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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. Which murmur is heard with mitral prolapse?
Late systolic crescendo murmur with a midsystolic click
Black > white > asian
Maintain blood flow to organ over wide range of perfussion pressures
Glossopharyngeal to soliary nucleus of medulla

2. fibrinous pericarditis several weeks post MI

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3. In an EKG - What is the T wave?
Ventricular repolarization
Increase intracellular Na - resulting in increased Ca
Holosystoiic
Unstable/crescendo angina

4. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Vasodilators
Fetal right to left - neonate left to right leading to RVH and failure
At least 55%
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

5. which medications are used to maintain patency or close the ductus arteriosus?
Indomethacin closes - and pge keeps it open
In HF
Acute thrombosis of coronary artery
SA>AV>bundle of His>ventricles

6. What does an isoelectric ST segment indicate?
Ventricles are depolarized
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Atrial contraction

7. What constitues the upstroke in pacemaker cells?
Crescendo - decrescendo systolic ejection murmur following ejection click
Cystic hygroma
Volatage gated Ca channels
2nd degree AV block - mobitz type 1

8. Exercise - overtransfusiion and excitiment causes and increase in...?
Right sided
Preload
LAD - V1 - V4
Vagus to medulla

9. How does digitatlis increase contractility?
Fluid movement through capillaries
Fetal right to left - neonate left to right leading to RVH and failure
Can progess to V fib
Increase intracellular Na - resulting in increased Ca

10. congenital heart defect with 22q11
Babies
Neg inotropy - HF - narcotic overdose
Truncus - tet of fallot
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

11. tearing chest pain radiation to the back - associated with marfan
In parallel
Purkingee>atria>ventricles>AV node
Aortic disecction - intraluminal tear forming false lumen
Pyogenic granuloma - associated with trauma and pregnancy

12. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Septal defects - PDA - pulm art stenosis
RCA - II - III - aVF
Henoch - Schlonlein purpura
The operating point of the heart

13. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Lymphangiosarcoma
Anterosuperior displacement of the infundibular septum
Failure of LV to in CO during exercise
R to L shunt caused by stenoic pulmonic valve

14. What is the cushing triad?
SA and AV nodes
Cyclophosphamide and corticosteroids
CO
HTN - bradycardia - and respiratory depression

15. What is associated with paradoxical spliting of S2
Extracellular calcium - calcium induced calcium release
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Aortic stenosis or LBBB
Rhabdomyomas

16. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Aortic stenosis or LBBB
Purkingee>atria>ventricles>AV node
Black > white > asian
Kaposi's sarcoma

17. Which bacteria causes endocarditis in the presence of colon cancer
Systolic dysfunction
MI
Transposition of great vessels
S. bovis

18. Why is there edema after burns or during infection
In series
Arteriolosclerosis in malignant hypertension
Inc Kf - capillary perm
Posterior descending (80% off the RCA - 20% off the circumflex)

19. polypoid capillary hemangioma that can ulcerate and bleed
During HF from microhemorrhages from inc pulm cap pressure
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Pyogenic granuloma - associated with trauma and pregnancy
Temporal arteritis

20. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Troponin I
Ventricular depolarization - nl < 120 msec
LV failure - pulm venous distention transudation of fluid
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

21. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Dec plasma proteins
ASD
S. bovis
Infective endocarditis

22. In what disease states is blood viscosity increased?
During HF from microhemorrhages from inc pulm cap pressure
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

23. stroke volume x HR =?
During diastole
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Mitral stenosis
CO

24. Which two mechanisms sense decrease MAP?
Septal defects - PDA - pulm art stenosis
Medullary vasomotor center senses baroreceptors and JGA
Wegener's
Glossopharyngeal to soliary nucleus of medulla

25. When does EF decrease
LAD - V1 - V4
LAD > RCA > circumflex
Pulmonic stenosis and RBBB
In HF

26. In an EKG - What is the QRS complex?
EKG
Takayasu's arteritis
Ventricular depolarization - nl < 120 msec
1st degree AV blodck

27. necrotizing granulomas in lung and upper airways - nectrotizing GN - small vessel vasculitis

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28. what happens to capillaries in lymphatic blockage
Inc TPR and LA return (expiration)
Early deaths from myocarditis
Total anomalous pulmonary trunk venous return
Inc interstitial osmotic pressure pulling fliud out of capillaries

29. What are the diastolic heart sounds?
Raynaud's
CO
Aortic/pulmonic regurg and mitral/tricuspid stenosis
MI

30. In terms of starling forces - why does heart failure cause edema?
Cherry hemangioma
Increase in Pc
Aortic/pulmonic stenosis and mitral/tricuspid regurg
MAP

31. prolonged PR interval
V fib arrhythima
1st degree AV blodck
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Aortic dilation - bicuspid aortic valve - RF -

32. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Hemorrhage
CO
Diastolic
Mitral and tricuspid closure

33. what percentage of HTN is secondary to renal disease?
Ventricles are depolarized
10%
Venodilators (nitrogylcerine)
Holosystolic - harsh sounding murmur - loudest over tricuspid area

34. systolic - diastolic
Pulse pressure
MI
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Pulsus parvus and tardus - weak - can lead to syncope

35. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Posterior descending (80% off the RCA - 20% off the circumflex)
Venodilators (nitrogylcerine)
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Decreases

36. What can cause mitral prolapse?
Transfusion
Glomus tumor
Myxomatous degeneration - RF - chordae rupture
V fib

37. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Wolff - Parkinson white syndrome
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Increasing activity of Ca pump in SR
Prinzmetal angina

38. What does HTN predispose to?
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Prinzmetal angina
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
V fib

39. congenital heart defect withdown syndrome
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
MAP
ASD - VSD - AV septal defect (endocardial cushion defect)
Dilated cardiomyopathy

40. What supplies the posterior left ventricle?
Increase intracellular Na - resulting in increased Ca
Mitral>aortic>>tricuspid - high pressure valves affected most
CFX
Failure of LV to in CO during exercise

41. Wegener's tx
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Polyarteritis nodosum
Cyclophosphamide and corticosteroids
Mitral stenosis

42. What other syndrom is associated with infantile aortic coarctation
Turners
3rd degree block - pacemaker - Lyme disease
HTN - bradycardia - and respiratory depression
Squat. Compression of femoral arteries - inc TPR - dec

43. What do the starling forces determine
Apex and anterior interventricular septum
Decrease in activity of Na/Ca exhanger and increase in contractility
HypoK and bradycardia
Fluid movement through capillaries

44. What is the most common cause of MI
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Anterosuperior displacement of the infundibular septum
Acute thrombosis of coronary artery
Pyogenic granuloma - associated with trauma and pregnancy

45. What happens in phase 0 of the cardiac ventricular action potential?
Vasocxn
Rapid upstroke - voltage gated Na channels open
Transfusion
In RA return (inspiration)

46. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
TAPVR
No - no pressure gradient
Wolff - Parkinson white syndrome
Atrial contraction

47. Central chemoreceptors do not respond directly to which parameter?
P02
Unstable/crescendo angina
The first 4 days
Squat. Compression of femoral arteries - inc TPR - dec

48. How do catecholamines increase contractility?
LV failure - pulm venous distention transudation of fluid
PDA
Increasing activity of Ca pump in SR
Right sided

49. Which murmur do you hear in mitral stenosis?
Ventricular repolarization
If sodium channel
Late diastolic murmur following an opening snap
Kids

50. What channels do the the pacemaker cells lack?
Acute thrombosis of coronary artery
Fast volatge gated Na channels
TAPVR
Vasocxn