck

43. serum marker for wegener's
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Dec P02 - inc PC02 and dec pH
Inc interstitial osmotic pressure pulling fliud out of capillaries
C - ANCA

44. What is the danger of torsades to pointes?
Can progess to V fib
Transposition of great vessels
HTN - bradycardia - and respiratory depression
Hypertrophied cardiomyopathy

45. SV CAP means?
Inc Kf - capillary perm
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Inc RA pressure - due to filling against closed tricupsid valve
Stroke volume affected by contractility - afterload - and preload

46. What happens with a decrease of extracellular Na
Mitral stenosis
LAD - V1- V2
Decrease in activity of Na/Ca exhanger and increase in contractility
MI

47. What does FROM JANE stand for in bacterial endocarditis?

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48. Which organ has the largest arteriovenous difference
Acute thrombosis of coronary artery
Heart - 02 extraction is always around 100%
LCX - I - aVL
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

49. What does FAN MY SKIN On Wednesday stand for?
Hematocrit
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
P02
Takayasu's arteritis

50. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Preload
Decreases
Aortic stenosis or LBBB
Torsades de pointes