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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 is the early and late lesion in rheumatic heart disease
Left heart failure
RV contraction (closed tricuspid valve bulding into atrium
Mitral valve prolapse
Fast volatge gated Na channels

2. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Lymphangiosarcoma
Atrial contraction
Posterior descending (80% off the RCA - 20% off the circumflex)
Failure of LV to in CO during exercise

3. Rank the pacemakers cells
Hemorrhage
SA and AV nodes
SA>AV>bundle of His>ventricles
Preload

4. If HR is too fast (V tach) what happens during diastole?
Glossopharyngeal to soliary nucleus of medulla
CK- MB
Filling is incomplete and CO falls
SV/ EDV

5. Which murmur is characteristic of mitral/tricuspid regurg?
Fast volatge gated Na channels
Tempral arteritis - may cause irreversible blindness
Holosystoiic
Increased SV

6. What is the S1 sound?
Atrial contraction
Mitral and tricuspid closure
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Changes in CO as a function of preload

7. How does a patient with Tet of fallot learn to improve symptoms?
Eisenmenger's syndrome
Preload
Babies
Squat. Compression of femoral arteries - inc TPR - dec

8. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Sturge weber - vasculitis of caps
Granuloma with giant cells
Microscopic polyangiitis - like wegener's without granulomas
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

9. Wegener's tx
Cyclophosphamide and corticosteroids
Maintain blood flow to organ over wide range of perfussion pressures
Gap junctions
Torsades de pointes

10. congenital heart defect with 22q11
The plateau period
Mechanican contraction of the ventricles
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Truncus - tet of fallot

11. Right to left shunts are more common in babies or kids?
2nd degree AV block - mobitz type 1
Babies
Venodilators (nitrogylcerine)
...

12. What causes ankle - sacral edema - jugular venous distention
RV failure - in venous pressure
Group a beta hemolytic strep
Kaposi's sarcoma
Subendocardial

13. Most common vasculitis affecting medium and large arteries
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Increase - increase the chance the If are open
Glomus tumor
Temporal arteritis

14. What causes aortic stenosis
V fib arrhythima
Wolff - Parkinson white syndrome
Age related calcifications or bicuspid aortic valve
Hyperlipidemia

15. PCWP > LV diastolic pressure
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
V fib
Mitral stenosis
Venodilators (nitrogylcerine)

16. Expiration causes an increase in which sided heart sounds
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
The first 4 days
Transmural
Left sided

17. congenital heart defect with turner's
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
140/90
Coarcation of aorta
Medullary vasomotor center senses baroreceptors and JGA

18. What does mitral prolapse predeispose to?
Left heart failure
Truncus - tet of fallot
CFX
Infective endocarditis

19. How are cadiac myocytes eltrically coupled?
No - no pressure gradient
Gap junctions
Aortic dilation - bicuspid aortic valve - RF -
Strawberry hemangioma

20. list the coronary vessels most likely to be occluded
No
Subendocardial - fewer collaterals and higher pressure
LAD > RCA > circumflex
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

21. Where does coronary artery occlusion occur most commonly?
Early deaths from myocarditis
Myxomatous degeneration - RF - chordae rupture
Aortic insuffic - late
LAD

22. in the JVP - What is the a wave?
Atrial contraction
RCA - II - III - aVF
SA>AV>bundle of His>ventricles
CO

23. What causes the early cyanosis in Tet of Fallot?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
R to L shunt caused by stenoic pulmonic valve
CHF
SA>AV>bundle of His>ventricles

24. 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
SV/ EDV
Temporal arteritis
If sodium channel

25. Where are pacemaker cells?
SA and AV nodes
Fick principle
Increase contractility
Transmural

26. Which enzymes are useful for diagnosing reinfarction
Vasodilators - (hydrAlAzine)
CK- MB
Takayasu's arteritis
Decrease in activity of Na/Ca exhanger and increase in contractility

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

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28. When and why is the S3 sound heard?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Temporal arteritis
No

29. What are aschoff bodies
S. bovis
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Temporal arteritis
Granuloma with giant cells

30. What are the four most common locations for atherosclerosis?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Can progess to V fib
Polyarteritis nodosum
Apex and anterior interventricular septum

31. Given P = QR - what factors influence resistance?
Proportional to viscosity and inversely proportional to the radius to the 4th power
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Prinzmetal angina
Fluid movement through capillaries

32. What does prolonged QT predispose to?
Torsades de pointes
R to L shunt caused by stenoic pulmonic valve
Myxomatous degeneration - RF - chordae rupture
No - no pressure gradient

33. Chronic mitral stenosis can lead to what changes in size of the LA
Fetal right to left - neonate left to right leading to RVH and failure
Afterload (proportional to peripheral resistance)
Dilation
Acute thrombosis of coronary artery

34. polypoid capillary hemangioma that can ulcerate and bleed
Inc Kf - capillary perm
C - ANCA
Glomus tumor
Pyogenic granuloma - associated with trauma and pregnancy

35. What is the difference between adult and infantile type aortic coarctation?
Atrial contraction
Sudden tensing of chordae tendinae
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

36. Which organ has the largest arteriovenous difference
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
V fib arrhythima
Myxoma
Heart - 02 extraction is always around 100%

37. In the cardiac cycle - which period has the highest 02 consumption?
Neg inotropy - HF - narcotic overdose
Isovolumetric contraction
HTN - bradycardia - and respiratory depression
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

38. What masks atrial repolarization?
Inc blood volume
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
QRS complex
2-4 day - early coag necrosis on the first day

39. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
2nd degree AV block - mobitz type 1
Aortic disecction - intraluminal tear forming false lumen
Increase - increase the chance the If are open
MI

40. with what heart sounds do ASD usually present?
V fib
Turners
Pulmonary flow murmur and diastolic rumble
Mitral>aortic>>tricuspid - high pressure valves affected most

41. What kind of infarct show ST depression
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
CO
2nd degree AV block - mobitz type 1
Subendocardial

42. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
Cystic hygroma
Chordae rupture - GN - suppurative pericarditis - emboli
LAD - V1- V2

43. EDV is also known as
TAPVR
Turners
Preload
Stroke volume affected by contractility - afterload - and preload

44. How are the sarcomeres added in eccentric hypertrophy?
In series
HTN - bradycardia - and respiratory depression
Eccentric - concentric hypertrophy causes diastolic disfunction
Increase - increase the chance the If are open

45. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Polyarteritis nodosum
Viridans streptococci
Tricuspid atresia - requires ASD and VSD
The operating point of the heart

46. How do catecholamines increase contractility?
The first 4 days
Increasing activity of Ca pump in SR
Angiosarcoma
Viridans streptococci

47. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
In series
Transposition of great vessels
Inc interstitial osmotic pressure pulling fliud out of capillaries
No - no pressure gradient

48. What is the classic X ray finding for tet of fallot?
Persistant truncus arteriosus
Torsades de pointes
Boot shaped heart
Wolff - Parkinson white syndrome

49. In an EKG - What is the PR interval?
Mitral valve prolapse
Conduction delay through AV node - nl < 200 msec
During diastole
HypoK and bradycardia

50. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Left heart failure
...
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral