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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. with what heart sounds do ASD usually present?
Wegener's
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Pulmonary flow murmur and diastolic rumble

2. How do beta blockers decrease contractility?
Decrease in cAMP
RV contraction (closed tricuspid valve bulding into atrium
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Unstable/crescendo angina

3. list the coronary vessels most likely to be occluded
Vasocxn - while other tissues it causes vasodilation
LAD > RCA > circumflex
Mitral valve
2nd degree AV block - mobitz type 1

4. In an EKG - What is the T wave?
Early deaths from myocarditis
Ventricular repolarization
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Vasocxn - while other tissues it causes vasodilation

5. The cause of cardiac dilation?
Greater ventricular EDV
Metastasis from melanoma or lymphoma
LCX - V4- V6
S. aureus

6. What causes tet of fallot?
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Anterosuperior displacement of the infundibular septum
Cardiac tamponde
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

7. What is sudden cardiac death most commonly due to...
Cardiac tamponde
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
V fib arrhythima
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

8. What does TAPVR stand for
Takayasu's arteritis
Polyarteritis nodosum
MI
Total anomalous pulmonary trunk venous return

9. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kawasaki
Aburpt halting of valve leaflets
Granuloma with giant cells
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

10. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Decreases
Decrease in cAMP
Kawasaki
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

11. benign - painful - red - blue tumor under fingernails from smooth muscle cells
The operating point of the heart
Glomus tumor
Vasodilators
Indomethacin closes - and pge keeps it open

12. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
SV/ EDV
Microscopic polyangiitis - like wegener's without granulomas
Varicose veins - thromboembolism rare
Neg inotropy - HF - narcotic overdose

13. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Increase - increase the chance the If are open
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Patent ductus arteriosus - congenital rubella or prematurity
Systolic dysfunction

14. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Decreases
Lymphangiosarcoma
Aortic insuffic - late
Wegener's

15. Which class of drugs decrease the murmur heard in aortic regurg?
Torsades de pointes
Vasodilators
Increasing activity of Ca pump in SR
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

16. What are aschoff bodies
C - ANCA
Granuloma with giant cells
Maintain blood flow to organ over wide range of perfussion pressures
CK- MB

17. What supplies the posterior left ventricle?
Non
CFX
Vasocxn
Stroke volume

18. When does EF decrease
C - ANCA
In HF
Liver
Transposition of great vessels

19. in the JVP - What is the c wave?
V fib
Preload
RV contraction (closed tricuspid valve bulding into atrium
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

20. most common primary cardiac tumor in children - associated with tuberous sclerosis
...
Rhabdomyomas
Venodilators (nitrogylcerine)
Activated histiocytes

21. What other syndrom is associated with infantile aortic coarctation
Turners
Glomus tumor
During diastole
Inc interstitial osmotic pressure pulling fliud out of capillaries

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

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23. What is the progression of atherosclerosis?
No
Inc venous return exaccerbates pulm vasc congestion
In series
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

24. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Dec plasma proteins
Transposition of great vessels
No - no pressure gradient
Liver

25. machine murmer
PDA
Chordae rupture - GN - suppurative pericarditis - emboli
Can progess to V fib
LCX - V4- V6

26. What 4 things drive myocardial 02 demand?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
MI
Varicose veins - thromboembolism rare
Kaposi's sarcoma

27. What are the complications of atherosclerosis?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Fick principle
Vagus to medulla
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

28. Which bacteria causes endocarditis in the presence of colon cancer
S. bovis
Stroke volume
Conduction delay through AV node - nl < 200 msec
...

29. disease of elastic arteries and large and medium sized muscular arteries
Vasocxn
Atherosclerosis
Systolic dysfunction
Aortic disecction - intraluminal tear forming false lumen

30. Exercise - overtransfusiion and excitiment causes and increase in...?
Preload
The operating point of the heart
Kids
At least 55%

31. What is association with fixed S2 splitting - does not increase with inspiration
Cystic hygroma
ASD
Aortic/pulmonic regurg and mitral/tricuspid stenosis
The first 4 days

32. What is indicated when CO and venous return are equal?
Decreases
The operating point of the heart
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Dec P02 - inc PC02 and dec pH

33. In an EKG - What is the p wave?
Atrial contraction
In series
Ischemic heart dz - mitral valve prolapse - LV dilation
During diastole

34. What happends in phase 1 of the ventricular cardiac action potential?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Vasodilators
Right sided
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

35. prolonged PR interval
Troponin I
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Increasing activity of Ca pump in SR
1st degree AV blodck

36. Churg Strauss - presentation and test
Aortic stenosis or LBBB
Mitral>aortic>>tricuspid - high pressure valves affected most
Increase intracellular Na - resulting in increased Ca
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

37. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Purkingee>atria>ventricles>AV node
Infective endocarditis
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

38. absecnce of tricuspid valve - hypoplastic RV
Tricuspid atresia - requires ASD and VSD
Transfusion
In parallel
Mitral valve

39. Right to left shunts are more common in babies or kids?
Babies
Troponin I
Transposition of great vessels
LAD > RCA > circumflex

40. How does aldosterone raise MAP
Inc blood volume
Pulmonary flow murmur and diastolic rumble
RCA
Late systolic crescendo murmur with a midsystolic click

41. What channels do the the pacemaker cells lack?
Can progess to V fib
Activated histiocytes
At least 55%
Fast volatge gated Na channels

42. fibrinous pericarditis several weeks post MI

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43. Which area of the endocardium is especially vulnerable to infarction? Why?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Subendocardial - fewer collaterals and higher pressure
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
P02

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

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45. What is the early and late lesion in rheumatic heart disease
Infective endocarditis
Mitral valve prolapse
In HF
Transfusion

46. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Unstable/crescendo angina
Inc central venous pressure - inc resistance to portal flow
Fetal right to left - neonate left to right leading to RVH and failure
Resting potential high K perm

47. What are the four most common locations for atherosclerosis?
Total anomalous pulmonary trunk venous return
Ventricular depolarization - nl < 120 msec
Fick principle
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

48. sawtooth wave

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49. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Aortic dilation - bicuspid aortic valve - RF -
During diastole
Libman - sacks endocarditis
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

50. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Mitral stenosis
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
LAD
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction