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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 happens in phase 2 of the cardiac ventricular action potential?
Vasodilators - (hydrAlAzine)
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
2-4 day - early coag necrosis on the first day
The operating point of the heart

2. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2nd degree AV block - mobitz type 1
Crescendo - decrescendo systolic ejection murmur following ejection click
Glomus tumor
RCA

3. Which enzymes are useful for diagnosing reinfarction
LCX - V4- V6
CK- MB
3rd degree block - pacemaker - Lyme disease
If sodium channel

4. What happens in phase 0 of the cardiac ventricular action potential?
RCA
Rapid upstroke - voltage gated Na channels open
Mitral valve
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

5. What masks atrial repolarization?
SA and AV nodes
SV/ EDV
Vasodilators - (hydrAlAzine)
QRS complex

6. What other syndrom is associated with infantile aortic coarctation
Ischemic heart dz - mitral valve prolapse - LV dilation
Turners
CFX
Fast volatge gated Na channels

7. list the coronary vessels most likely to be occluded
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Ventricular depolarization - nl < 120 msec
Conduction delay through AV node - nl < 200 msec
LAD > RCA > circumflex

8. Which organ has ht highest blood flow per gram of tissue
Anterosuperior displacement of the infundibular septum
ASD - VSD - AV septal defect (endocardial cushion defect)
Kidney
Cystic hygroma

9. benign cap hemangioma of infancy - spont regresses
Strawberry hemangioma
Aortic and pulmonary closing
Late diastolic murmur following an opening snap
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

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

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11. What do patients die early from in rheumatic heart disease?
Early deaths from myocarditis
In series
Posterior descending (80% off the RCA - 20% off the circumflex)
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

12. What causes aortic stenosis
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Kidney
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Age related calcifications or bicuspid aortic valve

13. Hyperplastic onion skinning
Vagus to medulla
Age related calcifications or bicuspid aortic valve
Arteriolosclerosis in malignant hypertension
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

14. Which murmur do you hear in mitral stenosis?
Hyperlipidemia
Increase contractility
Late diastolic murmur following an opening snap
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

15. Which sympathetic receptors raise MAP
Chordae rupture - GN - suppurative pericarditis - emboli
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
ANP
Increasing activity of Ca pump in SR

16. p - anca

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17. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Arteriolosclerosis in malignant hypertension
Transfusion
Afterload (proportional to peripheral resistance)
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

18. What is the most common cause of right heart failure
Left heart failure
MI
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Inc RA pressure - due to filling against closed tricupsid valve

19. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
Vasodilators - (hydrAlAzine)
LCX - I - aVL
Coarcation of aorta

20. The carotid sinus transmits along which nerve?
LAD - V1- V2
Glossopharyngeal to soliary nucleus of medulla
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

21. Where is the most posterior portion of the heart and What can it cause?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Lower right - MC - upper right - AO - upper right AC - lower left MO
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Angiosarcoma

22. In an EKG - What is the PR interval?
Conduction delay through AV node - nl < 200 msec
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Early deaths from myocarditis
Left atrial pressure

23. How does aldosterone raise MAP
Inc blood volume
SA and AV nodes
Infective endocarditis
MAP

24. What are the 5 T's of cyanoitc babies
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Ventricles are depolarized
Persistant truncus arteriosus
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

25. What does FROM JANE stand for in bacterial endocarditis?

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26. What does autoregulation do?
Acute thrombosis of coronary artery
C - ANCA
No
Maintain blood flow to organ over wide range of perfussion pressures

27. Which lab value indicates blood viscosity?
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Transmural
Vasocxn - while other tissues it causes vasodilation
Hematocrit

28. What are common causes of mitral regurg?
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Ischemic heart dz - mitral valve prolapse - LV dilation
Turners
Atherosclerosis

29. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
MI
Ischemic heart dz - mitral valve prolapse - LV dilation
Hypertrophied cardiomyopathy
Metastasis from melanoma or lymphoma

30. prolonged PR interval
1st degree AV blodck
Dilation
Arteriolosclerosis in malignant hypertension
Buerger's disease

31. In what disease states is blood viscosity increased?
Early deaths from myocarditis
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Raynaud's
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

32. What does increasing intracellular Ca do?
Increase contractility
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Kaposi's sarcoma
Mitral>aortic>>tricuspid - high pressure valves affected most

33. what conditions are associated with pulsus paradoxus
Subendocardial - fewer collaterals and higher pressure
Aortic disecction - intraluminal tear forming false lumen
LAD > RCA > circumflex
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

34. Which vessels account for the most total peripheral resistance
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Transfusion
Arteriorles
Rapid upstroke - voltage gated Na channels open

35. How does digitatlis increase contractility?
Cyclophosphamide and corticosteroids
Sudden tensing of chordae tendinae
Increase intracellular Na - resulting in increased Ca
Ventricular depolarization - nl < 120 msec

36. What is the machine like murmur? What is the heart pathology and the predisposing causes
Patent ductus arteriosus - congenital rubella or prematurity
Arteriorles
Stable angina
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

37. Which organ has the largest arteriovenous difference
Inc interstitial osmotic pressure pulling fliud out of capillaries
Left heart failure
Heart - 02 extraction is always around 100%
Purkingee>atria>ventricles>AV node

38. cavernous lymphangioma of the neck - associated with turner's
S. epidermidis
Increase - increase the chance the If are open
Cystic hygroma
Crescendo - decrescendo systolic ejection murmur following ejection click

39. What causes orthopnea?
Vasodilators
EKG
CHF
Inc venous return exaccerbates pulm vasc congestion

40. absecnce of tricuspid valve - hypoplastic RV
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Tricuspid atresia - requires ASD and VSD
LAD

41. What channels do the the pacemaker cells lack?
Fast volatge gated Na channels
Eisenmenger's syndrome
Troponin I
Cherry hemangioma

42. What kind of dysfunction ensues in restrictive cardiomyopathy
Isovolumetric contraction
Diastolic
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Left heart failure

43. When do you find hemosiderin laden macrophages in the lungs?
During HF from microhemorrhages from inc pulm cap pressure
Anterosuperior displacement of the infundibular septum
Mitral and tricuspid closure
Afterload (proportional to peripheral resistance)

44. What are the diastolic heart sounds?
LCX - I - aVL
Neg inotropy - HF - narcotic overdose
Varicose veins - thromboembolism rare
Aortic/pulmonic regurg and mitral/tricuspid stenosis

45. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Myxomatous degeneration - RF - chordae rupture
SA and AV nodes
Polyarteritis nodosum
LAD

46. What is the cushing triad?
LAD
Liver
HTN - bradycardia - and respiratory depression
Polyarteritis nodosum

47. Where are pacemaker cells?
Postinfarction fibrinous pericarditis
SA and AV nodes
MAP
Adult type aortic coarctation

48. In an acute MI - are there any visible changes via LM in the first 2-4 hours
No
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Filling is incomplete and CO falls
Heart - 02 extraction is always around 100%

49. with what heart sounds do ASD usually present?
No
Pulmonary flow murmur and diastolic rumble
Lower right - MC - upper right - AO - upper right AC - lower left MO
Venodilators (nitrogylcerine)

50. 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
Decrease in cAMP
LCX - I - aVL
In RA return (inspiration)