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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. dyspnea - fatigue - edema and rales - multiple causes
Isovolumetric contraction
Can progess to V fib
CHF
140/90

2. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Truncus - tet of fallot
Purkingee>atria>ventricles>AV node
Inc TPR and LA return (expiration)

3. How do catecholamines increase contractility?
1st degree AV blodck
Atherosclerosis
Increasing activity of Ca pump in SR
LAD > RCA > circumflex

4. fibrinous pericarditis several weeks post MI

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5. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Volatage gated Ca channels
Posterior descending (80% off the RCA - 20% off the circumflex)
Angiosarcoma
Varicose veins - thromboembolism rare

6. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Wolff - Parkinson white syndrome
The aortic before pulmonic - inspiration increases diff
Transfusion
Hemorrhage

7. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Systolic dysfunction
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Polyarteritis nodosum
S. aureus

8. What does the LAD supply?
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
MI
Cardiac tamponde
Apex and anterior interventricular septum

9. In terms of starling forces - why does heart failure cause edema?
Fast volatge gated Na channels
Extracellular calcium - calcium induced calcium release
The operating point of the heart
Increase in Pc

10. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Mitral stenosis
Inc RA pressure - due to filling against closed tricupsid valve
Raynaud's
MI

11. fibrous plaques and atheromas in intima of arteries
Ischemic heart dz - mitral valve prolapse - LV dilation
Kids
Atherosclerosis
LCX - I - aVL

12. Which bacteria causes endocarditis in the presence of colon cancer
Fick principle
In parallel
S. bovis
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

13. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Decreases
Holosystoiic
Wolff - Parkinson white syndrome
Non

14. cavernous lymphangioma of the neck - associated with turner's
S. epidermidis
Cystic hygroma
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Filling is incomplete and CO falls

15. Which kind of infarct show ST elevation - and/or pathologic Q waves
Increase in Pc
C - ANCA
Transmural
Changes in CO as a function of preload

16. Which organ has the largest arteriovenous difference
Dilation
Heart - 02 extraction is always around 100%
Vagus to medulla
Mitral valve prolapse

17. When does extracellular calcium enter the cardiac muscle cells during contraction?
Lymphangiosarcoma
The plateau period
Preload
SV/ EDV

18. What 4 things drive myocardial 02 demand?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Transfusion
Pulmonic stenosis and RBBB
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

19. What does the starling curve show?
Changes in CO as a function of preload
7 weeks
Polyarteritis nodosum
Mitral valve prolapse

20. What are the 5 T's of cyanoitc babies
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Decrease in cAMP
LV failure - pulm venous distention transudation of fluid
Cyclophosphamide and corticosteroids

21. no change in PR interval followed by dropped beat
Hyperlipidemia
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Takayasu's arteritis

22. Which lab value indicates blood viscosity?
Torsades de pointes
Hematocrit
Crescendo - decrescendo systolic ejection murmur following ejection click
Unstable/crescendo angina

23. What does increasing intracellular Ca do?
At least 55%
Turners
Increase contractility
Acute thrombosis of coronary artery

24. In an EKG - What is the p wave?
Atrial contraction
During diastole
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Changes in CO as a function of preload

25. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Myxomatous degeneration - RF - chordae rupture
Non
Preload
LAD > RCA > circumflex

26. Which enzymes are useful for diagnosing reinfarction
Aortic disecction - intraluminal tear forming false lumen
CK- MB
Indomethacin closes - and pge keeps it open
Cystic hygroma

27. What are the complications from bacterial endocarditis?
Myxomatous degeneration - RF - chordae rupture
RCA
Chordae rupture - GN - suppurative pericarditis - emboli
Strawberry hemangioma

28. with what heart sounds do ASD usually present?
140/90
Early deaths from myocarditis
QRS complex
Pulmonary flow murmur and diastolic rumble

29. What is the early and late lesion in rheumatic heart disease
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Mitral valve prolapse
Systolic dysfunction

30. What do the starling forces determine
Inc RA pressure - due to filling against closed tricupsid valve
Decrease in cAMP
Fluid movement through capillaries
TAPVR

31. In an anterior wall infarct - which artery is effected and which leads show Q waves
Varicose veins - thromboembolism rare
LAD - V1 - V4
Dilated cardiomyopathy
Holosystoiic

32. What stimulates release of calcium from the SR?
Transmural
Libman - sacks endocarditis
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Extracellular calcium - calcium induced calcium release

33. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Diastolic
Strawberry hemangioma
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

34. Which class of drugs decrease the murmur heard in aortic regurg?
The first 4 days
Maintain blood flow to organ over wide range of perfussion pressures
Vasodilators
Fetal right to left - neonate left to right leading to RVH and failure

35. In normal S2 splitting - which valve closes first? What increases it?
Subendocardial
The aortic before pulmonic - inspiration increases diff
Granuloma with giant cells
Vasodilators

36. Churg Strauss - presentation and test
Septal defects - PDA - pulm art stenosis
Prinzmetal angina
Late diastolic murmur following an opening snap
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

37. CO x Total peripheral resistance
Mean arterial pressure
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Increased SV
Left atrial pressure

38. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Dilated cardiomyopathy
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Volatage gated Ca channels

39. Which organ gets the largest share of systemic cardiac output
During diastole
Ventricles are depolarized
QRS complex
Liver

40. Most common vasculitis affecting medium and large arteries
Arteriorles
Strawberry hemangioma
Temporal arteritis
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

41. list the coronary vessels most likely to be occluded
Decreased
Subendocardial - fewer collaterals and higher pressure
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
LAD > RCA > circumflex

42. absecnce of tricuspid valve - hypoplastic RV
Yes
Tricuspid atresia - requires ASD and VSD
5-10 days - macs have degraded structural components
Activated histiocytes

43. Which murmur is characteristic of mitral/tricuspid regurg?
Varicose veins - thromboembolism rare
Fick principle
Holosystoiic
2-4 day - early coag necrosis on the first day

44. EDV is also known as
Cystic hygroma
Preload
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Transposition of great vessels

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

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46. What does autoregulation do?
LAD > RCA > circumflex
Maintain blood flow to organ over wide range of perfussion pressures
C - ANCA
Mitral valve

47. 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
Inc RA pressure - due to filling against closed tricupsid valve
Heart - 02 extraction is always around 100%
1st degree AV blodck

48. moncekberg
Aortic dilation - bicuspid aortic valve - RF -
5-10 days - macs have degraded structural components
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Neg inotropy - HF - narcotic overdose

49. Which vessels account for the most total peripheral resistance
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Postinfarction fibrinous pericarditis
Arteriorles
Glomus tumor

50. Which class of drugs decreases afterload?
Eccentric - concentric hypertrophy causes diastolic disfunction
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Vasodilators - (hydrAlAzine)
Diastolic