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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. clinical signs of cardiac tamponade
Preload
Crescendo - decrescendo systolic ejection murmur following ejection click
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
SA and AV nodes

2. What causes the midsystolic click
Sudden tensing of chordae tendinae
Conduction delay through AV node - nl < 200 msec
Crescendo - decrescendo systolic ejection murmur following ejection click
Stable angina

3. prolonged PR interval
3rd degree block - pacemaker - Lyme disease
1st degree AV blodck
In parallel
S. epidermidis

4. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Kaposi's sarcoma
Arteriolosclerosis in malignant hypertension
Adult type aortic coarctation
Increased SV

5. congenital heart defect with congenital rubella
Septal defects - PDA - pulm art stenosis
Increased SV
Mean arterial pressure
Inc central venous pressure - inc resistance to portal flow

6. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Henoch - Schlonlein purpura
If sodium channel
Ventricular depolarization - nl < 120 msec
HTN - bradycardia - and respiratory depression

7. Given P = QR - what factors influence resistance?
Proportional to viscosity and inversely proportional to the radius to the 4th power
QRS complex
Henoch - Schlonlein purpura
Failure of LV to in CO during exercise

8. sawtooth wave

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9. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Inc RA pressure - due to filling against closed tricupsid valve
Purkingee>atria>ventricles>AV node
Fick principle
Venodilators (nitrogylcerine)

10. congenital heart defect with marfan's
Atherosclerosis
Systolic dysfunction
Aortic insuffic - late
Holosystolic - harsh sounding murmur - loudest over tricuspid area

11. What is the S2 sound?
Aortic and pulmonary closing
Kawasaki
Neg inotropy - HF - narcotic overdose
In series

12. in the JVP - What is the v wave?
RCA
LAD - V1- V2
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Inc RA pressure - due to filling against closed tricupsid valve

13. Which bacteria causes endocarditis in the presence of colon cancer
Stable angina
Hyperlipidemia
S. bovis
Wolff - Parkinson white syndrome

14. PCWP is an estimate of...
EKG
Myxomatous degeneration - RF - chordae rupture
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Left atrial pressure

15. What is associated with paradoxical spliting of S2
140/90
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Aortic stenosis or LBBB
Dec P02 - inc PC02 and dec pH

16. What does hypoxia cause in the lung versus other tissues?
Aortic stenosis or LBBB
Posterior descending (80% off the RCA - 20% off the circumflex)
Vasocxn - while other tissues it causes vasodilation
Myxomatous degeneration - RF - chordae rupture

17. What causes hepatomegaly?
Inc central venous pressure - inc resistance to portal flow
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
The first 4 days
Aortic disecction - intraluminal tear forming false lumen

18. PCWP > LV diastolic pressure
MAP
Myxomatous degeneration - RF - chordae rupture
Fetal right to left - neonate left to right leading to RVH and failure
Mitral stenosis

19. Why is contractility decreased in heart failure?
Systolic dysfunction
Adult type aortic coarctation
Angiosarcoma
Hyperlipidemia

20. disease of elastic arteries and large and medium sized muscular arteries
Medullary vasomotor center senses baroreceptors and JGA
Atherosclerosis
Inc Kf - capillary perm
LCX - V4- V6

21. In terms of starling forces - why does heart failure cause edema?
Increase in Pc
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Ventricular depolarization - nl < 120 msec
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

22. Where are pacemaker cells?
Kawasaki
Atrial contraction
SA and AV nodes
LCX - V4- V6

23. What happens in phase 4 of the cardiac ventricular action potential?
Resting potential high K perm
Coarcation of aorta
LAD - V1- V2
Hematocrit

24. Unilateral headache - jaw claudication - impaired vision
Cherry hemangioma
Torsades de pointes
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Tempral arteritis - may cause irreversible blindness

25. What is sudden cardiac death most commonly due to...
V fib arrhythima
LAD - V1 - V4
Heart - 02 extraction is always around 100%
Wegener's

26. SV CAP means?
Stroke volume affected by contractility - afterload - and preload
Glossopharyngeal to soliary nucleus of medulla
Systolic dysfunction
Temporal arteritis

27. What is the progression of atherosclerosis?
Takayasu's arteritis
Patent ductus arteriosus - congenital rubella or prematurity
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Decreased

28. What other sign is often present with congenital long QT syndrome - why?
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Mitral and tricuspid closure
Maintain blood flow to organ over wide range of perfussion pressures
The plateau period

29. in the JVP - What is the c wave?
Late diastolic murmur following an opening snap
RV contraction (closed tricuspid valve bulding into atrium
HTN - bradycardia - and respiratory depression
Lymphangiosarcoma

30. Why is there edema after burns or during infection
Anterosuperior displacement of the infundibular septum
Inc Kf - capillary perm
Increase in Pc
V fib arrhythima

31. moncekberg
Chordae rupture - GN - suppurative pericarditis - emboli
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Ventricles are depolarized
Glomus tumor

32. What does the LAD supply?
Apex and anterior interventricular septum
RCA
Microscopic polyangiitis - like wegener's without granulomas
Buerger's disease

33. Where is the most posterior portion of the heart and What can it cause?
R to L shunt caused by stenoic pulmonic valve
Gap junctions
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
QRS complex

34. Which area of the endocardium is especially vulnerable to infarction? Why?
Hemorrhage
CFX
Varicose veins - thromboembolism rare
Subendocardial - fewer collaterals and higher pressure

35. necrotizing granulomas in lung and upper airways - nectrotizing GN - small vessel vasculitis

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36. What causes the murmur heard in tricuspid regurg to enhance
Cyclophosphamide and corticosteroids
Patent ductus arteriosus - congenital rubella or prematurity
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
In RA return (inspiration)

37. Which kind of infarct show ST elevation - and/or pathologic Q waves
Liver
Glossopharyngeal to soliary nucleus of medulla
Transmural
Hyperlipidemia

38. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
LV failure - pulm venous distention transudation of fluid
Volatage gated Ca channels
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Pulse pressure

39. What does the starling curve show?
PDA
MAP
Changes in CO as a function of preload
RCA

40. What are the four most common locations for atherosclerosis?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Pulsus parvus and tardus - weak - can lead to syncope
RV contraction (closed tricuspid valve bulding into atrium
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

41. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
Hemorrhage
During diastole
Decreased

42. What does prolonged QT predispose to?
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Torsades de pointes
Gap junctions
Aortic stenosis or LBBB

43. What do patients die early from in rheumatic heart disease?
In HF
Early deaths from myocarditis
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Arteriolosclerosis in malignant hypertension

44. dyspnea - fatigue - edema and rales - multiple causes
Transmural
CHF
CK- MB
Cystic hygroma

45. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kawasaki
C - ANCA
EKG
Arteriolosclerosis in malignant hypertension

46. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Proportional to viscosity and inversely proportional to the radius to the 4th power
Holosystoiic
Right sided

47. The aortic arch receptors transmit along which nerve?
Vagus to medulla
Medullary vasomotor center senses baroreceptors and JGA
Pos inotropy - exercise
LV failure - pulm venous distention transudation of fluid

48. In the cardiac cycle - which period has the highest 02 consumption?
Pulse pressure
Increased efferent SANS and decreased efferent PANS
Isovolumetric contraction
No - no pressure gradient

49. Wegener's tx
Cyclophosphamide and corticosteroids
Septal defects - PDA - pulm art stenosis
Stable angina
Chordae rupture - GN - suppurative pericarditis - emboli

50. When and why is the S3 sound heard?
Dilation
Lymphangiosarcoma
Boot shaped heart
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling