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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. PCWP is an estimate of...
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
During diastole
Left atrial pressure
Myxomatous degeneration - RF - chordae rupture

2. What causes the murmur heard in MR to enhance?
Stroke volume
Septal defects - PDA - pulm art stenosis
Black > white > asian
Inc TPR and LA return (expiration)

3. clinical signs of cardiac tamponade
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Venodilators (nitrogylcerine)
LAD - V1- V2
Microscopic polyangiitis - like wegener's without granulomas

4. What are the different etiologies of dialted cardiomyopathy
Subendocardial
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Raynaud's
V fib

5. How does aldosterone raise MAP
Cystic hygroma
Pulmonic stenosis and RBBB
Hyperlipidemia
Inc blood volume

6. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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7. PCWP > LV diastolic pressure
Increase contractility
Temporal arteritis
Inc TPR and LA return (expiration)
Mitral stenosis

8. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Adult type aortic coarctation
V fib
QRS complex
Ischemic heart dz - mitral valve prolapse - LV dilation

9. benign - painful - red - blue tumor under fingernails from smooth muscle cells
...
Infective endocarditis
Glomus tumor
No - no pressure gradient

10. What causes the CO curve to shift downwards?
Pulsus parvus and tardus - weak - can lead to syncope
Boot shaped heart
Neg inotropy - HF - narcotic overdose
Dilation

11. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Hyperlipidemia
5-10 days - macs have degraded structural components
Increased SV
Mitral stenosis

12. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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13. Which enzymes are useful for diagnosing reinfarction
Subendocardial - fewer collaterals and higher pressure
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Fetal right to left - neonate left to right leading to RVH and failure
CK- MB

14. What happens in phase 4 of the cardiac ventricular action potential?
Resting potential high K perm
Failure of LV to in CO during exercise
Medullary vasomotor center senses baroreceptors and JGA
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

15. Where are pacemaker cells?
SA and AV nodes
Filling is incomplete and CO falls
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
LAD > RCA > circumflex

16. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Dressler's - autoimmune
Stroke volume affected by contractility - afterload - and preload
EKG
Stable angina

17. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Heart - 02 extraction is always around 100%
Eccentric - concentric hypertrophy causes diastolic disfunction
MI

18. Rank the pacemakers cells
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
SA>AV>bundle of His>ventricles
SA and AV nodes

19. What does the LAD supply?
Resting potential high K perm
Apex and anterior interventricular septum
Indomethacin closes - and pge keeps it open
LCX - V4- V6

20. What is the most common cause of right heart failure
Early deaths from myocarditis
Crescendo - decrescendo systolic ejection murmur following ejection click
Left heart failure
If sodium channel

21. The cause of dyspnea on exertion?
Chordae rupture - GN - suppurative pericarditis - emboli
The plateau period
Lower right - MC - upper right - AO - upper right AC - lower left MO
Failure of LV to in CO during exercise

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

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23. Which valve is most commonly involved in bacterial endocarditis?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
RCA - II - III - aVF
Unstable/crescendo angina
Mitral valve

24. What happens in phase 3 of the cardiac ventricular action potential?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Increase intracellular Na - resulting in increased Ca
Unstable/crescendo angina
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

25. fibrinous pericarditis several weeks post MI

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26. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
Cyclophosphamide and corticosteroids
2nd degree AV block - mobitz type 1
Squat. Compression of femoral arteries - inc TPR - dec

27. What is the formula for EF?
SV/ EDV
Polyarteritis nodosum
Aortic and pulmonary closing
S. epidermidis

28. What can cause mitral prolapse?
Squat. Compression of femoral arteries - inc TPR - dec
Myxomatous degeneration - RF - chordae rupture
HTN - bradycardia - and respiratory depression
Polyarteritis nodosum

29. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
2-4 day - early coag necrosis on the first day
Pyogenic granuloma - associated with trauma and pregnancy
LCX - I - aVL
Aortic/pulmonic regurg and mitral/tricuspid stenosis

30. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Dressler's - autoimmune
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Henoch - Schlonlein purpura
Aortic and pulmonary closing

31. How does acidosis affect contractility?
HypoK and bradycardia
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Decreased
Persistant truncus arteriosus

32. In what disease states is blood viscosity increased?
Microscopic polyangiitis - like wegener's without granulomas
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
MAP
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

33. The cause of cardiac dilation?
MAP
2nd degree AV block - mobitz type 1
HTN - bradycardia - and respiratory depression
Greater ventricular EDV

34. What 4 things drive myocardial 02 demand?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Pos inotropy - exercise
Cardiac tamponde

35. What supplies the posterior left ventricle?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Atherosclerosis
CFX

36. moncekberg
SA>AV>bundle of His>ventricles
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Black > white > asian

37. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Increase contractility
Sturge weber - vasculitis of caps
Hemorrhage
Mitral and tricuspid closure

38. In an EKG - What is the QRS complex?
Polyarteritis nodosum
Glossopharyngeal to soliary nucleus of medulla
Ventricular depolarization - nl < 120 msec
Mitral and tricuspid closure

39. What do patients die early from in rheumatic heart disease?
C - ANCA
The aortic before pulmonic - inspiration increases diff
Early deaths from myocarditis
Holosystoiic

40. What channels do the the pacemaker cells lack?
Mitral>aortic>>tricuspid - high pressure valves affected most
Infective endocarditis
SA and AV nodes
Fast volatge gated Na channels

41. What does increasing intracellular Ca do?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Increase contractility
Kids
Wolff - Parkinson white syndrome

42. Which bacteria causes endocarditis in the presence of colon cancer
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Late diastolic murmur following an opening snap
S. bovis
Vasodilators

43. congenital heart defect in an infant with a diabetic mother?
Hyperlipidemia
Transposition of great vessels
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Myxoma

44. What are the systolic heart sounds
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Aburpt halting of valve leaflets
Aortic/pulmonic stenosis and mitral/tricuspid regurg
RCA

45. What cardiac change occurs in pregnancy?
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Increased SV
The aortic before pulmonic - inspiration increases diff
Squat. Compression of femoral arteries - inc TPR - dec

46. cavernous lymphangioma of the neck - associated with turner's
Eccentric - concentric hypertrophy causes diastolic disfunction
Cystic hygroma
ASD
Aortic/pulmonic regurg and mitral/tricuspid stenosis

47. What are the 5 T's of cyanoitc babies
LV failure - pulm venous distention transudation of fluid
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Myxomatous degeneration - RF - chordae rupture
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

48. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Black > white > asian
Afterload (proportional to peripheral resistance)
Cyclophosphamide and corticosteroids
MI

49. What do the starling forces determine
Fluid movement through capillaries
Anterosuperior displacement of the infundibular septum
Crescendo - decrescendo systolic ejection murmur following ejection click
Fetal right to left - neonate left to right leading to RVH and failure

50. In terms of starling forces - why does heart failure cause edema?
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
PDA
Increase in Pc
Purkingee>atria>ventricles>AV node