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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. Which class of drugs decreases afterload?
Vasodilators - (hydrAlAzine)
Dilation
Increase contractility
Arteriolosclerosis in malignant hypertension

2. Which valve is most commonly involved in bacterial endocarditis?
Vasocxn
Mitral valve
Sudden tensing of chordae tendinae
Isovolumetric contraction

3. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Increase contractility
Glomus tumor
Mitral valve prolapse

4. Which organ has ht highest blood flow per gram of tissue
Kidney
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
MI
Increased SV

5. Which murmur is heard with VSD?
Septal defects - PDA - pulm art stenosis
Viridans streptococci
Holosystolic - harsh sounding murmur - loudest over tricuspid area
The plateau period

6. When do coronary arteries fill?
LAD - V1- V2
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
During diastole
Rhabdomyomas

7. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Patent ductus arteriosus - congenital rubella or prematurity
Fick principle
Inc venous return exaccerbates pulm vasc congestion
Increase contractility

8. What is the time frame for arrhythmia risk in the evolution of MI
Ventricular repolarization
Cystic hygroma
Late diastolic murmur following an opening snap
The first 4 days

9. How do beta blockers decrease contractility?
In HF
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Volatage gated Ca channels
Decrease in cAMP

10. no change in PR interval followed by dropped beat
P02
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Transposition of great vessels
Torsades de pointes

11. How are cadiac myocytes eltrically coupled?
Gap junctions
Inc central venous pressure - inc resistance to portal flow
Vasocxn
Cyclophosphamide and corticosteroids

12. Exercise - overtransfusiion and excitiment causes and increase in...?
Increase in Pc
LAD - V1 - V4
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Preload

13. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Pos inotropy - exercise
Inc venous return exaccerbates pulm vasc congestion
CK- MB
Libman - sacks endocarditis

14. What does the LAD supply?
2nd degree AV block - mobitz type 1
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Apex and anterior interventricular septum
Filling is incomplete and CO falls

15. which heart valves are afected most in rheumatic heart diseease
Hypertrophied cardiomyopathy
Increase intracellular Na - resulting in increased Ca
RV contraction (closed tricuspid valve bulding into atrium
Mitral>aortic>>tricuspid - high pressure valves affected most

16. Right to left shunts are more common in babies or kids?
Mechanican contraction of the ventricles
Decrease in cAMP
Cystic hygroma
Babies

17. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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18. Expiration causes an increase in which sided heart sounds
Left sided
Eccentric - concentric hypertrophy causes diastolic disfunction
MI
Squat. Compression of femoral arteries - inc TPR - dec

19. Given P = QR - what factors influence resistance?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Subendocardial - fewer collaterals and higher pressure
Tempral arteritis - may cause irreversible blindness
Truncus - tet of fallot

20. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Eccentric - concentric hypertrophy causes diastolic disfunction
S. bovis
Raynaud's
Kawasaki

21. What does T wave inversion indicated?
MI
Coarcation of aorta
Dilation
Proportional to viscosity and inversely proportional to the radius to the 4th power

22. serum marker for wegener's
Vasocxn - while other tissues it causes vasodilation
Fluid movement through capillaries
LCX - I - aVL
C - ANCA

23. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
1st degree AV blodck
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Polyarteritis nodosum

24. tearing chest pain radiation to the back - associated with marfan
Rapid upstroke - voltage gated Na channels open
Sturge weber - vasculitis of caps
Aortic disecction - intraluminal tear forming false lumen
Age related calcifications or bicuspid aortic valve

25. What happens in phase 3 of the cardiac ventricular action potential?
Increasing activity of Ca pump in SR
Purkingee>atria>ventricles>AV node
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Buerger's disease

26. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Glossopharyngeal to soliary nucleus of medulla
Inc RA pressure - due to filling against closed tricupsid valve
Varicose veins - thromboembolism rare
In series

27. When and why do you hear the S4 sound
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Takayasu's arteritis
Tricuspid atresia - requires ASD and VSD
Metastasis from melanoma or lymphoma

28. What is the progression of atherosclerosis?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
RF
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

29. Which bacteria can cause endocarditis from prosthetic valves?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Non
Pulmonary flow murmur and diastolic rumble
S. epidermidis

30. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Sudden tensing of chordae tendinae
Purkingee>atria>ventricles>AV node
...
Troponin I

31. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Polyarteritis nodosum

32. Where are pacemaker cells?
SA and AV nodes
Tempral arteritis - may cause irreversible blindness
Hypertrophied cardiomyopathy
Viridans streptococci

33. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
...
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

34. What is indicated when CO and venous return are equal?
The operating point of the heart
Increase intracellular Na - resulting in increased Ca
2nd degree AV block - mobitz type 1
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

35. Which organ has the largest arteriovenous difference
Heart - 02 extraction is always around 100%
LAD > RCA > circumflex
Myxoma
Fick principle

36. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
RCA
Lower right - MC - upper right - AO - upper right AC - lower left MO
Preload
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

37. What is the definition of HTN?
140/90
LAD
RCA - II - III - aVF
Postinfarction fibrinous pericarditis

38. What is associated with paradoxical spliting of S2
Aortic stenosis or LBBB
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Rhabdomyomas
CHF

39. What is the difference between adult and infantile type aortic coarctation?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Takayasu's arteritis
Left sided

40. polypoid capillary hemangioma that can ulcerate and bleed
Inc venous return exaccerbates pulm vasc congestion
Inc Kf - capillary perm
Pyogenic granuloma - associated with trauma and pregnancy
Takayasu's arteritis

41. with what heart sounds do ASD usually present?
5-10 days - macs have degraded structural components
Pulmonary flow murmur and diastolic rumble
Left heart failure
V fib arrhythima

42. sawtooth wave

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43. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Mitral stenosis
No
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
During diastole

44. Which class of drugs decrease the murmur heard in aortic regurg?
Granuloma with giant cells
Vasodilators
RV failure - in venous pressure
Troponin I

45. bening capillary hemangioma of elderly - does not regress
RF
Eccentric - concentric hypertrophy causes diastolic disfunction
Cherry hemangioma
Aortic insuffic - late

46. PCWP is an estimate of...
Hyperlipidemia
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Left atrial pressure
Indomethacin closes - and pge keeps it open

47. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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48. How does aldosterone raise MAP
Inc blood volume
MI
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Takayasu's arteritis

49. What is the characteristic pulse in aortic stenosis?
Wolff - Parkinson white syndrome
Pulsus parvus and tardus - weak - can lead to syncope
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Inc central venous pressure - inc resistance to portal flow

50. What are the four most common locations for atherosclerosis?
Buerger's disease
Aortic dilation - bicuspid aortic valve - RF -
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
V fib