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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 difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
2-4 day - early coag necrosis on the first day
Mean arterial pressure
The operating point of the heart
Fetal right to left - neonate left to right leading to RVH and failure

2. Fatal arrhythmia
V fib
Increase contractility
Microscopic polyangiitis - like wegener's without granulomas
Aortic and pulmonary closing

3. In an EKG - What is the QT interval?
Raynaud's
Atherosclerosis
Mechanican contraction of the ventricles
Hemorrhage

4. What happens with a decrease of extracellular Na
Hematocrit
Aburpt halting of valve leaflets
Decrease in activity of Na/Ca exhanger and increase in contractility
Inc venous return exaccerbates pulm vasc congestion

5. What are anitschkow's cells
CO
Activated histiocytes
Purkingee>atria>ventricles>AV node
Mechanican contraction of the ventricles

6. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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7. What do patients die early from in rheumatic heart disease?
Tricuspid atresia - requires ASD and VSD
Aortic dilation - bicuspid aortic valve - RF -
Early deaths from myocarditis
7 weeks

8. What is associated with paradoxical spliting of S2
Aortic stenosis or LBBB
Atrial contraction
Greater ventricular EDV
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

9. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Gap junctions
Extracellular calcium - calcium induced calcium release
Ischemic heart dz - mitral valve prolapse - LV dilation
Non

10. What is the difference between adult and infantile type aortic coarctation?
Angiosarcoma
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Arteriolosclerosis in malignant hypertension
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

11. Churg Strauss - presentation and test
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Preload
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Mitral and tricuspid closure

12. Which sympathetic receptors raise MAP
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Fast volatge gated Na channels
...
Group a beta hemolytic strep

13. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
MI
Pulse pressure
Hemorrhage

14. which heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Acute thrombosis of coronary artery
Pulmonic stenosis and RBBB

15. How does angiotensin II raise MAP
Atrial contraction
Vasocxn
Posterior descending (80% off the RCA - 20% off the circumflex)
Kidney

16. which medications are used to maintain patency or close the ductus arteriosus?
Decreased
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Indomethacin closes - and pge keeps it open
LCX - V4- V6

17. What does the starling curve show?
Stroke volume
Changes in CO as a function of preload
Pulsus parvus and tardus - weak - can lead to syncope
Metastasis from melanoma or lymphoma

18. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Chordae rupture - GN - suppurative pericarditis - emboli
In HF
Wolff - Parkinson white syndrome
Subendocardial

19. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
Apex and anterior interventricular septum
Glossopharyngeal to soliary nucleus of medulla
Coarcation of aorta

20. What are the different etiologies of dialted cardiomyopathy
RCA
Increase - increase the chance the If are open
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Indomethacin closes - and pge keeps it open

21. Which artery supplies the SA and AV nodes?
SV/ EDV
LAD - V1- V2
Stable angina
RCA

22. What does mitral prolapse predeispose to?
Polyarteritis nodosum
Infective endocarditis
Anterosuperior displacement of the infundibular septum
Stroke volume

23. Which area of the endocardium is especially vulnerable to infarction? Why?
LCX - V4- V6
Subendocardial - fewer collaterals and higher pressure
CHF
Decrease in activity of Na/Ca exhanger and increase in contractility

24. congenital heart defect in an infant with a diabetic mother?
Adult type aortic coarctation
ASD - VSD - AV septal defect (endocardial cushion defect)
Transposition of great vessels
Unstable/crescendo angina

25. no change in PR interval followed by dropped beat
Decrease in cAMP
Microscopic polyangiitis - like wegener's without granulomas
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Inc venous return exaccerbates pulm vasc congestion

26. Which lab value indicates blood viscosity?
Stable angina
Hematocrit
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

27. In an anterior wall infarct - which artery is effected and which leads show Q waves
Vagus to medulla
No - no pressure gradient
LAD - V1 - V4
Turners

28. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Diastolic
5-10 days - macs have degraded structural components
Atrial contraction

29. What does the U wave indicated?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
HypoK and bradycardia
Pos inotropy - exercise
Increasing activity of Ca pump in SR

30. What kind of infarct show ST depression
Subendocardial
Mechanican contraction of the ventricles
Liver
Diastolic

31. What supplies the posterior left ventricle?
Preload
CFX
3rd degree block - pacemaker - Lyme disease
At least 55%

32. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Early deaths from myocarditis
Systolic dysfunction
Dec plasma proteins

33. How does aldosterone raise MAP
Increase intracellular Na - resulting in increased Ca
Rapid upstroke - voltage gated Na channels open
Inc blood volume
Total anomalous pulmonary trunk venous return

34. In terms of starling forces - why does heart failure cause edema?
Pulse pressure
LAD
Left heart failure
Increase in Pc

35. What is the early and late lesion in rheumatic heart disease
Gap junctions
Mitral valve prolapse
Failure of LV to in CO during exercise
Adult type aortic coarctation

36. Which channel accounts for automaticity of the SA and AV nodes?
Pulse pressure
Septal defects - PDA - pulm art stenosis
Dilation
If sodium channel

37. What does the LAD supply?
Eisenmenger's syndrome
Neg inotropy - HF - narcotic overdose
Apex and anterior interventricular septum
CO

38. fibrinous pericarditis several weeks post MI

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39. What does TAPVR stand for
Total anomalous pulmonary trunk venous return
Dressler's - autoimmune
Increase contractility
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

40. What does prolonged QT predispose to?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Libman - sacks endocarditis
Torsades de pointes
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

41. Exercise - overtransfusiion and excitiment causes and increase in...?
C - ANCA
Preload
Increase intracellular Na - resulting in increased Ca
Pos inotropy - exercise

42. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
EKG
Torsades de pointes
Stable angina
Kidney

43. What happends in phase 1 of the ventricular cardiac action potential?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
During diastole
ASD - VSD - AV septal defect (endocardial cushion defect)
Dilated cardiomyopathy

44. Where is the most posterior portion of the heart and What can it cause?
Inc TPR and LA return (expiration)
LCX - I - aVL
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

45. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
LAD - V1 - V4
Dec plasma proteins
5-10 days - macs have degraded structural components
SA>AV>bundle of His>ventricles

46. What does FAN MY SKIN On Wednesday stand for?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Vasodilators - (hydrAlAzine)
PDA

47. 2/3 diastolic + 1/3 systolic
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
MAP
ANP
LAD

48. list the coronary vessels most likely to be occluded
LAD > RCA > circumflex
ASD
Filling is incomplete and CO falls
3rd degree block - pacemaker - Lyme disease

49. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Conduction delay through AV node - nl < 200 msec
Greater ventricular EDV
Transfusion
MI

50. congenital heart defect with 22q11
Truncus - tet of fallot
LCX - V4- V6
LCX - I - aVL
Activated histiocytes