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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. The cause of cardiac dilation?
Greater ventricular EDV
Inc RA pressure - due to filling against closed tricupsid valve
LCX - V4- V6
Ischemic heart dz - mitral valve prolapse - LV dilation

2. What happens in phase 4 of the cardiac ventricular action potential?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
RCA
Aortic stenosis or LBBB
Resting potential high K perm

3. What happens in phase 2 of the cardiac ventricular action potential?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Hyperlipidemia
Extracellular calcium - calcium induced calcium release
EKG

4. In an EKG - What is the QRS complex?
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Libman - sacks endocarditis
Stroke volume affected by contractility - afterload - and preload
Ventricular depolarization - nl < 120 msec

5. In an anterior wall infarct - which artery is effected and which leads show Q waves
LAD - V1 - V4
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Black > white > asian
Sturge weber - vasculitis of caps

6. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Early deaths from myocarditis
Myxoma
Left sided
MAP

7. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
MAP
MI
CK- MB
Stable angina

8. Which class of drugs decrease the murmur heard in aortic regurg?
Vasodilators
Atrial contraction
CHF
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

9. failure of truncus arteriosus to divide?
Purkingee>atria>ventricles>AV node
Can progess to V fib
Atherosclerosis
Persistant truncus arteriosus

10. Which organ has ht highest blood flow per gram of tissue
Kidney
Isovolumetric contraction
During HF from microhemorrhages from inc pulm cap pressure
LAD > RCA > circumflex

11. Which murmur is heard with VSD?
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
LAD > RCA > circumflex
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Heart - 02 extraction is always around 100%

12. prolonged PR interval
1st degree AV blodck
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Preload
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

13. Where is the most posterior portion of the heart and What can it cause?
Left sided
Fast volatge gated Na channels
EKG
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

14. What kind of dysfunction ensues in restrictive cardiomyopathy
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Fast volatge gated Na channels
Lymphangiosarcoma
Diastolic

15. What is the most common cause of right heart failure
Gap junctions
P02
Purkingee>atria>ventricles>AV node
Left heart failure

16. What are the different etiologies of dialted cardiomyopathy
Wegener's
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Hypertrophied cardiomyopathy
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

17. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
Mitral>aortic>>tricuspid - high pressure valves affected most
Group a beta hemolytic strep
Changes in CO as a function of preload

18. What is the association with wide S2 splitting?
Metastasis from melanoma or lymphoma
Late diastolic murmur following an opening snap
Diastolic
Pulmonic stenosis and RBBB

19. Hyperplastic onion skinning
Left heart failure
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Arteriolosclerosis in malignant hypertension
Unstable/crescendo angina

20. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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21. The aortic arch receptors transmit along which nerve?
Aortic insuffic - late
Systolic dysfunction
Aortic disecction - intraluminal tear forming false lumen
Vagus to medulla

22. what happens to capillaries in lymphatic blockage
Inc interstitial osmotic pressure pulling fliud out of capillaries
V fib arrhythima
LAD
Mitral and tricuspid closure

23. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Hyperlipidemia
RCA - II - III - aVF
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Angiosarcoma

24. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Decreases
V fib arrhythima
Atrial contraction
Kaposi's sarcoma

25. PROVe
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Increased efferent SANS and decreased efferent PANS
S. aureus
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

26. What is the classic X ray finding for tet of fallot?
Increase in Pc
Cyclophosphamide and corticosteroids
Boot shaped heart
Inc TPR and LA return (expiration)

27. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Changes in CO as a function of preload
In series
Increase - increase the chance the If are open
Glossopharyngeal to soliary nucleus of medulla

28. How do catecholamines increase contractility?
Mechanican contraction of the ventricles
Vasodilators
Eisenmenger's syndrome
Increasing activity of Ca pump in SR

29. Left to right shunts are more common in babies or kids?
Rhabdomyomas
Kids
Can progess to V fib
Hemorrhage

30. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
Aortic insuffic - late
Left sided
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

31. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Subendocardial - fewer collaterals and higher pressure
MI
Indomethacin closes - and pge keeps it open
Cardiac tamponde

32. fibrous plaques and atheromas in intima of arteries
Libman - sacks endocarditis
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Atherosclerosis
In series

33. When do you find hemosiderin laden macrophages in the lungs?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Dressler's - autoimmune
Hypertrophied cardiomyopathy
During HF from microhemorrhages from inc pulm cap pressure

34. What does HTN predispose to?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
EKG
Late diastolic murmur following an opening snap
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

35. fibrinous pericarditis several weeks post MI

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36. Which channel accounts for automaticity of the SA and AV nodes?
Arteriorles
If sodium channel
Henoch - Schlonlein purpura
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

37. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Transposition of great vessels
Transfusion
Greater ventricular EDV
Dilated cardiomyopathy

38. What is the S1 sound?
Mitral and tricuspid closure
10%
Conduction delay through AV node - nl < 200 msec
Atherosclerosis

39. What is associated with paradoxical spliting of S2
Venodilators (nitrogylcerine)
Aortic stenosis or LBBB
Sturge weber - vasculitis of caps
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

40. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Apex and anterior interventricular septum
Libman - sacks endocarditis
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Viridans streptococci

41. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Mitral valve
Takayasu's arteritis
Microscopic polyangiitis - like wegener's without granulomas
Hypertrophied cardiomyopathy

42. sawtooth wave

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43. When does extracellular calcium enter the cardiac muscle cells during contraction?
Pulse pressure
The plateau period
Yes
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

44. benign cap hemangioma of infancy - spont regresses
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Strawberry hemangioma
In HF
Transfusion

45. What is the cushing triad?
Pos inotropy - exercise
Isovolumetric contraction
HTN - bradycardia - and respiratory depression
Microscopic polyangiitis - like wegener's without granulomas

46. Which vessels account for the most total peripheral resistance
Indomethacin closes - and pge keeps it open
Vasocxn
Arteriorles
Ischemic heart dz - mitral valve prolapse - LV dilation

47. When and why do you hear the S4 sound
Cherry hemangioma
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
S. bovis
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

48. What 4 things drive myocardial 02 demand?
Adult type aortic coarctation
HTN - bradycardia - and respiratory depression
Pos inotropy - exercise
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

49. bening capillary hemangioma of elderly - does not regress
Cherry hemangioma
LAD > RCA > circumflex
Mitral stenosis
Persistant truncus arteriosus

50. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Atherosclerosis
At least 55%
140/90
Purkingee>atria>ventricles>AV node