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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. In an inferior wall infarct - which artery is affected and which leads show Q waves
RCA - II - III - aVF
Activated histiocytes
Black > white > asian
3rd degree block - pacemaker - Lyme disease

2. What happens with a decrease of extracellular Na
Decrease in activity of Na/Ca exhanger and increase in contractility
Medullary vasomotor center senses baroreceptors and JGA
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Kawasaki

3. Churg Strauss - presentation and test
Early deaths from myocarditis
Pulmonic stenosis and RBBB
140/90
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

4. What masks atrial repolarization?
QRS complex
The operating point of the heart
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Indomethacin closes - and pge keeps it open

5. Exercise - overtransfusiion and excitiment causes and increase in...?
Septal defects - PDA - pulm art stenosis
Polyarteritis nodosum
Atherosclerosis
Preload

6. SV CAP means?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Anterosuperior displacement of the infundibular septum
Stroke volume affected by contractility - afterload - and preload
LV failure - pulm venous distention transudation of fluid

7. moncekberg
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
LAD - V1 - V4
Holosystoiic

8. clinical signs of cardiac tamponade
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Kids
Afterload (proportional to peripheral resistance)
CHF

9. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
HTN - bradycardia - and respiratory depression
Angiosarcoma
Purkingee>atria>ventricles>AV node

10. What is the result of not have fast sodium channels in pacemaker cells?
5-10 days - macs have degraded structural components
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Mitral valve
During diastole

11. What do patients die early from in rheumatic heart disease?
CFX
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Early deaths from myocarditis
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

12. What causes the cushing reflex and why
Glossopharyngeal to soliary nucleus of medulla
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Varicose veins - thromboembolism rare
Granuloma with giant cells

13. In an EKG - What is the PR interval?
Decreases
Dilation
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Conduction delay through AV node - nl < 200 msec

14. Which class of drugs decrease preload
Aortic dilation - bicuspid aortic valve - RF -
Venodilators (nitrogylcerine)
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Decreased

15. PCWP > LV diastolic pressure
Mitral valve
Mitral stenosis
Decreased
Sudden tensing of chordae tendinae

16. What causes tet of fallot?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Anterosuperior displacement of the infundibular septum
Raynaud's
Aortic stenosis or LBBB

17. Central chemoreceptors do not respond directly to which parameter?
Atrial contraction
Extracellular calcium - calcium induced calcium release
P02
Pulmonary flow murmur and diastolic rumble

18. Irregularly irregular ECG - no p waves: dx and treatment
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Tempral arteritis - may cause irreversible blindness
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Maintain blood flow to organ over wide range of perfussion pressures

19. Which murmur is heard with VSD?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Lower right - MC - upper right - AO - upper right AC - lower left MO
Kidney
At least 55%

20. What are anitschkow's cells
Inc interstitial osmotic pressure pulling fliud out of capillaries
Activated histiocytes
Right sided
Dec plasma proteins

21. What are the complications from bacterial endocarditis?
Coarcation of aorta
Chordae rupture - GN - suppurative pericarditis - emboli
Varicose veins - thromboembolism rare
Adult type aortic coarctation

22. When do you see extensive coagulative necrosis in an MI
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
2-4 day - early coag necrosis on the first day
Increase intracellular Na - resulting in increased Ca
Pulmonary flow murmur and diastolic rumble

23. How does digitatlis increase contractility?
Wolff - Parkinson white syndrome
Pulmonic stenosis and RBBB
Increase intracellular Na - resulting in increased Ca
Inc blood volume

24. Which kind of infarct show ST elevation - and/or pathologic Q waves
Transmural
5-10 days - macs have degraded structural components
Aortic dilation - bicuspid aortic valve - RF -
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

25. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
Inc RA pressure - due to filling against closed tricupsid valve
Rapid upstroke - voltage gated Na channels open
Patent ductus arteriosus - congenital rubella or prematurity

26. benign cap hemangioma of infancy - spont regresses
Systolic dysfunction
Preload
Lymphangiosarcoma
Strawberry hemangioma

27. How does a patient with Tet of fallot learn to improve symptoms?
Squat. Compression of femoral arteries - inc TPR - dec
Right sided
Increase intracellular Na - resulting in increased Ca
LAD - V1 - V4

28. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
Aortic dilation - bicuspid aortic valve - RF -
Aortic and pulmonary closing
The first 4 days

29. In terms of starling forces - why does heart failure cause edema?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Increase in Pc
C - ANCA
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

30. What causes aortic regurg
Greater ventricular EDV
Squat. Compression of femoral arteries - inc TPR - dec
Aortic dilation - bicuspid aortic valve - RF -
Kids

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

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32. PROVe
RCA - II - III - aVF
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Preload
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

33. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Increase contractility
Venodilators (nitrogylcerine)
Wolff - Parkinson white syndrome
Atherosclerosis

34. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Vasocxn - while other tissues it causes vasodilation
Viridans streptococci
Kaposi's sarcoma
Glomus tumor

35. In an EKG - What is the QRS complex?
RV contraction (closed tricuspid valve bulding into atrium
Ventricular depolarization - nl < 120 msec
Arteriorles
S. epidermidis

36. What does an isoelectric ST segment indicate?
Left sided
Black > white > asian
Ventricles are depolarized
Subendocardial

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

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38. Which bacteria causes rheumatic heart disease
Squat. Compression of femoral arteries - inc TPR - dec
During diastole
During diastole
Group a beta hemolytic strep

39. Which organ has ht highest blood flow per gram of tissue
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
CO
Kidney
MI

40. What causes the CO curve to shift upwards?
In series
Holosystolic - harsh sounding murmur - loudest over tricuspid area
During HF from microhemorrhages from inc pulm cap pressure
Pos inotropy - exercise

41. What happens in phase 3 of the cardiac ventricular action potential?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Purkingee>atria>ventricles>AV node
Cherry hemangioma
CO

42. What is the difference between adult and infantile type aortic coarctation?
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Fick principle
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
PDA

43. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Dec plasma proteins
Strawberry hemangioma
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
CFX

44. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Cherry hemangioma
Myxomatous degeneration - RF - chordae rupture
Dilated cardiomyopathy
No - no pressure gradient

45. In an anterolateral infarct - which artery is effected and which leads show Q waves
LCX - V4- V6
Aortic stenosis or LBBB
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Changes in CO as a function of preload

46. What is association with fixed S2 splitting - does not increase with inspiration
ASD
Gap junctions
Transfusion
PDA

47. When does extracellular calcium enter the cardiac muscle cells during contraction?
Group a beta hemolytic strep
Wegener's
The plateau period
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

48. What happens in phase 2 of the cardiac ventricular action potential?
Increase intracellular Na - resulting in increased Ca
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
EKG
Arteriolosclerosis in malignant hypertension

49. What are aschoff bodies
Extracellular calcium - calcium induced calcium release
Granuloma with giant cells
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Sudden tensing of chordae tendinae

50. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
RCA - II - III - aVF
LV failure - pulm venous distention transudation of fluid
Hemorrhage