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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 happens in phase 3 of the cardiac ventricular action potential?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Fluid movement through capillaries
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Troponin I

2. fibrinous pericarditis several weeks post MI

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3. In an EKG - What is the T wave?
...
Ventricular repolarization
Tricuspid atresia - requires ASD and VSD
Failure of LV to in CO during exercise

4. Wegener's presentation
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Aortic dilation - bicuspid aortic valve - RF -
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Wolff - Parkinson white syndrome

5. clinical signs of cardiac tamponade
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Increase intracellular Na - resulting in increased Ca
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
In RA return (inspiration)

6. What are aschoff bodies
Pyogenic granuloma - associated with trauma and pregnancy
Aortic and pulmonary closing
Granuloma with giant cells
RCA - II - III - aVF

7. In an anterior wall infarct - which artery is effected and which leads show Q waves
LAD - V1 - V4
RCA
Increasing activity of Ca pump in SR
During diastole

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

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9. 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
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Transmural
LAD - V1 - V4

10. What does an isoelectric ST segment indicate?
Aortic stenosis or LBBB
Patent ductus arteriosus - congenital rubella or prematurity
SA and AV nodes
Ventricles are depolarized

11. What happens in phase 2 of the cardiac ventricular action potential?
Microscopic polyangiitis - like wegener's without granulomas
Eccentric - concentric hypertrophy causes diastolic disfunction
Increase intracellular Na - resulting in increased Ca
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

12. How does angiotensin II raise MAP
Gap junctions
Vasocxn
7 weeks
Pulmonic stenosis and RBBB

13. When and why is the S3 sound heard?
CHF
Libman - sacks endocarditis
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

14. with what heart sounds do ASD usually present?
Stroke volume affected by contractility - afterload - and preload
CFX
Pulmonary flow murmur and diastolic rumble
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

15. What other syndrom is associated with infantile aortic coarctation
LAD > RCA > circumflex
LAD - V1- V2
Turners
LCX - I - aVL

16. What is the danger of torsades to pointes?
Ventricular depolarization - nl < 120 msec
LAD > RCA > circumflex
Pulmonic stenosis and RBBB
Can progess to V fib

17. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Mechanican contraction of the ventricles
Aburpt halting of valve leaflets
Kawasaki
Prinzmetal angina

18. In an EKG - What is the QRS complex?
Neg inotropy - HF - narcotic overdose
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Increase contractility
Ventricular depolarization - nl < 120 msec

19. Which bacteria causes endocarditis in the presence of colon cancer
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Wegener's
S. bovis
Coarcation of aorta

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

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21. EDV - ESV
Aortic insuffic - late
1st degree AV blodck
Stroke volume
If sodium channel

22. What causes the murmur heard in MR to enhance?
Infective endocarditis
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Squat. Compression of femoral arteries - inc TPR - dec
Inc TPR and LA return (expiration)

23. In the cardiac cycle - which period has the highest 02 consumption?
The aortic before pulmonic - inspiration increases diff
Isovolumetric contraction
Buerger's disease
S. bovis

24. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
Dec P02 - inc PC02 and dec pH
Transmural
Chordae rupture - GN - suppurative pericarditis - emboli

25. What channels do the the pacemaker cells lack?
Coarcation of aorta
Fast volatge gated Na channels
Hematocrit
Heart - 02 extraction is always around 100%

26. PCWP > LV diastolic pressure
Septal defects - PDA - pulm art stenosis
Fick principle
Mitral stenosis
During diastole

27. What causes the ejection click in the Cres - decres murmur?
TAPVR
Strawberry hemangioma
Extracellular calcium - calcium induced calcium release
Aburpt halting of valve leaflets

28. Inspiration causes an increase in which sided heart sounds?
Extracellular calcium - calcium induced calcium release
Subendocardial
Right sided
Ventricular depolarization - nl < 120 msec

29. In what disease states is blood viscosity increased?
Patent ductus arteriosus - congenital rubella or prematurity
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Early deaths from myocarditis
Transmural

30. What do the carotid and aortic bodies respond to?
Pulse pressure
Holosystoiic
Dec P02 - inc PC02 and dec pH
HTN - bradycardia - and respiratory depression

31. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2nd degree AV block - mobitz type 1
Black > white > asian
Postinfarction fibrinous pericarditis
Buerger's disease

32. What is the result of not have fast sodium channels in pacemaker cells?
LAD > RCA > circumflex
Medullary vasomotor center senses baroreceptors and JGA
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Kidney

33. systolic - diastolic
TAPVR
Pulse pressure
Filling is incomplete and CO falls
Maintain blood flow to organ over wide range of perfussion pressures

34. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Eccentric - concentric hypertrophy causes diastolic disfunction
Granuloma with giant cells
Prinzmetal angina
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

35. What does FROM JANE stand for in bacterial endocarditis?

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36. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Mitral stenosis
No - no pressure gradient
S. aureus
Decrease in activity of Na/Ca exhanger and increase in contractility

37. congenital heart defect in an infant with a diabetic mother?
LV failure - pulm venous distention transudation of fluid
Transposition of great vessels
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Metastasis from melanoma or lymphoma

38. What are the 5 T's of cyanoitc babies
Systolic dysfunction
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
During HF from microhemorrhages from inc pulm cap pressure
Greater ventricular EDV

39. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Buerger's disease
Libman - sacks endocarditis
Dilated cardiomyopathy
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

40. most common heart tumor
Liver
LCX - I - aVL
Metastasis from melanoma or lymphoma
Troponin I

41. Unilateral headache - jaw claudication - impaired vision
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Tempral arteritis - may cause irreversible blindness
SV/ EDV
Early deaths from myocarditis

42. What are the systolic heart sounds
Conduction delay through AV node - nl < 200 msec
Indomethacin closes - and pge keeps it open
Fast volatge gated Na channels
Aortic/pulmonic stenosis and mitral/tricuspid regurg

43. When and why do you hear the S4 sound
LCX - I - aVL
Increase in Pc
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Age related calcifications or bicuspid aortic valve

44. Fatal arrhythmia
LAD > RCA > circumflex
Late diastolic murmur following an opening snap
Crescendo - decrescendo systolic ejection murmur following ejection click
V fib

45. Wegener's tx
Cyclophosphamide and corticosteroids
Pulmonary flow murmur and diastolic rumble
Myxoma
5-10 days - macs have degraded structural components

46. What can cause mitral prolapse?
Myxomatous degeneration - RF - chordae rupture
Pyogenic granuloma - associated with trauma and pregnancy
Heart - 02 extraction is always around 100%
Pulmonic stenosis and RBBB

47. absecnce of tricuspid valve - hypoplastic RV
Lower right - MC - upper right - AO - upper right AC - lower left MO
Ventricular depolarization - nl < 120 msec
LAD - V1- V2
Tricuspid atresia - requires ASD and VSD

48. Hyperplastic onion skinning
Arteriolosclerosis in malignant hypertension
Pulmonary flow murmur and diastolic rumble
Increased efferent SANS and decreased efferent PANS
In HF

49. Which organ has ht highest blood flow per gram of tissue
Granuloma with giant cells
Wegener's
Kidney
Increased SV

50. Which class of drugs decrease the murmur heard in aortic regurg?
Vasodilators
Rhabdomyomas
Purkingee>atria>ventricles>AV node
Mitral stenosis