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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 does TAPVR stand for
Cystic hygroma
Increasing activity of Ca pump in SR
Total anomalous pulmonary trunk venous return
RV failure - in venous pressure

2. What causes the CO curve to shift downwards?
Neg inotropy - HF - narcotic overdose
Polyarteritis nodosum
Maintain blood flow to organ over wide range of perfussion pressures
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

3. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Diastolic
Glomus tumor
Anterosuperior displacement of the infundibular septum

4. Which murmur is heard in aortic stenosis?
Crescendo - decrescendo systolic ejection murmur following ejection click
Hemorrhage
Ventricular depolarization - nl < 120 msec
Hyperlipidemia

5. What is indicated when CO and venous return are equal?
The operating point of the heart
Group a beta hemolytic strep
TAPVR
Cystic hygroma

6. When during cardiac nodal cells depolarize?
Total anomalous pulmonary trunk venous return
During diastole
Increase in Pc
Left sided

7. What does prolonged QT predispose to?
Torsades de pointes
Aortic disecction - intraluminal tear forming false lumen
Hematocrit
Inc interstitial osmotic pressure pulling fliud out of capillaries

8. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Sudden tensing of chordae tendinae
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Lymphangiosarcoma
Coarcation of aorta

9. What are aschoff bodies
RF
140/90
Increase intracellular Na - resulting in increased Ca
Granuloma with giant cells

10. what happens to capillaries in lymphatic blockage
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Inc interstitial osmotic pressure pulling fliud out of capillaries
Activated histiocytes

11. polypoid capillary hemangioma that can ulcerate and bleed
At least 55%
During HF from microhemorrhages from inc pulm cap pressure
140/90
Pyogenic granuloma - associated with trauma and pregnancy

12. What are anitschkow's cells
In series
Glomus tumor
Activated histiocytes
Increase - increase the chance the If are open

13. What does FROM JANE stand for in bacterial endocarditis?

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14. What does mitral prolapse predeispose to?
Liver
Prinzmetal angina
Indomethacin closes - and pge keeps it open
Infective endocarditis

15. What kind of dysfunction ensues in restrictive cardiomyopathy
Diastolic
S. bovis
Aortic dilation - bicuspid aortic valve - RF -
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

16. What causes the cushing reflex and why
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Left heart failure
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

17. failure of truncus arteriosus to divide?
At least 55%
Mitral and tricuspid closure
RCA - II - III - aVF
Persistant truncus arteriosus

18. What are the different etiologies of dialted cardiomyopathy
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
In HF
Tempral arteritis - may cause irreversible blindness
CHF

19. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
LAD - V1- V2
Kawasaki
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Afterload (proportional to peripheral resistance)

20. clinical signs of cardiac tamponade
Unstable/crescendo angina
TAPVR
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Adult type aortic coarctation

21. serum marker for wegener's
C - ANCA
Hematocrit
No
LAD - V1 - V4

22. absecnce of tricuspid valve - hypoplastic RV
Right sided
No
Squat. Compression of femoral arteries - inc TPR - dec
Tricuspid atresia - requires ASD and VSD

23. How are cadiac myocytes eltrically coupled?
Polyarteritis nodosum
V fib
Increased efferent SANS and decreased efferent PANS
Gap junctions

24. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Inc central venous pressure - inc resistance to portal flow
Mean arterial pressure
Non
Inc TPR and LA return (expiration)

25. What does the U wave indicated?
No - no pressure gradient
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
HypoK and bradycardia
Takayasu's arteritis

26. In what disease states is blood viscosity increased?
Glossopharyngeal to soliary nucleus of medulla
Vasodilators
Fluid movement through capillaries
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

27. benign cap hemangioma of infancy - spont regresses
Indomethacin closes - and pge keeps it open
Strawberry hemangioma
Fluid movement through capillaries
In parallel

28. p - anca

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29. What is the S2 sound?
Transposition of great vessels
Aortic and pulmonary closing
Mitral stenosis
Increase intracellular Na - resulting in increased Ca

30. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Non
LCX - I - aVL
Libman - sacks endocarditis
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

31. Do you see elevaged ASO titers in rheumatic heart disease
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Yes
Aortic disecction - intraluminal tear forming false lumen
Torsades de pointes

32. What is the association with wide S2 splitting?
Pulmonic stenosis and RBBB
Septal defects - PDA - pulm art stenosis
Glossopharyngeal to soliary nucleus of medulla
LCX - V4- V6

33. If HR is too fast (V tach) what happens during diastole?
Increase - increase the chance the If are open
Filling is incomplete and CO falls
Vasocxn - while other tissues it causes vasodilation
Inc venous return exaccerbates pulm vasc congestion

34. What causes the murmur heard in tricuspid regurg to enhance
RV contraction (closed tricuspid valve bulding into atrium
Mitral and tricuspid closure
In RA return (inspiration)
C - ANCA

35. Why is there edema after burns or during infection
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Inc Kf - capillary perm
Chordae rupture - GN - suppurative pericarditis - emboli
V fib arrhythima

36. moncekberg
Left atrial pressure
Subendocardial - fewer collaterals and higher pressure
Mean arterial pressure
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

37. coronary artery spasm - ST elevation
Changes in CO as a function of preload
Prinzmetal angina
Persistant truncus arteriosus
Dec P02 - inc PC02 and dec pH

38. When and why do you hear the S4 sound
Polyarteritis nodosum
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Lower right - MC - upper right - AO - upper right AC - lower left MO
Atrial contraction

39. What causes aortic regurg
Transfusion
Increased efferent SANS and decreased efferent PANS
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Aortic dilation - bicuspid aortic valve - RF -

40. In an EKG - What is the QRS complex?
Ventricular depolarization - nl < 120 msec
Left heart failure
CFX
In HF

41. Which vessels account for the most total peripheral resistance
Viridans streptococci
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Arteriorles
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

42. What causes the midsystolic click
LAD > RCA > circumflex
Dec P02 - inc PC02 and dec pH
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Sudden tensing of chordae tendinae

43. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Eisenmenger's syndrome
No
Stroke volume affected by contractility - afterload - and preload
TAPVR

44. How does acidosis affect contractility?
Kawasaki
The first 4 days
QRS complex
Decreased

45. PROVe
Metastasis from melanoma or lymphoma
SA>AV>bundle of His>ventricles
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
In parallel

46. What are the four most common locations for atherosclerosis?
Kaposi's sarcoma
Extracellular calcium - calcium induced calcium release
Torsades de pointes
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

47. Which valve is most commonly involved in bacterial endocarditis?
Pos inotropy - exercise
Mitral valve
Adult type aortic coarctation
Inc TPR and LA return (expiration)

48. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Venodilators (nitrogylcerine)
Increase - increase the chance the If are open
Age related calcifications or bicuspid aortic valve
LCX - V4- V6

49. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Metastasis from melanoma or lymphoma
Subendocardial
Dec plasma proteins
Troponin I

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

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