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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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1. What happens in phase 2 of the cardiac ventricular action potential?
Mitral valve prolapse
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
...
LAD - V1 - V4

2. How does angiotensin II raise MAP
Vasocxn - while other tissues it causes vasodilation
Vasocxn
Lymphangiosarcoma
Glomus tumor

3. most common heart tumor
Metastasis from melanoma or lymphoma
Decrease in cAMP
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

4. Fatal arrhythmia
V fib
LCX - I - aVL
Age related calcifications or bicuspid aortic valve
Coarcation of aorta

5. What is the time frame for arrhythmia risk in the evolution of MI
Mitral and tricuspid closure
During diastole
Inc blood volume
The first 4 days

6. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
The operating point of the heart
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Patent ductus arteriosus - congenital rubella or prematurity
Lower right - MC - upper right - AO - upper right AC - lower left MO

7. How are sarcomeres added in concentric hypertrophy?
In parallel
5-10 days - macs have degraded structural components
CFX
Filling is incomplete and CO falls

8. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Persistant truncus arteriosus
Stable angina
Hemorrhage
Tricuspid atresia - requires ASD and VSD

9. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Crescendo - decrescendo systolic ejection murmur following ejection click
Sturge weber - vasculitis of caps
Cardiac tamponde
Postinfarction fibrinous pericarditis

10. which heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
Troponin I
Aortic disecction - intraluminal tear forming false lumen
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

11. Which bacteria can cause endocarditis from prosthetic valves?
S. epidermidis
Total anomalous pulmonary trunk venous return
Increase intracellular Na - resulting in increased Ca
5-10 days - macs have degraded structural components

12. In an EKG - What is the PR interval?
Conduction delay through AV node - nl < 200 msec
In HF
Total anomalous pulmonary trunk venous return
Cystic hygroma

13. Exercise - overtransfusiion and excitiment causes and increase in...?
Preload
Maintain blood flow to organ over wide range of perfussion pressures
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

14. In an acute MI - are there any visible changes via LM in the first 2-4 hours
S. aureus
No
During diastole
Can progess to V fib

15. How are the sarcomeres added in eccentric hypertrophy?
Decrease in activity of Na/Ca exhanger and increase in contractility
In series
Ventricular repolarization
If sodium channel

16. What happens in phase 0 of the cardiac ventricular action potential?
MI
Rapid upstroke - voltage gated Na channels open
Postinfarction fibrinous pericarditis
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

17. What does an isoelectric ST segment indicate?
1st degree AV blodck
Ventricles are depolarized
Kawasaki
Kidney

18. What causes the CO curve to shift upwards?
2nd degree AV block - mobitz type 1
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Pos inotropy - exercise
Atrial contraction

19. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Stroke volume affected by contractility - afterload - and preload
Libman - sacks endocarditis
SA and AV nodes
Atrial contraction

20. Which sympathetic receptors raise MAP
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Mean arterial pressure
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

21. congenital heart defect with congenital rubella
Septal defects - PDA - pulm art stenosis
Arteriolosclerosis in malignant hypertension
Increase intracellular Na - resulting in increased Ca
Persistant truncus arteriosus

22. In an EKG - What is the p wave?
Increase contractility
Atrial contraction
Eccentric - concentric hypertrophy causes diastolic disfunction
Dilation

23. The aortic arch receptors transmit along which nerve?
LCX - V4- V6
If sodium channel
Vagus to medulla
Left sided

24. What are the four most common locations for atherosclerosis?
Angiosarcoma
Pyogenic granuloma - associated with trauma and pregnancy
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
The first 4 days

25. CO x Total peripheral resistance
Mean arterial pressure
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
7 weeks
Transmural

26. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Vasocxn
Ventricular depolarization - nl < 120 msec
Transmural

27. When during cardiac nodal cells depolarize?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
During diastole
Liver
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

28. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
Ischemic heart dz - mitral valve prolapse - LV dilation
Ventricles are depolarized
Adult type aortic coarctation

29. Which organ has the largest arteriovenous difference
Kawasaki
RF
Can progess to V fib
Heart - 02 extraction is always around 100%

30. Which two mechanisms sense decrease MAP?
Increased efferent SANS and decreased efferent PANS
Pulsus parvus and tardus - weak - can lead to syncope
Medullary vasomotor center senses baroreceptors and JGA
Glomus tumor

31. moncekberg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Buerger's disease
TAPVR
Increase intracellular Na - resulting in increased Ca

32. list the coronary vessels most likely to be occluded
The first 4 days
HTN - bradycardia - and respiratory depression
Stroke volume affected by contractility - afterload - and preload
LAD > RCA > circumflex

33. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Increased SV
Non
The first 4 days
Cyclophosphamide and corticosteroids

34. fibrinous pericarditis several weeks post MI

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35. Chronic mitral stenosis can lead to what changes in size of the LA
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
SA and AV nodes
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Dilation

36. What do the starling forces determine
Proportional to viscosity and inversely proportional to the radius to the 4th power
Pulsus parvus and tardus - weak - can lead to syncope
Fluid movement through capillaries
Venodilators (nitrogylcerine)

37. with what heart sounds do ASD usually present?
Inc blood volume
Glossopharyngeal to soliary nucleus of medulla
V fib
Pulmonary flow murmur and diastolic rumble

38. When is the scar completely formed in an MI?
Transmural
Atherosclerosis
Vasocxn
7 weeks

39. Which murmur is heard with VSD?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
2-4 day - early coag necrosis on the first day
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

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

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41. What is the gold standard for dx of MI in the first 6 hours
S. aureus
EKG
PDA
Pyogenic granuloma - associated with trauma and pregnancy

42. What is the progression of atherosclerosis?
Inc interstitial osmotic pressure pulling fliud out of capillaries
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
In RA return (inspiration)

43. coronary artery spasm - ST elevation
Atrial contraction
Arteriorles
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Prinzmetal angina

44. What is the early and late lesion in rheumatic heart disease
Inc interstitial osmotic pressure pulling fliud out of capillaries
Mitral stenosis
If sodium channel
Mitral valve prolapse

45. Rank the pacemakers cells
During diastole
The plateau period
LAD - V1- V2
SA>AV>bundle of His>ventricles

46. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Afterload (proportional to peripheral resistance)
LAD
5-10 days - macs have degraded structural components
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

47. Which murmur is heard in aortic stenosis?
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Angiosarcoma
Crescendo - decrescendo systolic ejection murmur following ejection click
Hyperlipidemia

48. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kidney
Kawasaki
MAP
Transposition of great vessels

49. What kind of infarct show ST depression
Vagus to medulla
Wolff - Parkinson white syndrome
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Subendocardial

50. congenital heart defect with 22q11
Purkingee>atria>ventricles>AV node
2nd degree AV block - mobitz type 1
Truncus - tet of fallot
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open