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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 supplies the posterior left ventricle?
Angiosarcoma
CFX
LAD - V1- V2
Changes in CO as a function of preload

2. If HR is too fast (V tach) what happens during diastole?
Medullary vasomotor center senses baroreceptors and JGA
Late diastolic murmur following an opening snap
Filling is incomplete and CO falls
Heart - 02 extraction is always around 100%

3. in the JVP - What is the c wave?
In RA return (inspiration)
RV contraction (closed tricuspid valve bulding into atrium
Libman - sacks endocarditis
140/90

4. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Inc RA pressure - due to filling against closed tricupsid valve
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Viridans streptococci
Venodilators (nitrogylcerine)

5. What causes the CO curve to shift downwards?
Diastolic
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Coarcation of aorta
Neg inotropy - HF - narcotic overdose

6. Right to left shunts are more common in babies or kids?
Babies
Total anomalous pulmonary trunk venous return
Activated histiocytes
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

7. Which two mechanisms sense decrease MAP?
Medullary vasomotor center senses baroreceptors and JGA
Vasocxn - while other tissues it causes vasodilation
Hemorrhage
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

8. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
Septal defects - PDA - pulm art stenosis
Failure of LV to in CO during exercise
Persistant truncus arteriosus

9. disease of elastic arteries and large and medium sized muscular arteries
Maintain blood flow to organ over wide range of perfussion pressures
Pyogenic granuloma - associated with trauma and pregnancy
Strawberry hemangioma
Atherosclerosis

10. In an EKG - What is the QRS complex?
EKG
Lymphangiosarcoma
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Ventricular depolarization - nl < 120 msec

11. fibrous plaques and atheromas in intima of arteries
Atherosclerosis
Dec plasma proteins
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Increase contractility

12. What is the difference between adult and infantile type aortic coarctation?
Squat. Compression of femoral arteries - inc TPR - dec
...
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Myxoma

13. Irregularly irregular ECG - no p waves: dx and treatment
Greater ventricular EDV
Tempral arteritis - may cause irreversible blindness
7 weeks
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

14. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
PDA
HTN - bradycardia - and respiratory depression
LAD - V1- V2
RCA

15. Which murmur is characteristic of mitral/tricuspid regurg?
CO
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Myxomatous degeneration - RF - chordae rupture
Holosystoiic

16. Which bacteria causes rheumatic heart disease
Group a beta hemolytic strep
ANP
Atherosclerosis
Extracellular calcium - calcium induced calcium release

17. with what heart sounds do ASD usually present?
Truncus - tet of fallot
Sturge weber - vasculitis of caps
Pulmonary flow murmur and diastolic rumble
Vasodilators

18. what happens to capillaries in lymphatic blockage
Inc interstitial osmotic pressure pulling fliud out of capillaries
Volatage gated Ca channels
In RA return (inspiration)
Pos inotropy - exercise

19. What causes the midsystolic click
Sudden tensing of chordae tendinae
Boot shaped heart
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Increase in Pc

20. The cause of dyspnea on exertion?
Holosystoiic
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Increase intracellular Na - resulting in increased Ca
Failure of LV to in CO during exercise

21. In an anterior wall infarct - which artery is effected and which leads show Q waves
Vasodilators - (hydrAlAzine)
Granuloma with giant cells
Vagus to medulla
LAD - V1 - V4

22. How are sarcomeres added in concentric hypertrophy?
LAD - V1 - V4
ASD
Liver
In parallel

23. What causes the cushing reflex and why
Mitral stenosis
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
2-4 day - early coag necrosis on the first day
Dilated cardiomyopathy

24. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Viridans streptococci
Lymphangiosarcoma
Subendocardial - fewer collaterals and higher pressure
LAD

25. PCWP is an estimate of...
Atherosclerosis
Granuloma with giant cells
Subendocardial
Left atrial pressure

26. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Venodilators (nitrogylcerine)
Rhabdomyomas
Purkingee>atria>ventricles>AV node

27. p - anca

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28. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Vagus to medulla
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
LAD
S. aureus

29. What does autoregulation do?
Maintain blood flow to organ over wide range of perfussion pressures
Inc TPR and LA return (expiration)
Liver
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

30. When do you find hemosiderin laden macrophages in the lungs?
Atherosclerosis
During HF from microhemorrhages from inc pulm cap pressure
Myxomatous degeneration - RF - chordae rupture
Left heart failure

31. What is the cushing triad?
QRS complex
Kids
HTN - bradycardia - and respiratory depression
Truncus - tet of fallot

32. What is the gold standard for dx of MI in the first 6 hours
EKG
Venodilators (nitrogylcerine)
Increase in Pc
MI

33. Which organ gets the largest share of systemic cardiac output
Liver
Mitral and tricuspid closure
Inc blood volume
Septal defects - PDA - pulm art stenosis

34. When does extracellular calcium enter the cardiac muscle cells during contraction?
LCX - V4- V6
Arteriolosclerosis in malignant hypertension
HTN - bradycardia - and respiratory depression
The plateau period

35. What are the complications from bacterial endocarditis?
Early deaths from myocarditis
CFX
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Chordae rupture - GN - suppurative pericarditis - emboli

36. in the JVP - What is the v wave?
Increase intracellular Na - resulting in increased Ca
RCA
Inc RA pressure - due to filling against closed tricupsid valve
Ventricles are depolarized

37. congenital heart defect withdown syndrome
ASD - VSD - AV septal defect (endocardial cushion defect)
Increase in Pc
Aortic insuffic - late
Prinzmetal angina

38. In an acute MI - are there any visible changes via LM in the first 2-4 hours
No
Increased SV
In RA return (inspiration)
Total anomalous pulmonary trunk venous return

39. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Fick principle
Hemorrhage
Cherry hemangioma
During HF from microhemorrhages from inc pulm cap pressure

40. What is the association with wide S2 splitting?
Pulmonic stenosis and RBBB
Liver
LAD > RCA > circumflex
Yes

41. most common primary cardiac tumor in children - associated with tuberous sclerosis
Filling is incomplete and CO falls
Postinfarction fibrinous pericarditis
Rhabdomyomas
Isovolumetric contraction

42. How do catecholamines increase contractility?
Pulmonic stenosis and RBBB
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Increasing activity of Ca pump in SR
LAD - V1 - V4

43. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
CFX
Transfusion
Anterosuperior displacement of the infundibular septum
Pyogenic granuloma - associated with trauma and pregnancy

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

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45. How does acidosis affect contractility?
Systolic dysfunction
Mitral stenosis
Diastolic
Decreased

46. What do patients die early from in rheumatic heart disease?
Increase - increase the chance the If are open
Vasocxn - while other tissues it causes vasodilation
Late systolic crescendo murmur with a midsystolic click
Early deaths from myocarditis

47. What causes the early cyanosis in Tet of Fallot?
R to L shunt caused by stenoic pulmonic valve
Microscopic polyangiitis - like wegener's without granulomas
ASD - VSD - AV septal defect (endocardial cushion defect)
Atherosclerosis

48. What causes aortic stenosis
Apex and anterior interventricular septum
Age related calcifications or bicuspid aortic valve
The plateau period
Greater ventricular EDV

49. In terms of starling forces - why does heart failure cause edema?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Increase in Pc
Transposition of great vessels
Stable angina

50. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Vasodilators
Mechanican contraction of the ventricles
Fick principle
Myxomatous degeneration - RF - chordae rupture