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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. which heart valves are afected most in rheumatic heart diseease
SA>AV>bundle of His>ventricles
Pulse pressure
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Mitral>aortic>>tricuspid - high pressure valves affected most

2. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Fluid movement through capillaries
Medullary vasomotor center senses baroreceptors and JGA
LV failure - pulm venous distention transudation of fluid
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

3. Rank the pacemakers cells
Hematocrit
Cherry hemangioma
SA>AV>bundle of His>ventricles
Stroke volume

4. What does TAPVR stand for
S. epidermidis
Total anomalous pulmonary trunk venous return
LCX - V4- V6
Preload

5. What are the diastolic heart sounds?
Lymphangiosarcoma
Aortic/pulmonic regurg and mitral/tricuspid stenosis
LCX - V4- V6
Tricuspid atresia - requires ASD and VSD

6. What does FAN MY SKIN On Wednesday stand for?
Dilation
Wegener's
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

7. coronary artery spasm - ST elevation
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Prinzmetal angina
LCX - V4- V6
Crescendo - decrescendo systolic ejection murmur following ejection click

8. The 7 complications of MI

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9. Which murmur is characteristic of mitral/tricuspid regurg?
RCA - II - III - aVF
Atherosclerosis
Holosystoiic
Vagus to medulla

10. What are the systolic heart sounds
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Persistant truncus arteriosus
Decrease in cAMP
Liver

11. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2nd degree AV block - mobitz type 1
Persistant truncus arteriosus
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Pos inotropy - exercise

12. In terms of starling forces - why does heart failure cause edema?
Increase in Pc
HTN - bradycardia - and respiratory depression
Group a beta hemolytic strep
Inc venous return exaccerbates pulm vasc congestion

13. When and why do you hear the S4 sound
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Kawasaki
LAD - V1 - V4

14. Expiration causes an increase in which sided heart sounds
Fast volatge gated Na channels
Can progess to V fib
Pulse pressure
Left sided

15. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Mitral valve prolapse
Sturge weber - vasculitis of caps
No
Gap junctions

16. What cardiac change occurs in pregnancy?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Extracellular calcium - calcium induced calcium release
Pos inotropy - exercise
Increased SV

17. What are the complications from bacterial endocarditis?
Vasocxn
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
P02
Chordae rupture - GN - suppurative pericarditis - emboli

18. Inspiration causes an increase in which sided heart sounds?
Right sided
Cyclophosphamide and corticosteroids
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Diastolic

19. congenital heart defect with turner's
Coarcation of aorta
During diastole
Early deaths from myocarditis
Increase contractility

20. Mitral stenosis is most often secondary to which condition?
Right sided
RF
140/90
Anterosuperior displacement of the infundibular septum

21. What are common causes of mitral regurg?
Crescendo - decrescendo systolic ejection murmur following ejection click
Conduction delay through AV node - nl < 200 msec
Ischemic heart dz - mitral valve prolapse - LV dilation
Apex and anterior interventricular septum

22. stroke volume x HR =?
Sudden tensing of chordae tendinae
Left atrial pressure
CO
Aortic disecction - intraluminal tear forming false lumen

23. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Wolff - Parkinson white syndrome
Takayasu's arteritis
Libman - sacks endocarditis
Polyarteritis nodosum

24. What are anitschkow's cells
Increase in Pc
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Fick principle
Activated histiocytes

25. What is associated with paradoxical spliting of S2
Arteriolosclerosis in malignant hypertension
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Aortic stenosis or LBBB
Tempral arteritis - may cause irreversible blindness

26. What causes orthopnea?
ASD - VSD - AV septal defect (endocardial cushion defect)
Decreased
Dilated cardiomyopathy
Inc venous return exaccerbates pulm vasc congestion

27. in the JVP - What is the c wave?
Vasocxn - while other tissues it causes vasodilation
Granuloma with giant cells
Aortic insuffic - late
RV contraction (closed tricuspid valve bulding into atrium

28. In what disease states is blood viscosity increased?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Atherosclerosis
The plateau period
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

29. Which artery supplies the SA and AV nodes?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Rhabdomyomas
Filling is incomplete and CO falls
RCA

30. What does hypoxia cause in the lung versus other tissues?
Vasocxn - while other tissues it causes vasodilation
HTN - bradycardia - and respiratory depression
Group a beta hemolytic strep
During diastole

31. Where is the most posterior portion of the heart and What can it cause?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Glossopharyngeal to soliary nucleus of medulla

32. What does the atria release in response to inc blood volume and atrial pressure
ANP
S. aureus
Purkingee>atria>ventricles>AV node
RV failure - in venous pressure

33. What causes the murmur heard in tricuspid regurg to enhance
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
In RA return (inspiration)
Viridans streptococci
Truncus - tet of fallot

34. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
Pos inotropy - exercise
Unstable/crescendo angina
Granuloma with giant cells

35. Exercise - overtransfusiion and excitiment causes and increase in...?
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Preload
Cystic hygroma
Babies

36. What happens in phase 3 of the cardiac ventricular action potential?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
The operating point of the heart

37. How do catecholamines increase contractility?
Increasing activity of Ca pump in SR
Ventricular depolarization - nl < 120 msec
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
RV contraction (closed tricuspid valve bulding into atrium

38. in the JVP - What is the v wave?
Systolic dysfunction
Increased SV
Viridans streptococci
Inc RA pressure - due to filling against closed tricupsid valve

39. Which bacteria can cause endocarditis from prosthetic valves?
S. epidermidis
SA and AV nodes
Can progess to V fib
Truncus - tet of fallot

40. What do patients die early from in rheumatic heart disease?
Glossopharyngeal to soliary nucleus of medulla
Hypertrophied cardiomyopathy
10%
Early deaths from myocarditis

41. When is the scar completely formed in an MI?
Eisenmenger's syndrome
Vasocxn - while other tissues it causes vasodilation
Filling is incomplete and CO falls
7 weeks

42. How do beta blockers decrease contractility?
Maintain blood flow to organ over wide range of perfussion pressures
Atherosclerosis
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Decrease in cAMP

43. What channels do the the pacemaker cells lack?
Ventricles are depolarized
Can progess to V fib
Volatage gated Ca channels
Fast volatge gated Na channels

44. The carotid sinus transmits along which nerve?
Glossopharyngeal to soliary nucleus of medulla
TAPVR
Inc TPR and LA return (expiration)
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

45. Unilateral headache - jaw claudication - impaired vision
Fetal right to left - neonate left to right leading to RVH and failure
Isovolumetric contraction
Tempral arteritis - may cause irreversible blindness
Eisenmenger's syndrome

46. 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
Afterload (proportional to peripheral resistance)
Pos inotropy - exercise
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

47. Do you see elevaged ASO titers in rheumatic heart disease
Yes
Venodilators (nitrogylcerine)
Arteriorles
Myxomatous degeneration - RF - chordae rupture

48. Which organ gets the largest share of systemic cardiac output
Liver
MI
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
RF

49. Chronic mitral stenosis can lead to what changes in size of the LA
Patent ductus arteriosus - congenital rubella or prematurity
Strawberry hemangioma
The first 4 days
Dilation

50. Which two mechanisms sense decrease MAP?
Holosystoiic
Fetal right to left - neonate left to right leading to RVH and failure
Medullary vasomotor center senses baroreceptors and JGA
LAD