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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 causes ankle - sacral edema - jugular venous distention
Boot shaped heart
RV failure - in venous pressure
Pyogenic granuloma - associated with trauma and pregnancy
LCX - V4- V6

2. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Tricuspid atresia - requires ASD and VSD
Kawasaki
Indomethacin closes - and pge keeps it open
Transmural

3. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Increasing activity of Ca pump in SR
7 weeks
Ventricles are depolarized
No

4. PCWP > LV diastolic pressure
Mitral stenosis
Left atrial pressure
Viridans streptococci
Sturge weber - vasculitis of caps

5. What does increasing intracellular Ca do?
Increase contractility
Preload
In RA return (inspiration)
LAD > RCA > circumflex

6. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Polyarteritis nodosum
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
At least 55%
RCA

7. What is the danger of torsades to pointes?
Can progess to V fib
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Mitral stenosis
S. aureus

8. Which murmur is characteristic of mitral/tricuspid regurg?
Vasocxn - while other tissues it causes vasodilation
Takayasu's arteritis
Indomethacin closes - and pge keeps it open
Holosystoiic

9. What is the most common cause of MI
Acute thrombosis of coronary artery
Maintain blood flow to organ over wide range of perfussion pressures
Cherry hemangioma
S. epidermidis

10. In an EKG - What is the PR interval?
Aortic and pulmonary closing
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Conduction delay through AV node - nl < 200 msec

11. The carotid sinus transmits along which nerve?
Cherry hemangioma
Aortic disecction - intraluminal tear forming false lumen
Glossopharyngeal to soliary nucleus of medulla
Total anomalous pulmonary trunk venous return

12. What 4 things drive myocardial 02 demand?
Right sided
Holosystoiic
Stroke volume affected by contractility - afterload - and preload
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

13. most common primary cardiac tumor in children - associated with tuberous sclerosis
Rhabdomyomas
The operating point of the heart
P02
2nd degree AV block - mobitz type 1

14. Why is there edema after burns or during infection
Inc Kf - capillary perm
SV/ EDV
Varicose veins - thromboembolism rare
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

15. What is the cushing triad?
LCX - V4- V6
HTN - bradycardia - and respiratory depression
Left atrial pressure
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

16. Wegener's tx
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Angiosarcoma
SV/ EDV
Cyclophosphamide and corticosteroids

17. What is association with fixed S2 splitting - does not increase with inspiration
ASD
No - no pressure gradient
Atrial contraction
Medullary vasomotor center senses baroreceptors and JGA

18. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Aortic disecction - intraluminal tear forming false lumen
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Adult type aortic coarctation
Pulmonic stenosis and RBBB

19. In an anterior wall infarct - which artery is effected and which leads show Q waves
Inc RA pressure - due to filling against closed tricupsid valve
Maintain blood flow to organ over wide range of perfussion pressures
LAD - V1 - V4
The plateau period

20. How do beta blockers decrease contractility?
Decrease in cAMP
R to L shunt caused by stenoic pulmonic valve
SA>AV>bundle of His>ventricles
PDA

21. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
LCX - V4- V6
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

22. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Subendocardial
Viridans streptococci
Pyogenic granuloma - associated with trauma and pregnancy
Torsades de pointes

23. When is the scar completely formed in an MI?
Microscopic polyangiitis - like wegener's without granulomas
7 weeks
Holosystoiic
Chordae rupture - GN - suppurative pericarditis - emboli

24. What constitues the upstroke in pacemaker cells?
Ventricular depolarization - nl < 120 msec
Fluid movement through capillaries
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Volatage gated Ca channels

25. What causes the CO curve to shift downwards?
No
Torsades de pointes
Polyarteritis nodosum
Neg inotropy - HF - narcotic overdose

26. Which murmur is heard with VSD?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Turners
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Holosystolic - harsh sounding murmur - loudest over tricuspid area

27. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Age related calcifications or bicuspid aortic valve
CFX
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Venodilators (nitrogylcerine)

28. pulseless disease - granulomatous thickening of the aortic arch and/or proximal great vessels - elev ESR - asian females > 40

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29. What happends in phase 1 of the ventricular cardiac action potential?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Liver
Rapid upstroke - voltage gated Na channels open

30. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Increase - increase the chance the If are open
Mitral and tricuspid closure
Apex and anterior interventricular septum

31. What are common causes of mitral regurg?
Pulse pressure
Ischemic heart dz - mitral valve prolapse - LV dilation
Maintain blood flow to organ over wide range of perfussion pressures
Glomus tumor

32. What happens with a decrease of extracellular Na
Decrease in activity of Na/Ca exhanger and increase in contractility
Diastolic
Cardiac tamponde
Dressler's - autoimmune

33. in the JVP - What is the c wave?
RV contraction (closed tricuspid valve bulding into atrium
Eisenmenger's syndrome
Age related calcifications or bicuspid aortic valve
Changes in CO as a function of preload

34. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Hemorrhage
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
During HF from microhemorrhages from inc pulm cap pressure

35. Left to right shunts are more common in babies or kids?
Pulmonary flow murmur and diastolic rumble
Kids
Fetal right to left - neonate left to right leading to RVH and failure
Resting potential high K perm

36. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
EKG
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Hyperlipidemia

37. When during cardiac nodal cells depolarize?
During diastole
Pulse pressure
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

38. What does FEVERSS stand for in rheumatic heart disease
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Septal defects - PDA - pulm art stenosis
Takayasu's arteritis
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

39. Where is the most posterior portion of the heart and What can it cause?
The plateau period
SV/ EDV
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Maintain blood flow to organ over wide range of perfussion pressures

40. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Dilated cardiomyopathy
Glomus tumor
Purkingee>atria>ventricles>AV node

41. What are the 5 T's of cyanoitc babies
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
At least 55%
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
P02

42. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Tempral arteritis - may cause irreversible blindness
Subendocardial
Cardiac tamponde
PDA

43. polypoid capillary hemangioma that can ulcerate and bleed
CK- MB
Sudden tensing of chordae tendinae
Pyogenic granuloma - associated with trauma and pregnancy
Arteriolosclerosis in malignant hypertension

44. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
LAD - V1- V2
Tempral arteritis - may cause irreversible blindness
Vagus to medulla

45. Right to left shunts are more common in babies or kids?
Arteriolosclerosis in malignant hypertension
Right sided
Conduction delay through AV node - nl < 200 msec
Babies

46. Irregularly irregular ECG - no p waves: dx and treatment
Afterload (proportional to peripheral resistance)
7 weeks
Buerger's disease
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

47. What are the complications from bacterial endocarditis?
Fast volatge gated Na channels
Dec P02 - inc PC02 and dec pH
LAD
Chordae rupture - GN - suppurative pericarditis - emboli

48. list the coronary vessels most likely to be occluded
Turners
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Aortic/pulmonic regurg and mitral/tricuspid stenosis
LAD > RCA > circumflex

49. What causes the cushing reflex and why
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Eccentric - concentric hypertrophy causes diastolic disfunction
Purkingee>atria>ventricles>AV node

50. Which artery supplies the SA and AV nodes?
RCA
Preload
Proportional to viscosity and inversely proportional to the radius to the 4th power
Extracellular calcium - calcium induced calcium release