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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. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Increased SV
Chordae rupture - GN - suppurative pericarditis - emboli
Hemorrhage

2. coronary artery spasm - ST elevation
Glossopharyngeal to soliary nucleus of medulla
Prinzmetal angina
Decrease in activity of Na/Ca exhanger and increase in contractility
SA>AV>bundle of His>ventricles

3. What is the characteristic pulse in aortic stenosis?
Troponin I
Pulsus parvus and tardus - weak - can lead to syncope
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Prinzmetal angina

4. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
No - no pressure gradient
Group a beta hemolytic strep
Hemorrhage
Myxomatous degeneration - RF - chordae rupture

5. When do you find hemosiderin laden macrophages in the lungs?
Rapid upstroke - voltage gated Na channels open
Inc central venous pressure - inc resistance to portal flow
During HF from microhemorrhages from inc pulm cap pressure
Aortic stenosis or LBBB

6. PCWP > LV diastolic pressure
Hemorrhage
Pyogenic granuloma - associated with trauma and pregnancy
Viridans streptococci
Mitral stenosis

7. What is the classic X ray finding for tet of fallot?
Lymphangiosarcoma
Afterload (proportional to peripheral resistance)
Boot shaped heart
Mechanican contraction of the ventricles

8. Unilateral headache - jaw claudication - impaired vision
Tempral arteritis - may cause irreversible blindness
Buerger's disease
LCX - I - aVL
MAP

9. exaggerated decrease in pulse during inspiration.

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10. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
7 weeks
Fick principle
Pos inotropy - exercise
Mitral and tricuspid closure

11. Which bacteria can cause endocarditis from prosthetic valves?
No
S. epidermidis
At least 55%
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

12. What does prolonged QT predispose to?
Hemorrhage
Dilated cardiomyopathy
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Torsades de pointes

13. What is sudden cardiac death most commonly due to...
During HF from microhemorrhages from inc pulm cap pressure
V fib arrhythima
Mitral>aortic>>tricuspid - high pressure valves affected most
Pulmonic stenosis and RBBB

14. What causes the early cyanosis in Tet of Fallot?
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
In parallel
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
R to L shunt caused by stenoic pulmonic valve

15. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Atherosclerosis
Total anomalous pulmonary trunk venous return
Stable angina
Pulmonic stenosis and RBBB

16. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Septal defects - PDA - pulm art stenosis
SA>AV>bundle of His>ventricles
Age related calcifications or bicuspid aortic valve
Dilated cardiomyopathy

17. What cardiac change occurs in pregnancy?
The operating point of the heart
Wolff - Parkinson white syndrome
Increased SV
7 weeks

18. What does FEVERSS stand for in rheumatic heart disease
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
RCA - II - III - aVF
Sudden tensing of chordae tendinae
Conduction delay through AV node - nl < 200 msec

19. What causes the CO curve to shift downwards?
S. bovis
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Aburpt halting of valve leaflets
Neg inotropy - HF - narcotic overdose

20. In an EKG - What is the T wave?
Transfusion
Ventricular repolarization
Pos inotropy - exercise
Inc Kf - capillary perm

21. Where is the most posterior portion of the heart and What can it cause?
Troponin I
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Subendocardial
Prinzmetal angina

22. no change in PR interval followed by dropped beat
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
5-10 days - macs have degraded structural components
RCA - II - III - aVF
QRS complex

23. tearing chest pain radiation to the back - associated with marfan
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Mechanican contraction of the ventricles
Aortic disecction - intraluminal tear forming false lumen
Septal defects - PDA - pulm art stenosis

24. The aortic arch receptors transmit along which nerve?
Vagus to medulla
Cystic hygroma
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Decrease in cAMP

25. Which class of drugs decrease the murmur heard in aortic regurg?
Kidney
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Vasodilators
Subendocardial - fewer collaterals and higher pressure

26. Which channel accounts for automaticity of the SA and AV nodes?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
If sodium channel
Persistant truncus arteriosus
RCA - II - III - aVF

27. friction rub - 3-5 days post MI
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
5-10 days - macs have degraded structural components
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Postinfarction fibrinous pericarditis

28. congenital heart defect withdown syndrome
MI
Afterload (proportional to peripheral resistance)
S. bovis
ASD - VSD - AV septal defect (endocardial cushion defect)

29. What are the diastolic heart sounds?
Inc venous return exaccerbates pulm vasc congestion
Afterload (proportional to peripheral resistance)
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Inc Kf - capillary perm

30. Central chemoreceptors do not respond directly to which parameter?
P02
Varicose veins - thromboembolism rare
Mitral stenosis
Troponin I

31. CO x Total peripheral resistance
In RA return (inspiration)
The aortic before pulmonic - inspiration increases diff
Metastasis from melanoma or lymphoma
Mean arterial pressure

32. what percentage of HTN is secondary to renal disease?
Left sided
Right sided
Increase in Pc
10%

33. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Arteriolosclerosis in malignant hypertension
RV contraction (closed tricuspid valve bulding into atrium
Aburpt halting of valve leaflets
MI

34. What is the early and late lesion in rheumatic heart disease
Microscopic polyangiitis - like wegener's without granulomas
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Mitral valve prolapse
Inc TPR and LA return (expiration)

35. Mitral stenosis is most often secondary to which condition?
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Group a beta hemolytic strep
RF
Dressler's - autoimmune

36. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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37. What are the four most common locations for atherosclerosis?
Libman - sacks endocarditis
Aortic dilation - bicuspid aortic valve - RF -
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
LAD - V1- V2

38. What happens in phase 4 of the cardiac ventricular action potential?
Kids
S. aureus
Resting potential high K perm
Adult type aortic coarctation

39. congenital heart defect with marfan's
Dilation
Aortic insuffic - late
Pulmonary flow murmur and diastolic rumble
Persistant truncus arteriosus

40. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Cystic hygroma
Viridans streptococci
In RA return (inspiration)
Mitral stenosis

41. what conditions are associated with pulsus paradoxus
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Dec plasma proteins
Transposition of great vessels
Maintain blood flow to organ over wide range of perfussion pressures

42. What happens in phase 0 of the cardiac ventricular action potential?
R to L shunt caused by stenoic pulmonic valve
Myxomatous degeneration - RF - chordae rupture
Neg inotropy - HF - narcotic overdose
Rapid upstroke - voltage gated Na channels open

43. What does the LAD supply?
Age related calcifications or bicuspid aortic valve
Apex and anterior interventricular septum
Dec P02 - inc PC02 and dec pH
In series

44. Which vessels account for the most total peripheral resistance
Mitral and tricuspid closure
Arteriorles
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Stroke volume

45. Which enzymes are useful for diagnosing reinfarction
RV failure - in venous pressure
Takayasu's arteritis
CK- MB
Vagus to medulla

46. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Glomus tumor
140/90
ASD
Inc RA pressure - due to filling against closed tricupsid valve

47. Which lab value indicates blood viscosity?
Hematocrit
Boot shaped heart
ANP
7 weeks

48. What is the S2 sound?
Aortic and pulmonary closing
S. aureus
Apex and anterior interventricular septum
Fetal right to left - neonate left to right leading to RVH and failure

49. What is the formula for EF?
Myxoma
The plateau period
Glomus tumor
SV/ EDV

50. If HR is too fast (V tach) what happens during diastole?
Filling is incomplete and CO falls
LAD > RCA > circumflex
CO
Failure of LV to in CO during exercise