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Cardiology

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What happens in phase 0 of the cardiac ventricular action potential?
Diastolic
Rapid upstroke - voltage gated Na channels open
Systolic dysfunction
SV/ EDV

2. Which bacteria causes rheumatic heart disease
CFX
LAD - V1- V2
Atherosclerosis
Group a beta hemolytic strep

3. no relation between p waves and QRS intervals - treatment and predisposing factor
Sudden tensing of chordae tendinae
3rd degree block - pacemaker - Lyme disease
CK- MB
No - no pressure gradient

4. Irregularly irregular ECG - no p waves: dx and treatment
Wegener's
Dressler's - autoimmune
Non
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

5. In an EKG - What is the PR interval?
At least 55%
Conduction delay through AV node - nl < 200 msec
P02
S. bovis

6. What are common causes of mitral regurg?
Ischemic heart dz - mitral valve prolapse - LV dilation
QRS complex
LV failure - pulm venous distention transudation of fluid
Increase - increase the chance the If are open

7. What are aschoff bodies
Granuloma with giant cells
Lymphangiosarcoma
If sodium channel
Vasodilators - (hydrAlAzine)

8. CO x Total peripheral resistance
In series
Black > white > asian
2nd degree AV block - mobitz type 1
Mean arterial pressure

9. What causes the midsystolic click
Inc interstitial osmotic pressure pulling fliud out of capillaries
3rd degree block - pacemaker - Lyme disease
Kids
Sudden tensing of chordae tendinae

10. What cardiac change occurs in pregnancy?
Increased SV
Activated histiocytes
Fluid movement through capillaries
Aortic stenosis or LBBB

11. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Septal defects - PDA - pulm art stenosis
140/90
Non
Strawberry hemangioma

12. What is the S1 sound?
Raynaud's
Mitral and tricuspid closure
LAD - V1- V2
CHF

13. Which murmur is heard in aortic stenosis?
Crescendo - decrescendo systolic ejection murmur following ejection click
Gap junctions
S. aureus
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

14. How does angiotensin II raise MAP
SA and AV nodes
Vasocxn
Holosystolic - harsh sounding murmur - loudest over tricuspid area
1st degree AV blodck

15. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Cystic hygroma
Unstable/crescendo angina
Pulse pressure
Hypertrophied cardiomyopathy

16. decrease stretch in baroreceptors leads to what response?
Rapid upstroke - voltage gated Na channels open
Henoch - Schlonlein purpura
Increased efferent SANS and decreased efferent PANS
Systolic dysfunction

17. How does acidosis affect contractility?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Tricuspid atresia - requires ASD and VSD
Decreased
S. epidermidis

18. Which organ has the largest arteriovenous difference
Greater ventricular EDV
Heart - 02 extraction is always around 100%
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Increase - increase the chance the If are open

19. absecnce of tricuspid valve - hypoplastic RV
Transposition of great vessels
Fast volatge gated Na channels
Tricuspid atresia - requires ASD and VSD
Atherosclerosis

20. What causes the early cyanosis in Tet of Fallot?
Changes in CO as a function of preload
R to L shunt caused by stenoic pulmonic valve
Right sided
Vasodilators

21. What 4 things drive myocardial 02 demand?
V fib arrhythima
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Aortic dilation - bicuspid aortic valve - RF -
Greater ventricular EDV

22. The cause of cardiac dilation?
Greater ventricular EDV
MAP
Buerger's disease
Patent ductus arteriosus - congenital rubella or prematurity

23. What are the complications from bacterial endocarditis?
Chordae rupture - GN - suppurative pericarditis - emboli
Inc central venous pressure - inc resistance to portal flow
Fluid movement through capillaries
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

24. In an anterolateral infarct - which artery is effected and which leads show Q waves
Conduction delay through AV node - nl < 200 msec
LCX - V4- V6
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

25. Why is contractility decreased in heart failure?
Vagus to medulla
Wegener's
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Systolic dysfunction

26. what conditions are associated with pulsus paradoxus
Arteriolosclerosis in malignant hypertension
Vagus to medulla
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
RCA - II - III - aVF

27. what percentage of HTN is secondary to renal disease?
Acute thrombosis of coronary artery
10%
Increase contractility
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

28. Expiration causes an increase in which sided heart sounds
The plateau period
Myxomatous degeneration - RF - chordae rupture
Left sided
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

29. Which two mechanisms sense decrease MAP?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Medullary vasomotor center senses baroreceptors and JGA
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Hemorrhage

30. What is the classic X ray finding for tet of fallot?
Preload
Subendocardial
Mean arterial pressure
Boot shaped heart

31. systolic - diastolic
Inc RA pressure - due to filling against closed tricupsid valve
Age related calcifications or bicuspid aortic valve
Polyarteritis nodosum
Pulse pressure

32. What can cause mitral prolapse?
Myxomatous degeneration - RF - chordae rupture
Aortic stenosis or LBBB
Troponin I
Arteriolosclerosis in malignant hypertension

33. In an EKG - What is the QT interval?
Fick principle
Turners
Preload
Mechanican contraction of the ventricles

34. What does T wave inversion indicated?
The first 4 days
Dilated cardiomyopathy
MI
RCA - II - III - aVF

35. The aortic arch receptors transmit along which nerve?
Neg inotropy - HF - narcotic overdose
TAPVR
Changes in CO as a function of preload
Vagus to medulla

36. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
S. epidermidis
Chordae rupture - GN - suppurative pericarditis - emboli
CFX
No - no pressure gradient

37. What happends in phase 1 of the ventricular cardiac action potential?
Transmural
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
LCX - V4- V6

38. Which valve is commonly involved in bacterial endocarditis from IV drug use and Which bacteria are most common?

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39. MAP is also known as
SA and AV nodes
Afterload (proportional to peripheral resistance)
Ischemic heart dz - mitral valve prolapse - LV dilation
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

40. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Lymphangiosarcoma
Fast volatge gated Na channels
Apex and anterior interventricular septum
Aortic disecction - intraluminal tear forming false lumen

41. Exercise - overtransfusiion and excitiment causes and increase in...?
Left atrial pressure
Isovolumetric contraction
Preload
Viridans streptococci

42. What causes ankle - sacral edema - jugular venous distention
HTN - bradycardia - and respiratory depression
Tempral arteritis - may cause irreversible blindness
RV failure - in venous pressure
Purkingee>atria>ventricles>AV node

43. PCWP > LV diastolic pressure
Left sided
Mitral stenosis
Adult type aortic coarctation
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

44. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Aortic stenosis or LBBB
Purkingee>atria>ventricles>AV node
RV failure - in venous pressure
Filling is incomplete and CO falls

45. What is sudden cardiac death most commonly due to...
Hemorrhage
V fib arrhythima
LCX - V4- V6
Increased efferent SANS and decreased efferent PANS

46. What are anitschkow's cells
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Angiosarcoma
Activated histiocytes
LAD - V1- V2

47. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Holosystolic - harsh sounding murmur - loudest over tricuspid area
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Fick principle

48. What is the most common cause of right heart failure
Kawasaki
P02
Left heart failure
Lymphangiosarcoma

49. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Sudden tensing of chordae tendinae
Cardiac tamponde
HypoK and bradycardia
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

50. EDV - ESV
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Stroke volume
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Granuloma with giant cells

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