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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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1. Which organ has the largest arteriovenous difference
Mitral valve
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Heart - 02 extraction is always around 100%
Early deaths from myocarditis

2. How are sarcomeres added in concentric hypertrophy?
In parallel
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Strawberry hemangioma
MAP

3. What can cause mitral prolapse?
ASD - VSD - AV septal defect (endocardial cushion defect)
Septal defects - PDA - pulm art stenosis
Wegener's
Myxomatous degeneration - RF - chordae rupture

4. What is sudden cardiac death most commonly due to...
V fib arrhythima
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Preload
140/90

5. What 4 things drive myocardial 02 demand?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Gap junctions
Aortic stenosis or LBBB
Mitral and tricuspid closure

6. Which bacteria causes rheumatic heart disease
Group a beta hemolytic strep
In parallel
Metastasis from melanoma or lymphoma
Septal defects - PDA - pulm art stenosis

7. What causes the early cyanosis in Tet of Fallot?
Late systolic crescendo murmur with a midsystolic click
Viridans streptococci
In HF
R to L shunt caused by stenoic pulmonic valve

8. benign cap hemangioma of infancy - spont regresses
Fast volatge gated Na channels
Mitral>aortic>>tricuspid - high pressure valves affected most
Persistant truncus arteriosus
Strawberry hemangioma

9. congenital heart defect with turner's
Buerger's disease
Metastasis from melanoma or lymphoma
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Coarcation of aorta

10. What does FAN MY SKIN On Wednesday stand for?
PDA
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Greater ventricular EDV
V fib arrhythima

11. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
Non
Heart - 02 extraction is always around 100%
Late systolic crescendo murmur with a midsystolic click

12. What other sign is often present with congenital long QT syndrome - why?
Ventricles are depolarized
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
RCA - II - III - aVF
SA>AV>bundle of His>ventricles

13. decrease stretch in baroreceptors leads to what response?
Increase intracellular Na - resulting in increased Ca
Atherosclerosis
Increased efferent SANS and decreased efferent PANS
RV contraction (closed tricuspid valve bulding into atrium

14. How does angiotensin II raise MAP
Vasocxn
Volatage gated Ca channels
HTN - bradycardia - and respiratory depression
SA and AV nodes

15. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
CO
P02
Chordae rupture - GN - suppurative pericarditis - emboli

16. systolic - diastolic
Ventricular depolarization - nl < 120 msec
Persistant truncus arteriosus
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Pulse pressure

17. In an anterior wall infarct - which artery is effected and which leads show Q waves
LAD - V1 - V4
Mechanican contraction of the ventricles
Aortic/pulmonic stenosis and mitral/tricuspid regurg
During diastole

18. Exercise - overtransfusiion and excitiment causes and increase in...?
Fluid movement through capillaries
Anterosuperior displacement of the infundibular septum
Preload
Temporal arteritis

19. What is indicated when CO and venous return are equal?
The operating point of the heart
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
CK- MB
Dressler's - autoimmune

20. Right to left shunts are more common in babies or kids?
Babies
Atrial contraction
LAD - V1 - V4
Kaposi's sarcoma

21. Which vessels account for the most total peripheral resistance
Pyogenic granuloma - associated with trauma and pregnancy
In RA return (inspiration)
Wegener's
Arteriorles

22. What murmur is heard with aortic regurg?
Eccentric - concentric hypertrophy causes diastolic disfunction
Vasocxn - while other tissues it causes vasodilation
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
The operating point of the heart

23. How do catecholamines increase contractility?
Left heart failure
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Fetal right to left - neonate left to right leading to RVH and failure
Increasing activity of Ca pump in SR

24. machine murmer
LAD
PDA
Changes in CO as a function of preload
Ventricular repolarization

25. What kind of infarct show ST depression
Purkingee>atria>ventricles>AV node
Resting potential high K perm
Dec P02 - inc PC02 and dec pH
Subendocardial

26. What does the U wave indicated?
HypoK and bradycardia
Chordae rupture - GN - suppurative pericarditis - emboli
Temporal arteritis
The aortic before pulmonic - inspiration increases diff

27. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Non
ANP
Infective endocarditis
Libman - sacks endocarditis

28. coronary artery spasm - ST elevation
Prinzmetal angina
At least 55%
Pulmonary flow murmur and diastolic rumble
Anterosuperior displacement of the infundibular septum

29. How are the sarcomeres added in eccentric hypertrophy?
In series
Ventricular depolarization - nl < 120 msec
Mitral>aortic>>tricuspid - high pressure valves affected most
Left atrial pressure

30. tearing chest pain radiation to the back - associated with marfan
ASD
Indomethacin closes - and pge keeps it open
RF
Aortic disecction - intraluminal tear forming false lumen

31. What does the LAD supply?
Sudden tensing of chordae tendinae
Maintain blood flow to organ over wide range of perfussion pressures
Apex and anterior interventricular septum
Transmural

32. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Left heart failure
Dilated cardiomyopathy
Glomus tumor
ASD - VSD - AV septal defect (endocardial cushion defect)

33. What is associated with paradoxical spliting of S2
Aburpt halting of valve leaflets
Aortic stenosis or LBBB
ANP
Mitral stenosis

34. sawtooth wave

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35. What is the difference between adult and infantile type aortic coarctation?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Prinzmetal angina
Can progess to V fib
Postinfarction fibrinous pericarditis

36. What is the most common cause of MI
P02
Stable angina
Acute thrombosis of coronary artery
Rhabdomyomas

37. How does digitatlis increase contractility?
Left atrial pressure
Increase intracellular Na - resulting in increased Ca
Sturge weber - vasculitis of caps
V fib

38. Do you see elevaged ASO titers in rheumatic heart disease
Inc venous return exaccerbates pulm vasc congestion
Postinfarction fibrinous pericarditis
Yes
In HF

39. Which bacteria causes endocarditis in the presence of colon cancer
S. bovis
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Pyogenic granuloma - associated with trauma and pregnancy
Black > white > asian

40. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
PDA
Cyclophosphamide and corticosteroids
Aortic stenosis or LBBB
No - no pressure gradient

41. Chronic mitral stenosis can lead to what changes in size of the LA
P02
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Dilation
Eccentric - concentric hypertrophy causes diastolic disfunction

42. What kind of dysfunction ensues in restrictive cardiomyopathy
Diastolic
Henoch - Schlonlein purpura
Kidney
Proportional to viscosity and inversely proportional to the radius to the 4th power

43. CO x Total peripheral resistance
Aortic dilation - bicuspid aortic valve - RF -
Pulmonary flow murmur and diastolic rumble
3rd degree block - pacemaker - Lyme disease
Mean arterial pressure

44. Rank the pacemakers cells
LCX - V4- V6
Age related calcifications or bicuspid aortic valve
SA>AV>bundle of His>ventricles
SA and AV nodes

45. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Persistant truncus arteriosus
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
ANP
7 weeks

46. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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47. Restrictive cardiomyopathy causes
Changes in CO as a function of preload
During HF from microhemorrhages from inc pulm cap pressure
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
S. epidermidis

48. What are the complications from bacterial endocarditis?
Microscopic polyangiitis - like wegener's without granulomas
Right sided
Chordae rupture - GN - suppurative pericarditis - emboli
CO

49. What does the atria release in response to inc blood volume and atrial pressure
ANP
Patent ductus arteriosus - congenital rubella or prematurity
Henoch - Schlonlein purpura
Septal defects - PDA - pulm art stenosis

50. In the cardiac cycle - which period has the highest 02 consumption?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Glossopharyngeal to soliary nucleus of medulla
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Isovolumetric contraction