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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. 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
Prinzmetal angina
Heart - 02 extraction is always around 100%
Black > white > asian

2. SV CAP means?
Stroke volume affected by contractility - afterload - and preload
MAP
Strawberry hemangioma
Indomethacin closes - and pge keeps it open

3. Which valve is most commonly involved in bacterial endocarditis?
3rd degree block - pacemaker - Lyme disease
Mitral valve
CK- MB
Chordae rupture - GN - suppurative pericarditis - emboli

4. What causes the cushing reflex and why
Failure of LV to in CO during exercise
Lymphangiosarcoma
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
S. aureus

5. When do coronary arteries fill?
Group a beta hemolytic strep
During diastole
Adult type aortic coarctation
QRS complex

6. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Libman - sacks endocarditis
Atherosclerosis
Non
Isovolumetric contraction

7. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Hyperlipidemia
Myxomatous degeneration - RF - chordae rupture
LCX - V4- V6

8. What happens in phase 4 of the cardiac ventricular action potential?
Age related calcifications or bicuspid aortic valve
Resting potential high K perm
...
Ischemic heart dz - mitral valve prolapse - LV dilation

9. Which area of the endocardium is especially vulnerable to infarction? Why?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Dressler's - autoimmune
Subendocardial - fewer collaterals and higher pressure
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

10. What are the 5 T's of cyanoitc babies
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
S. bovis
Medullary vasomotor center senses baroreceptors and JGA
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

11. What is sudden cardiac death most commonly due to...
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
V fib arrhythima
Arteriolosclerosis in malignant hypertension
Mitral and tricuspid closure

12. congenital heart defect with marfan's
Aortic insuffic - late
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Inc interstitial osmotic pressure pulling fliud out of capillaries
In series

13. What does hypoxia cause in the lung versus other tissues?
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Vasocxn - while other tissues it causes vasodilation
Wegener's
RCA

14. What does FEVERSS stand for in rheumatic heart disease
Angiosarcoma
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Age related calcifications or bicuspid aortic valve

15. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Varicose veins - thromboembolism rare
Afterload (proportional to peripheral resistance)
SA>AV>bundle of His>ventricles
Myxomatous degeneration - RF - chordae rupture

16. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Volatage gated Ca channels
Increasing activity of Ca pump in SR
Atherosclerosis
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

17. Which vessels account for the most total peripheral resistance
Stroke volume
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Stable angina
Arteriorles

18. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
No - no pressure gradient
During HF from microhemorrhages from inc pulm cap pressure
Truncus - tet of fallot
CHF

19. In terms of starling forces - why does heart failure cause edema?
LAD - V1- V2
The operating point of the heart
1st degree AV blodck
Increase in Pc

20. PCWP is an estimate of...
Hemorrhage
Left atrial pressure
Pulmonary flow murmur and diastolic rumble
RF

21. What are the systolic heart sounds
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Acute thrombosis of coronary artery
Microscopic polyangiitis - like wegener's without granulomas
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

22. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
V fib arrhythima
Viridans streptococci
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

23. What causes orthopnea?
ANP
Cherry hemangioma
Myxoma
Inc venous return exaccerbates pulm vasc congestion

24. When do you find hemosiderin laden macrophages in the lungs?
Neg inotropy - HF - narcotic overdose
During HF from microhemorrhages from inc pulm cap pressure
In HF
Acute thrombosis of coronary artery

25. in the JVP - What is the a wave?
Libman - sacks endocarditis
Atrial contraction
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Systolic dysfunction

26. What stimulates release of calcium from the SR?
Inc RA pressure - due to filling against closed tricupsid valve
Extracellular calcium - calcium induced calcium release
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Anterosuperior displacement of the infundibular septum

27. dyspnea - fatigue - edema and rales - multiple causes
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
HTN - bradycardia - and respiratory depression
Granuloma with giant cells
CHF

28. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
S. aureus
Myxomatous degeneration - RF - chordae rupture
Septal defects - PDA - pulm art stenosis

29. Wegener's tx
140/90
Raynaud's
Proportional to viscosity and inversely proportional to the radius to the 4th power
Cyclophosphamide and corticosteroids

30. The aortic arch receptors transmit along which nerve?
Vagus to medulla
Granuloma with giant cells
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Pos inotropy - exercise

31. Rank the pacemakers cells
Dec plasma proteins
ASD - VSD - AV septal defect (endocardial cushion defect)
SA>AV>bundle of His>ventricles
No

32. disease of elastic arteries and large and medium sized muscular arteries
Decrease in cAMP
CHF
Atherosclerosis
Hematocrit

33. Which bacteria causes endocarditis in the presence of colon cancer
Torsades de pointes
S. epidermidis
Diastolic
S. bovis

34. What causes the CO curve to shift downwards?
Neg inotropy - HF - narcotic overdose
Atrial contraction
LCX - V4- V6
Polyarteritis nodosum

35. which medications are used to maintain patency or close the ductus arteriosus?
Indomethacin closes - and pge keeps it open
Right sided
CHF
Raynaud's

36. coronary artery spasm - ST elevation
Polyarteritis nodosum
Prinzmetal angina
Truncus - tet of fallot
Arteriorles

37. What is the danger of torsades to pointes?
Can progess to V fib
Tricuspid atresia - requires ASD and VSD
Torsades de pointes
Angiosarcoma

38. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Unstable/crescendo angina
Coarcation of aorta
Inc Kf - capillary perm
During HF from microhemorrhages from inc pulm cap pressure

39. Right to left shunts are more common in babies or kids?
In HF
Liver
Viridans streptococci
Babies

40. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
If sodium channel
SA>AV>bundle of His>ventricles
Henoch - Schlonlein purpura
Left heart failure

41. Which organ gets the largest share of systemic cardiac output
No - no pressure gradient
Liver
If sodium channel
Acute thrombosis of coronary artery

42. EDV is also known as
Proportional to viscosity and inversely proportional to the radius to the 4th power
Transmural
Cyclophosphamide and corticosteroids
Preload

43. which ethnic groups have higher association with HTN?
Takayasu's arteritis
Black > white > asian
Viridans streptococci
Granuloma with giant cells

44. fibrinous pericarditis several weeks post MI

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45. How does acidosis affect contractility?
LCX - I - aVL
Decreased
Indomethacin closes - and pge keeps it open
Inc RA pressure - due to filling against closed tricupsid valve

46. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
In RA return (inspiration)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Aortic dilation - bicuspid aortic valve - RF -

47. CO x Total peripheral resistance
S. bovis
Pyogenic granuloma - associated with trauma and pregnancy
Inc blood volume
Mean arterial pressure

48. Which sympathetic receptors raise MAP
Subendocardial
Strawberry hemangioma
MI
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

49. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Purkingee>atria>ventricles>AV node
Sturge weber - vasculitis of caps
Babies

50. Do you see elevaged ASO titers in rheumatic heart disease
ASD
Fick principle
Yes
Diastolic