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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 are the systolic heart sounds
RF
Mitral and tricuspid closure
The aortic before pulmonic - inspiration increases diff
Aortic/pulmonic stenosis and mitral/tricuspid regurg

2. dyspnea - fatigue - edema and rales - multiple causes
CHF
Liver
Activated histiocytes
CFX

3. Which organ has ht highest blood flow per gram of tissue
Kidney
Inc Kf - capillary perm
SA and AV nodes
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

4. serum marker for wegener's
Increase in Pc
C - ANCA
Adult type aortic coarctation
Angiosarcoma

5. The cause of cardiac dilation?
Inc Kf - capillary perm
Greater ventricular EDV
Hypertrophied cardiomyopathy
Inc venous return exaccerbates pulm vasc congestion

6. PCWP is an estimate of...
Left heart failure
Left atrial pressure
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

7. which ethnic groups have higher association with HTN?
Black > white > asian
Late systolic crescendo murmur with a midsystolic click
If sodium channel
MI

8. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
...
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Cystic hygroma
Vasocxn

9. What causes the CO curve to shift upwards?
LAD
Viridans streptococci
Pos inotropy - exercise
Transfusion

10. Left to right shunts are more common in babies or kids?
Mitral valve prolapse
Wolff - Parkinson white syndrome
Kids
If sodium channel

11. Which bacteria causes endocarditis in the presence of colon cancer
S. bovis
Can progess to V fib
Transmural
Tricuspid atresia - requires ASD and VSD

12. In an EKG - What is the T wave?
Temporal arteritis
Myxoma
Hyperlipidemia
Ventricular repolarization

13. When during cardiac nodal cells depolarize?
Hyperlipidemia
Aortic disecction - intraluminal tear forming false lumen
During diastole
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

14. What stimulates release of calcium from the SR?
Henoch - Schlonlein purpura
Kidney
QRS complex
Extracellular calcium - calcium induced calcium release

15. What are the four most common locations for atherosclerosis?
Apex and anterior interventricular septum
2nd degree AV block - mobitz type 1
LV failure - pulm venous distention transudation of fluid
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

16. When and why do you hear the S4 sound
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Late systolic crescendo murmur with a midsystolic click
Angiosarcoma
The operating point of the heart

17. cavernous lymphangioma of the neck - associated with turner's
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Cystic hygroma
10%
LAD - V1- V2

18. What murmur is heard with aortic regurg?
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Postinfarction fibrinous pericarditis
Mitral and tricuspid closure
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

19. How does digitatlis increase contractility?
Tempral arteritis - may cause irreversible blindness
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Increase intracellular Na - resulting in increased Ca

20. Right to left shunts are more common in babies or kids?
Babies
Transfusion
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
In series

21. In an inferior wall infarct - which artery is affected and which leads show Q waves
Pulmonic stenosis and RBBB
Kaposi's sarcoma
Yes
RCA - II - III - aVF

22. Which bacteria causes rheumatic heart disease
V fib arrhythima
Metastasis from melanoma or lymphoma
Granuloma with giant cells
Group a beta hemolytic strep

23. fibrous plaques and atheromas in intima of arteries
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Atherosclerosis
RV failure - in venous pressure

24. What does an isoelectric ST segment indicate?
Kaposi's sarcoma
1st degree AV blodck
Hypertrophied cardiomyopathy
Ventricles are depolarized

25. Unilateral headache - jaw claudication - impaired vision
Tempral arteritis - may cause irreversible blindness
Mechanican contraction of the ventricles
Pulsus parvus and tardus - weak - can lead to syncope
ASD - VSD - AV septal defect (endocardial cushion defect)

26. What causes hepatomegaly?
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
2nd degree AV block - mobitz type 1
Inc central venous pressure - inc resistance to portal flow
V fib

27. How are cadiac myocytes eltrically coupled?
Prinzmetal angina
Gap junctions
Kids
Ischemic heart dz - mitral valve prolapse - LV dilation

28. Which class of drugs decreases afterload?
Stable angina
Vasodilators - (hydrAlAzine)
Dec P02 - inc PC02 and dec pH
140/90

29. What causes the early cyanosis in Tet of Fallot?
Buerger's disease
R to L shunt caused by stenoic pulmonic valve
Pulsus parvus and tardus - weak - can lead to syncope
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

30. When do you find hemosiderin laden macrophages in the lungs?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
S. epidermidis
During HF from microhemorrhages from inc pulm cap pressure
Transfusion

31. How do catecholamines increase contractility?
Increasing activity of Ca pump in SR
Yes
Mitral>aortic>>tricuspid - high pressure valves affected most
Arteriorles

32. What causes aortic regurg
Aortic dilation - bicuspid aortic valve - RF -
No - no pressure gradient
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Mitral and tricuspid closure

33. What does TAPVR stand for
Total anomalous pulmonary trunk venous return
Volatage gated Ca channels
Postinfarction fibrinous pericarditis
Greater ventricular EDV

34. What does increasing intracellular Ca do?
Increase contractility
Wolff - Parkinson white syndrome
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
5-10 days - macs have degraded structural components

35. in the JVP - What is the a wave?
Crescendo - decrescendo systolic ejection murmur following ejection click
Atrial contraction
MI
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

36. pulseless disease - granulomatous thickening of the aortic arch and/or proximal great vessels - elev ESR - asian females > 40

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37. What causes tet of fallot?
Anterosuperior displacement of the infundibular septum
Increasing activity of Ca pump in SR
Varicose veins - thromboembolism rare
Black > white > asian

38. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Viridans streptococci
Transfusion
Posterior descending (80% off the RCA - 20% off the circumflex)
Subendocardial

39. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Anterosuperior displacement of the infundibular septum
Sturge weber - vasculitis of caps
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Temporal arteritis

40. Which area of the endocardium is especially vulnerable to infarction? Why?
RCA - II - III - aVF
CFX
Subendocardial - fewer collaterals and higher pressure
The aortic before pulmonic - inspiration increases diff

41. What causes the murmur heard in tricuspid regurg to enhance
Transfusion
Henoch - Schlonlein purpura
Hematocrit
In RA return (inspiration)

42. What is the most common cause of MI
Increase contractility
Acute thrombosis of coronary artery
In series
Aortic and pulmonary closing

43. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
CO
Pos inotropy - exercise
Wolff - Parkinson white syndrome
3rd degree block - pacemaker - Lyme disease

44. congenital heart defect with congenital rubella
Septal defects - PDA - pulm art stenosis
Kids
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Mitral and tricuspid closure

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

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46. Irregularly irregular ECG - no p waves: dx and treatment
Atherosclerosis
Atrial contraction
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

47. What is the association with wide S2 splitting?
Gap junctions
Pulmonic stenosis and RBBB
QRS complex
Patent ductus arteriosus - congenital rubella or prematurity

48. What constitues the upstroke in pacemaker cells?
MI
Volatage gated Ca channels
RCA - II - III - aVF
SV/ EDV

49. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Apex and anterior interventricular septum
Libman - sacks endocarditis
Temporal arteritis
Stroke volume

50. congenital heart defect with 22q11
Neg inotropy - HF - narcotic overdose
S. aureus
Truncus - tet of fallot
Hypertrophied cardiomyopathy