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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 causes the murmur heard in MR to enhance?
Non
Inc TPR and LA return (expiration)
During diastole
Aortic disecction - intraluminal tear forming false lumen

2. MAP is also known as
Increase - increase the chance the If are open
Afterload (proportional to peripheral resistance)
5-10 days - macs have degraded structural components
Aortic stenosis or LBBB

3. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
1st degree AV blodck
Stroke volume affected by contractility - afterload - and preload

4. What causes the cushing reflex and why
Apex and anterior interventricular septum
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Hypertrophied cardiomyopathy
CHF

5. What kind of infarct show ST depression
PDA
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
MAP
Subendocardial

6. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Dilated cardiomyopathy
MI
Glomus tumor
Inc TPR and LA return (expiration)

7. What other sign is often present with congenital long QT syndrome - why?
Temporal arteritis
LAD
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Postinfarction fibrinous pericarditis

8. What are the complications of atherosclerosis?
Varicose veins - thromboembolism rare
Vasocxn - while other tissues it causes vasodilation
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
CK- MB

9. How does digitatlis increase contractility?
In RA return (inspiration)
Increase intracellular Na - resulting in increased Ca
Babies
LV failure - pulm venous distention transudation of fluid

10. Which bacteria causes endocarditis in the presence of colon cancer
S. bovis
SV/ EDV
Right sided
Inc Kf - capillary perm

11. Rank the pacemakers cells
7 weeks
The aortic before pulmonic - inspiration increases diff
SA>AV>bundle of His>ventricles
Aortic disecction - intraluminal tear forming false lumen

12. What is the S1 sound?
Mitral and tricuspid closure
Total anomalous pulmonary trunk venous return
RCA - II - III - aVF
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

13. Which organ gets the largest share of systemic cardiac output
Liver
Dilation
Black > white > asian
Atrial contraction

14. In the cardiac cycle - which period has the highest 02 consumption?
Isovolumetric contraction
Preload
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Postinfarction fibrinous pericarditis

15. In an EKG - What is the p wave?
Inc TPR and LA return (expiration)
Apex and anterior interventricular septum
Atrial contraction
If sodium channel

16. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
ASD
Dec plasma proteins
Adult type aortic coarctation
Decreased

17. congenital heart defect in an infant with a diabetic mother?
Left sided
Heart - 02 extraction is always around 100%
Transposition of great vessels
Group a beta hemolytic strep

18. disease of elastic arteries and large and medium sized muscular arteries
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Myxoma
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Atherosclerosis

19. which medications are used to maintain patency or close the ductus arteriosus?
Indomethacin closes - and pge keeps it open
Mean arterial pressure
Kawasaki
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

20. What does the starling curve show?
Maintain blood flow to organ over wide range of perfussion pressures
Subendocardial
Granuloma with giant cells
Changes in CO as a function of preload

21. polypoid capillary hemangioma that can ulcerate and bleed
Maintain blood flow to organ over wide range of perfussion pressures
Fetal right to left - neonate left to right leading to RVH and failure
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Pyogenic granuloma - associated with trauma and pregnancy

22. How do beta blockers decrease contractility?
Aburpt halting of valve leaflets
3rd degree block - pacemaker - Lyme disease
Dilation
Decrease in cAMP

23. tearing chest pain radiation to the back - associated with marfan
Total anomalous pulmonary trunk venous return
LAD - V1 - V4
Patent ductus arteriosus - congenital rubella or prematurity
Aortic disecction - intraluminal tear forming false lumen

24. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Decreases
Vagus to medulla
10%

25. What are the complications from bacterial endocarditis?
LV failure - pulm venous distention transudation of fluid
Arteriorles
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Chordae rupture - GN - suppurative pericarditis - emboli

26. Churg Strauss - presentation and test
Adult type aortic coarctation
Viridans streptococci
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

27. Left to right shunts are more common in babies or kids?
Afterload (proportional to peripheral resistance)
Kids
Conduction delay through AV node - nl < 200 msec
During diastole

28. EDV is also known as
Extracellular calcium - calcium induced calcium release
Preload
RCA - II - III - aVF
Stroke volume

29. What is the danger of torsades to pointes?
Can progess to V fib
Hypertrophied cardiomyopathy
Inc central venous pressure - inc resistance to portal flow
Posterior descending (80% off the RCA - 20% off the circumflex)

30. What happens in phase 4 of the cardiac ventricular action potential?
Fetal right to left - neonate left to right leading to RVH and failure
Resting potential high K perm
Increased efferent SANS and decreased efferent PANS
SA>AV>bundle of His>ventricles

31. friction rub - 3-5 days post MI
Increased efferent SANS and decreased efferent PANS
Postinfarction fibrinous pericarditis
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Venodilators (nitrogylcerine)

32. Which two mechanisms sense decrease MAP?
Activated histiocytes
In parallel
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Medullary vasomotor center senses baroreceptors and JGA

33. How does acidosis affect contractility?
Increasing activity of Ca pump in SR
2-4 day - early coag necrosis on the first day
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Decreased

34. What is the formula for EF?
LCX - I - aVL
TAPVR
During diastole
SV/ EDV

35. What does TAPVR stand for
RV contraction (closed tricuspid valve bulding into atrium
Tricuspid atresia - requires ASD and VSD
Conduction delay through AV node - nl < 200 msec
Total anomalous pulmonary trunk venous return

36. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
LAD - V1- V2
SV/ EDV
Gap junctions
Troponin I

37. What causes hepatomegaly?
Inc central venous pressure - inc resistance to portal flow
MI
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Venodilators (nitrogylcerine)

38. What causes the murmur heard in tricuspid regurg to enhance
Viridans streptococci
Aortic insuffic - late
In RA return (inspiration)
Sudden tensing of chordae tendinae

39. Why is there edema after burns or during infection
Decrease in activity of Na/Ca exhanger and increase in contractility
Transmural
Inc Kf - capillary perm
Aortic disecction - intraluminal tear forming false lumen

40. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Raynaud's
Strawberry hemangioma
Kawasaki
RV contraction (closed tricuspid valve bulding into atrium

41. What does mitral prolapse predeispose to?
Infective endocarditis
Diastolic
Afterload (proportional to peripheral resistance)
CO

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

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43. The aortic arch receptors transmit along which nerve?
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Transfusion
Vagus to medulla
In RA return (inspiration)

44. If HR is too fast (V tach) what happens during diastole?
CK- MB
Filling is incomplete and CO falls
Atrial contraction
ANP

45. What supplies the posterior left ventricle?
C - ANCA
Activated histiocytes
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
CFX

46. PROVe
TAPVR
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
V fib arrhythima
Eccentric - concentric hypertrophy causes diastolic disfunction

47. congenital heart defect with marfan's
Increased efferent SANS and decreased efferent PANS
Kawasaki
Aortic insuffic - late
Pulmonic stenosis and RBBB

48. Which organ has ht highest blood flow per gram of tissue
7 weeks
Kidney
Pos inotropy - exercise
Strawberry hemangioma

49. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Left sided
Aburpt halting of valve leaflets
1st degree AV blodck
LV failure - pulm venous distention transudation of fluid

50. What causes the CO curve to shift downwards?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Neg inotropy - HF - narcotic overdose
Mitral valve
Hypertrophied cardiomyopathy

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