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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. sawtooth wave

2. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Eccentric - concentric hypertrophy causes diastolic disfunction
LCX - I - aVL
In parallel
Sturge weber - vasculitis of caps

3. PROVe
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
ASD - VSD - AV septal defect (endocardial cushion defect)
At least 55%
Black > white > asian

4. what happens to capillaries in lymphatic blockage
Increased SV
Pulmonary flow murmur and diastolic rumble
At least 55%
Inc interstitial osmotic pressure pulling fliud out of capillaries

5. What is the gold standard for dx of MI in the first 6 hours
EKG
Dilation
Decrease in activity of Na/Ca exhanger and increase in contractility
Inc interstitial osmotic pressure pulling fliud out of capillaries

6. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Varicose veins - thromboembolism rare
Patent ductus arteriosus - congenital rubella or prematurity
Group a beta hemolytic strep
Hemorrhage

7. no change in PR interval followed by dropped beat
Wolff - Parkinson white syndrome
Transfusion
Turners
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

8. What causes the cushing reflex and why
Viridans streptococci
Crescendo - decrescendo systolic ejection murmur following ejection click
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

9. What kind of dysfunction ensues in restrictive cardiomyopathy
Mean arterial pressure
S. aureus
Ventricular depolarization - nl < 120 msec
Diastolic

10. What happens in phase 3 of the cardiac ventricular action potential?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Vasodilators - (hydrAlAzine)
Neg inotropy - HF - narcotic overdose

11. Why is contractility decreased in heart failure?
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
S. epidermidis
Inc TPR and LA return (expiration)
Systolic dysfunction

12. PCWP > LV diastolic pressure
Posterior descending (80% off the RCA - 20% off the circumflex)
Aortic and pulmonary closing
Mitral stenosis
Aortic/pulmonic stenosis and mitral/tricuspid regurg

13. What does T wave inversion indicated?
Total anomalous pulmonary trunk venous return
MI
Hypertrophied cardiomyopathy
Purkingee>atria>ventricles>AV node

14. What causes ankle - sacral edema - jugular venous distention
Kaposi's sarcoma
RV failure - in venous pressure
Vasodilators - (hydrAlAzine)
Increasing activity of Ca pump in SR

15. Which area of the endocardium is especially vulnerable to infarction? Why?
Stroke volume
Rhabdomyomas
Fick principle
Subendocardial - fewer collaterals and higher pressure

16. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Left sided
CFX
Kawasaki
Atherosclerosis

17. What does prolonged QT predispose to?
Decreased
Indomethacin closes - and pge keeps it open
Torsades de pointes
Afterload (proportional to peripheral resistance)

18. disease of elastic arteries and large and medium sized muscular arteries
Hemorrhage
Atherosclerosis
Liver
Varicose veins - thromboembolism rare

19. What happens in phase 2 of the cardiac ventricular action potential?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Aortic dilation - bicuspid aortic valve - RF -
Hemorrhage
Inc venous return exaccerbates pulm vasc congestion

20. What are the systolic heart sounds
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Activated histiocytes
Vasodilators
S. bovis

21. How do beta blockers decrease contractility?
Decreased
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Decrease in cAMP
ASD

22. Which murmur is heard with VSD?
Mitral valve
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Pulmonary flow murmur and diastolic rumble

23. congenital heart defect in an infant with a diabetic mother?
Transposition of great vessels
Infective endocarditis
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Heart - 02 extraction is always around 100%

24. When do you find hemosiderin laden macrophages in the lungs?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
During HF from microhemorrhages from inc pulm cap pressure
Increased efferent SANS and decreased efferent PANS
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

25. Which class of drugs decrease preload
Venodilators (nitrogylcerine)
Dilation
Rhabdomyomas
Liver

26. Which organ has ht highest blood flow per gram of tissue
Metastasis from melanoma or lymphoma
Group a beta hemolytic strep
Kidney
The first 4 days

27. in the JVP - What is the v wave?
Tricuspid atresia - requires ASD and VSD
Resting potential high K perm
R to L shunt caused by stenoic pulmonic valve
Inc RA pressure - due to filling against closed tricupsid valve

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?
5-10 days - macs have degraded structural components
Black > white > asian
RV contraction (closed tricuspid valve bulding into atrium
2nd degree AV block - mobitz type 1

29. What does the atria release in response to inc blood volume and atrial pressure
P02
ANP
LAD > RCA > circumflex
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

30. What is the S1 sound?
S. bovis
Buerger's disease
Mitral and tricuspid closure
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

31. What happends in phase 1 of the ventricular cardiac action potential?
Infective endocarditis
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
LAD - V1 - V4
Cherry hemangioma

32. Hyperplastic onion skinning
Diastolic
Decrease in cAMP
Arteriolosclerosis in malignant hypertension
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

33. EDV - ESV
Lower right - MC - upper right - AO - upper right AC - lower left MO
Stroke volume
Posterior descending (80% off the RCA - 20% off the circumflex)
Dilation

34. which medications are used to maintain patency or close the ductus arteriosus?
Rapid upstroke - voltage gated Na channels open
Vasodilators - (hydrAlAzine)
Increased SV
Indomethacin closes - and pge keeps it open

35. machine murmer
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
PDA
Cherry hemangioma
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

36. In an EKG - What is the QRS complex?
Filling is incomplete and CO falls
Transmural
Stroke volume
Ventricular depolarization - nl < 120 msec

37. Left to right shunts are more common in babies or kids?
PDA
Kids
R to L shunt caused by stenoic pulmonic valve
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

38. What causes the CO curve to shift downwards?
Neg inotropy - HF - narcotic overdose
Increased efferent SANS and decreased efferent PANS
Can progess to V fib
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

39. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Increased efferent SANS and decreased efferent PANS
MI
Transposition of great vessels
Chordae rupture - GN - suppurative pericarditis - emboli

40. What other sign is often present with congenital long QT syndrome - why?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Turners
Hypertrophied cardiomyopathy
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

41. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Polyarteritis nodosum
Changes in CO as a function of preload
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Holosystolic - harsh sounding murmur - loudest over tricuspid area

42. congenital heart defect with turner's
In RA return (inspiration)
Patent ductus arteriosus - congenital rubella or prematurity
Coarcation of aorta
Failure of LV to in CO during exercise

43. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Subendocardial
Dec plasma proteins
Stable angina
During HF from microhemorrhages from inc pulm cap pressure

44. fibrinous pericarditis several weeks post MI

45. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Late diastolic murmur following an opening snap
Decreased
During HF from microhemorrhages from inc pulm cap pressure
Cardiac tamponde

46. How do catecholamines increase contractility?
Increasing activity of Ca pump in SR
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Glossopharyngeal to soliary nucleus of medulla
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

47. How are cadiac myocytes eltrically coupled?
Mean arterial pressure
Temporal arteritis
Gap junctions
Cyclophosphamide and corticosteroids

48. What are common causes of mitral regurg?
RCA - II - III - aVF
V fib
Eccentric - concentric hypertrophy causes diastolic disfunction
Ischemic heart dz - mitral valve prolapse - LV dilation

49. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
S. bovis
Angiosarcoma
Myxoma

50. congenital heart defect with 22q11
Truncus - tet of fallot
Increased efferent SANS and decreased efferent PANS
Volatage gated Ca channels
Liver