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Cardiology

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 causes the CO curve to shift downwards?
Neg inotropy - HF - narcotic overdose
Isovolumetric contraction
Eisenmenger's syndrome
Cherry hemangioma

2. What happends in phase 1 of the ventricular cardiac action potential?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Vasodilators
Neg inotropy - HF - narcotic overdose
Vasocxn

3. Wegener's presentation
Extracellular calcium - calcium induced calcium release
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Left heart failure
Myxoma

4. What does the atria release in response to inc blood volume and atrial pressure
ANP
During diastole
3rd degree block - pacemaker - Lyme disease
Pos inotropy - exercise

5. In terms of starling forces - why does heart failure cause edema?
Transposition of great vessels
LAD
Increase in Pc
Increase contractility

6. What causes ankle - sacral edema - jugular venous distention
No
2nd degree AV block - mobitz type 1
RV failure - in venous pressure
Postinfarction fibrinous pericarditis

7. What is the classic X ray finding for tet of fallot?
Boot shaped heart
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Aburpt halting of valve leaflets
Filling is incomplete and CO falls

8. What do patients die early from in rheumatic heart disease?
Pulse pressure
Cyclophosphamide and corticosteroids
Early deaths from myocarditis
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

9. serum marker for wegener's
Lower right - MC - upper right - AO - upper right AC - lower left MO
C - ANCA
Early deaths from myocarditis
RCA

10. what happens to capillaries in lymphatic blockage
Inc RA pressure - due to filling against closed tricupsid valve
Inc interstitial osmotic pressure pulling fliud out of capillaries
Mechanican contraction of the ventricles
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

11. Where is the most posterior portion of the heart and What can it cause?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Cystic hygroma
Vasodilators
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

12. What do the starling forces determine
Inc interstitial osmotic pressure pulling fliud out of capillaries
Fluid movement through capillaries
Liver
MAP

13. What does the U wave indicated?
Hypertrophied cardiomyopathy
Late diastolic murmur following an opening snap
HypoK and bradycardia
Cystic hygroma

14. Central chemoreceptors do not respond directly to which parameter?
P02
Activated histiocytes
LV failure - pulm venous distention transudation of fluid
Early deaths from myocarditis

15. PCWP is an estimate of...
Dilation
Aortic stenosis or LBBB
Left atrial pressure
Aortic/pulmonic stenosis and mitral/tricuspid regurg

16. What causes aortic regurg
Pulmonary flow murmur and diastolic rumble
Dec P02 - inc PC02 and dec pH
Aortic dilation - bicuspid aortic valve - RF -
Angiosarcoma

17. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Raynaud's
Hyperlipidemia
Stroke volume affected by contractility - afterload - and preload
Early deaths from myocarditis

18. How does aldosterone raise MAP
Liver
Maintain blood flow to organ over wide range of perfussion pressures
Inc blood volume
Decrease in activity of Na/Ca exhanger and increase in contractility

19. What other syndrom is associated with infantile aortic coarctation
Proportional to viscosity and inversely proportional to the radius to the 4th power
Turners
5-10 days - macs have degraded structural components
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

20. What causes the CO curve to shift upwards?
Fick principle
Mitral stenosis
Strawberry hemangioma
Pos inotropy - exercise

21. 2/3 diastolic + 1/3 systolic
MAP
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Dilation
No

22. When and why is the S3 sound heard?
Increasing activity of Ca pump in SR
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

23. CO x Total peripheral resistance
Neg inotropy - HF - narcotic overdose
Aortic stenosis or LBBB
CO
Mean arterial pressure

24. systolic - diastolic
Arteriorles
Dec P02 - inc PC02 and dec pH
The first 4 days
Pulse pressure

25. How are cadiac myocytes eltrically coupled?
Gap junctions
Arteriorles
CHF
Mitral>aortic>>tricuspid - high pressure valves affected most

26. What are common causes of mitral regurg?
Rapid upstroke - voltage gated Na channels open
Torsades de pointes
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Ischemic heart dz - mitral valve prolapse - LV dilation

27. Wegener's tx
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Aburpt halting of valve leaflets
Cyclophosphamide and corticosteroids
Fluid movement through capillaries

28. In an anterolateral infarct - which artery is effected and which leads show Q waves
LCX - V4- V6
Ischemic heart dz - mitral valve prolapse - LV dilation
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Subendocardial - fewer collaterals and higher pressure

29. When do you find hemosiderin laden macrophages in the lungs?
Systolic dysfunction
During HF from microhemorrhages from inc pulm cap pressure
Adult type aortic coarctation
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

30. in the JVP - What is the v wave?
Stable angina
Inc RA pressure - due to filling against closed tricupsid valve
LAD - V1 - V4
SA>AV>bundle of His>ventricles

31. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
SA and AV nodes
Adult type aortic coarctation
Mitral and tricuspid closure

32. What murmur is heard with aortic regurg?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Hematocrit
Mean arterial pressure

33. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Mitral>aortic>>tricuspid - high pressure valves affected most
Dilated cardiomyopathy
Atrial contraction
Viridans streptococci

34. Chronic mitral stenosis can lead to what changes in size of the LA
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Henoch - Schlonlein purpura
Raynaud's
Dilation

35. Most common vasculitis affecting medium and large arteries
Conduction delay through AV node - nl < 200 msec
LAD - V1 - V4
Pulmonic stenosis and RBBB
Temporal arteritis

36. Which murmur do you hear in mitral stenosis?
Late diastolic murmur following an opening snap
Cardiac tamponde
Pyogenic granuloma - associated with trauma and pregnancy
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

37. moncekberg
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Aortic disecction - intraluminal tear forming false lumen
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Mean arterial pressure

38. polypoid capillary hemangioma that can ulcerate and bleed
Fetal right to left - neonate left to right leading to RVH and failure
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Pyogenic granuloma - associated with trauma and pregnancy

39. Which channel accounts for automaticity of the SA and AV nodes?
Mitral and tricuspid closure
If sodium channel
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
In RA return (inspiration)

40. How does digitatlis increase contractility?
Hyperlipidemia
Isovolumetric contraction
Increase intracellular Na - resulting in increased Ca
Increased efferent SANS and decreased efferent PANS

41. list the coronary vessels most likely to be occluded
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
LAD > RCA > circumflex

42. Which organ gets the largest share of systemic cardiac output
SA and AV nodes
Liver
Polyarteritis nodosum
Group a beta hemolytic strep

43. What is the cushing triad?
Cardiac tamponde
HTN - bradycardia - and respiratory depression
S. bovis
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

44. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Conduction delay through AV node - nl < 200 msec
Cardiac tamponde
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
The first 4 days

45. Rank the pacemakers cells
Vasocxn
Myxoma
SA>AV>bundle of His>ventricles
Buerger's disease

46. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
140/90
Eisenmenger's syndrome
Troponin I
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

47. Where does coronary artery occlusion occur most commonly?
Heart - 02 extraction is always around 100%
CFX
LAD
Decrease in activity of Na/Ca exhanger and increase in contractility

48. What can cause mitral prolapse?
CK- MB
Conduction delay through AV node - nl < 200 msec
Myxomatous degeneration - RF - chordae rupture
RCA

49. What is the early and late lesion in rheumatic heart disease
Apex and anterior interventricular septum
Atrial contraction
Mitral valve prolapse
CK- MB

50. What is the time frame for arrhythmia risk in the evolution of MI
TAPVR
Indomethacin closes - and pge keeps it open
RV failure - in venous pressure
The first 4 days