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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. Fatal arrhythmia
Troponin I
Kidney
Increased efferent SANS and decreased efferent PANS
V fib

2. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Transposition of great vessels
Decreases
Conduction delay through AV node - nl < 200 msec
Turners

3. prolonged PR interval
Afterload (proportional to peripheral resistance)
Hematocrit
Cherry hemangioma
1st degree AV blodck

4. What happens in phase 2 of the cardiac ventricular action potential?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
P02
Granuloma with giant cells
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

5. Chronic mitral stenosis can lead to what changes in size of the LA
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Aortic disecction - intraluminal tear forming false lumen
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Dilation

6. PCWP is an estimate of...
Left atrial pressure
Preload
Fick principle
SA>AV>bundle of His>ventricles

7. What is association with fixed S2 splitting - does not increase with inspiration
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
ASD
Vasodilators
QRS complex

8. How are sarcomeres added in concentric hypertrophy?
Mitral valve
Postinfarction fibrinous pericarditis
In parallel
ASD - VSD - AV septal defect (endocardial cushion defect)

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

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10. What are the different etiologies of dialted cardiomyopathy
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Henoch - Schlonlein purpura
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

11. What causes the CO curve to shift downwards?
Stroke volume affected by contractility - afterload - and preload
Neg inotropy - HF - narcotic overdose
Mean arterial pressure
LAD > RCA > circumflex

12. What causes orthopnea?
In HF
Inc venous return exaccerbates pulm vasc congestion
CK- MB
Volatage gated Ca channels

13. Where is the most posterior portion of the heart and What can it cause?
Kids
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Fetal right to left - neonate left to right leading to RVH and failure
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

14. which heart valves are afected most in rheumatic heart diseease
Myxoma
ASD
Mitral>aortic>>tricuspid - high pressure valves affected most
S. aureus

15. What is a normal EF
3rd degree block - pacemaker - Lyme disease
At least 55%
S. bovis
SA and AV nodes

16. stroke volume x HR =?
CO
Transfusion
Inc Kf - capillary perm
LAD - V1 - V4

17. How does angiotensin II raise MAP
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Vasocxn
5-10 days - macs have degraded structural components
...

18. systolic - diastolic
Pulse pressure
Aortic stenosis or LBBB
During diastole
Left heart failure

19. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
RCA
Crescendo - decrescendo systolic ejection murmur following ejection click
Transfusion
At least 55%

20. What 4 things drive myocardial 02 demand?
RF
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Boot shaped heart
Troponin I

21. What does FEVERSS stand for in rheumatic heart disease
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
5-10 days - macs have degraded structural components
SA and AV nodes

22. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Angiosarcoma
Afterload (proportional to peripheral resistance)
Cardiac tamponde
In parallel

23. What does mitral prolapse predeispose to?
Infective endocarditis
Arteriorles
HTN - bradycardia - and respiratory depression
No

24. What is the association with wide S2 splitting?
Mitral stenosis
Late systolic crescendo murmur with a midsystolic click
Pulmonic stenosis and RBBB
No - no pressure gradient

25. Why is contractility decreased in heart failure?
Liver
Inc RA pressure - due to filling against closed tricupsid valve
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Systolic dysfunction

26. cavernous lymphangioma of the neck - associated with turner's
RF
Arteriolosclerosis in malignant hypertension
Mitral>aortic>>tricuspid - high pressure valves affected most
Cystic hygroma

27. Which organ has ht highest blood flow per gram of tissue
Aortic dilation - bicuspid aortic valve - RF -
Kidney
Atherosclerosis
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

28. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
P02
CFX
S. aureus
Unstable/crescendo angina

29. What masks atrial repolarization?
No
QRS complex
Ischemic heart dz - mitral valve prolapse - LV dilation
Vasocxn - while other tissues it causes vasodilation

30. What is indicated when CO and venous return are equal?
Troponin I
Yes
Maintain blood flow to organ over wide range of perfussion pressures
The operating point of the heart

31. machine murmer
PDA
LCX - I - aVL
Raynaud's
Stable angina

32. In an EKG - What is the p wave?
Atherosclerosis
Aortic disecction - intraluminal tear forming false lumen
Acute thrombosis of coronary artery
Atrial contraction

33. absecnce of tricuspid valve - hypoplastic RV
Activated histiocytes
Truncus - tet of fallot
S. aureus
Tricuspid atresia - requires ASD and VSD

34. What happends in phase 1 of the ventricular cardiac action potential?
Inc interstitial osmotic pressure pulling fliud out of capillaries
Left sided
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
The plateau period

35. Which organ has the largest arteriovenous difference
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Volatage gated Ca channels
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Heart - 02 extraction is always around 100%

36. In an EKG - What is the T wave?
Ventricular repolarization
Total anomalous pulmonary trunk venous return
Failure of LV to in CO during exercise
Stable angina

37. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Neg inotropy - HF - narcotic overdose
Henoch - Schlonlein purpura
Prinzmetal angina
Coarcation of aorta

38. When do you find hemosiderin laden macrophages in the lungs?
Temporal arteritis
During HF from microhemorrhages from inc pulm cap pressure
Inc blood volume
Hyperlipidemia

39. What is the gold standard for dx of MI in the first 6 hours
EKG
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Kawasaki
7 weeks

40. When during cardiac nodal cells depolarize?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Wegener's
Extracellular calcium - calcium induced calcium release
During diastole

41. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Vagus to medulla
LCX - I - aVL
During diastole
ANP

42. Which class of drugs decreases afterload?
LV failure - pulm venous distention transudation of fluid
Vasodilators - (hydrAlAzine)
Proportional to viscosity and inversely proportional to the radius to the 4th power
Pulse pressure

43. How does aldosterone raise MAP
Decreases
Inc blood volume
Vasocxn
Adult type aortic coarctation

44. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Dilated cardiomyopathy
Stable angina
LAD - V1- V2
Buerger's disease

45. What causes the midsystolic click
Yes
The first 4 days
Can progess to V fib
Sudden tensing of chordae tendinae

46. What do the carotid and aortic bodies respond to?
In series
Greater ventricular EDV
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Dec P02 - inc PC02 and dec pH

47. Which class of drugs decrease the murmur heard in aortic regurg?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Cherry hemangioma
Pos inotropy - exercise
Vasodilators

48. In an anterior wall infarct - which artery is effected and which leads show Q waves
Activated histiocytes
Mitral>aortic>>tricuspid - high pressure valves affected most
LAD - V1 - V4
Henoch - Schlonlein purpura

49. What does increasing intracellular Ca do?
Dec plasma proteins
Increase contractility
Liver
At least 55%

50. What causes aortic stenosis
Age related calcifications or bicuspid aortic valve
Pulsus parvus and tardus - weak - can lead to syncope
Preload
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy