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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 does FAN MY SKIN On Wednesday stand for?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
In HF
Myxoma
Arteriolosclerosis in malignant hypertension

2. Restrictive cardiomyopathy causes
Extracellular calcium - calcium induced calcium release
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
In series
ANP

3. What does an isoelectric ST segment indicate?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
1st degree AV blodck
LAD
Ventricles are depolarized

4. What is the formula for EF?
SV/ EDV
Hemorrhage
Inc blood volume
Tricuspid atresia - requires ASD and VSD

5. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Vasocxn
Inc blood volume
ASD - VSD - AV septal defect (endocardial cushion defect)
Henoch - Schlonlein purpura

6. Which bacteria causes endocarditis in the presence of colon cancer
Apex and anterior interventricular septum
S. aureus
S. bovis
Eccentric - concentric hypertrophy causes diastolic disfunction

7. In normal S2 splitting - which valve closes first? What increases it?
Purkingee>atria>ventricles>AV node
The aortic before pulmonic - inspiration increases diff
Kids
Babies

8. p - anca

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9. stroke volume x HR =?
ASD - VSD - AV septal defect (endocardial cushion defect)
LCX - I - aVL
Cardiac tamponde
CO

10. How does aldosterone raise MAP
Coarcation of aorta
ASD
Left atrial pressure
Inc blood volume

11. What causes the CO curve to shift upwards?
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Pos inotropy - exercise
RV contraction (closed tricuspid valve bulding into atrium

12. most common primary cardiac tumor in children - associated with tuberous sclerosis
LCX - V4- V6
Crescendo - decrescendo systolic ejection murmur following ejection click
Left sided
Rhabdomyomas

13. What is the time frame for arrhythmia risk in the evolution of MI
CHF
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
The first 4 days
10%

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

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15. systolic - diastolic
Troponin I
Rapid upstroke - voltage gated Na channels open
Pulse pressure
Adult type aortic coarctation

16. Given P = QR - what factors influence resistance?
RCA - II - III - aVF
Mitral stenosis
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

17. What are anitschkow's cells
HypoK and bradycardia
5-10 days - macs have degraded structural components
S. aureus
Activated histiocytes

18. Wegener's tx
Subendocardial - fewer collaterals and higher pressure
Cyclophosphamide and corticosteroids
Angiosarcoma
Dec P02 - inc PC02 and dec pH

19. exaggerated decrease in pulse during inspiration.

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20. The aortic arch receptors transmit along which nerve?
Activated histiocytes
Raynaud's
Vagus to medulla
Group a beta hemolytic strep

21. What does hypoxia cause in the lung versus other tissues?
CFX
Squat. Compression of femoral arteries - inc TPR - dec
Atherosclerosis
Vasocxn - while other tissues it causes vasodilation

22. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
The operating point of the heart
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Polyarteritis nodosum
3rd degree block - pacemaker - Lyme disease

23. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
Strawberry hemangioma
Stroke volume
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

24. What is the danger of torsades to pointes?
Can progess to V fib
Cardiac tamponde
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Troponin I

25. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Mechanican contraction of the ventricles
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
No

26. In an anterolateral infarct - which artery is effected and which leads show Q waves
Truncus - tet of fallot
Crescendo - decrescendo systolic ejection murmur following ejection click
No - no pressure gradient
LCX - V4- V6

27. Which murmur is heard with mitral prolapse?
Filling is incomplete and CO falls
Mitral valve prolapse
Late systolic crescendo murmur with a midsystolic click
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

28. Chronic mitral stenosis can lead to what changes in size of the LA
Dilation
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Right sided
RCA

29. What cardiac change occurs in pregnancy?
RF
Coarcation of aorta
S. bovis
Increased SV

30. fibrinous pericarditis several weeks post MI

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31. How are the sarcomeres added in eccentric hypertrophy?
In series
Resting potential high K perm
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
1st degree AV blodck

32. What is the characteristic pulse in aortic stenosis?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Microscopic polyangiitis - like wegener's without granulomas
Pulsus parvus and tardus - weak - can lead to syncope
Hyperlipidemia

33. What happens with a decrease of extracellular Na
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Tricuspid atresia - requires ASD and VSD
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Decrease in activity of Na/Ca exhanger and increase in contractility

34. What is the difference between adult and infantile type aortic coarctation?
Late diastolic murmur following an opening snap
Vagus to medulla
Henoch - Schlonlein purpura
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

35. Which channel accounts for automaticity of the SA and AV nodes?
Pulmonic stenosis and RBBB
If sodium channel
Vasocxn - while other tissues it causes vasodilation
5-10 days - macs have degraded structural components

36. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Aortic and pulmonary closing
Kawasaki
Fick principle
Septal defects - PDA - pulm art stenosis

37. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
Aortic dilation - bicuspid aortic valve - RF -
Venodilators (nitrogylcerine)
Pos inotropy - exercise

38. Which organ has ht highest blood flow per gram of tissue
LAD - V1 - V4
The aortic before pulmonic - inspiration increases diff
Kidney
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

39. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Eisenmenger's syndrome
Adult type aortic coarctation
Troponin I
Inc interstitial osmotic pressure pulling fliud out of capillaries

40. What is association with fixed S2 splitting - does not increase with inspiration
Systolic dysfunction
Inc Kf - capillary perm
Atrial contraction
ASD

41. What does mitral prolapse predeispose to?
Infective endocarditis
Sturge weber - vasculitis of caps
Truncus - tet of fallot
The first 4 days

42. What do patients die early from in rheumatic heart disease?
Early deaths from myocarditis
SA>AV>bundle of His>ventricles
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Transposition of great vessels

43. Hyperplastic onion skinning
Arteriolosclerosis in malignant hypertension
Truncus - tet of fallot
Mitral valve
MI

44. Irregularly irregular ECG - no p waves: dx and treatment
During diastole
Troponin I
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Group a beta hemolytic strep

45. What are aschoff bodies
Granuloma with giant cells
Infective endocarditis
Fluid movement through capillaries
Vasodilators - (hydrAlAzine)

46. The cause of dyspnea on exertion?
Failure of LV to in CO during exercise
Dressler's - autoimmune
Liver
LCX - V4- V6

47. with what heart sounds do ASD usually present?
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Pulmonary flow murmur and diastolic rumble
LAD > RCA > circumflex
Pulsus parvus and tardus - weak - can lead to syncope

48. What other syndrom is associated with infantile aortic coarctation
Postinfarction fibrinous pericarditis
Turners
Liver
Glossopharyngeal to soliary nucleus of medulla

49. Which valve is most commonly involved in bacterial endocarditis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Increasing activity of Ca pump in SR
Mitral valve
In series

50. Which bacteria can cause endocarditis from prosthetic valves?
Preload
HTN - bradycardia - and respiratory depression
S. epidermidis
RCA - II - III - aVF