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Cardiology

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Answer 50 questions in 15 minutes.
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1. Rank the pacemakers cells
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
SA>AV>bundle of His>ventricles
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Inc TPR and LA return (expiration)

2. no change in PR interval followed by dropped beat
Decreases
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Cyclophosphamide and corticosteroids

3. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
1st degree AV blodck
Pulmonary flow murmur and diastolic rumble
Purkingee>atria>ventricles>AV node
Afterload (proportional to peripheral resistance)

4. How does angiotensin II raise MAP
Vasocxn
V fib arrhythima
Pulmonary flow murmur and diastolic rumble
In RA return (inspiration)

5. PROVe
Kaposi's sarcoma
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

6. congenital heart defect with congenital rubella
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Septal defects - PDA - pulm art stenosis
Anterosuperior displacement of the infundibular septum
Inc Kf - capillary perm

7. What causes the CO curve to shift upwards?
Metastasis from melanoma or lymphoma
Pos inotropy - exercise
Inc blood volume
Aortic stenosis or LBBB

8. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
...
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Tempral arteritis - may cause irreversible blindness
Lower right - MC - upper right - AO - upper right AC - lower left MO

9. What happens with a decrease of extracellular Na
Transfusion
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Decrease in activity of Na/Ca exhanger and increase in contractility
Kidney

10. What causes the early cyanosis in Tet of Fallot?
140/90
Tempral arteritis - may cause irreversible blindness
R to L shunt caused by stenoic pulmonic valve
In RA return (inspiration)

11. What causes the murmur heard in tricuspid regurg to enhance
Greater ventricular EDV
Atrial contraction
Postinfarction fibrinous pericarditis
In RA return (inspiration)

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

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13. dyspnea - fatigue - edema and rales - multiple causes
Greater ventricular EDV
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Inc TPR and LA return (expiration)
CHF

14. In an EKG - What is the QT interval?
Mechanican contraction of the ventricles
The first 4 days
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Pulmonic stenosis and RBBB

15. what percentage of HTN is secondary to renal disease?
10%
During HF from microhemorrhages from inc pulm cap pressure
Subendocardial
Decrease in activity of Na/Ca exhanger and increase in contractility

16. What is associated with paradoxical spliting of S2
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Truncus - tet of fallot
Stroke volume
Aortic stenosis or LBBB

17. Which murmur is heard in aortic stenosis?
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Vasodilators
Crescendo - decrescendo systolic ejection murmur following ejection click
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

18. What is association with fixed S2 splitting - does not increase with inspiration
Transposition of great vessels
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
ASD
Wolff - Parkinson white syndrome

19. Which class of drugs decrease preload
Venodilators (nitrogylcerine)
Prinzmetal angina
Increase - increase the chance the If are open
Changes in CO as a function of preload

20. In an EKG - What is the PR interval?
Conduction delay through AV node - nl < 200 msec
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
In parallel
Dilation

21. What does the starling curve show?
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Lower right - MC - upper right - AO - upper right AC - lower left MO
Changes in CO as a function of preload
LCX - I - aVL

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

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23. What kind of infarct show ST depression
ANP
Subendocardial
Henoch - Schlonlein purpura
Granuloma with giant cells

24. What is the most common cause of right heart failure
Conduction delay through AV node - nl < 200 msec
Kawasaki
Left heart failure
Cherry hemangioma

25. which heart valves are afected most in rheumatic heart diseease
Afterload (proportional to peripheral resistance)
Apex and anterior interventricular septum
If sodium channel
Mitral>aortic>>tricuspid - high pressure valves affected most

26. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
CO
The plateau period
Pulmonic stenosis and RBBB

27. What is the classic X ray finding for tet of fallot?
Mitral and tricuspid closure
Dec P02 - inc PC02 and dec pH
Boot shaped heart
LAD - V1 - V4

28. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Lower right - MC - upper right - AO - upper right AC - lower left MO
LAD
Pulsus parvus and tardus - weak - can lead to syncope

29. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Babies
Subendocardial - fewer collaterals and higher pressure
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Polyarteritis nodosum

30. What happens in phase 4 of the cardiac ventricular action potential?
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Resting potential high K perm
Increase in Pc
Vagus to medulla

31. What is sudden cardiac death most commonly due to...
Resting potential high K perm
Fick principle
Increased efferent SANS and decreased efferent PANS
V fib arrhythima

32. What is the time frame for arrhythmia risk in the evolution of MI
Myxomatous degeneration - RF - chordae rupture
Septal defects - PDA - pulm art stenosis
Pulse pressure
The first 4 days

33. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LCX - I - aVL
Inc blood volume
Vasocxn
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

34. What does autoregulation do?
Failure of LV to in CO during exercise
Pulsus parvus and tardus - weak - can lead to syncope
Maintain blood flow to organ over wide range of perfussion pressures
Preload

35. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Varicose veins - thromboembolism rare
Hemorrhage
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

36. serum marker for wegener's
Troponin I
C - ANCA
Unstable/crescendo angina
Atherosclerosis

37. in the JVP - What is the v wave?
Late diastolic murmur following an opening snap
Coarcation of aorta
Inc RA pressure - due to filling against closed tricupsid valve
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

38. When does extracellular calcium enter the cardiac muscle cells during contraction?
The plateau period
Ventricular repolarization
ASD
Heart - 02 extraction is always around 100%

39. What causes the CO curve to shift downwards?
Squat. Compression of femoral arteries - inc TPR - dec
Neg inotropy - HF - narcotic overdose
Wolff - Parkinson white syndrome
ANP

40. If HR is too fast (V tach) what happens during diastole?
Filling is incomplete and CO falls
CO
RCA
Increased SV

41. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Activated histiocytes
Viridans streptococci
Dilated cardiomyopathy
Proportional to viscosity and inversely proportional to the radius to the 4th power

42. Which lab value indicates blood viscosity?
Hematocrit
Diastolic
Inc Kf - capillary perm
Postinfarction fibrinous pericarditis

43. What causes the cushing reflex and why
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Cystic hygroma
Arteriorles
Postinfarction fibrinous pericarditis

44. in the JVP - What is the c wave?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Holosystolic - harsh sounding murmur - loudest over tricuspid area
RV contraction (closed tricuspid valve bulding into atrium
Microscopic polyangiitis - like wegener's without granulomas

45. What does the atria release in response to inc blood volume and atrial pressure
In parallel
ANP
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Resting potential high K perm

46. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Angiosarcoma
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Subendocardial - fewer collaterals and higher pressure

47. Why is there edema after burns or during infection
Inc Kf - capillary perm
Glomus tumor
Metastasis from melanoma or lymphoma
Cyclophosphamide and corticosteroids

48. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Cherry hemangioma
Maintain blood flow to organ over wide range of perfussion pressures
C - ANCA
LV failure - pulm venous distention transudation of fluid

49. What causes the ejection click in the Cres - decres murmur?
LCX - I - aVL
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Aburpt halting of valve leaflets

50. The cause of cardiac dilation?
Mitral>aortic>>tricuspid - high pressure valves affected most
Pulmonary flow murmur and diastolic rumble
Boot shaped heart
Greater ventricular EDV

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Cardiology

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