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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. What are the complications from bacterial endocarditis?
Glossopharyngeal to soliary nucleus of medulla
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Tricuspid atresia - requires ASD and VSD
Chordae rupture - GN - suppurative pericarditis - emboli

2. Which class of drugs decrease preload
Venodilators (nitrogylcerine)
Kawasaki
Atherosclerosis
Vasodilators - (hydrAlAzine)

3. What does the atria release in response to inc blood volume and atrial pressure
ANP
Pulmonary flow murmur and diastolic rumble
Preload
Vasocxn

4. How does digitatlis increase contractility?
CHF
3rd degree block - pacemaker - Lyme disease
Increase intracellular Na - resulting in increased Ca
Ventricular repolarization

5. Given P = QR - what factors influence resistance?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Fluid movement through capillaries
Glossopharyngeal to soliary nucleus of medulla

6. The 7 complications of MI

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7. How are the sarcomeres added in eccentric hypertrophy?
Eisenmenger's syndrome
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
In series

8. EDV - ESV
Pulmonic stenosis and RBBB
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Kids
Stroke volume

9. exaggerated decrease in pulse during inspiration.

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10. How does acidosis affect contractility?
LV failure - pulm venous distention transudation of fluid
Mitral valve
C - ANCA
Decreased

11. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Systolic dysfunction
5-10 days - macs have degraded structural components
Stable angina
SA>AV>bundle of His>ventricles

12. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Hyperlipidemia
Chordae rupture - GN - suppurative pericarditis - emboli
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Tricuspid atresia - requires ASD and VSD

13. When do you find hemosiderin laden macrophages in the lungs?
In HF
Group a beta hemolytic strep
Stroke volume affected by contractility - afterload - and preload
During HF from microhemorrhages from inc pulm cap pressure

14. In an EKG - What is the T wave?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Subendocardial
R to L shunt caused by stenoic pulmonic valve
Ventricular repolarization

15. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Vasocxn
Dilation
Subendocardial - fewer collaterals and higher pressure
Lymphangiosarcoma

16. Which artery supplies the SA and AV nodes?
Acute thrombosis of coronary artery
RCA
Group a beta hemolytic strep
Glomus tumor

17. failure of truncus arteriosus to divide?
Hypertrophied cardiomyopathy
5-10 days - macs have degraded structural components
Persistant truncus arteriosus
If sodium channel

18. In an EKG - What is the PR interval?
Aortic and pulmonary closing
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Hemorrhage
Conduction delay through AV node - nl < 200 msec

19. Which class of drugs decrease the murmur heard in aortic regurg?
Vasodilators
Dec plasma proteins
The operating point of the heart
Arteriorles

20. What does FAN MY SKIN On Wednesday stand for?
LAD - V1 - V4
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Yes
Late systolic crescendo murmur with a midsystolic click

21. What does the starling curve show?
Purkingee>atria>ventricles>AV node
Metastasis from melanoma or lymphoma
Aortic stenosis or LBBB
Changes in CO as a function of preload

22. sawtooth wave

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23. what percentage of HTN is secondary to renal disease?
Venodilators (nitrogylcerine)
Rhabdomyomas
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
10%

24. MAP is also known as
Afterload (proportional to peripheral resistance)
CFX
Yes
Aortic and pulmonary closing

25. What causes the murmur heard in tricuspid regurg to enhance
S. aureus
In RA return (inspiration)
Crescendo - decrescendo systolic ejection murmur following ejection click
140/90

26. What are anitschkow's cells
Activated histiocytes
Turners
Sudden tensing of chordae tendinae
Holosystoiic

27. Rank the pacemakers cells
Aburpt halting of valve leaflets
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
SA>AV>bundle of His>ventricles
S. epidermidis

28. 2/3 diastolic + 1/3 systolic
The aortic before pulmonic - inspiration increases diff
Hemorrhage
Vasocxn
MAP

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

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30. coronary artery spasm - ST elevation
Posterior descending (80% off the RCA - 20% off the circumflex)
Prinzmetal angina
Rapid upstroke - voltage gated Na channels open
Fetal right to left - neonate left to right leading to RVH and failure

31. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
No - no pressure gradient
Purkingee>atria>ventricles>AV node
Metastasis from melanoma or lymphoma

32. In an inferior wall infarct - which artery is affected and which leads show Q waves
Patent ductus arteriosus - congenital rubella or prematurity
RCA - II - III - aVF
Yes
Inc RA pressure - due to filling against closed tricupsid valve

33. what conditions are associated with pulsus paradoxus
Can progess to V fib
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Fast volatge gated Na channels
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

34. What causes the early cyanosis in Tet of Fallot?
Black > white > asian
Apex and anterior interventricular septum
R to L shunt caused by stenoic pulmonic valve
Neg inotropy - HF - narcotic overdose

35. When and why do you hear the S4 sound
Arteriolosclerosis in malignant hypertension
Inc blood volume
Indomethacin closes - and pge keeps it open
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

36. What does prolonged QT predispose to?
Ventricular depolarization - nl < 120 msec
Hematocrit
Torsades de pointes
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

37. What cardiac change occurs in pregnancy?
Inc Kf - capillary perm
Increased SV
Late systolic crescendo murmur with a midsystolic click
Volatage gated Ca channels

38. Which two mechanisms sense decrease MAP?
Preload
CFX
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Medullary vasomotor center senses baroreceptors and JGA

39. What causes orthopnea?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Aortic disecction - intraluminal tear forming false lumen
Buerger's disease
Inc venous return exaccerbates pulm vasc congestion

40. What causes ankle - sacral edema - jugular venous distention
Kaposi's sarcoma
Glossopharyngeal to soliary nucleus of medulla
RV failure - in venous pressure
Rapid upstroke - voltage gated Na channels open

41. Which area of the endocardium is especially vulnerable to infarction? Why?
Subendocardial - fewer collaterals and higher pressure
Venodilators (nitrogylcerine)
Vasodilators
Atrial contraction

42. Chronic mitral stenosis can lead to what changes in size of the LA
Dilation
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Posterior descending (80% off the RCA - 20% off the circumflex)
Aortic disecction - intraluminal tear forming false lumen

43. What is the association with wide S2 splitting?
Stable angina
Inc central venous pressure - inc resistance to portal flow
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Pulmonic stenosis and RBBB

44. Why is contractility decreased in heart failure?
Aortic and pulmonary closing
Systolic dysfunction
In parallel
In RA return (inspiration)

45. In an anterior wall infarct - which artery is effected and which leads show Q waves
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
LAD - V1 - V4
LAD > RCA > circumflex

46. Left to right shunts are more common in babies or kids?
Kids
Dilated cardiomyopathy
LAD > RCA > circumflex
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

47. How are cadiac myocytes eltrically coupled?
Transposition of great vessels
RV contraction (closed tricuspid valve bulding into atrium
Gap junctions
Failure of LV to in CO during exercise

48. Which lab value indicates blood viscosity?
During diastole
HTN - bradycardia - and respiratory depression
Hematocrit
Fast volatge gated Na channels

49. most common primary cardiac tumor in children - associated with tuberous sclerosis
Mitral and tricuspid closure
The aortic before pulmonic - inspiration increases diff
Rhabdomyomas
Aortic dilation - bicuspid aortic valve - RF -

50. decrease stretch in baroreceptors leads to what response?
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Increasing activity of Ca pump in SR
Increased efferent SANS and decreased efferent PANS
Proportional to viscosity and inversely proportional to the radius to the 4th power