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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 are the complications from bacterial endocarditis?
S. bovis
Ischemic heart dz - mitral valve prolapse - LV dilation
Chordae rupture - GN - suppurative pericarditis - emboli
Torsades de pointes

2. Central chemoreceptors do not respond directly to which parameter?
Varicose veins - thromboembolism rare
P02
Aortic and pulmonary closing
At least 55%

3. Inspiration causes an increase in which sided heart sounds?
Right sided
If sodium channel
Fast volatge gated Na channels
Atrial contraction

4. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Dec plasma proteins
Increase - increase the chance the If are open
The operating point of the heart
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

5. What does the starling curve show?
Changes in CO as a function of preload
Preload
Activated histiocytes
Turners

6. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
LV failure - pulm venous distention transudation of fluid
Changes in CO as a function of preload
Mitral and tricuspid closure
Increase - increase the chance the If are open

7. Which class of drugs decrease the murmur heard in aortic regurg?
LAD - V1- V2
Liver
Lymphangiosarcoma
Vasodilators

8. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Sturge weber - vasculitis of caps
Age related calcifications or bicuspid aortic valve
Inc RA pressure - due to filling against closed tricupsid valve
Late diastolic murmur following an opening snap

9. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
The first 4 days
S. aureus
RV contraction (closed tricuspid valve bulding into atrium
Persistant truncus arteriosus

10. In an EKG - What is the QRS complex?
Stroke volume affected by contractility - afterload - and preload
...
Libman - sacks endocarditis
Ventricular depolarization - nl < 120 msec

11. decrease stretch in baroreceptors leads to what response?
2-4 day - early coag necrosis on the first day
Increased efferent SANS and decreased efferent PANS
Cystic hygroma
Afterload (proportional to peripheral resistance)

12. Given P = QR - what factors influence resistance?
Proportional to viscosity and inversely proportional to the radius to the 4th power
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
QRS complex
Kaposi's sarcoma

13. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Varicose veins - thromboembolism rare
Increase - increase the chance the If are open
Cyclophosphamide and corticosteroids

14. Do you see elevaged ASO titers in rheumatic heart disease
CO
Chordae rupture - GN - suppurative pericarditis - emboli
EKG
Yes

15. Which lab value indicates blood viscosity?
Vasodilators
The plateau period
Hematocrit
Temporal arteritis

16. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Fick principle
Mitral stenosis
Total anomalous pulmonary trunk venous return
Decreases

17. moncekberg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Inc TPR and LA return (expiration)
Temporal arteritis
Rapid upstroke - voltage gated Na channels open

18. Where is the most posterior portion of the heart and What can it cause?
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Crescendo - decrescendo systolic ejection murmur following ejection click
Aortic/pulmonic regurg and mitral/tricuspid stenosis
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

19. MAP is also known as
Filling is incomplete and CO falls
Afterload (proportional to peripheral resistance)
Patent ductus arteriosus - congenital rubella or prematurity
Fast volatge gated Na channels

20. The 7 complications of MI

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21. What does prolonged QT predispose to?
Torsades de pointes
Venodilators (nitrogylcerine)
Vagus to medulla
Neg inotropy - HF - narcotic overdose

22. How does a patient with Tet of fallot learn to improve symptoms?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Squat. Compression of femoral arteries - inc TPR - dec
Tempral arteritis - may cause irreversible blindness
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

23. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
Chordae rupture - GN - suppurative pericarditis - emboli
Liver
RV failure - in venous pressure

24. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Venodilators (nitrogylcerine)
Libman - sacks endocarditis
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Arteriolosclerosis in malignant hypertension

25. no relation between p waves and QRS intervals - treatment and predisposing factor
3rd degree block - pacemaker - Lyme disease
Vagus to medulla
Ventricles are depolarized
Troponin I

26. In an EKG - What is the T wave?
Ventricular repolarization
Stroke volume affected by contractility - afterload - and preload
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

27. What causes the CO curve to shift upwards?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Hyperlipidemia
Cyclophosphamide and corticosteroids
Pos inotropy - exercise

28. Wegener's presentation
Increased efferent SANS and decreased efferent PANS
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Postinfarction fibrinous pericarditis
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

29. Which kind of infarct show ST elevation - and/or pathologic Q waves
Mitral>aortic>>tricuspid - high pressure valves affected most
Transmural
LCX - I - aVL
Inc venous return exaccerbates pulm vasc congestion

30. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Glomus tumor
Adult type aortic coarctation
Lower right - MC - upper right - AO - upper right AC - lower left MO
Eccentric - concentric hypertrophy causes diastolic disfunction

31. If HR is too fast (V tach) what happens during diastole?
Filling is incomplete and CO falls
Vagus to medulla
Troponin I
Preload

32. Which murmur do you hear in mitral stenosis?
Eccentric - concentric hypertrophy causes diastolic disfunction
Late diastolic murmur following an opening snap
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Microscopic polyangiitis - like wegener's without granulomas

33. What causes the murmur heard in tricuspid regurg to enhance
Changes in CO as a function of preload
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
In RA return (inspiration)
Increase - increase the chance the If are open

34. What happens in phase 0 of the cardiac ventricular action potential?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Rapid upstroke - voltage gated Na channels open
LCX - I - aVL
Mechanican contraction of the ventricles

35. What is the most common cause of right heart failure
Takayasu's arteritis
Left heart failure
In series
Hyperlipidemia

36. what percentage of HTN is secondary to renal disease?
Subendocardial - fewer collaterals and higher pressure
Decrease in activity of Na/Ca exhanger and increase in contractility
Failure of LV to in CO during exercise
10%

37. list the coronary vessels most likely to be occluded
2nd degree AV block - mobitz type 1
LAD > RCA > circumflex
Atherosclerosis
Takayasu's arteritis

38. stroke volume x HR =?
Anterosuperior displacement of the infundibular septum
10%
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
CO

39. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Mitral valve
RF
Inc blood volume
5-10 days - macs have degraded structural components

40. What happens in phase 4 of the cardiac ventricular action potential?
Late systolic crescendo murmur with a midsystolic click
Resting potential high K perm
Increase - increase the chance the If are open
Medullary vasomotor center senses baroreceptors and JGA

41. What causes the murmur heard in MR to enhance?
Diastolic
Inc TPR and LA return (expiration)
In series
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

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

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43. serum marker for wegener's
S. aureus
C - ANCA
Ventricles are depolarized
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

44. what conditions are associated with pulsus paradoxus
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Infective endocarditis
SA and AV nodes
RV contraction (closed tricuspid valve bulding into atrium

45. Churg Strauss - presentation and test
Failure of LV to in CO during exercise
MAP
Viridans streptococci
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

46. fibrinous pericarditis several weeks post MI

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47. which ethnic groups have higher association with HTN?
Atrial contraction
Raynaud's
Black > white > asian
3rd degree block - pacemaker - Lyme disease

48. What is the characteristic pulse in aortic stenosis?
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Pulsus parvus and tardus - weak - can lead to syncope
In series
Atherosclerosis

49. What does HTN predispose to?
S. epidermidis
Atherosclerosis
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Granuloma with giant cells

50. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Maintain blood flow to organ over wide range of perfussion pressures
Afterload (proportional to peripheral resistance)
...
Decreased