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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. what happens to capillaries in lymphatic blockage
Inc interstitial osmotic pressure pulling fliud out of capillaries
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
LAD
Decrease in cAMP

2. What does T wave inversion indicated?
Stroke volume
Filling is incomplete and CO falls
MI
Aortic disecction - intraluminal tear forming false lumen

3. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
The first 4 days
Extracellular calcium - calcium induced calcium release
Vasodilators

4. What cardiac change occurs in pregnancy?
Increased SV
Cherry hemangioma
Black > white > asian
Age related calcifications or bicuspid aortic valve

5. Fatal arrhythmia
RCA
Stroke volume affected by contractility - afterload - and preload
Dilated cardiomyopathy
V fib

6. In terms of starling forces - why does heart failure cause edema?
Inc interstitial osmotic pressure pulling fliud out of capillaries
Increase in Pc
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

7. most common primary cardiac tumor in children - associated with tuberous sclerosis
Changes in CO as a function of preload
Rhabdomyomas
2nd degree AV block - mobitz type 1
In RA return (inspiration)

8. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
At least 55%
Polyarteritis nodosum
Stroke volume
Extracellular calcium - calcium induced calcium release

9. In normal S2 splitting - which valve closes first? What increases it?
Arteriorles
P02
The aortic before pulmonic - inspiration increases diff
Increase intracellular Na - resulting in increased Ca

10. what percentage of HTN is secondary to renal disease?
Atherosclerosis
10%
Left sided
Vasodilators

11. What can cause mitral prolapse?
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Volatage gated Ca channels
Myxomatous degeneration - RF - chordae rupture
Systolic dysfunction

12. MAP is also known as
Can progess to V fib
Afterload (proportional to peripheral resistance)
Patent ductus arteriosus - congenital rubella or prematurity
Raynaud's

13. What causes ankle - sacral edema - jugular venous distention
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Tempral arteritis - may cause irreversible blindness
Vasodilators - (hydrAlAzine)
RV failure - in venous pressure

14. PCWP is an estimate of...
Inc central venous pressure - inc resistance to portal flow
Ventricles are depolarized
Non
Left atrial pressure

15. When does EF decrease
P02
The aortic before pulmonic - inspiration increases diff
In HF
Vasodilators

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

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17. congenital heart defect with marfan's
Temporal arteritis
Crescendo - decrescendo systolic ejection murmur following ejection click
HypoK and bradycardia
Aortic insuffic - late

18. When and why is the S3 sound heard?
Increase intracellular Na - resulting in increased Ca
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
CFX
Mitral and tricuspid closure

19. How are sarcomeres added in concentric hypertrophy?
During diastole
In parallel
Varicose veins - thromboembolism rare
Holosystolic - harsh sounding murmur - loudest over tricuspid area

20. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
...
Sturge weber - vasculitis of caps
The plateau period
Age related calcifications or bicuspid aortic valve

21. 2/3 diastolic + 1/3 systolic
MAP
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
V fib
Unstable/crescendo angina

22. When do you find hemosiderin laden macrophages in the lungs?
Vasocxn - while other tissues it causes vasodilation
Kaposi's sarcoma
Isovolumetric contraction
During HF from microhemorrhages from inc pulm cap pressure

23. Do you see elevaged ASO titers in rheumatic heart disease
Yes
Inc RA pressure - due to filling against closed tricupsid valve
Total anomalous pulmonary trunk venous return
Hemorrhage

24. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Cherry hemangioma
Fetal right to left - neonate left to right leading to RVH and failure
Takayasu's arteritis
Henoch - Schlonlein purpura

25. What happens in phase 2 of the cardiac ventricular action potential?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
In parallel
Proportional to viscosity and inversely proportional to the radius to the 4th power
Raynaud's

26. Why is contractility decreased in heart failure?
Systolic dysfunction
Hematocrit
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Kawasaki

27. in the JVP - What is the a wave?
The plateau period
Transposition of great vessels
Liver
Atrial contraction

28. What are anitschkow's cells
Activated histiocytes
Vagus to medulla
Proportional to viscosity and inversely proportional to the radius to the 4th power
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

29. What other sign is often present with congenital long QT syndrome - why?
Subendocardial - fewer collaterals and higher pressure
Myxomatous degeneration - RF - chordae rupture
Wolff - Parkinson white syndrome
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

30. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Aortic stenosis or LBBB
Left atrial pressure
Transfusion
Aortic insuffic - late

31. What do patients die early from in rheumatic heart disease?
Buerger's disease
ASD
Early deaths from myocarditis
RV failure - in venous pressure

32. What other syndrom is associated with infantile aortic coarctation
Decreased
Babies
Eisenmenger's syndrome
Turners

33. What does the starling curve show?
Changes in CO as a function of preload
Myxomatous degeneration - RF - chordae rupture
CHF
Crescendo - decrescendo systolic ejection murmur following ejection click

34. What kind of dysfunction ensues in restrictive cardiomyopathy
Dilated cardiomyopathy
Diastolic
Unstable/crescendo angina
Subendocardial

35. no relation between p waves and QRS intervals - treatment and predisposing factor
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Afterload (proportional to peripheral resistance)
3rd degree block - pacemaker - Lyme disease
TAPVR

36. In an EKG - What is the QRS complex?
Right sided
Ventricular depolarization - nl < 120 msec
2-4 day - early coag necrosis on the first day
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

37. which ethnic groups have higher association with HTN?
Black > white > asian
Late diastolic murmur following an opening snap
Decreased
Increased SV

38. What does FEVERSS stand for in rheumatic heart disease
Gap junctions
Hyperlipidemia
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Mechanican contraction of the ventricles

39. friction rub - 3-5 days post MI
Angiosarcoma
MI
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Postinfarction fibrinous pericarditis

40. Which two mechanisms sense decrease MAP?
Medullary vasomotor center senses baroreceptors and JGA
Right sided
No
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

41. The cause of dyspnea on exertion?
Preload
HypoK and bradycardia
Failure of LV to in CO during exercise
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

42. What causes the cushing reflex and why
P02
Vagus to medulla
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
7 weeks

43. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Angiosarcoma
Mitral stenosis
Kawasaki

44. What are the different etiologies of dialted cardiomyopathy
Black > white > asian
Raynaud's
RCA - II - III - aVF
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

45. How does a patient with Tet of fallot learn to improve symptoms?
R to L shunt caused by stenoic pulmonic valve
Subendocardial
Hyperlipidemia
Squat. Compression of femoral arteries - inc TPR - dec

46. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Viridans streptococci
Henoch - Schlonlein purpura
Myxomatous degeneration - RF - chordae rupture
Angiosarcoma

47. SV CAP means?
Changes in CO as a function of preload
Pulmonic stenosis and RBBB
Stroke volume affected by contractility - afterload - and preload
HTN - bradycardia - and respiratory depression

48. EDV is also known as
Age related calcifications or bicuspid aortic valve
Preload
ASD - VSD - AV septal defect (endocardial cushion defect)
Granuloma with giant cells

49. What happens in phase 3 of the cardiac ventricular action potential?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Subendocardial - fewer collaterals and higher pressure
SA>AV>bundle of His>ventricles
10%

50. What 4 things drive myocardial 02 demand?
140/90
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Dec plasma proteins
Increasing activity of Ca pump in SR