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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. Where are pacemaker cells?
SA and AV nodes
Liver
Eccentric - concentric hypertrophy causes diastolic disfunction
Conduction delay through AV node - nl < 200 msec

2. PROVe
TAPVR
Liver
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Chordae rupture - GN - suppurative pericarditis - emboli

3. Chronic mitral stenosis can lead to what changes in size of the LA
7 weeks
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Aburpt halting of valve leaflets
Dilation

4. What are the four most common locations for atherosclerosis?
Temporal arteritis
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Black > white > asian

5. Why is contractility decreased in heart failure?
Posterior descending (80% off the RCA - 20% off the circumflex)
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Systolic dysfunction
Maintain blood flow to organ over wide range of perfussion pressures

6. What causes the early cyanosis in Tet of Fallot?
Increased efferent SANS and decreased efferent PANS
R to L shunt caused by stenoic pulmonic valve
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

7. Which vessels account for the most total peripheral resistance
7 weeks
Arteriorles
Stroke volume
CFX

8. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Unstable/crescendo angina
5-10 days - macs have degraded structural components
Increase intracellular Na - resulting in increased Ca
Neg inotropy - HF - narcotic overdose

9. What causes the CO curve to shift upwards?
Inc TPR and LA return (expiration)
Pos inotropy - exercise
Increasing activity of Ca pump in SR
Late systolic crescendo murmur with a midsystolic click

10. Fatal arrhythmia
V fib
Glomus tumor
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
In RA return (inspiration)

11. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Lymphangiosarcoma
Vasodilators - (hydrAlAzine)
Hemorrhage
Transposition of great vessels

12. What does the U wave indicated?
HypoK and bradycardia
LAD > RCA > circumflex
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
QRS complex

13. Why is there edema after burns or during infection
V fib
S. epidermidis
Inc Kf - capillary perm
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

14. Right to left shunts are more common in babies or kids?
Turners
No - no pressure gradient
CK- MB
Babies

15. What does FEVERSS stand for in rheumatic heart disease
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
In HF
Ventricular repolarization
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

16. Which bacteria causes endocarditis in the presence of colon cancer
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Mitral>aortic>>tricuspid - high pressure valves affected most
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
S. bovis

17. What kind of dysfunction ensues in restrictive cardiomyopathy
Inc TPR and LA return (expiration)
Dressler's - autoimmune
RV contraction (closed tricuspid valve bulding into atrium
Diastolic

18. EDV is also known as
No
Preload
5-10 days - macs have degraded structural components
Inc interstitial osmotic pressure pulling fliud out of capillaries

19. CO x Total peripheral resistance
Wolff - Parkinson white syndrome
Mean arterial pressure
CK- MB
Ventricular depolarization - nl < 120 msec

20. What are the diastolic heart sounds?
At least 55%
...
Ventricular depolarization - nl < 120 msec
Aortic/pulmonic regurg and mitral/tricuspid stenosis

21. Where does coronary artery occlusion occur most commonly?
Atrial contraction
LAD
Eccentric - concentric hypertrophy causes diastolic disfunction
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

22. What murmur is heard with aortic regurg?
Group a beta hemolytic strep
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Extracellular calcium - calcium induced calcium release
Cystic hygroma

23. polypoid capillary hemangioma that can ulcerate and bleed
The operating point of the heart
Pyogenic granuloma - associated with trauma and pregnancy
Glomus tumor
Kaposi's sarcoma

24. Which murmur is heard with VSD?
Ventricular repolarization
5-10 days - macs have degraded structural components
Neg inotropy - HF - narcotic overdose
Holosystolic - harsh sounding murmur - loudest over tricuspid area

25. What is the machine like murmur? What is the heart pathology and the predisposing causes
Acute thrombosis of coronary artery
Purkingee>atria>ventricles>AV node
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Patent ductus arteriosus - congenital rubella or prematurity

26. Rank the pacemakers cells
SA>AV>bundle of His>ventricles
PDA
Purkingee>atria>ventricles>AV node
Mitral valve

27. What causes the murmur heard in tricuspid regurg to enhance
Vasodilators - (hydrAlAzine)
Henoch - Schlonlein purpura
In RA return (inspiration)
At least 55%

28. Wegener's tx
Ventricles are depolarized
Sudden tensing of chordae tendinae
Cherry hemangioma
Cyclophosphamide and corticosteroids

29. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
LAD > RCA > circumflex
Decrease in cAMP
TAPVR
Left atrial pressure

30. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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31. How does digitatlis increase contractility?
Atrial contraction
Dilated cardiomyopathy
Increase intracellular Na - resulting in increased Ca
Microscopic polyangiitis - like wegener's without granulomas

32. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
The plateau period
Hypertrophied cardiomyopathy
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Systolic dysfunction

33. What does increasing intracellular Ca do?
Anterosuperior displacement of the infundibular septum
Can progess to V fib
Aortic dilation - bicuspid aortic valve - RF -
Increase contractility

34. What does T wave inversion indicated?
MI
V fib
Chordae rupture - GN - suppurative pericarditis - emboli
Crescendo - decrescendo systolic ejection murmur following ejection click

35. dyspnea - fatigue - edema and rales - multiple causes
CHF
R to L shunt caused by stenoic pulmonic valve
LAD > RCA > circumflex
Mean arterial pressure

36. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
EKG
Cardiac tamponde
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
LAD - V1- V2

37. What is the classic X ray finding for tet of fallot?
S. aureus
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Turners
Boot shaped heart

38. What kind of infarct show ST depression
Tricuspid atresia - requires ASD and VSD
Subendocardial
Mechanican contraction of the ventricles
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

39. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kawasaki
Transmural
Can progess to V fib
LAD - V1- V2

40. What is the difference between adult and infantile type aortic coarctation?
Sudden tensing of chordae tendinae
Age related calcifications or bicuspid aortic valve
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

41. decrease stretch in baroreceptors leads to what response?
Dec plasma proteins
Pos inotropy - exercise
Liver
Increased efferent SANS and decreased efferent PANS

42. What is the gold standard for dx of MI in the first 6 hours
EKG
Varicose veins - thromboembolism rare
Crescendo - decrescendo systolic ejection murmur following ejection click
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

43. What does prolonged QT predispose to?
Torsades de pointes
During HF from microhemorrhages from inc pulm cap pressure
Total anomalous pulmonary trunk venous return
SA and AV nodes

44. what percentage of HTN is secondary to renal disease?
Crescendo - decrescendo systolic ejection murmur following ejection click
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
10%
Metastasis from melanoma or lymphoma

45. what happens to capillaries in lymphatic blockage
Inc central venous pressure - inc resistance to portal flow
Hypertrophied cardiomyopathy
Medullary vasomotor center senses baroreceptors and JGA
Inc interstitial osmotic pressure pulling fliud out of capillaries

46. The aortic arch receptors transmit along which nerve?
HypoK and bradycardia
Mitral stenosis
Acute thrombosis of coronary artery
Vagus to medulla

47. What is the formula for EF?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Pulmonary flow murmur and diastolic rumble
SV/ EDV
Transfusion

48. Which organ has ht highest blood flow per gram of tissue
Kidney
Age related calcifications or bicuspid aortic valve
Varicose veins - thromboembolism rare
Hematocrit

49. bening capillary hemangioma of elderly - does not regress
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Purkingee>atria>ventricles>AV node
Activated histiocytes
Cherry hemangioma

50. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Hemorrhage
Isovolumetric contraction
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Patent ductus arteriosus - congenital rubella or prematurity