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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. When is the scar completely formed in an MI?
Afterload (proportional to peripheral resistance)
MI
7 weeks
Viridans streptococci

2. cavernous lymphangioma of the neck - associated with turner's
Cystic hygroma
Persistant truncus arteriosus
Inc venous return exaccerbates pulm vasc congestion
S. bovis

3. How are cadiac myocytes eltrically coupled?
Gap junctions
Pulmonary flow murmur and diastolic rumble
Postinfarction fibrinous pericarditis
Dec plasma proteins

4. polypoid capillary hemangioma that can ulcerate and bleed
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Pyogenic granuloma - associated with trauma and pregnancy
10%
Eisenmenger's syndrome

5. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Volatage gated Ca channels
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Transfusion
Tricuspid atresia - requires ASD and VSD

6. What is the classic X ray finding for tet of fallot?
Atherosclerosis
Posterior descending (80% off the RCA - 20% off the circumflex)
Isovolumetric contraction
Boot shaped heart

7. machine murmer
The aortic before pulmonic - inspiration increases diff
Ventricles are depolarized
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
PDA

8. What is the early and late lesion in rheumatic heart disease
MAP
LAD - V1- V2
Mitral valve prolapse
Microscopic polyangiitis - like wegener's without granulomas

9. what happens to capillaries in lymphatic blockage
Inc interstitial osmotic pressure pulling fliud out of capillaries
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Non
Yes

10. with what heart sounds do ASD usually present?
Ventricular depolarization - nl < 120 msec
Pulmonary flow murmur and diastolic rumble
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Age related calcifications or bicuspid aortic valve

11. in the JVP - What is the v wave?
Late diastolic murmur following an opening snap
Inc RA pressure - due to filling against closed tricupsid valve
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Mitral stenosis

12. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Chordae rupture - GN - suppurative pericarditis - emboli
Patent ductus arteriosus - congenital rubella or prematurity
Libman - sacks endocarditis
Varicose veins - thromboembolism rare

13. Right to left shunts are more common in babies or kids?
Preload
Libman - sacks endocarditis
Babies
Afterload (proportional to peripheral resistance)

14. How are sarcomeres added in concentric hypertrophy?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
SA>AV>bundle of His>ventricles
Aortic stenosis or LBBB
In parallel

15. failure of truncus arteriosus to divide?
Persistant truncus arteriosus
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Liver
Pulsus parvus and tardus - weak - can lead to syncope

16. What is the danger of torsades to pointes?
Age related calcifications or bicuspid aortic valve
Can progess to V fib
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
SA and AV nodes

17. What does hypoxia cause in the lung versus other tissues?
Mitral stenosis
Vasocxn - while other tissues it causes vasodilation
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Increased SV

18. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Purkingee>atria>ventricles>AV node
7 weeks
Septal defects - PDA - pulm art stenosis

19. Why is contractility decreased in heart failure?
Inc TPR and LA return (expiration)
Systolic dysfunction
Total anomalous pulmonary trunk venous return
Stroke volume

20. In normal S2 splitting - which valve closes first? What increases it?
Truncus - tet of fallot
Torsades de pointes
The aortic before pulmonic - inspiration increases diff
At least 55%

21. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
LAD - V1- V2
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Venodilators (nitrogylcerine)
2nd degree AV block - mobitz type 1

22. What do the carotid and aortic bodies respond to?
Vasocxn
Sturge weber - vasculitis of caps
Polyarteritis nodosum
Dec P02 - inc PC02 and dec pH

23. p - anca

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

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25. Chronic mitral stenosis can lead to what changes in size of the LA
...
Dilation
Greater ventricular EDV
Atherosclerosis

26. Where are pacemaker cells?
SA and AV nodes
Squat. Compression of femoral arteries - inc TPR - dec
Varicose veins - thromboembolism rare
Wolff - Parkinson white syndrome

27. What does FEVERSS stand for in rheumatic heart disease
Increasing activity of Ca pump in SR
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

28. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Proportional to viscosity and inversely proportional to the radius to the 4th power
Babies
Activated histiocytes

29. PCWP > LV diastolic pressure
TAPVR
Arteriorles
Mitral stenosis
SV/ EDV

30. In an EKG - What is the T wave?
Ventricular repolarization
Myxoma
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Fluid movement through capillaries

31. congenital heart defect with marfan's
Conduction delay through AV node - nl < 200 msec
Hyperlipidemia
Aortic insuffic - late
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

32. When during cardiac nodal cells depolarize?
HypoK and bradycardia
Left sided
Decrease in activity of Na/Ca exhanger and increase in contractility
During diastole

33. What kind of infarct show ST depression
Vasodilators - (hydrAlAzine)
Subendocardial
140/90
Venodilators (nitrogylcerine)

34. In an anterolateral infarct - which artery is effected and which leads show Q waves
Aortic and pulmonary closing
LCX - V4- V6
Hematocrit
Crescendo - decrescendo systolic ejection murmur following ejection click

35. congenital heart defect withdown syndrome
Fluid movement through capillaries
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
ASD - VSD - AV septal defect (endocardial cushion defect)
Left atrial pressure

36. Which class of drugs decreases afterload?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Left heart failure
Vasodilators - (hydrAlAzine)
Dec plasma proteins

37. In what disease states is blood viscosity increased?
S. epidermidis
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Proportional to viscosity and inversely proportional to the radius to the 4th power
Varicose veins - thromboembolism rare

38. In terms of starling forces - why does heart failure cause edema?
Granuloma with giant cells
Increase in Pc
Pyogenic granuloma - associated with trauma and pregnancy
Holosystoiic

39. What causes the early cyanosis in Tet of Fallot?
R to L shunt caused by stenoic pulmonic valve
S. bovis
Gap junctions
ANP

40. What causes ankle - sacral edema - jugular venous distention
RV failure - in venous pressure
In parallel
Aortic insuffic - late
Isovolumetric contraction

41. What does increasing intracellular Ca do?
Takayasu's arteritis
LAD
Chordae rupture - GN - suppurative pericarditis - emboli
Increase contractility

42. What does the LAD supply?
Decrease in cAMP
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Apex and anterior interventricular septum
RF

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

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44. which ethnic groups have higher association with HTN?
Black > white > asian
MI
Kidney
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

45. fibrous plaques and atheromas in intima of arteries
Black > white > asian
Atherosclerosis
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
MI

46. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Sturge weber - vasculitis of caps
The operating point of the heart
Preload
S. bovis

47. What causes the murmur heard in tricuspid regurg to enhance
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Metastasis from melanoma or lymphoma
S. bovis
In RA return (inspiration)

48. Which area of the endocardium is especially vulnerable to infarction? Why?
Total anomalous pulmonary trunk venous return
Vasocxn
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Subendocardial - fewer collaterals and higher pressure

49. SV CAP means?
Pulmonary flow murmur and diastolic rumble
Tricuspid atresia - requires ASD and VSD
Stroke volume affected by contractility - afterload - and preload
No

50. What is the S1 sound?
Fick principle
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Mitral and tricuspid closure