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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 JVP - What is the v wave?
Inc RA pressure - due to filling against closed tricupsid valve
In series
Metastasis from melanoma or lymphoma
Tricuspid atresia - requires ASD and VSD

2. What do patients die early from in rheumatic heart disease?
Glossopharyngeal to soliary nucleus of medulla
Subendocardial - fewer collaterals and higher pressure
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Early deaths from myocarditis

3. What other sign is often present with congenital long QT syndrome - why?
Wolff - Parkinson white syndrome
HypoK and bradycardia
RCA - II - III - aVF
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

4. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Wegener's
5-10 days - macs have degraded structural components
Mitral valve
Acute thrombosis of coronary artery

5. How does digitatlis increase contractility?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Increase intracellular Na - resulting in increased Ca
Dilated cardiomyopathy
ANP

6. What is the most common cause of MI
Afterload (proportional to peripheral resistance)
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Acute thrombosis of coronary artery
Decrease in activity of Na/Ca exhanger and increase in contractility

7. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Inc interstitial osmotic pressure pulling fliud out of capillaries
Left sided
Viridans streptococci
Posterior descending (80% off the RCA - 20% off the circumflex)

8. What is the early and late lesion in rheumatic heart disease
Mitral valve prolapse
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Black > white > asian
Increased SV

9. What causes the midsystolic click
Vasodilators
Myxomatous degeneration - RF - chordae rupture
Sudden tensing of chordae tendinae
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

10. p - anca

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11. What causes the murmur heard in tricuspid regurg to enhance
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
In RA return (inspiration)
Transfusion

12. cavernous lymphangioma of the neck - associated with turner's
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Cystic hygroma
LAD
Aortic/pulmonic stenosis and mitral/tricuspid regurg

13. What channels do the the pacemaker cells lack?
Acute thrombosis of coronary artery
Arteriorles
S. aureus
Fast volatge gated Na channels

14. most common primary cardiac tumor in children - associated with tuberous sclerosis
RV contraction (closed tricuspid valve bulding into atrium
Rhabdomyomas
Varicose veins - thromboembolism rare
Subendocardial

15. Which murmur do you hear in mitral stenosis?
Late diastolic murmur following an opening snap
Decreases
CHF
Activated histiocytes

16. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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17. machine murmer
PDA
CK- MB
Sturge weber - vasculitis of caps
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

18. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Liver
EKG
Cardiac tamponde
No

19. Unilateral headache - jaw claudication - impaired vision
Viridans streptococci
Stroke volume
S. bovis
Tempral arteritis - may cause irreversible blindness

20. absecnce of tricuspid valve - hypoplastic RV
2-4 day - early coag necrosis on the first day
Mitral valve prolapse
Cyclophosphamide and corticosteroids
Tricuspid atresia - requires ASD and VSD

21. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Troponin I
...
LAD > RCA > circumflex

22. What are the 5 T's of cyanoitc babies
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Kids
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Neg inotropy - HF - narcotic overdose

23. In an EKG - What is the QT interval?
5-10 days - macs have degraded structural components
Rhabdomyomas
In RA return (inspiration)
Mechanican contraction of the ventricles

24. Which bacteria can cause endocarditis from prosthetic valves?
Libman - sacks endocarditis
Holosystolic - harsh sounding murmur - loudest over tricuspid area
S. epidermidis
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

25. what conditions are associated with pulsus paradoxus
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Hyperlipidemia
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
RCA - II - III - aVF

26. Where are pacemaker cells?
Diastolic
Inc interstitial osmotic pressure pulling fliud out of capillaries
Babies
SA and AV nodes

27. friction rub - 3-5 days post MI
Cyclophosphamide and corticosteroids
Postinfarction fibrinous pericarditis
MAP
P02

28. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LAD
LCX - I - aVL
Granuloma with giant cells
Indomethacin closes - and pge keeps it open

29. What is the most common cause of right heart failure
Left heart failure
Aortic dilation - bicuspid aortic valve - RF -
Ischemic heart dz - mitral valve prolapse - LV dilation
2-4 day - early coag necrosis on the first day

30. Which organ gets the largest share of systemic cardiac output
ANP
Torsades de pointes
Liver
2-4 day - early coag necrosis on the first day

31. Which bacteria causes endocarditis in the presence of colon cancer
Eisenmenger's syndrome
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
S. bovis
Mitral and tricuspid closure

32. Exercise - overtransfusiion and excitiment causes and increase in...?
Preload
Raynaud's
Increase contractility
CK- MB

33. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Sturge weber - vasculitis of caps
Right sided
Wegener's

34. What are the different etiologies of dialted cardiomyopathy
Boot shaped heart
Aburpt halting of valve leaflets
Pyogenic granuloma - associated with trauma and pregnancy
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

35. How are the sarcomeres added in eccentric hypertrophy?
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
1st degree AV blodck
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
In series

36. congenital heart defect with congenital rubella
RV failure - in venous pressure
Myxoma
Septal defects - PDA - pulm art stenosis
Decrease in activity of Na/Ca exhanger and increase in contractility

37. no relation between p waves and QRS intervals - treatment and predisposing factor
C - ANCA
3rd degree block - pacemaker - Lyme disease
Rapid upstroke - voltage gated Na channels open
HypoK and bradycardia

38. in the JVP - What is the a wave?
Persistant truncus arteriosus
QRS complex
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Atrial contraction

39. How does acidosis affect contractility?
Pulmonic stenosis and RBBB
Rapid upstroke - voltage gated Na channels open
Decreased
Stable angina

40. What cardiac change occurs in pregnancy?
Increased SV
Afterload (proportional to peripheral resistance)
Libman - sacks endocarditis
Lymphangiosarcoma

41. Which murmur is characteristic of mitral/tricuspid regurg?
Holosystoiic
Transfusion
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Cyclophosphamide and corticosteroids

42. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Hyperlipidemia
Increased efferent SANS and decreased efferent PANS
Viridans streptococci
CK- MB

43. What are the complications from bacterial endocarditis?
Myxoma
Diastolic
Chordae rupture - GN - suppurative pericarditis - emboli
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

44. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Aburpt halting of valve leaflets
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Purkingee>atria>ventricles>AV node
Mitral valve

45. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Dilated cardiomyopathy
No - no pressure gradient
Posterior descending (80% off the RCA - 20% off the circumflex)
During HF from microhemorrhages from inc pulm cap pressure

46. What causes the murmur heard in MR to enhance?
Varicose veins - thromboembolism rare
Inc TPR and LA return (expiration)
Torsades de pointes
...

47. What happens with a decrease of extracellular Na
Decrease in activity of Na/Ca exhanger and increase in contractility
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
RV failure - in venous pressure
Persistant truncus arteriosus

48. Do you see elevaged ASO titers in rheumatic heart disease
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Mechanican contraction of the ventricles
Yes
Polyarteritis nodosum

49. What is the cushing triad?
Holosystoiic
RCA
HTN - bradycardia - and respiratory depression
Heart - 02 extraction is always around 100%

50. What is associated with paradoxical spliting of S2
10%
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Aortic stenosis or LBBB
Rapid upstroke - voltage gated Na channels open