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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 is the classic X ray finding for tet of fallot?
Truncus - tet of fallot
Preload
Boot shaped heart
LCX - I - aVL

2. what conditions are associated with pulsus paradoxus
Subendocardial
Cardiac tamponde
Infective endocarditis
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

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

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4. stroke volume x HR =?
CO
Pos inotropy - exercise
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

5. What is the danger of torsades to pointes?
The aortic before pulmonic - inspiration increases diff
Increasing activity of Ca pump in SR
R to L shunt caused by stenoic pulmonic valve
Can progess to V fib

6. What can cause mitral prolapse?
The plateau period
Aortic dilation - bicuspid aortic valve - RF -
RV failure - in venous pressure
Myxomatous degeneration - RF - chordae rupture

7. What causes aortic stenosis
Age related calcifications or bicuspid aortic valve
Early deaths from myocarditis
Atherosclerosis
ASD - VSD - AV septal defect (endocardial cushion defect)

8. moncekberg
10%
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
The first 4 days
HypoK and bradycardia

9. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Mitral stenosis
ANP
LV failure - pulm venous distention transudation of fluid
Myxomatous degeneration - RF - chordae rupture

10. most common heart tumor
No - no pressure gradient
The first 4 days
Microscopic polyangiitis - like wegener's without granulomas
Metastasis from melanoma or lymphoma

11. How are the sarcomeres added in eccentric hypertrophy?
Left heart failure
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
In series
Glomus tumor

12. exaggerated decrease in pulse during inspiration.

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13. Exercise - overtransfusiion and excitiment causes and increase in...?
LAD > RCA > circumflex
Preload
Glomus tumor
Afterload (proportional to peripheral resistance)

14. Which bacteria causes endocarditis in the presence of colon cancer
Metastasis from melanoma or lymphoma
Greater ventricular EDV
Cherry hemangioma
S. bovis

15. Where are pacemaker cells?
SA and AV nodes
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
RV contraction (closed tricuspid valve bulding into atrium
Holosystoiic

16. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Increase - increase the chance the If are open
Posterior descending (80% off the RCA - 20% off the circumflex)
Late systolic crescendo murmur with a midsystolic click
Total anomalous pulmonary trunk venous return

17. What is the time frame for arrhythmia risk in the evolution of MI
Lymphangiosarcoma
Yes
Inc venous return exaccerbates pulm vasc congestion
The first 4 days

18. Which lab value indicates blood viscosity?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Hematocrit
Late systolic crescendo murmur with a midsystolic click
Decreased

19. PROVe
Raynaud's
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
R to L shunt caused by stenoic pulmonic valve
Aortic/pulmonic stenosis and mitral/tricuspid regurg

20. In an anterolateral infarct - which artery is effected and which leads show Q waves
Crescendo - decrescendo systolic ejection murmur following ejection click
Atrial contraction
LCX - V4- V6
Proportional to viscosity and inversely proportional to the radius to the 4th power

21. PCWP > LV diastolic pressure
Mitral stenosis
10%
5-10 days - macs have degraded structural components
C - ANCA

22. What do the carotid and aortic bodies respond to?
Decrease in cAMP
Dec P02 - inc PC02 and dec pH
Pulse pressure
2-4 day - early coag necrosis on the first day

23. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Dilated cardiomyopathy
Dec P02 - inc PC02 and dec pH
LV failure - pulm venous distention transudation of fluid
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

24. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LCX - I - aVL
During HF from microhemorrhages from inc pulm cap pressure
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
No

25. The cause of dyspnea on exertion?
Glossopharyngeal to soliary nucleus of medulla
Increase contractility
Failure of LV to in CO during exercise
Lymphangiosarcoma

26. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Turners
Henoch - Schlonlein purpura
Aortic and pulmonary closing
LAD - V1- V2

27. Which murmur is heard with VSD?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Systolic dysfunction
Holosystolic - harsh sounding murmur - loudest over tricuspid area
5-10 days - macs have degraded structural components

28. list the coronary vessels most likely to be occluded
Aortic stenosis or LBBB
LAD > RCA > circumflex
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Henoch - Schlonlein purpura

29. Which class of drugs decrease preload
Venodilators (nitrogylcerine)
Angiosarcoma
TAPVR
Cystic hygroma

30. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Aortic insuffic - late
Cardiac tamponde
Group a beta hemolytic strep
Non

31. How does acidosis affect contractility?
Venodilators (nitrogylcerine)
Dilated cardiomyopathy
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Decreased

32. Which vessels account for the most total peripheral resistance
10%
Arteriorles
Henoch - Schlonlein purpura
3rd degree block - pacemaker - Lyme disease

33. what percentage of HTN is secondary to renal disease?
Inc TPR and LA return (expiration)
10%
Tempral arteritis - may cause irreversible blindness
Glomus tumor

34. coronary artery spasm - ST elevation
RF
Prinzmetal angina
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
CO

35. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Angiosarcoma
Fick principle
Eisenmenger's syndrome

36. no change in PR interval followed by dropped beat
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
ASD - VSD - AV septal defect (endocardial cushion defect)
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

37. Do you see elevaged ASO titers in rheumatic heart disease
Raynaud's
Extracellular calcium - calcium induced calcium release
Yes
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

38. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
Aortic dilation - bicuspid aortic valve - RF -
2nd degree AV block - mobitz type 1
The operating point of the heart
Cystic hygroma

39. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Conduction delay through AV node - nl < 200 msec
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Preload
Inc Kf - capillary perm

40. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
TAPVR
Takayasu's arteritis
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

41. pulseless disease - granulomatous thickening of the aortic arch and/or proximal great vessels - elev ESR - asian females > 40

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42. What are the complications of atherosclerosis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Preload
Crescendo - decrescendo systolic ejection murmur following ejection click
Mean arterial pressure

43. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Buerger's disease
Glomus tumor
Septal defects - PDA - pulm art stenosis
Varicose veins - thromboembolism rare

44. What is associated with paradoxical spliting of S2
Aortic stenosis or LBBB
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Sudden tensing of chordae tendinae
V fib

45. 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
Increased efferent SANS and decreased efferent PANS
...
Aortic and pulmonary closing

46. Given P = QR - what factors influence resistance?
Angiosarcoma
Rapid upstroke - voltage gated Na channels open
Proportional to viscosity and inversely proportional to the radius to the 4th power
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

47. What causes aortic regurg
Aortic dilation - bicuspid aortic valve - RF -
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Left atrial pressure
Mitral and tricuspid closure

48. Mitral stenosis is most often secondary to which condition?
RF
Truncus - tet of fallot
Can progess to V fib
No - no pressure gradient

49. Most common vasculitis affecting medium and large arteries
Sudden tensing of chordae tendinae
Temporal arteritis
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Patent ductus arteriosus - congenital rubella or prematurity

50. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Pulmonic stenosis and RBBB
Failure of LV to in CO during exercise
Polyarteritis nodosum
Strawberry hemangioma