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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 is a normal EF
TAPVR
At least 55%
C - ANCA
Ventricles are depolarized

2. moncekberg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Left heart failure
Postinfarction fibrinous pericarditis

3. Wegener's tx
Apex and anterior interventricular septum
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Cyclophosphamide and corticosteroids
Subendocardial

4. Churg Strauss - presentation and test
Preload
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
During HF from microhemorrhages from inc pulm cap pressure
Wegener's

5. which heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
SA and AV nodes
Takayasu's arteritis
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

6. Irregularly irregular ECG - no p waves: dx and treatment
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Stable angina
Cherry hemangioma
Temporal arteritis

7. When do you find hemosiderin laden macrophages in the lungs?
Left sided
During HF from microhemorrhages from inc pulm cap pressure
Lymphangiosarcoma
Inc interstitial osmotic pressure pulling fliud out of capillaries

8. What does autoregulation do?
Polyarteritis nodosum
ASD - VSD - AV septal defect (endocardial cushion defect)
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Maintain blood flow to organ over wide range of perfussion pressures

9. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Stable angina
Filling is incomplete and CO falls
Raynaud's
Increased SV

10. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Vasodilators - (hydrAlAzine)
Subendocardial
Left atrial pressure
Polyarteritis nodosum

11. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Turners
Wolff - Parkinson white syndrome
Aortic insuffic - late
Truncus - tet of fallot

12. Why is contractility decreased in heart failure?
Systolic dysfunction
No
Mitral valve prolapse
RCA - II - III - aVF

13. What is the S2 sound?
Increased SV
Gap junctions
CHF
Aortic and pulmonary closing

14. What is the difference between adult and infantile type aortic coarctation?
Buerger's disease
Kawasaki
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Aortic dilation - bicuspid aortic valve - RF -

15. The aortic arch receptors transmit along which nerve?
1st degree AV blodck
Vagus to medulla
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Postinfarction fibrinous pericarditis

16. Left to right shunts are more common in babies or kids?
Kids
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Adult type aortic coarctation
Proportional to viscosity and inversely proportional to the radius to the 4th power

17. How are the sarcomeres added in eccentric hypertrophy?
Liver
RV contraction (closed tricuspid valve bulding into atrium
S. epidermidis
In series

18. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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19. What 4 things drive myocardial 02 demand?
The aortic before pulmonic - inspiration increases diff
Microscopic polyangiitis - like wegener's without granulomas
SV/ EDV
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

20. What is the cushing triad?
Rhabdomyomas
HTN - bradycardia - and respiratory depression
Adult type aortic coarctation
Pyogenic granuloma - associated with trauma and pregnancy

21. What causes the murmur heard in MR to enhance?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Wegener's
Inc TPR and LA return (expiration)
The operating point of the heart

22. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Kawasaki
Preload
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Decreases

23. The 7 complications of MI

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24. serum marker for wegener's
MAP
Mitral stenosis
C - ANCA
SA>AV>bundle of His>ventricles

25. Which class of drugs decreases afterload?
Myxomatous degeneration - RF - chordae rupture
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Vasodilators - (hydrAlAzine)
Unstable/crescendo angina

26. When is the scar completely formed in an MI?
LAD
In parallel
7 weeks
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

27. What causes the CO curve to shift downwards?
Inc venous return exaccerbates pulm vasc congestion
Neg inotropy - HF - narcotic overdose
Decrease in cAMP
Stroke volume

28. What are aschoff bodies
Medullary vasomotor center senses baroreceptors and JGA
Granuloma with giant cells
Kaposi's sarcoma
ASD - VSD - AV septal defect (endocardial cushion defect)

29. tearing chest pain radiation to the back - associated with marfan
Eccentric - concentric hypertrophy causes diastolic disfunction
Strawberry hemangioma
Aortic disecction - intraluminal tear forming false lumen
SA>AV>bundle of His>ventricles

30. What causes the cushing reflex and why
Ventricular repolarization
5-10 days - macs have degraded structural components
Myxoma
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

31. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Sudden tensing of chordae tendinae
LAD - V1- V2
Squat. Compression of femoral arteries - inc TPR - dec
In RA return (inspiration)

32. decrease stretch in baroreceptors leads to what response?
Increased efferent SANS and decreased efferent PANS
Turners
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Angiosarcoma

33. How does digitatlis increase contractility?
Ventricles are depolarized
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Increase intracellular Na - resulting in increased Ca

34. clinical signs of cardiac tamponade
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Kidney

35. which ethnic groups have higher association with HTN?
Inc central venous pressure - inc resistance to portal flow
Left heart failure
Black > white > asian
Kaposi's sarcoma

36. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Adult type aortic coarctation
Chordae rupture - GN - suppurative pericarditis - emboli
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Left heart failure

37. congenital heart defect with congenital rubella
Arteriolosclerosis in malignant hypertension
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Septal defects - PDA - pulm art stenosis
Pulsus parvus and tardus - weak - can lead to syncope

38. Wegener's presentation
Inc central venous pressure - inc resistance to portal flow
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Late diastolic murmur following an opening snap
Fick principle

39. What causes the early cyanosis in Tet of Fallot?
HypoK and bradycardia
Chordae rupture - GN - suppurative pericarditis - emboli
Holosystolic - harsh sounding murmur - loudest over tricuspid area
R to L shunt caused by stenoic pulmonic valve

40. Which bacteria causes rheumatic heart disease
HypoK and bradycardia
Dressler's - autoimmune
Group a beta hemolytic strep
ANP

41. What masks atrial repolarization?
Ventricles are depolarized
LCX - V4- V6
Glossopharyngeal to soliary nucleus of medulla
QRS complex

42. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
R to L shunt caused by stenoic pulmonic valve
Eccentric - concentric hypertrophy causes diastolic disfunction
Transmural
Libman - sacks endocarditis

43. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
LCX - V4- V6
Kids
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Varicose veins - thromboembolism rare

44. In an EKG - What is the PR interval?
Arteriorles
Left sided
2nd degree AV block - mobitz type 1
Conduction delay through AV node - nl < 200 msec

45. What does hypoxia cause in the lung versus other tissues?
Medullary vasomotor center senses baroreceptors and JGA
Heart - 02 extraction is always around 100%
Anterosuperior displacement of the infundibular septum
Vasocxn - while other tissues it causes vasodilation

46. In what disease states is blood viscosity increased?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Pulmonary flow murmur and diastolic rumble
Unstable/crescendo angina
Pulmonic stenosis and RBBB

47. disease of elastic arteries and large and medium sized muscular arteries
Buerger's disease
Atherosclerosis
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
SV/ EDV

48. cavernous lymphangioma of the neck - associated with turner's
Cystic hygroma
Vasocxn
Cardiac tamponde
Ventricles are depolarized

49. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kawasaki
Group a beta hemolytic strep
Pulsus parvus and tardus - weak - can lead to syncope
The first 4 days

50. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Decreased
Henoch - Schlonlein purpura
Left atrial pressure
Late systolic crescendo murmur with a midsystolic click