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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 is the danger of torsades to pointes?
140/90
SV/ EDV
...
Can progess to V fib

2. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
RCA
Fick principle
Pos inotropy - exercise
Non

3. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2nd degree AV block - mobitz type 1
Boot shaped heart
Pulsus parvus and tardus - weak - can lead to syncope
ASD

4. in the JVP - What is the v wave?
Inc RA pressure - due to filling against closed tricupsid valve
Subendocardial - fewer collaterals and higher pressure
Vagus to medulla
Temporal arteritis

5. What kind of infarct show ST depression
In RA return (inspiration)
Ventricular depolarization - nl < 120 msec
Subendocardial
Late diastolic murmur following an opening snap

6. What are common causes of mitral regurg?
Takayasu's arteritis
Preload
The operating point of the heart
Ischemic heart dz - mitral valve prolapse - LV dilation

7. Which bacteria causes endocarditis in the presence of colon cancer
S. bovis
Pulsus parvus and tardus - weak - can lead to syncope
LV failure - pulm venous distention transudation of fluid
Hematocrit

8. In an EKG - What is the QT interval?
SA and AV nodes
The operating point of the heart
Mechanican contraction of the ventricles
Septal defects - PDA - pulm art stenosis

9. In an EKG - What is the PR interval?
Eccentric - concentric hypertrophy causes diastolic disfunction
Conduction delay through AV node - nl < 200 msec
Torsades de pointes
Apex and anterior interventricular septum

10. polypoid capillary hemangioma that can ulcerate and bleed
Pyogenic granuloma - associated with trauma and pregnancy
Mitral stenosis
Transmural
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

11. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Takayasu's arteritis
Age related calcifications or bicuspid aortic valve
Stable angina
Filling is incomplete and CO falls

12. congenital heart defect with congenital rubella
Takayasu's arteritis
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Septal defects - PDA - pulm art stenosis

13. What is the formula for EF?
Kaposi's sarcoma
Transmural
Greater ventricular EDV
SV/ EDV

14. Which organ gets the largest share of systemic cardiac output
Mitral valve prolapse
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Liver
Dilated cardiomyopathy

15. What murmur is heard with aortic regurg?
Pulsus parvus and tardus - weak - can lead to syncope
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Henoch - Schlonlein purpura

16. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Atherosclerosis
Purkingee>atria>ventricles>AV node
5-10 days - macs have degraded structural components
Apex and anterior interventricular septum

17. What channels do the the pacemaker cells lack?
Unstable/crescendo angina
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Fast volatge gated Na channels
Inc RA pressure - due to filling against closed tricupsid valve

18. tearing chest pain radiation to the back - associated with marfan
Changes in CO as a function of preload
Inc central venous pressure - inc resistance to portal flow
Aortic disecction - intraluminal tear forming false lumen
Wegener's

19. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Postinfarction fibrinous pericarditis
Polyarteritis nodosum
Increase intracellular Na - resulting in increased Ca
Takayasu's arteritis

20. The carotid sinus transmits along which nerve?
Dilated cardiomyopathy
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Glossopharyngeal to soliary nucleus of medulla
LV failure - pulm venous distention transudation of fluid

21. What does mitral prolapse predeispose to?
During diastole
Infective endocarditis
Polyarteritis nodosum
Cardiac tamponde

22. What does HTN predispose to?
Cyclophosphamide and corticosteroids
Total anomalous pulmonary trunk venous return
Increase in Pc
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

23. Wegener's tx
Cyclophosphamide and corticosteroids
Patent ductus arteriosus - congenital rubella or prematurity
Raynaud's
Inc venous return exaccerbates pulm vasc congestion

24. 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
Hematocrit
Atrial contraction
Inc RA pressure - due to filling against closed tricupsid valve

25. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Preload
Kawasaki
Inc venous return exaccerbates pulm vasc congestion
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

26. most common heart tumor
No
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Black > white > asian
Metastasis from melanoma or lymphoma

27. When during cardiac nodal cells depolarize?
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
During diastole
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Microscopic polyangiitis - like wegener's without granulomas

28. serum marker for wegener's
Hemorrhage
C - ANCA
The plateau period
Isovolumetric contraction

29. What causes the cushing reflex and why
Preload
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Fluid movement through capillaries
Activated histiocytes

30. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
MAP
MI
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Vasodilators

31. What causes aortic stenosis
Sturge weber - vasculitis of caps
Age related calcifications or bicuspid aortic valve
Eccentric - concentric hypertrophy causes diastolic disfunction
Adult type aortic coarctation

32. Which bacteria can cause endocarditis from prosthetic valves?
Troponin I
At least 55%
Vasodilators
S. epidermidis

33. How does aldosterone raise MAP
Dilated cardiomyopathy
Conduction delay through AV node - nl < 200 msec
Babies
Inc blood volume

34. clinical signs of cardiac tamponade
Chordae rupture - GN - suppurative pericarditis - emboli
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Systolic dysfunction
Acute thrombosis of coronary artery

35. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Metastasis from melanoma or lymphoma
Dec plasma proteins

36. When do you find hemosiderin laden macrophages in the lungs?
Ventricular repolarization
2nd degree AV block - mobitz type 1
During HF from microhemorrhages from inc pulm cap pressure
Decreases

37. exaggerated decrease in pulse during inspiration.

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38. pulseless disease - granulomatous thickening of the aortic arch and/or proximal great vessels - elev ESR - asian females > 40

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39. What does TAPVR stand for
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Transfusion
Total anomalous pulmonary trunk venous return
SA>AV>bundle of His>ventricles

40. p - anca

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41. What are anitschkow's cells
Left sided
Activated histiocytes
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Black > white > asian

42. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Libman - sacks endocarditis
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Inc central venous pressure - inc resistance to portal flow
Aortic stenosis or LBBB

43. What other sign is often present with congenital long QT syndrome - why?
Varicose veins - thromboembolism rare
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
LAD - V1- V2

44. Wegener's presentation
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Group a beta hemolytic strep
The first 4 days
Kaposi's sarcoma

45. Which murmur is characteristic of mitral/tricuspid regurg?
Holosystoiic
Inc blood volume
Cystic hygroma
LAD > RCA > circumflex

46. What does the starling curve show?
140/90
Changes in CO as a function of preload
CO
Viridans streptococci

47. What causes hepatomegaly?
Inc central venous pressure - inc resistance to portal flow
Tricuspid atresia - requires ASD and VSD
R to L shunt caused by stenoic pulmonic valve
Septal defects - PDA - pulm art stenosis

48. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Increase intracellular Na - resulting in increased Ca
Fick principle
Transfusion
Inc RA pressure - due to filling against closed tricupsid valve

49. What is the cushing triad?
Postinfarction fibrinous pericarditis
HTN - bradycardia - and respiratory depression
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
...

50. What are aschoff bodies
Atherosclerosis
Stroke volume affected by contractility - afterload - and preload
Granuloma with giant cells
Indomethacin closes - and pge keeps it open