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Cardiology

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What other syndrom is associated with infantile aortic coarctation
7 weeks
RV failure - in venous pressure
RF
Turners

2. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Pulmonary flow murmur and diastolic rumble
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
LAD - V1- V2
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

3. list the coronary vessels most likely to be occluded
Chordae rupture - GN - suppurative pericarditis - emboli
Pos inotropy - exercise
Pulmonary flow murmur and diastolic rumble
LAD > RCA > circumflex

4. When do you see extensive coagulative necrosis in an MI
No
Cherry hemangioma
2-4 day - early coag necrosis on the first day
Non

5. Which class of drugs decrease the murmur heard in aortic regurg?
Vasodilators
Aortic disecction - intraluminal tear forming false lumen
The aortic before pulmonic - inspiration increases diff
Eisenmenger's syndrome

6. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
7 weeks
Increase intracellular Na - resulting in increased Ca

7. What causes the midsystolic click
Sudden tensing of chordae tendinae
At least 55%
Mean arterial pressure
Pyogenic granuloma - associated with trauma and pregnancy

8. Which sympathetic receptors raise MAP
At least 55%
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

9. What other sign is often present with congenital long QT syndrome - why?
Right sided
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
P02
Aortic stenosis or LBBB

10. clinical signs of cardiac tamponade
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
LAD > RCA > circumflex
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Dressler's - autoimmune

11. What causes the cushing reflex and why
Aortic disecction - intraluminal tear forming false lumen
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
2nd degree AV block - mobitz type 1
Mitral>aortic>>tricuspid - high pressure valves affected most

12. What are anitschkow's cells
Activated histiocytes
Postinfarction fibrinous pericarditis
Kidney
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

13. absecnce of tricuspid valve - hypoplastic RV
Wegener's
LCX - V4- V6
Tricuspid atresia - requires ASD and VSD
Babies

14. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Inc venous return exaccerbates pulm vasc congestion
Viridans streptococci
During diastole
Libman - sacks endocarditis

15. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Aortic dilation - bicuspid aortic valve - RF -
Holosystoiic
Varicose veins - thromboembolism rare
Mitral valve prolapse

16. Do you see elevaged ASO titers in rheumatic heart disease
140/90
The aortic before pulmonic - inspiration increases diff
Yes
LAD - V1- V2

17. Given P = QR - what factors influence resistance?
MI
Changes in CO as a function of preload
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Proportional to viscosity and inversely proportional to the radius to the 4th power

18. How does digitatlis increase contractility?
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
R to L shunt caused by stenoic pulmonic valve
Increase intracellular Na - resulting in increased Ca
Lymphangiosarcoma

19. Which murmur is characteristic of mitral/tricuspid regurg?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Mitral valve
Holosystoiic
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

20. The cause of cardiac dilation?
Fast volatge gated Na channels
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Maintain blood flow to organ over wide range of perfussion pressures
Greater ventricular EDV

21. benign cap hemangioma of infancy - spont regresses
Activated histiocytes
Patent ductus arteriosus - congenital rubella or prematurity
Increased SV
Strawberry hemangioma

22. What is the machine like murmur? What is the heart pathology and the predisposing causes
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Patent ductus arteriosus - congenital rubella or prematurity
Adult type aortic coarctation
Dilated cardiomyopathy

23. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Fick principle
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Stable angina
Decrease in cAMP

24. bening capillary hemangioma of elderly - does not regress
Cherry hemangioma
Neg inotropy - HF - narcotic overdose
Arteriolosclerosis in malignant hypertension
Vasodilators

25. fibrinous pericarditis several weeks post MI

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26. What are the different etiologies of dialted cardiomyopathy
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Aortic dilation - bicuspid aortic valve - RF -
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Changes in CO as a function of preload

27. What 4 things drive myocardial 02 demand?
Hypertrophied cardiomyopathy
The operating point of the heart
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
LV failure - pulm venous distention transudation of fluid

28. What is the danger of torsades to pointes?
Total anomalous pulmonary trunk venous return
Can progess to V fib
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Lower right - MC - upper right - AO - upper right AC - lower left MO

29. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Increase in Pc
Aburpt halting of valve leaflets
Turners
Transfusion

30. Which bacteria causes rheumatic heart disease
Liver
Late diastolic murmur following an opening snap
Kidney
Group a beta hemolytic strep

31. In normal S2 splitting - which valve closes first? What increases it?
The aortic before pulmonic - inspiration increases diff
Fluid movement through capillaries
Ventricular repolarization
Pulmonic stenosis and RBBB

32. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Increase intracellular Na - resulting in increased Ca
LCX - V4- V6
LV failure - pulm venous distention transudation of fluid
Rapid upstroke - voltage gated Na channels open

33. Most common vasculitis affecting medium and large arteries
Inc Kf - capillary perm
10%
Temporal arteritis
Dec P02 - inc PC02 and dec pH

34. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Angiosarcoma
Increased efferent SANS and decreased efferent PANS
Postinfarction fibrinous pericarditis
Squat. Compression of femoral arteries - inc TPR - dec

35. Which murmur is heard with mitral prolapse?
In series
Late systolic crescendo murmur with a midsystolic click
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Wolff - Parkinson white syndrome

36. disease of elastic arteries and large and medium sized muscular arteries
Atherosclerosis
MI
S. bovis
Hematocrit

37. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
R to L shunt caused by stenoic pulmonic valve
Diastolic
Hypertrophied cardiomyopathy
Aortic/pulmonic regurg and mitral/tricuspid stenosis

38. What is the cushing triad?
Pulsus parvus and tardus - weak - can lead to syncope
Increase contractility
PDA
HTN - bradycardia - and respiratory depression

39. In the cardiac cycle - which period has the highest 02 consumption?
Isovolumetric contraction
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Dilated cardiomyopathy

40. What is associated with paradoxical spliting of S2
Lymphangiosarcoma
Stroke volume
Increase contractility
Aortic stenosis or LBBB

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

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42. Expiration causes an increase in which sided heart sounds
Left sided
Kids
Aortic disecction - intraluminal tear forming false lumen
7 weeks

43. What are the complications of atherosclerosis?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Medullary vasomotor center senses baroreceptors and JGA
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

44. Which two mechanisms sense decrease MAP?
Medullary vasomotor center senses baroreceptors and JGA
Anterosuperior displacement of the infundibular septum
In series
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

45. In an inferior wall infarct - which artery is affected and which leads show Q waves
Kawasaki
RCA - II - III - aVF
Babies
Aortic stenosis or LBBB

46. What causes the CO curve to shift downwards?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
SV/ EDV
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Neg inotropy - HF - narcotic overdose

47. Unilateral headache - jaw claudication - impaired vision
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
MI
Tempral arteritis - may cause irreversible blindness
Coarcation of aorta

48. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Systolic dysfunction
Aortic dilation - bicuspid aortic valve - RF -
Wegener's
No - no pressure gradient

49. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Gap junctions
Babies
Posterior descending (80% off the RCA - 20% off the circumflex)
Heart - 02 extraction is always around 100%

50. What is a normal EF
At least 55%
Increase - increase the chance the If are open
Wolff - Parkinson white syndrome
Kids