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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. Which murmur is heard with mitral prolapse?
Decrease in cAMP
Late systolic crescendo murmur with a midsystolic click
C - ANCA
Atrial contraction

2. How do catecholamines increase contractility?
Angiosarcoma
Hemorrhage
Increasing activity of Ca pump in SR
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

3. Inspiration causes an increase in which sided heart sounds?
Heart - 02 extraction is always around 100%
Right sided
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Inc interstitial osmotic pressure pulling fliud out of capillaries

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

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5. Why is contractility decreased in heart failure?
Temporal arteritis
Dilated cardiomyopathy
Systolic dysfunction
Posterior descending (80% off the RCA - 20% off the circumflex)

6. p - anca

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7. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
RCA
RV failure - in venous pressure
No

8. In the cardiac cycle - which period has the highest 02 consumption?
Turners
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Isovolumetric contraction
Venodilators (nitrogylcerine)

9. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Fast volatge gated Na channels
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Myxoma
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

10. What is the early and late lesion in rheumatic heart disease
S. aureus
Mitral valve prolapse
Dilated cardiomyopathy
Left sided

11. What masks atrial repolarization?
Increase contractility
Afterload (proportional to peripheral resistance)
7 weeks
QRS complex

12. What supplies the posterior left ventricle?
Squat. Compression of femoral arteries - inc TPR - dec
Stroke volume affected by contractility - afterload - and preload
Kawasaki
CFX

13. dyspnea - fatigue - edema and rales - multiple causes
Posterior descending (80% off the RCA - 20% off the circumflex)
Aortic disecction - intraluminal tear forming false lumen
CHF
Atherosclerosis

14. CO x Total peripheral resistance
Mean arterial pressure
2nd degree AV block - mobitz type 1
Anterosuperior displacement of the infundibular septum
MI

15. coronary artery spasm - ST elevation
RV failure - in venous pressure
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Prinzmetal angina
EKG

16. What stimulates release of calcium from the SR?
The aortic before pulmonic - inspiration increases diff
R to L shunt caused by stenoic pulmonic valve
Extracellular calcium - calcium induced calcium release
Late systolic crescendo murmur with a midsystolic click

17. Which class of drugs decrease preload
Decreases
CK- MB
Venodilators (nitrogylcerine)
Prinzmetal angina

18. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
At least 55%
Hemorrhage
Pulmonic stenosis and RBBB
Arteriolosclerosis in malignant hypertension

19. What causes the cushing reflex and why
Changes in CO as a function of preload
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Isovolumetric contraction
Left sided

20. Central chemoreceptors do not respond directly to which parameter?
P02
Failure of LV to in CO during exercise
No - no pressure gradient
Total anomalous pulmonary trunk venous return

21. Which sympathetic receptors raise MAP
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Decrease in activity of Na/Ca exhanger and increase in contractility
CHF
P02

22. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Cystic hygroma
No - no pressure gradient
Angiosarcoma
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

23. Which bacteria causes rheumatic heart disease
Varicose veins - thromboembolism rare
Group a beta hemolytic strep
Fetal right to left - neonate left to right leading to RVH and failure
MI

24. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Cyclophosphamide and corticosteroids
Mitral and tricuspid closure
Vasocxn - while other tissues it causes vasodilation
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

25. If HR is too fast (V tach) what happens during diastole?
Transfusion
Age related calcifications or bicuspid aortic valve
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Filling is incomplete and CO falls

26. What does autoregulation do?
Maintain blood flow to organ over wide range of perfussion pressures
Hypertrophied cardiomyopathy
Decrease in cAMP
Subendocardial

27. congenital heart defect with turner's
LAD > RCA > circumflex
Coarcation of aorta
Angiosarcoma
Patent ductus arteriosus - congenital rubella or prematurity

28. What is the classic X ray finding for tet of fallot?
Aburpt halting of valve leaflets
Boot shaped heart
Polyarteritis nodosum
Fetal right to left - neonate left to right leading to RVH and failure

29. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Atrial contraction
Failure of LV to in CO during exercise
Purkingee>atria>ventricles>AV node
Volatage gated Ca channels

30. Which area of the endocardium is especially vulnerable to infarction? Why?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Myxomatous degeneration - RF - chordae rupture
Subendocardial - fewer collaterals and higher pressure
MI

31. absecnce of tricuspid valve - hypoplastic RV
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Tricuspid atresia - requires ASD and VSD
Mitral valve prolapse
Pulmonic stenosis and RBBB

32. What happens in phase 0 of the cardiac ventricular action potential?
Activated histiocytes
Systolic dysfunction
Rapid upstroke - voltage gated Na channels open
LAD

33. Mitral stenosis is most often secondary to which condition?
Yes
RF
Inc RA pressure - due to filling against closed tricupsid valve
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

34. Which murmur do you hear in mitral stenosis?
Troponin I
Stroke volume
Late diastolic murmur following an opening snap
2-4 day - early coag necrosis on the first day

35. In an anterior wall infarct - which artery is effected and which leads show Q waves
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
LAD - V1 - V4
Stroke volume
Mitral stenosis

36. no relation between p waves and QRS intervals - treatment and predisposing factor
Increased SV
Granuloma with giant cells
3rd degree block - pacemaker - Lyme disease
Squat. Compression of femoral arteries - inc TPR - dec

37. what conditions are associated with pulsus paradoxus
Left heart failure
Inc interstitial osmotic pressure pulling fliud out of capillaries
5-10 days - macs have degraded structural components
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

38. When does extracellular calcium enter the cardiac muscle cells during contraction?
S. aureus
Increased efferent SANS and decreased efferent PANS
The plateau period
Cherry hemangioma

39. What do the carotid and aortic bodies respond to?
Kawasaki
Dec P02 - inc PC02 and dec pH
Atrial contraction
Early deaths from myocarditis

40. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Posterior descending (80% off the RCA - 20% off the circumflex)
ANP
LCX - I - aVL
Ventricular repolarization

41. What is the most common cause of MI
Dressler's - autoimmune
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Acute thrombosis of coronary artery
Mitral valve prolapse

42. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Crescendo - decrescendo systolic ejection murmur following ejection click
Fetal right to left - neonate left to right leading to RVH and failure
Inc TPR and LA return (expiration)
Inc central venous pressure - inc resistance to portal flow

43. What other sign is often present with congenital long QT syndrome - why?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Inc venous return exaccerbates pulm vasc congestion
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
The first 4 days

44. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
...
Liver
1st degree AV blodck
SA>AV>bundle of His>ventricles

45. What causes the murmur heard in tricuspid regurg to enhance
In RA return (inspiration)
Late systolic crescendo murmur with a midsystolic click
Posterior descending (80% off the RCA - 20% off the circumflex)
Varicose veins - thromboembolism rare

46. What murmur is heard with aortic regurg?
S. epidermidis
Purkingee>atria>ventricles>AV node
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
CHF

47. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
No
LCX - I - aVL
Turners
TAPVR

48. What other syndrom is associated with infantile aortic coarctation
ASD
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Turners
Angiosarcoma

49. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
Liver
Black > white > asian
Proportional to viscosity and inversely proportional to the radius to the 4th power

50. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Apex and anterior interventricular septum
Henoch - Schlonlein purpura
Inc venous return exaccerbates pulm vasc congestion
Eccentric - concentric hypertrophy causes diastolic disfunction