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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. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
CO
Lymphangiosarcoma
Polyarteritis nodosum

2. When and why is the S3 sound heard?
Aburpt halting of valve leaflets
EKG
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

3. What are aschoff bodies
Granuloma with giant cells
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Babies
HTN - bradycardia - and respiratory depression

4. What is sudden cardiac death most commonly due to...
Right sided
V fib arrhythima
Neg inotropy - HF - narcotic overdose
Myxomatous degeneration - RF - chordae rupture

5. What is the classic X ray finding for tet of fallot?
Boot shaped heart
Subendocardial - fewer collaterals and higher pressure
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Temporal arteritis

6. Where does coronary artery occlusion occur most commonly?
The operating point of the heart
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
LAD
LCX - I - aVL

7. friction rub - 3-5 days post MI
Pulse pressure
Atrial contraction
Postinfarction fibrinous pericarditis
2-4 day - early coag necrosis on the first day

8. which medications are used to maintain patency or close the ductus arteriosus?
Failure of LV to in CO during exercise
Non
LAD
Indomethacin closes - and pge keeps it open

9. CO x Total peripheral resistance
Mean arterial pressure
Conduction delay through AV node - nl < 200 msec
Afterload (proportional to peripheral resistance)
Left heart failure

10. Which class of drugs decreases afterload?
In parallel
Vasodilators - (hydrAlAzine)
Increase in Pc
Increase intracellular Na - resulting in increased Ca

11. What do the carotid and aortic bodies respond to?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Indomethacin closes - and pge keeps it open
Dec P02 - inc PC02 and dec pH
Postinfarction fibrinous pericarditis

12. What is the S2 sound?
Atherosclerosis
Aortic and pulmonary closing
Group a beta hemolytic strep
Isovolumetric contraction

13. Wegener's tx
Resting potential high K perm
EKG
Cyclophosphamide and corticosteroids
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

14. What cardiac change occurs in pregnancy?
Mitral>aortic>>tricuspid - high pressure valves affected most
Increased SV
Afterload (proportional to peripheral resistance)
Activated histiocytes

15. Which organ gets the largest share of systemic cardiac output
Liver
Viridans streptococci
Tempral arteritis - may cause irreversible blindness
Changes in CO as a function of preload

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

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17. What causes the midsystolic click
Septal defects - PDA - pulm art stenosis
Kids
Sudden tensing of chordae tendinae
Aortic/pulmonic regurg and mitral/tricuspid stenosis

18. What is the S1 sound?
Mitral and tricuspid closure
Persistant truncus arteriosus
Non
QRS complex

19. The carotid sinus transmits along which nerve?
Glossopharyngeal to soliary nucleus of medulla
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Turners
Microscopic polyangiitis - like wegener's without granulomas

20. no change in PR interval followed by dropped beat
Increase - increase the chance the If are open
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Kids

21. What causes the early cyanosis in Tet of Fallot?
R to L shunt caused by stenoic pulmonic valve
Vasocxn - while other tissues it causes vasodilation
Temporal arteritis
Kidney

22. Wegener's presentation
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Chordae rupture - GN - suppurative pericarditis - emboli
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Inc TPR and LA return (expiration)

23. Which bacteria causes rheumatic heart disease
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Aortic stenosis or LBBB
CFX
Group a beta hemolytic strep

24. absecnce of tricuspid valve - hypoplastic RV
Left heart failure
Tricuspid atresia - requires ASD and VSD
Gap junctions
Decreases

25. Right to left shunts are more common in babies or kids?
Medullary vasomotor center senses baroreceptors and JGA
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Babies
Tempral arteritis - may cause irreversible blindness

26. When do you find hemosiderin laden macrophages in the lungs?
In parallel
During HF from microhemorrhages from inc pulm cap pressure
Troponin I
ANP

27. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Non
During HF from microhemorrhages from inc pulm cap pressure
Cherry hemangioma
Purkingee>atria>ventricles>AV node

28. How are cadiac myocytes eltrically coupled?
ASD
Increase in Pc
RF
Gap junctions

29. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Dilated cardiomyopathy
Posterior descending (80% off the RCA - 20% off the circumflex)
Inc venous return exaccerbates pulm vasc congestion
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

30. disease of elastic arteries and large and medium sized muscular arteries
Mean arterial pressure
Persistant truncus arteriosus
Cardiac tamponde
Atherosclerosis

31. What is the formula for EF?
SV/ EDV
Volatage gated Ca channels
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Aortic disecction - intraluminal tear forming false lumen

32. Do you see elevaged ASO titers in rheumatic heart disease
5-10 days - macs have degraded structural components
Myxomatous degeneration - RF - chordae rupture
Yes
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

33. The 7 complications of MI

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34. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
140/90
Wolff - Parkinson white syndrome
Wegener's

35. Why is contractility decreased in heart failure?
2nd degree AV block - mobitz type 1
Cardiac tamponde
Increase intracellular Na - resulting in increased Ca
Systolic dysfunction

36. What are the diastolic heart sounds?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Buerger's disease
Left heart failure
Aortic/pulmonic regurg and mitral/tricuspid stenosis

37. Which murmur is heard with mitral prolapse?
R to L shunt caused by stenoic pulmonic valve
Late systolic crescendo murmur with a midsystolic click
Microscopic polyangiitis - like wegener's without granulomas
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

38. What does T wave inversion indicated?
Venodilators (nitrogylcerine)
MI
Inc central venous pressure - inc resistance to portal flow
Henoch - Schlonlein purpura

39. Which vessels account for the most total peripheral resistance
Failure of LV to in CO during exercise
RCA - II - III - aVF
Left sided
Arteriorles

40. Restrictive cardiomyopathy causes
Dilation
Aortic and pulmonary closing
Cyclophosphamide and corticosteroids
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

41. What is the cushing triad?
Vagus to medulla
Arteriorles
HTN - bradycardia - and respiratory depression
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

42. What are the different etiologies of dialted cardiomyopathy
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Persistant truncus arteriosus
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

43. What causes aortic stenosis
Total anomalous pulmonary trunk venous return
Age related calcifications or bicuspid aortic valve
Rapid upstroke - voltage gated Na channels open
Left atrial pressure

44. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Dilated cardiomyopathy
7 weeks
HTN - bradycardia - and respiratory depression

45. When do coronary arteries fill?
Pulmonary flow murmur and diastolic rumble
During diastole
Septal defects - PDA - pulm art stenosis
During HF from microhemorrhages from inc pulm cap pressure

46. What do patients die early from in rheumatic heart disease?
Heart - 02 extraction is always around 100%
Subendocardial
Early deaths from myocarditis
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

47. PCWP > LV diastolic pressure
Fick principle
Wegener's
Left sided
Mitral stenosis

48. Rank the pacemakers cells
Activated histiocytes
SA>AV>bundle of His>ventricles
Squat. Compression of femoral arteries - inc TPR - dec
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

49. In an inferior wall infarct - which artery is affected and which leads show Q waves
Acute thrombosis of coronary artery
At least 55%
Resting potential high K perm
RCA - II - III - aVF

50. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Fick principle
During diastole
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
2nd degree AV block - mobitz type 1