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

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2. What does TAPVR stand for
Total anomalous pulmonary trunk venous return
Pos inotropy - exercise
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Polyarteritis nodosum

3. What 4 things drive myocardial 02 demand?
The aortic before pulmonic - inspiration increases diff
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Aortic and pulmonary closing
Pulmonary flow murmur and diastolic rumble

4. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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5. 2/3 diastolic + 1/3 systolic
MAP
LCX - V4- V6
Can progess to V fib
C - ANCA

6. What is the machine like murmur? What is the heart pathology and the predisposing causes
Patent ductus arteriosus - congenital rubella or prematurity
SV/ EDV
Filling is incomplete and CO falls
Ventricular repolarization

7. Exercise - overtransfusiion and excitiment causes and increase in...?
No
Neg inotropy - HF - narcotic overdose
Transfusion
Preload

8. What constitues the upstroke in pacemaker cells?
Afterload (proportional to peripheral resistance)
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
MI
Volatage gated Ca channels

9. In normal S2 splitting - which valve closes first? What increases it?
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
The aortic before pulmonic - inspiration increases diff
Increasing activity of Ca pump in SR
Maintain blood flow to organ over wide range of perfussion pressures

10. moncekberg
In HF
Rhabdomyomas
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Hypertrophied cardiomyopathy

11. What are the 5 T's of cyanoitc babies
Extracellular calcium - calcium induced calcium release
Activated histiocytes
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Subendocardial

12. most common heart tumor
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Lower right - MC - upper right - AO - upper right AC - lower left MO
Metastasis from melanoma or lymphoma

13. In an anterior wall infarct - which artery is effected and which leads show Q waves
Ventricular depolarization - nl < 120 msec
LAD - V1 - V4
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Rapid upstroke - voltage gated Na channels open

14. Which vessels account for the most total peripheral resistance
Arteriorles
MI
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Stroke volume

15. What causes the CO curve to shift downwards?
Wegener's
Neg inotropy - HF - narcotic overdose
Pos inotropy - exercise
Proportional to viscosity and inversely proportional to the radius to the 4th power

16. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Unstable/crescendo angina
Viridans streptococci
R to L shunt caused by stenoic pulmonic valve
During diastole

17. EDV is also known as
No
S. bovis
Preload
Chordae rupture - GN - suppurative pericarditis - emboli

18. polypoid capillary hemangioma that can ulcerate and bleed
C - ANCA
Pyogenic granuloma - associated with trauma and pregnancy
Indomethacin closes - and pge keeps it open
Preload

19. What is the S1 sound?
Failure of LV to in CO during exercise
Acute thrombosis of coronary artery
Transposition of great vessels
Mitral and tricuspid closure

20. In an EKG - What is the T wave?
Subendocardial - fewer collaterals and higher pressure
Raynaud's
Ventricular repolarization
Increase intracellular Na - resulting in increased Ca

21. prolonged PR interval
1st degree AV blodck
Aburpt halting of valve leaflets
ASD - VSD - AV septal defect (endocardial cushion defect)
Chordae rupture - GN - suppurative pericarditis - emboli

22. What kind of infarct show ST depression
LAD - V1 - V4
Glossopharyngeal to soliary nucleus of medulla
Subendocardial
SV/ EDV

23. Which valve is most commonly involved in bacterial endocarditis?
Dec plasma proteins
Squat. Compression of femoral arteries - inc TPR - dec
Mitral valve
Filling is incomplete and CO falls

24. Which organ has ht highest blood flow per gram of tissue
Kidney
Myxoma
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
SA and AV nodes

25. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Mitral stenosis
Glomus tumor
Increased efferent SANS and decreased efferent PANS
Neg inotropy - HF - narcotic overdose

26. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Glossopharyngeal to soliary nucleus of medulla
Afterload (proportional to peripheral resistance)
In HF
Viridans streptococci

27. Which channel accounts for automaticity of the SA and AV nodes?
R to L shunt caused by stenoic pulmonic valve
Mitral>aortic>>tricuspid - high pressure valves affected most
MI
If sodium channel

28. systolic - diastolic
Pulse pressure
Stroke volume
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Neg inotropy - HF - narcotic overdose

29. What causes the murmur heard in tricuspid regurg to enhance
SA>AV>bundle of His>ventricles
ASD - VSD - AV septal defect (endocardial cushion defect)
In RA return (inspiration)
Cardiac tamponde

30. What is the formula for EF?
SV/ EDV
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Stable angina
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

31. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Adult type aortic coarctation
In RA return (inspiration)
Vasocxn - while other tissues it causes vasodilation
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

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

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33. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Late systolic crescendo murmur with a midsystolic click
Decreases
Babies
The first 4 days

34. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Indomethacin closes - and pge keeps it open
Lower right - MC - upper right - AO - upper right AC - lower left MO
Age related calcifications or bicuspid aortic valve

35. In an EKG - What is the p wave?
Atrial contraction
C - ANCA
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Aortic insuffic - late

36. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Group a beta hemolytic strep
Glomus tumor
Dilated cardiomyopathy
Henoch - Schlonlein purpura

37. Given P = QR - what factors influence resistance?
Stroke volume
Proportional to viscosity and inversely proportional to the radius to the 4th power
Eccentric - concentric hypertrophy causes diastolic disfunction
Subendocardial

38. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Yes
7 weeks
At least 55%
Wolff - Parkinson white syndrome

39. What does autoregulation do?
Septal defects - PDA - pulm art stenosis
Maintain blood flow to organ over wide range of perfussion pressures
Ventricles are depolarized
HTN - bradycardia - and respiratory depression

40. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Stroke volume
MI
Squat. Compression of femoral arteries - inc TPR - dec
Aortic/pulmonic regurg and mitral/tricuspid stenosis

41. serum marker for wegener's
Increasing activity of Ca pump in SR
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
C - ANCA
Vasodilators

42. In an inferior wall infarct - which artery is affected and which leads show Q waves
Cardiac tamponde
RCA - II - III - aVF
In parallel
Lower right - MC - upper right - AO - upper right AC - lower left MO

43. When and why do you hear the S4 sound
During diastole
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Indomethacin closes - and pge keeps it open
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

44. what percentage of HTN is secondary to renal disease?
Truncus - tet of fallot
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
SA and AV nodes
10%

45. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Kidney
Aortic stenosis or LBBB
No
Sturge weber - vasculitis of caps

46. Mitral stenosis is most often secondary to which condition?
Vasodilators
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
RF
Cherry hemangioma

47. Which sympathetic receptors raise MAP
Aortic insuffic - late
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
During diastole
Inc Kf - capillary perm

48. Which murmur do you hear in mitral stenosis?
Pulse pressure
Adult type aortic coarctation
Fick principle
Late diastolic murmur following an opening snap

49. Expiration causes an increase in which sided heart sounds
P02
Hemorrhage
Maintain blood flow to organ over wide range of perfussion pressures
Left sided

50. Why is contractility decreased in heart failure?
Systolic dysfunction
Inc interstitial osmotic pressure pulling fliud out of capillaries
Cardiac tamponde
LAD