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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 murmur is heard with VSD?
7 weeks
Wegener's
Dilation
Holosystolic - harsh sounding murmur - loudest over tricuspid area

2. What does hypoxia cause in the lung versus other tissues?
Late diastolic murmur following an opening snap
Vasocxn - while other tissues it causes vasodilation
During diastole
Posterior descending (80% off the RCA - 20% off the circumflex)

3. cavernous lymphangioma of the neck - associated with turner's
Inc interstitial osmotic pressure pulling fliud out of capillaries
Cystic hygroma
ASD
10%

4. What is the most common cause of right heart failure
Dec plasma proteins
140/90
Increase intracellular Na - resulting in increased Ca
Left heart failure

5. disease of elastic arteries and large and medium sized muscular arteries
Transposition of great vessels
Atherosclerosis
LAD > RCA > circumflex
Cherry hemangioma

6. Which class of drugs decrease the murmur heard in aortic regurg?
Vasodilators
The plateau period
Apex and anterior interventricular septum
Pos inotropy - exercise

7. necrotizing granulomas in lung and upper airways - nectrotizing GN - small vessel vasculitis

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8. What does FAN MY SKIN On Wednesday stand for?
MI
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Buerger's disease
Varicose veins - thromboembolism rare

9. What does an isoelectric ST segment indicate?
Total anomalous pulmonary trunk venous return
Ventricles are depolarized
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Wolff - Parkinson white syndrome

10. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Ventricular repolarization
Hematocrit
Fick principle
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

11. What constitues the upstroke in pacemaker cells?
Glossopharyngeal to soliary nucleus of medulla
Transposition of great vessels
Kids
Volatage gated Ca channels

12. What causes ankle - sacral edema - jugular venous distention
Increasing activity of Ca pump in SR
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Henoch - Schlonlein purpura
RV failure - in venous pressure

13. Wegener's presentation
Increase in Pc
Patent ductus arteriosus - congenital rubella or prematurity
S. bovis
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

14. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Vasodilators - (hydrAlAzine)
Left heart failure
Purkingee>atria>ventricles>AV node
Kids

15. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Troponin I
Hyperlipidemia
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
R to L shunt caused by stenoic pulmonic valve

16. What is associated with paradoxical spliting of S2
Torsades de pointes
Tricuspid atresia - requires ASD and VSD
The first 4 days
Aortic stenosis or LBBB

17. failure of truncus arteriosus to divide?
Non
No - no pressure gradient
Persistant truncus arteriosus
Extracellular calcium - calcium induced calcium release

18. Which organ has ht highest blood flow per gram of tissue
LAD - V1- V2
In HF
Conduction delay through AV node - nl < 200 msec
Kidney

19. How are sarcomeres added in concentric hypertrophy?
5-10 days - macs have degraded structural components
Glossopharyngeal to soliary nucleus of medulla
In parallel
Changes in CO as a function of preload

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

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21. What can cause mitral prolapse?
Myxomatous degeneration - RF - chordae rupture
Dilation
Truncus - tet of fallot
Systolic dysfunction

22. What is the most common cause of MI
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Acute thrombosis of coronary artery
Late systolic crescendo murmur with a midsystolic click
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

23. PCWP > LV diastolic pressure
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Transposition of great vessels
Mitral stenosis
Chordae rupture - GN - suppurative pericarditis - emboli

24. What causes tet of fallot?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Anterosuperior displacement of the infundibular septum
Heart - 02 extraction is always around 100%
Early deaths from myocarditis

25. What does autoregulation do?
Black > white > asian
Mitral>aortic>>tricuspid - high pressure valves affected most
Maintain blood flow to organ over wide range of perfussion pressures
Preload

26. When during cardiac nodal cells depolarize?
Kawasaki
Chordae rupture - GN - suppurative pericarditis - emboli
During diastole
LV failure - pulm venous distention transudation of fluid

27. What is the danger of torsades to pointes?
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Can progess to V fib
Aortic dilation - bicuspid aortic valve - RF -
Inc blood volume

28. Which two mechanisms sense decrease MAP?
Ventricular repolarization
If sodium channel
Medullary vasomotor center senses baroreceptors and JGA
Atrial contraction

29. Where does coronary artery occlusion occur most commonly?
Inc Kf - capillary perm
ASD
Increase contractility
LAD

30. What is the progression of atherosclerosis?
RV failure - in venous pressure
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Liver
Acute thrombosis of coronary artery

31. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LCX - I - aVL
Varicose veins - thromboembolism rare
...
Decreases

32. What causes the cushing reflex and why
Late diastolic murmur following an opening snap
At least 55%
Microscopic polyangiitis - like wegener's without granulomas
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

33. What does T wave inversion indicated?
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
MI
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Afterload (proportional to peripheral resistance)

34. congenital heart defect with congenital rubella
Septal defects - PDA - pulm art stenosis
Ventricular repolarization
Heart - 02 extraction is always around 100%
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

35. Exercise - overtransfusiion and excitiment causes and increase in...?
Buerger's disease
Boot shaped heart
Preload
P02

36. What causes the early cyanosis in Tet of Fallot?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
S. epidermidis
R to L shunt caused by stenoic pulmonic valve
Late diastolic murmur following an opening snap

37. What does the atria release in response to inc blood volume and atrial pressure
3rd degree block - pacemaker - Lyme disease
P02
ANP
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

38. serum marker for wegener's
Libman - sacks endocarditis
Mitral and tricuspid closure
Failure of LV to in CO during exercise
C - ANCA

39. Which sympathetic receptors raise MAP
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Buerger's disease
Crescendo - decrescendo systolic ejection murmur following ejection click
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

40. What causes the ejection click in the Cres - decres murmur?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Aburpt halting of valve leaflets
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Turners

41. Where are pacemaker cells?
SA and AV nodes
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Kidney
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

42. When and why is the S3 sound heard?
PDA
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Cherry hemangioma
Late diastolic murmur following an opening snap

43. benign cap hemangioma of infancy - spont regresses
Strawberry hemangioma
Glossopharyngeal to soliary nucleus of medulla
Mechanican contraction of the ventricles
Decreased

44. dyspnea - fatigue - edema and rales - multiple causes
CHF
Squat. Compression of femoral arteries - inc TPR - dec
Mitral stenosis
C - ANCA

45. Unilateral headache - jaw claudication - impaired vision
Hyperlipidemia
Tempral arteritis - may cause irreversible blindness
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
CFX

46. When and why do you hear the S4 sound
Viridans streptococci
Vagus to medulla
During HF from microhemorrhages from inc pulm cap pressure
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

47. congenital heart defect in an infant with a diabetic mother?
Transposition of great vessels
Greater ventricular EDV
S. aureus
Group a beta hemolytic strep

48. list the coronary vessels most likely to be occluded
Unstable/crescendo angina
LAD > RCA > circumflex
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Dec plasma proteins

49. Fatal arrhythmia
V fib
Raynaud's
Late diastolic murmur following an opening snap
Troponin I

50. Which valve is commonly involved in bacterial endocarditis from IV drug use and Which bacteria are most common?

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