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Cardiology

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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. In an EKG - What is the PR interval?
Conduction delay through AV node - nl < 200 msec
Increase - increase the chance the If are open
Hypertrophied cardiomyopathy
LCX - I - aVL

2. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Lymphangiosarcoma
Kawasaki
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Torsades de pointes

3. What stimulates release of calcium from the SR?
TAPVR
Extracellular calcium - calcium induced calcium release
Vasocxn - while other tissues it causes vasodilation
Dilation

4. CO x Total peripheral resistance
Changes in CO as a function of preload
Dec P02 - inc PC02 and dec pH
Mean arterial pressure
Adult type aortic coarctation

5. The aortic arch receptors transmit along which nerve?
Vagus to medulla
Pyogenic granuloma - associated with trauma and pregnancy
CFX
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

6. Which bacteria can cause endocarditis from prosthetic valves?
Apex and anterior interventricular septum
Liver
S. epidermidis
Extracellular calcium - calcium induced calcium release

7. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
No - no pressure gradient
Activated histiocytes
Chordae rupture - GN - suppurative pericarditis - emboli
RF

8. congenital heart defect with 22q11
Truncus - tet of fallot
Stroke volume affected by contractility - afterload - and preload
Aburpt halting of valve leaflets
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

9. Why is there edema after burns or during infection
S. bovis
V fib arrhythima
Increased SV
Inc Kf - capillary perm

10. What does FEVERSS stand for in rheumatic heart disease
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Fick principle
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Extracellular calcium - calcium induced calcium release

11. Which lab value indicates blood viscosity?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Hematocrit
Changes in CO as a function of preload

12. What causes the cushing reflex and why
Troponin I
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Inc Kf - capillary perm
Fetal right to left - neonate left to right leading to RVH and failure

13. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Hemorrhage
Atherosclerosis
Preload

14. What is associated with paradoxical spliting of S2
Torsades de pointes
Transmural
Aortic stenosis or LBBB
C - ANCA

15. What does the LAD supply?
LAD - V1 - V4
Apex and anterior interventricular septum
Neg inotropy - HF - narcotic overdose
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

16. When does extracellular calcium enter the cardiac muscle cells during contraction?
Aortic disecction - intraluminal tear forming false lumen
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Polyarteritis nodosum
The plateau period

17. When do coronary arteries fill?
No - no pressure gradient
Resting potential high K perm
Septal defects - PDA - pulm art stenosis
During diastole

18. How do catecholamines increase contractility?
Increasing activity of Ca pump in SR
Heart - 02 extraction is always around 100%
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

19. The cause of dyspnea on exertion?
Conduction delay through AV node - nl < 200 msec
Stroke volume affected by contractility - afterload - and preload
Failure of LV to in CO during exercise
Transposition of great vessels

20. In an EKG - What is the QT interval?
Subendocardial - fewer collaterals and higher pressure
Increase intracellular Na - resulting in increased Ca
Mechanican contraction of the ventricles
Proportional to viscosity and inversely proportional to the radius to the 4th power

21. Chronic mitral stenosis can lead to what changes in size of the LA
Cherry hemangioma
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Dilation

22. Right to left shunts are more common in babies or kids?
Greater ventricular EDV
LAD - V1- V2
Babies
Eisenmenger's syndrome

23. systolic - diastolic
Pulse pressure
Aortic/pulmonic regurg and mitral/tricuspid stenosis
During diastole
Venodilators (nitrogylcerine)

24. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
ASD
V fib arrhythima
Sturge weber - vasculitis of caps
Cardiac tamponde

25. What other syndrom is associated with infantile aortic coarctation
Varicose veins - thromboembolism rare
Turners
Coarcation of aorta
Rhabdomyomas

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

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27. most common heart tumor
Group a beta hemolytic strep
In RA return (inspiration)
Metastasis from melanoma or lymphoma
In series

28. What causes the ejection click in the Cres - decres murmur?
Aburpt halting of valve leaflets
Right sided
Aortic and pulmonary closing
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

29. Where is the most posterior portion of the heart and What can it cause?
MI
RF
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
During diastole

30. When does EF decrease
Atherosclerosis
In RA return (inspiration)
In HF
Indomethacin closes - and pge keeps it open

31. Exercise - overtransfusiion and excitiment causes and increase in...?
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Preload
Decrease in cAMP
LV failure - pulm venous distention transudation of fluid

32. What is the definition of HTN?
Pyogenic granuloma - associated with trauma and pregnancy
Aortic disecction - intraluminal tear forming false lumen
140/90
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

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

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34. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Increased SV
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
TAPVR
Vagus to medulla

35. Hyperplastic onion skinning
Glossopharyngeal to soliary nucleus of medulla
Arteriolosclerosis in malignant hypertension
5-10 days - macs have degraded structural components
Can progess to V fib

36. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Resting potential high K perm
Microscopic polyangiitis - like wegener's without granulomas
Increase - increase the chance the If are open
Increased SV

37. prolonged PR interval
Fluid movement through capillaries
1st degree AV blodck
Black > white > asian
Hematocrit

38. decrease stretch in baroreceptors leads to what response?
RV contraction (closed tricuspid valve bulding into atrium
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Increased efferent SANS and decreased efferent PANS

39. What causes ankle - sacral edema - jugular venous distention
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Rhabdomyomas
RV failure - in venous pressure
Fast volatge gated Na channels

40. In what disease states is blood viscosity increased?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Aortic dilation - bicuspid aortic valve - RF -
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Hyperlipidemia

41. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
The operating point of the heart
Troponin I
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
CHF

42. fibrinous pericarditis several weeks post MI

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43. no relation between p waves and QRS intervals - treatment and predisposing factor
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Increased efferent SANS and decreased efferent PANS
R to L shunt caused by stenoic pulmonic valve
3rd degree block - pacemaker - Lyme disease

44. What happends in phase 1 of the ventricular cardiac action potential?
SV/ EDV
Preload
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

45. What does hypoxia cause in the lung versus other tissues?
During diastole
Eisenmenger's syndrome
Vasocxn - while other tissues it causes vasodilation
Proportional to viscosity and inversely proportional to the radius to the 4th power

46. What are the complications from bacterial endocarditis?
Prinzmetal angina
Granuloma with giant cells
Transmural
Chordae rupture - GN - suppurative pericarditis - emboli

47. Expiration causes an increase in which sided heart sounds
7 weeks
Adult type aortic coarctation
Left sided
Mitral stenosis

48. Which murmur is heard with VSD?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
1st degree AV blodck

49. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Chordae rupture - GN - suppurative pericarditis - emboli
Arteriorles
Afterload (proportional to peripheral resistance)
Glomus tumor

50. How does digitatlis increase contractility?
Aortic stenosis or LBBB
MAP
Increase intracellular Na - resulting in increased Ca
Mitral>aortic>>tricuspid - high pressure valves affected most

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