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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 does the starling curve show?
Changes in CO as a function of preload
Kids
Wolff - Parkinson white syndrome
Purkingee>atria>ventricles>AV node

2. What are aschoff bodies
Vasodilators - (hydrAlAzine)
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Increasing activity of Ca pump in SR
Granuloma with giant cells

3. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Holosystoiic
Pyogenic granuloma - associated with trauma and pregnancy
Sudden tensing of chordae tendinae
Stable angina

4. What does TAPVR stand for
Crescendo - decrescendo systolic ejection murmur following ejection click
Total anomalous pulmonary trunk venous return
During HF from microhemorrhages from inc pulm cap pressure
Increasing activity of Ca pump in SR

5. What do the carotid and aortic bodies respond to?
V fib arrhythima
Afterload (proportional to peripheral resistance)
RV contraction (closed tricuspid valve bulding into atrium
Dec P02 - inc PC02 and dec pH

6. Given P = QR - what factors influence resistance?
Temporal arteritis
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Proportional to viscosity and inversely proportional to the radius to the 4th power
Troponin I

7. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Wolff - Parkinson white syndrome
Vasodilators - (hydrAlAzine)
Apex and anterior interventricular septum
Unstable/crescendo angina

8. Which artery supplies the SA and AV nodes?
Inc interstitial osmotic pressure pulling fliud out of capillaries
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
RCA
CHF

9. Which murmur is characteristic of mitral/tricuspid regurg?
Holosystoiic
Polyarteritis nodosum
MAP
Transfusion

10. no relation between p waves and QRS intervals - treatment and predisposing factor
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Myxomatous degeneration - RF - chordae rupture
3rd degree block - pacemaker - Lyme disease
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

11. What are the complications from bacterial endocarditis?
Postinfarction fibrinous pericarditis
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Chordae rupture - GN - suppurative pericarditis - emboli
The plateau period

12. PROVe
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Vasocxn
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Ventricular repolarization

13. congenital heart defect withdown syndrome
S. epidermidis
In parallel
ASD - VSD - AV septal defect (endocardial cushion defect)
Increase in Pc

14. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Extracellular calcium - calcium induced calcium release
Hyperlipidemia
Troponin I
Apex and anterior interventricular septum

15. If HR is too fast (V tach) what happens during diastole?
SV/ EDV
Prinzmetal angina
Filling is incomplete and CO falls
Hyperlipidemia

16. Which class of drugs decrease preload
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
...
Maintain blood flow to organ over wide range of perfussion pressures
Venodilators (nitrogylcerine)

17. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Aortic insuffic - late
Glomus tumor
Extracellular calcium - calcium induced calcium release
ANP

18. Which enzymes are useful for diagnosing reinfarction
CK- MB
LCX - I - aVL
Afterload (proportional to peripheral resistance)
V fib

19. What causes the midsystolic click
Fetal right to left - neonate left to right leading to RVH and failure
Inc blood volume
Sudden tensing of chordae tendinae
Inc TPR and LA return (expiration)

20. Which bacteria causes rheumatic heart disease
Group a beta hemolytic strep
Atrial contraction
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Arteriorles

21. In an anterior wall infarct - which artery is effected and which leads show Q waves
5-10 days - macs have degraded structural components
Fick principle
LAD - V1 - V4
Inc central venous pressure - inc resistance to portal flow

22. What causes orthopnea?
Inc venous return exaccerbates pulm vasc congestion
Inc Kf - capillary perm
Dilated cardiomyopathy
Vasocxn

23. Unilateral headache - jaw claudication - impaired vision
Pos inotropy - exercise
No
Tempral arteritis - may cause irreversible blindness
In HF

24. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Arteriorles
TAPVR
During diastole

25. What causes the murmur heard in tricuspid regurg to enhance
Subendocardial - fewer collaterals and higher pressure
Temporal arteritis
In RA return (inspiration)
Fick principle

26. Which bacteria causes endocarditis in the presence of colon cancer
The first 4 days
S. bovis
140/90
Cystic hygroma

27. What is the progression of atherosclerosis?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Systolic dysfunction
Hyperlipidemia

28. What happens in phase 4 of the cardiac ventricular action potential?
Resting potential high K perm
Kidney
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Dec P02 - inc PC02 and dec pH

29. What is the difference between adult and infantile type aortic coarctation?
Acute thrombosis of coronary artery
Dilated cardiomyopathy
Aortic dilation - bicuspid aortic valve - RF -
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

30. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Dec plasma proteins
Heart - 02 extraction is always around 100%
Holosystolic - harsh sounding murmur - loudest over tricuspid area
LAD > RCA > circumflex

31. What 4 things drive myocardial 02 demand?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Torsades de pointes
Prinzmetal angina
QRS complex

32. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
Preload
If sodium channel
ASD - VSD - AV septal defect (endocardial cushion defect)

33. p - anca

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34. What are the 5 T's of cyanoitc babies
Posterior descending (80% off the RCA - 20% off the circumflex)
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Adult type aortic coarctation

35. list the coronary vessels most likely to be occluded
Atherosclerosis
LAD > RCA > circumflex
Hypertrophied cardiomyopathy
Angiosarcoma

36. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Transfusion
PDA
No
ASD

37. In terms of starling forces - why does heart failure cause edema?
Coarcation of aorta
Increase in Pc
Rapid upstroke - voltage gated Na channels open
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

38. Which murmur is heard with VSD?
Aburpt halting of valve leaflets
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Holosystolic - harsh sounding murmur - loudest over tricuspid area
TAPVR

39. What is the most common cause of MI
Acute thrombosis of coronary artery
Libman - sacks endocarditis
SV/ EDV
In parallel

40. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Granuloma with giant cells
Kawasaki
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
In parallel

41. When is the scar completely formed in an MI?
The aortic before pulmonic - inspiration increases diff
7 weeks
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
The operating point of the heart

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

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43. with what heart sounds do ASD usually present?
Atrial contraction
Patent ductus arteriosus - congenital rubella or prematurity
Pulmonary flow murmur and diastolic rumble
Septal defects - PDA - pulm art stenosis

44. Which channel accounts for automaticity of the SA and AV nodes?
Mechanican contraction of the ventricles
If sodium channel
Diastolic
LCX - V4- V6

45. Which organ gets the largest share of systemic cardiac output
Diastolic
Aortic insuffic - late
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Liver

46. What kind of dysfunction ensues in restrictive cardiomyopathy
Conduction delay through AV node - nl < 200 msec
Diastolic
Vasocxn
Late systolic crescendo murmur with a midsystolic click

47. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
Wegener's
RV failure - in venous pressure
10%

48. What is the early and late lesion in rheumatic heart disease
Increase intracellular Na - resulting in increased Ca
Mitral valve prolapse
Mitral valve
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

49. What are the complications of atherosclerosis?
Can progess to V fib
Vasocxn
Buerger's disease
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

50. What is the most common cause of right heart failure
Hypertrophied cardiomyopathy
Left heart failure
Preload
Unstable/crescendo angina