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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 causes ankle - sacral edema - jugular venous distention
RV failure - in venous pressure
Dilated cardiomyopathy
Late systolic crescendo murmur with a midsystolic click
Posterior descending (80% off the RCA - 20% off the circumflex)

2. Fatal arrhythmia
V fib
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Infective endocarditis
SA>AV>bundle of His>ventricles

3. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Mitral stenosis
Conduction delay through AV node - nl < 200 msec
Unstable/crescendo angina
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

4. What are anitschkow's cells
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Transfusion
Pos inotropy - exercise
Activated histiocytes

5. Which vessels account for the most total peripheral resistance
Decreases
Aortic dilation - bicuspid aortic valve - RF -
SA>AV>bundle of His>ventricles
Arteriorles

6. What is the association with wide S2 splitting?
Pulmonic stenosis and RBBB
10%
Decreases
Anterosuperior displacement of the infundibular septum

7. In an EKG - What is the PR interval?
Pulmonary flow murmur and diastolic rumble
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Conduction delay through AV node - nl < 200 msec
Tricuspid atresia - requires ASD and VSD

8. coronary artery spasm - ST elevation
Posterior descending (80% off the RCA - 20% off the circumflex)
Unstable/crescendo angina
Vasodilators - (hydrAlAzine)
Prinzmetal angina

9. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Aortic dilation - bicuspid aortic valve - RF -
Boot shaped heart
Decreases
Ischemic heart dz - mitral valve prolapse - LV dilation

10. What does FEVERSS stand for in rheumatic heart disease
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Afterload (proportional to peripheral resistance)
CO

11. What causes aortic stenosis
Age related calcifications or bicuspid aortic valve
During diastole
RV failure - in venous pressure
If sodium channel

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

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13. prolonged PR interval
1st degree AV blodck
Atherosclerosis
Conduction delay through AV node - nl < 200 msec
Early deaths from myocarditis

14. What causes the early cyanosis in Tet of Fallot?
CO
R to L shunt caused by stenoic pulmonic valve
Viridans streptococci
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

15. When is the scar completely formed in an MI?
Preload
7 weeks
Ventricular repolarization
Acute thrombosis of coronary artery

16. What happens in phase 0 of the cardiac ventricular action potential?
Rapid upstroke - voltage gated Na channels open
ANP
Cardiac tamponde
Gap junctions

17. Which two mechanisms sense decrease MAP?
5-10 days - macs have degraded structural components
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Left heart failure
Medullary vasomotor center senses baroreceptors and JGA

18. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Mitral and tricuspid closure
Eccentric - concentric hypertrophy causes diastolic disfunction
Late diastolic murmur following an opening snap
Dressler's - autoimmune

19. What causes aortic regurg
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Aortic dilation - bicuspid aortic valve - RF -
Inc Kf - capillary perm
ASD - VSD - AV septal defect (endocardial cushion defect)

20. What constitues the upstroke in pacemaker cells?
Ventricular depolarization - nl < 120 msec
Volatage gated Ca channels
Inc blood volume
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

21. Inspiration causes an increase in which sided heart sounds?
Right sided
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Cystic hygroma
Patent ductus arteriosus - congenital rubella or prematurity

22. Which channel accounts for automaticity of the SA and AV nodes?
Pulse pressure
Buerger's disease
If sodium channel
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

23. In an EKG - What is the QRS complex?
Kaposi's sarcoma
Ventricular depolarization - nl < 120 msec
Pulmonary flow murmur and diastolic rumble
Increased efferent SANS and decreased efferent PANS

24. What are the different etiologies of dialted cardiomyopathy
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
SA and AV nodes
Holosystolic - harsh sounding murmur - loudest over tricuspid area
In series

25. friction rub - 3-5 days post MI
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
ASD - VSD - AV septal defect (endocardial cushion defect)
Postinfarction fibrinous pericarditis
Wolff - Parkinson white syndrome

26. How does angiotensin II raise MAP
Patent ductus arteriosus - congenital rubella or prematurity
Vasocxn
Left sided
Group a beta hemolytic strep

27. What does the starling curve show?
Eccentric - concentric hypertrophy causes diastolic disfunction
RF
Dressler's - autoimmune
Changes in CO as a function of preload

28. What does autoregulation do?
Maintain blood flow to organ over wide range of perfussion pressures
Septal defects - PDA - pulm art stenosis
Fetal right to left - neonate left to right leading to RVH and failure
Heart - 02 extraction is always around 100%

29. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Age related calcifications or bicuspid aortic valve
Henoch - Schlonlein purpura
...
Ventricles are depolarized

30. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
ASD
S. aureus
Pos inotropy - exercise
Ventricular depolarization - nl < 120 msec

31. In normal S2 splitting - which valve closes first? What increases it?
Vasodilators - (hydrAlAzine)
The aortic before pulmonic - inspiration increases diff
Ventricular depolarization - nl < 120 msec
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

32. Which kind of infarct show ST elevation - and/or pathologic Q waves
Transposition of great vessels
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Pyogenic granuloma - associated with trauma and pregnancy
Transmural

33. What kind of dysfunction ensues in restrictive cardiomyopathy
Diastolic
RF
Eisenmenger's syndrome
Mechanican contraction of the ventricles

34. moncekberg
Tricuspid atresia - requires ASD and VSD
Persistant truncus arteriosus
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
In series

35. What does increasing intracellular Ca do?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Arteriolosclerosis in malignant hypertension
Increase contractility
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

36. What does HTN predispose to?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
S. aureus
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
S. bovis

37. What is the definition of HTN?
TAPVR
140/90
Pyogenic granuloma - associated with trauma and pregnancy
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

38. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
S. bovis
10%
Troponin I
Systolic dysfunction

39. Which area of the endocardium is especially vulnerable to infarction? Why?
Atrial contraction
Subendocardial - fewer collaterals and higher pressure
Can progess to V fib
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

40. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
Cystic hygroma
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Crescendo - decrescendo systolic ejection murmur following ejection click

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

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42. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Changes in CO as a function of preload
Wolff - Parkinson white syndrome
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Squat. Compression of femoral arteries - inc TPR - dec

43. What is the S2 sound?
Aortic and pulmonary closing
Liver
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Venodilators (nitrogylcerine)

44. Why is there edema after burns or during infection
Cystic hygroma
Inc Kf - capillary perm
C - ANCA
At least 55%

45. In terms of starling forces - why does heart failure cause edema?
1st degree AV blodck
Increase in Pc
Changes in CO as a function of preload
S. aureus

46. congenital heart defect with 22q11
No
In parallel
Truncus - tet of fallot
Stroke volume

47. The aortic arch receptors transmit along which nerve?
Metastasis from melanoma or lymphoma
Vagus to medulla
Cystic hygroma
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

48. The carotid sinus transmits along which nerve?
Glossopharyngeal to soliary nucleus of medulla
RF
Lymphangiosarcoma
In series

49. What is a normal EF
Decrease in cAMP
At least 55%
During diastole
LAD > RCA > circumflex

50. benign cap hemangioma of infancy - spont regresses
V fib arrhythima
Strawberry hemangioma
Left heart failure
Hyperlipidemia