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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 masks atrial repolarization?
Lymphangiosarcoma
Infective endocarditis
QRS complex
Cystic hygroma

2. no relation between p waves and QRS intervals - treatment and predisposing factor
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
3rd degree block - pacemaker - Lyme disease
Preload
Vasodilators

3. Restrictive cardiomyopathy causes
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Mean arterial pressure

4. What 4 things drive myocardial 02 demand?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
SA and AV nodes
No - no pressure gradient

5. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Transmural
Increase - increase the chance the If are open
Sturge weber - vasculitis of caps

6. What does the atria release in response to inc blood volume and atrial pressure
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Hemorrhage
Sudden tensing of chordae tendinae
ANP

7. disease of elastic arteries and large and medium sized muscular arteries
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Pos inotropy - exercise
Atherosclerosis
Decreases

8. congenital heart defect in an infant with a diabetic mother?
Transposition of great vessels
R to L shunt caused by stenoic pulmonic valve
In HF
SA>AV>bundle of His>ventricles

9. The 7 complications of MI

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10. What is sudden cardiac death most commonly due to...
Kids
V fib arrhythima
Non
Mean arterial pressure

11. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Decreased
Aortic disecction - intraluminal tear forming false lumen
Transfusion
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

12. What does the starling curve show?
Eisenmenger's syndrome
Mitral valve prolapse
Transmural
Changes in CO as a function of preload

13. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Mechanican contraction of the ventricles
Maintain blood flow to organ over wide range of perfussion pressures
Adult type aortic coarctation
Cardiac tamponde

14. What is the most common cause of MI
Acute thrombosis of coronary artery
Aortic insuffic - late
Sudden tensing of chordae tendinae
Non

15. Do you see elevaged ASO titers in rheumatic heart disease
Aortic insuffic - late
Yes
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Non

16. p - anca

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17. Rank the pacemakers cells
SA>AV>bundle of His>ventricles
Prinzmetal angina
Babies
RF

18. what percentage of HTN is secondary to renal disease?
10%
HypoK and bradycardia
QRS complex
Can progess to V fib

19. What is the most common cause of right heart failure
1st degree AV blodck
Left heart failure
Chordae rupture - GN - suppurative pericarditis - emboli
2-4 day - early coag necrosis on the first day

20. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
S. epidermidis
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Liver
Increase - increase the chance the If are open

21. How are the sarcomeres added in eccentric hypertrophy?
Right sided
In series
Ischemic heart dz - mitral valve prolapse - LV dilation
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

22. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Unstable/crescendo angina
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
LAD - V1 - V4
Increase intracellular Na - resulting in increased Ca

23. tearing chest pain radiation to the back - associated with marfan
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
RV contraction (closed tricuspid valve bulding into atrium
Aortic disecction - intraluminal tear forming false lumen

24. What causes the early cyanosis in Tet of Fallot?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Angiosarcoma
CFX
R to L shunt caused by stenoic pulmonic valve

25. Which enzymes are useful for diagnosing reinfarction
2-4 day - early coag necrosis on the first day
CK- MB
Mitral and tricuspid closure
Hypertrophied cardiomyopathy

26. fibrous plaques and atheromas in intima of arteries
Babies
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Decrease in activity of Na/Ca exhanger and increase in contractility
Atherosclerosis

27. Wegener's presentation
Apex and anterior interventricular septum
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
140/90
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

28. What does prolonged QT predispose to?
Torsades de pointes
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
At least 55%
LCX - I - aVL

29. congenital heart defect with congenital rubella
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Septal defects - PDA - pulm art stenosis
Can progess to V fib
2nd degree AV block - mobitz type 1

30. What stimulates release of calcium from the SR?
2-4 day - early coag necrosis on the first day
QRS complex
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Extracellular calcium - calcium induced calcium release

31. coronary artery spasm - ST elevation
Libman - sacks endocarditis
SV/ EDV
Prinzmetal angina
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

32. 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
Increase contractility
Coarcation of aorta
Squat. Compression of femoral arteries - inc TPR - dec

33. What kind of infarct show ST depression
Subendocardial
Subendocardial - fewer collaterals and higher pressure
Truncus - tet of fallot
Turners

34. What does an isoelectric ST segment indicate?
Transfusion
Ventricles are depolarized
Lymphangiosarcoma
Septal defects - PDA - pulm art stenosis

35. What is the early and late lesion in rheumatic heart disease
P02
Venodilators (nitrogylcerine)
Mitral valve prolapse
Can progess to V fib

36. most common heart tumor
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Inc venous return exaccerbates pulm vasc congestion
Prinzmetal angina
Metastasis from melanoma or lymphoma

37. In an anterior wall infarct - which artery is effected and which leads show Q waves
Hyperlipidemia
Arteriorles
LAD - V1 - V4
Late diastolic murmur following an opening snap

38. Which bacteria can cause endocarditis from prosthetic valves?
MI
At least 55%
Non
S. epidermidis

39. Which bacteria causes endocarditis in the presence of colon cancer
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Inc blood volume
S. bovis

40. Which sympathetic receptors raise MAP
Atherosclerosis
Dressler's - autoimmune
Increase intracellular Na - resulting in increased Ca
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

41. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Cyclophosphamide and corticosteroids
Subendocardial - fewer collaterals and higher pressure
Pulmonary flow murmur and diastolic rumble

42. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
EKG
No
In parallel
LAD - V1- V2

43. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Dilated cardiomyopathy
Venodilators (nitrogylcerine)
Pulmonic stenosis and RBBB
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

44. in the JVP - What is the v wave?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Atrial contraction
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Inc RA pressure - due to filling against closed tricupsid valve

45. What is the characteristic pulse in aortic stenosis?
LCX - V4- V6
...
Pulsus parvus and tardus - weak - can lead to syncope
Transfusion

46. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
The operating point of the heart
Sturge weber - vasculitis of caps
Diastolic
Glossopharyngeal to soliary nucleus of medulla

47. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
RV contraction (closed tricuspid valve bulding into atrium
Anterosuperior displacement of the infundibular septum
Decreases
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

48. Which murmur is heard with mitral prolapse?
Aortic insuffic - late
Angiosarcoma
Late systolic crescendo murmur with a midsystolic click
C - ANCA

49. What other syndrom is associated with infantile aortic coarctation
CFX
Turners
Transposition of great vessels
SA>AV>bundle of His>ventricles

50. What causes the CO curve to shift upwards?
Mechanican contraction of the ventricles
Pos inotropy - exercise
Can progess to V fib
Afterload (proportional to peripheral resistance)