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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 causes ankle - sacral edema - jugular venous distention
Crescendo - decrescendo systolic ejection murmur following ejection click
RV failure - in venous pressure
Arteriolosclerosis in malignant hypertension
Hematocrit

2. In an anterolateral infarct - which artery is effected and which leads show Q waves
Ventricular depolarization - nl < 120 msec
S. bovis
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
LCX - V4- V6

3. no change in PR interval followed by dropped beat
Apex and anterior interventricular septum
Transfusion
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Conduction delay through AV node - nl < 200 msec

4. What happens in phase 4 of the cardiac ventricular action potential?
Granuloma with giant cells
Resting potential high K perm
Vasocxn - while other tissues it causes vasodilation
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

5. In an EKG - What is the QT interval?
Mitral>aortic>>tricuspid - high pressure valves affected most
Mechanican contraction of the ventricles
Cherry hemangioma
Neg inotropy - HF - narcotic overdose

6. How does angiotensin II raise MAP
2nd degree AV block - mobitz type 1
During diastole
Vasocxn
SA and AV nodes

7. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
No - no pressure gradient
2nd degree AV block - mobitz type 1
Inc venous return exaccerbates pulm vasc congestion
Squat. Compression of femoral arteries - inc TPR - dec

8. Which class of drugs decreases afterload?
Can progess to V fib
The plateau period
Vasodilators - (hydrAlAzine)
5-10 days - macs have degraded structural components

9. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Atrial contraction
Vasodilators - (hydrAlAzine)
RCA
Henoch - Schlonlein purpura

10. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
CFX
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Volatage gated Ca channels
Increase - increase the chance the If are open

11. Churg Strauss - presentation and test
Extracellular calcium - calcium induced calcium release
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
RCA - II - III - aVF
Early deaths from myocarditis

12. Exercise - overtransfusiion and excitiment causes and increase in...?
Kawasaki
If sodium channel
Preload
Vagus to medulla

13. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Adult type aortic coarctation
2-4 day - early coag necrosis on the first day
Aortic and pulmonary closing
Extracellular calcium - calcium induced calcium release

14. congenital heart defect in an infant with a diabetic mother?
Aortic dilation - bicuspid aortic valve - RF -
Transposition of great vessels
Turners
Inc venous return exaccerbates pulm vasc congestion

15. What channels do the the pacemaker cells lack?
Decreases
Glomus tumor
Fast volatge gated Na channels
Preload

16. What happens in phase 3 of the cardiac ventricular action potential?
Mechanican contraction of the ventricles
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Cardiac tamponde

17. EDV is also known as
Vasocxn - while other tissues it causes vasodilation
RV failure - in venous pressure
Hypertrophied cardiomyopathy
Preload

18. What masks atrial repolarization?
Microscopic polyangiitis - like wegener's without granulomas
Transposition of great vessels
Aortic and pulmonary closing
QRS complex

19. What causes hepatomegaly?
Inc central venous pressure - inc resistance to portal flow
Pos inotropy - exercise
Aortic disecction - intraluminal tear forming false lumen
Holosystolic - harsh sounding murmur - loudest over tricuspid area

20. Where is the most posterior portion of the heart and What can it cause?
Yes
Inc blood volume
Cherry hemangioma
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

21. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
The aortic before pulmonic - inspiration increases diff
Mitral stenosis
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Decreases

22. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
Inc venous return exaccerbates pulm vasc congestion
Vasodilators
In RA return (inspiration)

23. What does the U wave indicated?
Acute thrombosis of coronary artery
HypoK and bradycardia
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
CO

24. What are aschoff bodies
Venodilators (nitrogylcerine)
Ventricles are depolarized
Granuloma with giant cells
Mitral and tricuspid closure

25. What is the formula for EF?
Coarcation of aorta
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Metastasis from melanoma or lymphoma
SV/ EDV

26. What does autoregulation do?
MI
Babies
Diastolic
Maintain blood flow to organ over wide range of perfussion pressures

27. In an acute MI - are there any visible changes via LM in the first 2-4 hours
The operating point of the heart
Angiosarcoma
No
Coarcation of aorta

28. What murmur is heard with aortic regurg?
Pyogenic granuloma - associated with trauma and pregnancy
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Increasing activity of Ca pump in SR
No - no pressure gradient

29. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Volatage gated Ca channels
In series
Kawasaki
LV failure - pulm venous distention transudation of fluid

30. What does the LAD supply?
Apex and anterior interventricular septum
Increase - increase the chance the If are open
Hematocrit
Mitral>aortic>>tricuspid - high pressure valves affected most

31. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
C - ANCA
Increased SV
Libman - sacks endocarditis
CK- MB

32. decrease stretch in baroreceptors leads to what response?
Increased efferent SANS and decreased efferent PANS
Cystic hygroma
Dec plasma proteins
SA>AV>bundle of His>ventricles

33. systolic - diastolic
Aortic and pulmonary closing
Failure of LV to in CO during exercise
Pulse pressure
Mitral valve

34. CO x Total peripheral resistance
1st degree AV blodck
ANP
Venodilators (nitrogylcerine)
Mean arterial pressure

35. Which organ has the largest arteriovenous difference
Lymphangiosarcoma
Non
Heart - 02 extraction is always around 100%
Wolff - Parkinson white syndrome

36. What does the starling curve show?
Changes in CO as a function of preload
Inc RA pressure - due to filling against closed tricupsid valve
Fick principle
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

37. What happens in phase 2 of the cardiac ventricular action potential?
SA and AV nodes
...
Rhabdomyomas
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

38. What are the diastolic heart sounds?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Raynaud's
Atrial contraction

39. 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
Inc RA pressure - due to filling against closed tricupsid valve
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Ventricular depolarization - nl < 120 msec

40. What does FEVERSS stand for in rheumatic heart disease
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Pos inotropy - exercise
Venodilators (nitrogylcerine)

41. in the JVP - What is the a wave?
10%
Mitral valve
Persistant truncus arteriosus
Atrial contraction

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

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43. Which bacteria can cause endocarditis from prosthetic valves?
Age related calcifications or bicuspid aortic valve
S. epidermidis
Vasocxn
Granuloma with giant cells

44. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Stable angina
Ventricles are depolarized
No - no pressure gradient

45. If HR is too fast (V tach) what happens during diastole?
Sturge weber - vasculitis of caps
Filling is incomplete and CO falls
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Polyarteritis nodosum

46. What other syndrom is associated with infantile aortic coarctation
Prinzmetal angina
Turners
Gap junctions
MI

47. Do you see elevaged ASO titers in rheumatic heart disease
Yes
Squat. Compression of femoral arteries - inc TPR - dec
P02
Arteriorles

48. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Unstable/crescendo angina
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Mitral stenosis
Pulsus parvus and tardus - weak - can lead to syncope

49. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
2-4 day - early coag necrosis on the first day
Volatage gated Ca channels
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
MI

50. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
RV failure - in venous pressure
C - ANCA
Cardiac tamponde
Late diastolic murmur following an opening snap