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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. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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2. Which murmur do you hear in mitral stenosis?
HTN - bradycardia - and respiratory depression
Henoch - Schlonlein purpura
Late diastolic murmur following an opening snap
Increased efferent SANS and decreased efferent PANS

3. Rank the pacemakers cells
Mitral>aortic>>tricuspid - high pressure valves affected most
Eccentric - concentric hypertrophy causes diastolic disfunction
Anterosuperior displacement of the infundibular septum
SA>AV>bundle of His>ventricles

4. most common primary cardiac tumor in children - associated with tuberous sclerosis
Cystic hygroma
Fetal right to left - neonate left to right leading to RVH and failure
Rhabdomyomas
Dec plasma proteins

5. What is the most common cause of MI
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Acute thrombosis of coronary artery
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
CO

6. Most common vasculitis affecting medium and large arteries
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
The plateau period
Atherosclerosis
Temporal arteritis

7. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
ASD
Dec plasma proteins
Strawberry hemangioma

8. What does mitral prolapse predeispose to?
Vasocxn - while other tissues it causes vasodilation
Aortic stenosis or LBBB
Infective endocarditis
LAD - V1- V2

9. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
PDA
The first 4 days
Tempral arteritis - may cause irreversible blindness
Troponin I

10. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2-4 day - early coag necrosis on the first day
Dec P02 - inc PC02 and dec pH
Holosystolic - harsh sounding murmur - loudest over tricuspid area
2nd degree AV block - mobitz type 1

11. What does TAPVR stand for
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Mechanican contraction of the ventricles
Total anomalous pulmonary trunk venous return

12. What causes the midsystolic click
Sudden tensing of chordae tendinae
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Acute thrombosis of coronary artery

13. Hyperplastic onion skinning
Holosystoiic
Arteriolosclerosis in malignant hypertension
Henoch - Schlonlein purpura
Ventricular repolarization

14. Unilateral headache - jaw claudication - impaired vision
Increase - increase the chance the If are open
R to L shunt caused by stenoic pulmonic valve
Tempral arteritis - may cause irreversible blindness
Decrease in cAMP

15. which heart valves are afected most in rheumatic heart diseease
The aortic before pulmonic - inspiration increases diff
Subendocardial - fewer collaterals and higher pressure
Wolff - Parkinson white syndrome
Mitral>aortic>>tricuspid - high pressure valves affected most

16. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Late diastolic murmur following an opening snap
Sturge weber - vasculitis of caps
V fib arrhythima
V fib

17. congenital heart defect in an infant with a diabetic mother?
Indomethacin closes - and pge keeps it open
Sturge weber - vasculitis of caps
Transposition of great vessels
Greater ventricular EDV

18. What are the four most common locations for atherosclerosis?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
LCX - I - aVL
Anterosuperior displacement of the infundibular septum
Adult type aortic coarctation

19. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
MI
In HF
Sudden tensing of chordae tendinae
TAPVR

20. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Hemorrhage
Posterior descending (80% off the RCA - 20% off the circumflex)
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Left heart failure

21. What happens in phase 2 of the cardiac ventricular action potential?
Filling is incomplete and CO falls
Systolic dysfunction
Henoch - Schlonlein purpura
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

22. What are the systolic heart sounds
Subendocardial - fewer collaterals and higher pressure
Sturge weber - vasculitis of caps
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Pos inotropy - exercise

23. What does the LAD supply?
SV/ EDV
LV failure - pulm venous distention transudation of fluid
Apex and anterior interventricular septum
Transmural

24. 2/3 diastolic + 1/3 systolic
Takayasu's arteritis
MAP
LCX - V4- V6
Maintain blood flow to organ over wide range of perfussion pressures

25. what percentage of HTN is secondary to renal disease?
10%
Raynaud's
Dec plasma proteins
Mean arterial pressure

26. What is the result of not have fast sodium channels in pacemaker cells?
Inc TPR and LA return (expiration)
Atherosclerosis
Septal defects - PDA - pulm art stenosis
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

27. What does the starling curve show?
LAD > RCA > circumflex
Chordae rupture - GN - suppurative pericarditis - emboli
Changes in CO as a function of preload
Subendocardial

28. What is the definition of HTN?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
RCA - II - III - aVF
Sudden tensing of chordae tendinae
140/90

29. In an EKG - What is the QT interval?
Increase contractility
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Left atrial pressure
Mechanican contraction of the ventricles

30. What does hypoxia cause in the lung versus other tissues?
Vasocxn - while other tissues it causes vasodilation
Isovolumetric contraction
Cyclophosphamide and corticosteroids
Inc venous return exaccerbates pulm vasc congestion

31. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Activated histiocytes
Purkingee>atria>ventricles>AV node
Glossopharyngeal to soliary nucleus of medulla
Decrease in activity of Na/Ca exhanger and increase in contractility

32. What is the danger of torsades to pointes?
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Left sided
Can progess to V fib
Vasocxn - while other tissues it causes vasodilation

33. Which murmur is characteristic of mitral/tricuspid regurg?
Holosystoiic
S. epidermidis
Pulse pressure
During HF from microhemorrhages from inc pulm cap pressure

34. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Turners
Decreases
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

35. What does the atria release in response to inc blood volume and atrial pressure
ANP
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
If sodium channel
TAPVR

36. What is the classic X ray finding for tet of fallot?
Boot shaped heart
Filling is incomplete and CO falls
Anterosuperior displacement of the infundibular septum
Coarcation of aorta

37. Restrictive cardiomyopathy causes
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Black > white > asian
Fast volatge gated Na channels
Greater ventricular EDV

38. What is the early and late lesion in rheumatic heart disease
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Pulsus parvus and tardus - weak - can lead to syncope
Mitral stenosis
Mitral valve prolapse

39. When do coronary arteries fill?
Hyperlipidemia
LAD - V1- V2
Fluid movement through capillaries
During diastole

40. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Heart - 02 extraction is always around 100%
Kawasaki
Left sided
HypoK and bradycardia

41. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
5-10 days - macs have degraded structural components
Cyclophosphamide and corticosteroids
At least 55%
Libman - sacks endocarditis

42. machine murmer
Torsades de pointes
Postinfarction fibrinous pericarditis
PDA
S. bovis

43. What causes tet of fallot?
1st degree AV blodck
Anterosuperior displacement of the infundibular septum
Greater ventricular EDV
Aortic/pulmonic stenosis and mitral/tricuspid regurg

44. Which class of drugs decreases afterload?
Vasodilators - (hydrAlAzine)
LAD - V1- V2
Sudden tensing of chordae tendinae
Ventricles are depolarized

45. What are the complications from bacterial endocarditis?
Turners
Mechanican contraction of the ventricles
...
Chordae rupture - GN - suppurative pericarditis - emboli

46. How does acidosis affect contractility?
Cystic hygroma
Hematocrit
Decreased
Troponin I

47. When is the scar completely formed in an MI?
Afterload (proportional to peripheral resistance)
7 weeks
Resting potential high K perm
3rd degree block - pacemaker - Lyme disease

48. In an anterior wall infarct - which artery is effected and which leads show Q waves
Indomethacin closes - and pge keeps it open
LAD - V1 - V4
During HF from microhemorrhages from inc pulm cap pressure
RCA

49. friction rub - 3-5 days post MI
Dilation
Postinfarction fibrinous pericarditis
Changes in CO as a function of preload
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

50. with what heart sounds do ASD usually present?
3rd degree block - pacemaker - Lyme disease
Neg inotropy - HF - narcotic overdose
Rapid upstroke - voltage gated Na channels open
Pulmonary flow murmur and diastolic rumble

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