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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 the atria release in response to inc blood volume and atrial pressure
Septal defects - PDA - pulm art stenosis
ANP
Acute thrombosis of coronary artery
Medullary vasomotor center senses baroreceptors and JGA

2. In terms of starling forces - why does heart failure cause edema?
Holosystoiic
Pulse pressure
ANP
Increase in Pc

3. exaggerated decrease in pulse during inspiration.

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4. What other sign is often present with congenital long QT syndrome - why?
Myxomatous degeneration - RF - chordae rupture
V fib
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Septal defects - PDA - pulm art stenosis

5. Which enzymes are useful for diagnosing reinfarction
CK- MB
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
PDA
SA and AV nodes

6. tearing chest pain radiation to the back - associated with marfan
10%
Increase - increase the chance the If are open
Aortic disecction - intraluminal tear forming false lumen
Changes in CO as a function of preload

7. What are the four most common locations for atherosclerosis?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
CO
Late diastolic murmur following an opening snap
Inc central venous pressure - inc resistance to portal flow

8. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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9. PROVe
Failure of LV to in CO during exercise
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
HypoK and bradycardia
Vagus to medulla

10. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Atherosclerosis
Mitral and tricuspid closure
Hemorrhage
Stable angina

11. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Stable angina
LAD - V1 - V4
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Maintain blood flow to organ over wide range of perfussion pressures

12. dyspnea - fatigue - edema and rales - multiple causes
Libman - sacks endocarditis
CHF
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Ischemic heart dz - mitral valve prolapse - LV dilation

13. What causes hepatomegaly?
Fast volatge gated Na channels
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Troponin I
Inc central venous pressure - inc resistance to portal flow

14. How does aldosterone raise MAP
Inc blood volume
10%
ASD
Mitral valve prolapse

15. Which two mechanisms sense decrease MAP?
Torsades de pointes
Medullary vasomotor center senses baroreceptors and JGA
Neg inotropy - HF - narcotic overdose
Chordae rupture - GN - suppurative pericarditis - emboli

16. What do the carotid and aortic bodies respond to?
Conduction delay through AV node - nl < 200 msec
Buerger's disease
Dec P02 - inc PC02 and dec pH
Arteriolosclerosis in malignant hypertension

17. Unilateral headache - jaw claudication - impaired vision
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Decrease in activity of Na/Ca exhanger and increase in contractility
Tempral arteritis - may cause irreversible blindness
Preload

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

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19. Central chemoreceptors do not respond directly to which parameter?
PDA
Granuloma with giant cells
P02
Heart - 02 extraction is always around 100%

20. If HR is too fast (V tach) what happens during diastole?
Fick principle
HypoK and bradycardia
Filling is incomplete and CO falls
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

21. in the JVP - What is the c wave?
Boot shaped heart
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Late systolic crescendo murmur with a midsystolic click
RV contraction (closed tricuspid valve bulding into atrium

22. Which artery supplies the SA and AV nodes?
Left atrial pressure
Cardiac tamponde
RCA
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

23. What kind of dysfunction ensues in restrictive cardiomyopathy
During diastole
Unstable/crescendo angina
Diastolic
Age related calcifications or bicuspid aortic valve

24. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Increase intracellular Na - resulting in increased Ca
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Torsades de pointes
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

25. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Afterload (proportional to peripheral resistance)
Atherosclerosis
Polyarteritis nodosum
Rapid upstroke - voltage gated Na channels open

26. What is indicated when CO and venous return are equal?
The operating point of the heart
Cherry hemangioma
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

27. What causes aortic regurg
TAPVR
Increase - increase the chance the If are open
Aortic dilation - bicuspid aortic valve - RF -
Holosystolic - harsh sounding murmur - loudest over tricuspid area

28. The aortic arch receptors transmit along which nerve?
Filling is incomplete and CO falls
Vagus to medulla
The aortic before pulmonic - inspiration increases diff
Failure of LV to in CO during exercise

29. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Tempral arteritis - may cause irreversible blindness
LCX - I - aVL
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
LAD - V1- V2

30. Which organ has ht highest blood flow per gram of tissue
Kidney
Left heart failure
Truncus - tet of fallot
SA>AV>bundle of His>ventricles

31. Restrictive cardiomyopathy causes
Indomethacin closes - and pge keeps it open
Increasing activity of Ca pump in SR
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Atrial contraction

32. What is the result of not have fast sodium channels in pacemaker cells?
Conduction delay through AV node - nl < 200 msec
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Decreased
Atrial contraction

33. What are anitschkow's cells
Lymphangiosarcoma
Rapid upstroke - voltage gated Na channels open
Activated histiocytes
Group a beta hemolytic strep

34. coronary artery spasm - ST elevation
Prinzmetal angina
Glossopharyngeal to soliary nucleus of medulla
LCX - I - aVL
In parallel

35. What does mitral prolapse predeispose to?
Atrial contraction
Infective endocarditis
Glossopharyngeal to soliary nucleus of medulla
Persistant truncus arteriosus

36. What does the U wave indicated?
Mechanican contraction of the ventricles
HypoK and bradycardia
Glossopharyngeal to soliary nucleus of medulla
Torsades de pointes

37. What does FEVERSS stand for in rheumatic heart disease
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Failure of LV to in CO during exercise
No
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

38. What is the most common cause of right heart failure
Raynaud's
2-4 day - early coag necrosis on the first day
Prinzmetal angina
Left heart failure

39. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
Dec plasma proteins
LAD
2nd degree AV block - mobitz type 1
CHF

40. no relation between p waves and QRS intervals - treatment and predisposing factor
RCA - II - III - aVF
MI
3rd degree block - pacemaker - Lyme disease
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

41. What is the cushing triad?
LAD
Ventricular depolarization - nl < 120 msec
HTN - bradycardia - and respiratory depression
Fetal right to left - neonate left to right leading to RVH and failure

42. What does hypoxia cause in the lung versus other tissues?
Rhabdomyomas
Vasocxn - while other tissues it causes vasodilation
The operating point of the heart
Tricuspid atresia - requires ASD and VSD

43. What is the gold standard for dx of MI in the first 6 hours
Postinfarction fibrinous pericarditis
EKG
Fluid movement through capillaries
Lymphangiosarcoma

44. congenital heart defect with congenital rubella
Septal defects - PDA - pulm art stenosis
Age related calcifications or bicuspid aortic valve
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Inc venous return exaccerbates pulm vasc congestion

45. How does acidosis affect contractility?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Libman - sacks endocarditis
Decreased
Holosystolic - harsh sounding murmur - loudest over tricuspid area

46. Wegener's presentation
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
ASD - VSD - AV septal defect (endocardial cushion defect)
Increase - increase the chance the If are open
Systolic dysfunction

47. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Inc blood volume
Aortic insuffic - late
5-10 days - macs have degraded structural components
Yes

48. most common primary cardiac tumor in children - associated with tuberous sclerosis
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Hypertrophied cardiomyopathy
Aortic and pulmonary closing
Rhabdomyomas

49. What causes the ejection click in the Cres - decres murmur?
Heart - 02 extraction is always around 100%
Left heart failure
Aburpt halting of valve leaflets
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

50. What does TAPVR stand for
10%
Glossopharyngeal to soliary nucleus of medulla
Total anomalous pulmonary trunk venous return
Kaposi's sarcoma