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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. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Cystic hygroma
Turners
Kawasaki
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

2. What are the four most common locations for atherosclerosis?
At least 55%
Vasocxn
Rapid upstroke - voltage gated Na channels open
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

3. Which two mechanisms sense decrease MAP?
Metastasis from melanoma or lymphoma
Aortic insuffic - late
Medullary vasomotor center senses baroreceptors and JGA
ASD - VSD - AV septal defect (endocardial cushion defect)

4. What is the most common cause of MI
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Glossopharyngeal to soliary nucleus of medulla
Unstable/crescendo angina
Acute thrombosis of coronary artery

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

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6. What are the diastolic heart sounds?
Rhabdomyomas
Cherry hemangioma
Cyclophosphamide and corticosteroids
Aortic/pulmonic regurg and mitral/tricuspid stenosis

7. What is the progression of atherosclerosis?
SA and AV nodes
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Stroke volume affected by contractility - afterload - and preload
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

8. EDV is also known as
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Systolic dysfunction
Preload
Group a beta hemolytic strep

9. polypoid capillary hemangioma that can ulcerate and bleed
Stroke volume
Cherry hemangioma
Pyogenic granuloma - associated with trauma and pregnancy
Mitral>aortic>>tricuspid - high pressure valves affected most

10. What happens in phase 4 of the cardiac ventricular action potential?
Resting potential high K perm
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Eisenmenger's syndrome
Left atrial pressure

11. How does digitatlis increase contractility?
LCX - V4- V6
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Increase intracellular Na - resulting in increased Ca
CK- MB

12. Hyperplastic onion skinning
7 weeks
Ventricular repolarization
Arteriolosclerosis in malignant hypertension
Buerger's disease

13. Rank the pacemakers cells
Activated histiocytes
SA>AV>bundle of His>ventricles
Decreases
Cherry hemangioma

14. What causes orthopnea?
Inc venous return exaccerbates pulm vasc congestion
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Pulmonic stenosis and RBBB
S. bovis

15. Which organ has ht highest blood flow per gram of tissue
Patent ductus arteriosus - congenital rubella or prematurity
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Systolic dysfunction
Kidney

16. most common primary cardiac tumor in children - associated with tuberous sclerosis
Mechanican contraction of the ventricles
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Rhabdomyomas

17. What causes aortic stenosis
Atrial contraction
Age related calcifications or bicuspid aortic valve
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Cyclophosphamide and corticosteroids

18. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Extracellular calcium - calcium induced calcium release
Late diastolic murmur following an opening snap
No - no pressure gradient
Lower right - MC - upper right - AO - upper right AC - lower left MO

19. What constitues the upstroke in pacemaker cells?
Metastasis from melanoma or lymphoma
Inc RA pressure - due to filling against closed tricupsid valve
Volatage gated Ca channels
Mitral stenosis

20. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Tempral arteritis - may cause irreversible blindness
Septal defects - PDA - pulm art stenosis
Hemorrhage
5-10 days - macs have degraded structural components

21. What happens with a decrease of extracellular Na
During HF from microhemorrhages from inc pulm cap pressure
In parallel
No
Decrease in activity of Na/Ca exhanger and increase in contractility

22. In terms of starling forces - why does heart failure cause edema?
Vasocxn - while other tissues it causes vasodilation
Increase in Pc
Lower right - MC - upper right - AO - upper right AC - lower left MO
Subendocardial - fewer collaterals and higher pressure

23. Restrictive cardiomyopathy causes
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Mitral valve
S. epidermidis
Unstable/crescendo angina

24. What causes the midsystolic click
Inc venous return exaccerbates pulm vasc congestion
Sudden tensing of chordae tendinae
Mitral valve
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

25. What causes aortic regurg
Aortic dilation - bicuspid aortic valve - RF -
Eisenmenger's syndrome
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
1st degree AV blodck

26. 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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27. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Sturge weber - vasculitis of caps
Adult type aortic coarctation
RV contraction (closed tricuspid valve bulding into atrium
MI

28. What causes ankle - sacral edema - jugular venous distention
Ventricles are depolarized
Raynaud's
RV failure - in venous pressure
Squat. Compression of femoral arteries - inc TPR - dec

29. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Cardiac tamponde
1st degree AV blodck
Dec plasma proteins
Fetal right to left - neonate left to right leading to RVH and failure

30. bening capillary hemangioma of elderly - does not regress
Prinzmetal angina
Polyarteritis nodosum
Greater ventricular EDV
Cherry hemangioma

31. what conditions are associated with pulsus paradoxus
Kidney
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Libman - sacks endocarditis
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

32. What is the formula for EF?
SV/ EDV
Myxoma
Tempral arteritis - may cause irreversible blindness
Temporal arteritis

33. What is the association with wide S2 splitting?
Decrease in cAMP
Pulmonic stenosis and RBBB
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
CHF

34. What causes the cushing reflex and why
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
HTN - bradycardia - and respiratory depression
Prinzmetal angina

35. What does FAN MY SKIN On Wednesday stand for?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Increasing activity of Ca pump in SR
Ischemic heart dz - mitral valve prolapse - LV dilation
Early deaths from myocarditis

36. What is the cushing triad?
HTN - bradycardia - and respiratory depression
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Fick principle
The first 4 days

37. When is the scar completely formed in an MI?
Neg inotropy - HF - narcotic overdose
7 weeks
Ventricles are depolarized
RF

38. What is the danger of torsades to pointes?
Mitral stenosis
Can progess to V fib
Conduction delay through AV node - nl < 200 msec
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

39. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
The operating point of the heart
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
...
Cardiac tamponde

40. Expiration causes an increase in which sided heart sounds
Left sided
Changes in CO as a function of preload
Venodilators (nitrogylcerine)
LAD - V1 - V4

41. Where does coronary artery occlusion occur most commonly?
LAD
Coarcation of aorta
Atrial contraction
Greater ventricular EDV

42. which heart valves are afected most in rheumatic heart diseease
Ischemic heart dz - mitral valve prolapse - LV dilation
Persistant truncus arteriosus
Hyperlipidemia
Mitral>aortic>>tricuspid - high pressure valves affected most

43. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Unstable/crescendo angina
Temporal arteritis
Hemorrhage
Microscopic polyangiitis - like wegener's without granulomas

44. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
LCX - I - aVL
Cardiac tamponde
Proportional to viscosity and inversely proportional to the radius to the 4th power

45. What causes the murmur heard in tricuspid regurg to enhance
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
In RA return (inspiration)
S. epidermidis
Transmural

46. EDV - ESV
Stroke volume
Polyarteritis nodosum
At least 55%
CK- MB

47. What is the S1 sound?
Cherry hemangioma
Mitral and tricuspid closure
V fib arrhythima
Medullary vasomotor center senses baroreceptors and JGA

48. Which kind of infarct show ST elevation - and/or pathologic Q waves
Atrial contraction
Transmural
Cystic hygroma
HTN - bradycardia - and respiratory depression

49. Which murmur is heard with VSD?
MAP
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Inc RA pressure - due to filling against closed tricupsid valve
Kawasaki

50. When do you find hemosiderin laden macrophages in the lungs?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Glossopharyngeal to soliary nucleus of medulla
Inc central venous pressure - inc resistance to portal flow
During HF from microhemorrhages from inc pulm cap pressure