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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. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Libman - sacks endocarditis
Greater ventricular EDV
Increase intracellular Na - resulting in increased Ca
Increasing activity of Ca pump in SR

2. Which class of drugs decrease the murmur heard in aortic regurg?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Systolic dysfunction
Apex and anterior interventricular septum
Vasodilators

3. most common heart tumor
Atrial contraction
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Metastasis from melanoma or lymphoma
Mitral and tricuspid closure

4. what conditions are associated with pulsus paradoxus
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Ventricles are depolarized
Dilation

5. How does angiotensin II raise MAP
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Glossopharyngeal to soliary nucleus of medulla
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Vasocxn

6. What causes the CO curve to shift downwards?
The aortic before pulmonic - inspiration increases diff
Increased efferent SANS and decreased efferent PANS
Neg inotropy - HF - narcotic overdose
140/90

7. What causes the ejection click in the Cres - decres murmur?
Late diastolic murmur following an opening snap
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
QRS complex
Aburpt halting of valve leaflets

8. Which artery supplies the SA and AV nodes?
No
Inc central venous pressure - inc resistance to portal flow
RCA
140/90

9. What are common causes of mitral regurg?
Pulmonary flow murmur and diastolic rumble
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Infective endocarditis
Ischemic heart dz - mitral valve prolapse - LV dilation

10. What are the diastolic heart sounds?
Eisenmenger's syndrome
Glomus tumor
Aortic/pulmonic regurg and mitral/tricuspid stenosis
MI

11. When is the scar completely formed in an MI?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
7 weeks
SA and AV nodes
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

12. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
CFX
Pulsus parvus and tardus - weak - can lead to syncope
2nd degree AV block - mobitz type 1
Arteriorles

13. no change in PR interval followed by dropped beat
Subendocardial - fewer collaterals and higher pressure
Myxoma
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Atrial contraction

14. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Maintain blood flow to organ over wide range of perfussion pressures
The aortic before pulmonic - inspiration increases diff
Wolff - Parkinson white syndrome
Posterior descending (80% off the RCA - 20% off the circumflex)

15. What causes ankle - sacral edema - jugular venous distention
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
...
RV failure - in venous pressure
Stroke volume affected by contractility - afterload - and preload

16. What is the result of not have fast sodium channels in pacemaker cells?
Arteriolosclerosis in malignant hypertension
Decrease in activity of Na/Ca exhanger and increase in contractility
P02
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

17. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Troponin I
CO
Purkingee>atria>ventricles>AV node
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

18. What 4 things drive myocardial 02 demand?
Ventricular repolarization
RCA - II - III - aVF
Chordae rupture - GN - suppurative pericarditis - emboli
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

19. p - anca

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20. Given P = QR - what factors influence resistance?
Black > white > asian
Proportional to viscosity and inversely proportional to the radius to the 4th power
Mitral stenosis
LAD > RCA > circumflex

21. What is the difference between adult and infantile type aortic coarctation?
Non
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Inc blood volume
Inc central venous pressure - inc resistance to portal flow

22. In the cardiac cycle - which period has the highest 02 consumption?
MAP
Mechanican contraction of the ventricles
Isovolumetric contraction
Vasodilators - (hydrAlAzine)

23. What is indicated when CO and venous return are equal?
Arteriorles
Arteriolosclerosis in malignant hypertension
The aortic before pulmonic - inspiration increases diff
The operating point of the heart

24. What does autoregulation do?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
MAP
Torsades de pointes
Maintain blood flow to organ over wide range of perfussion pressures

25. congenital heart defect with marfan's
S. bovis
Atherosclerosis
Aortic insuffic - late
Tempral arteritis - may cause irreversible blindness

26. congenital heart defect with turner's
Aortic insuffic - late
Coarcation of aorta
Mitral>aortic>>tricuspid - high pressure valves affected most
Decrease in activity of Na/Ca exhanger and increase in contractility

27. no relation between p waves and QRS intervals - treatment and predisposing factor
Microscopic polyangiitis - like wegener's without granulomas
Atrial contraction
Ventricles are depolarized
3rd degree block - pacemaker - Lyme disease

28. How does a patient with Tet of fallot learn to improve symptoms?
Squat. Compression of femoral arteries - inc TPR - dec
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Inc Kf - capillary perm
Transfusion

29. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Metastasis from melanoma or lymphoma
Increase - increase the chance the If are open
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Fick principle

30. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
No - no pressure gradient
Can progess to V fib
S. epidermidis
Buerger's disease

31. What happends in phase 1 of the ventricular cardiac action potential?
Activated histiocytes
Mean arterial pressure
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Takayasu's arteritis

32. Inspiration causes an increase in which sided heart sounds?
R to L shunt caused by stenoic pulmonic valve
Hematocrit
Acute thrombosis of coronary artery
Right sided

33. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Kidney
Fluid movement through capillaries
Kawasaki

34. What kind of infarct show ST depression
Subendocardial
Subendocardial - fewer collaterals and higher pressure
Right sided
SA and AV nodes

35. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Holosystoiic
Eccentric - concentric hypertrophy causes diastolic disfunction
S. bovis
Pulse pressure

36. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Hyperlipidemia
Babies
LAD
...

37. What causes aortic regurg
HTN - bradycardia - and respiratory depression
Kawasaki
Aortic dilation - bicuspid aortic valve - RF -
EKG

38. clinical signs of cardiac tamponade
Turners
Fast volatge gated Na channels
Mitral stenosis
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

39. When and why is the S3 sound heard?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
SA>AV>bundle of His>ventricles

40. What channels do the the pacemaker cells lack?
Fluid movement through capillaries
Aortic insuffic - late
Fast volatge gated Na channels
Cyclophosphamide and corticosteroids

41. What does an isoelectric ST segment indicate?
Glomus tumor
Vagus to medulla
Ventricles are depolarized
The plateau period

42. which medications are used to maintain patency or close the ductus arteriosus?
Tempral arteritis - may cause irreversible blindness
Indomethacin closes - and pge keeps it open
RV failure - in venous pressure
ANP

43. When and why do you hear the S4 sound
Granuloma with giant cells
Stroke volume
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

44. necrotizing granulomas in lung and upper airways - nectrotizing GN - small vessel vasculitis

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45. Which class of drugs decrease preload
Venodilators (nitrogylcerine)
Boot shaped heart
Glomus tumor
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

46. What is the progression of atherosclerosis?
Decreases
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
2nd degree AV block - mobitz type 1
Decreased

47. What are the systolic heart sounds
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Aortic stenosis or LBBB
Angiosarcoma
Aortic/pulmonic stenosis and mitral/tricuspid regurg

48. What is the S1 sound?
Mitral and tricuspid closure
RV failure - in venous pressure
Vasodilators
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

49. Which lab value indicates blood viscosity?
RV failure - in venous pressure
P02
Hematocrit
Inc venous return exaccerbates pulm vasc congestion

50. What are the different etiologies of dialted cardiomyopathy
Subendocardial
HypoK and bradycardia
Increase intracellular Na - resulting in increased Ca
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy