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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. sawtooth wave

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2. What is the result of not have fast sodium channels in pacemaker cells?
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Cardiac tamponde
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

3. Which kind of infarct show ST elevation - and/or pathologic Q waves
Holosystoiic
Ventricles are depolarized
Decrease in activity of Na/Ca exhanger and increase in contractility
Transmural

4. What causes the midsystolic click
Sudden tensing of chordae tendinae
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Decreases
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

5. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
1st degree AV blodck
Volatage gated Ca channels
Inc venous return exaccerbates pulm vasc congestion
Lower right - MC - upper right - AO - upper right AC - lower left MO

6. in the JVP - What is the a wave?
Decreased
Mitral>aortic>>tricuspid - high pressure valves affected most
In RA return (inspiration)
Atrial contraction

7. Why is contractility decreased in heart failure?
QRS complex
Pulse pressure
Mitral and tricuspid closure
Systolic dysfunction

8. Which valve is most commonly involved in bacterial endocarditis?
Mitral valve
S. aureus
Activated histiocytes
Mitral>aortic>>tricuspid - high pressure valves affected most

9. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Activated histiocytes
Eccentric - concentric hypertrophy causes diastolic disfunction
Buerger's disease
...

10. Wegener's tx
Heart - 02 extraction is always around 100%
Cyclophosphamide and corticosteroids
Decrease in activity of Na/Ca exhanger and increase in contractility
Takayasu's arteritis

11. What is the cushing triad?
Aortic dilation - bicuspid aortic valve - RF -
RV contraction (closed tricuspid valve bulding into atrium
CK- MB
HTN - bradycardia - and respiratory depression

12. How are sarcomeres added in concentric hypertrophy?
Vasodilators
Takayasu's arteritis
Neg inotropy - HF - narcotic overdose
In parallel

13. disease of elastic arteries and large and medium sized muscular arteries
Anterosuperior displacement of the infundibular septum
Fast volatge gated Na channels
Atherosclerosis
Buerger's disease

14. How does digitatlis increase contractility?
Right sided
CO
3rd degree block - pacemaker - Lyme disease
Increase intracellular Na - resulting in increased Ca

15. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Non
Hyperlipidemia
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Maintain blood flow to organ over wide range of perfussion pressures

16. PCWP > LV diastolic pressure
Black > white > asian
Stroke volume
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Mitral stenosis

17. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
LAD - V1- V2
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Transmural
S. aureus

18. congenital heart defect with 22q11
Wegener's
Truncus - tet of fallot
At least 55%
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

19. fibrous plaques and atheromas in intima of arteries
Wolff - Parkinson white syndrome
Total anomalous pulmonary trunk venous return
Inc Kf - capillary perm
Atherosclerosis

20. What is the association with wide S2 splitting?
Pulmonic stenosis and RBBB
Stable angina
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
LAD > RCA > circumflex

21. Which class of drugs decrease the murmur heard in aortic regurg?
Truncus - tet of fallot
CHF
Vasodilators
Raynaud's

22. What is the most common cause of right heart failure
Inc interstitial osmotic pressure pulling fliud out of capillaries
No - no pressure gradient
Age related calcifications or bicuspid aortic valve
Left heart failure

23. Which murmur is heard with mitral prolapse?
Henoch - Schlonlein purpura
Late systolic crescendo murmur with a midsystolic click
Glomus tumor
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

24. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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25. What are the systolic heart sounds
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Coarcation of aorta
Atrial contraction
Non

26. PROVe
2nd degree AV block - mobitz type 1
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Glossopharyngeal to soliary nucleus of medulla
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

27. Where is the most posterior portion of the heart and What can it cause?
Increase contractility
Decrease in activity of Na/Ca exhanger and increase in contractility
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Boot shaped heart

28. Which class of drugs decrease preload
Venodilators (nitrogylcerine)
S. epidermidis
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
10%

29. Where does coronary artery occlusion occur most commonly?
LV failure - pulm venous distention transudation of fluid
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Aburpt halting of valve leaflets
LAD

30. How are the sarcomeres added in eccentric hypertrophy?
In series
Takayasu's arteritis
2-4 day - early coag necrosis on the first day
Mitral>aortic>>tricuspid - high pressure valves affected most

31. Which artery supplies the inferior portion of the left ventricle and posterior septum?
The operating point of the heart
Ventricular depolarization - nl < 120 msec
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Posterior descending (80% off the RCA - 20% off the circumflex)

32. In the cardiac cycle - which period has the highest 02 consumption?
Inc venous return exaccerbates pulm vasc congestion
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Aortic disecction - intraluminal tear forming false lumen
Isovolumetric contraction

33. What causes the early cyanosis in Tet of Fallot?
Wegener's
Atherosclerosis
Polyarteritis nodosum
R to L shunt caused by stenoic pulmonic valve

34. congenital heart defect with marfan's
Tempral arteritis - may cause irreversible blindness
Purkingee>atria>ventricles>AV node
S. aureus
Aortic insuffic - late

35. What are aschoff bodies
Maintain blood flow to organ over wide range of perfussion pressures
Kaposi's sarcoma
MI
Granuloma with giant cells

36. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
If sodium channel
Polyarteritis nodosum

37. Which enzymes are useful for diagnosing reinfarction
RCA
CK- MB
Lymphangiosarcoma
Squat. Compression of femoral arteries - inc TPR - dec

38. benign cap hemangioma of infancy - spont regresses
Afterload (proportional to peripheral resistance)
Strawberry hemangioma
HTN - bradycardia - and respiratory depression
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

39. What does TAPVR stand for
Viridans streptococci
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Total anomalous pulmonary trunk venous return

40. What are the diastolic heart sounds?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

41. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Increase in Pc
Mitral and tricuspid closure
Adult type aortic coarctation
Anterosuperior displacement of the infundibular septum

42. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Acute thrombosis of coronary artery
Non
Increased efferent SANS and decreased efferent PANS

43. What does an isoelectric ST segment indicate?
Late diastolic murmur following an opening snap
Fast volatge gated Na channels
Ventricles are depolarized
Total anomalous pulmonary trunk venous return

44. How are cadiac myocytes eltrically coupled?
LAD
Myxomatous degeneration - RF - chordae rupture
Ventricular repolarization
Gap junctions

45. What does the LAD supply?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Rapid upstroke - voltage gated Na channels open
Apex and anterior interventricular septum
Increasing activity of Ca pump in SR

46. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Mitral valve
Diastolic
Non
Increase - increase the chance the If are open

47. systolic - diastolic
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Pulse pressure
Pyogenic granuloma - associated with trauma and pregnancy
Diastolic

48. What other syndrom is associated with infantile aortic coarctation
Pulse pressure
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Pos inotropy - exercise
Turners

49. fibrinous pericarditis several weeks post MI

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50. What causes ankle - sacral edema - jugular venous distention
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Infective endocarditis
3rd degree block - pacemaker - Lyme disease
RV failure - in venous pressure