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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 happens with a decrease of extracellular Na
Wegener's
Pulmonary flow murmur and diastolic rumble
MAP
Decrease in activity of Na/Ca exhanger and increase in contractility

2. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Venodilators (nitrogylcerine)
Wolff - Parkinson white syndrome
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

3. What is associated with paradoxical spliting of S2
Aortic stenosis or LBBB
S. epidermidis
Acute thrombosis of coronary artery
Vagus to medulla

4. in the JVP - What is the a wave?
P02
Atrial contraction
Prinzmetal angina
Resting potential high K perm

5. What causes the CO curve to shift downwards?
V fib arrhythima
3rd degree block - pacemaker - Lyme disease
Atherosclerosis
Neg inotropy - HF - narcotic overdose

6. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Decreases
Boot shaped heart
Apex and anterior interventricular septum
Increasing activity of Ca pump in SR

7. Which organ has ht highest blood flow per gram of tissue
Kidney
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Myxomatous degeneration - RF - chordae rupture
Varicose veins - thromboembolism rare

8. What is the result of not have fast sodium channels in pacemaker cells?
Ventricular repolarization
Afterload (proportional to peripheral resistance)
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

9. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
LAD
Turners
MI

10. Which vessels account for the most total peripheral resistance
Isovolumetric contraction
The operating point of the heart
Atrial contraction
Arteriorles

11. What does mitral prolapse predeispose to?
Non
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Infective endocarditis
S. bovis

12. Why is there edema after burns or during infection
Pulmonic stenosis and RBBB
Decrease in activity of Na/Ca exhanger and increase in contractility
Mitral valve
Inc Kf - capillary perm

13. Which lab value indicates blood viscosity?
Boot shaped heart
Fick principle
Subendocardial - fewer collaterals and higher pressure
Hematocrit

14. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Right sided
Septal defects - PDA - pulm art stenosis
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
LAD - V1- V2

15. When does extracellular calcium enter the cardiac muscle cells during contraction?
Coarcation of aorta
SV/ EDV
The plateau period
Henoch - Schlonlein purpura

16. most common primary cardiac tumor in children - associated with tuberous sclerosis
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Rhabdomyomas
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Stroke volume affected by contractility - afterload - and preload

17. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2nd degree AV block - mobitz type 1
Coarcation of aorta
Posterior descending (80% off the RCA - 20% off the circumflex)
Strawberry hemangioma

18. What does TAPVR stand for
Total anomalous pulmonary trunk venous return
Dec P02 - inc PC02 and dec pH
3rd degree block - pacemaker - Lyme disease
CK- MB

19. What stimulates release of calcium from the SR?
Angiosarcoma
Pos inotropy - exercise
Extracellular calcium - calcium induced calcium release
The plateau period

20. Expiration causes an increase in which sided heart sounds
Varicose veins - thromboembolism rare
Left sided
Aortic insuffic - late
10%

21. What causes the murmur heard in MR to enhance?
Babies
Anterosuperior displacement of the infundibular septum
Decrease in activity of Na/Ca exhanger and increase in contractility
Inc TPR and LA return (expiration)

22. What causes the CO curve to shift upwards?
Activated histiocytes
Pos inotropy - exercise
Increase intracellular Na - resulting in increased Ca
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

23. When do you find hemosiderin laden macrophages in the lungs?
Posterior descending (80% off the RCA - 20% off the circumflex)
During HF from microhemorrhages from inc pulm cap pressure
LAD - V1 - V4
MAP

24. What does FAN MY SKIN On Wednesday stand for?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Atrial contraction
Venodilators (nitrogylcerine)
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

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

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26. What does autoregulation do?
RCA
During diastole
Maintain blood flow to organ over wide range of perfussion pressures
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

27. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Decreases
Troponin I
Inc central venous pressure - inc resistance to portal flow
CK- MB

28. In what disease states is blood viscosity increased?
Late systolic crescendo murmur with a midsystolic click
Vasodilators - (hydrAlAzine)
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

29. What cardiac change occurs in pregnancy?
Fluid movement through capillaries
Increased SV
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
...

30. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
RV contraction (closed tricuspid valve bulding into atrium
Cardiac tamponde
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Ischemic heart dz - mitral valve prolapse - LV dilation

31. Unilateral headache - jaw claudication - impaired vision
Can progess to V fib
Tempral arteritis - may cause irreversible blindness
Hyperlipidemia
Aburpt halting of valve leaflets

32. absecnce of tricuspid valve - hypoplastic RV
Cyclophosphamide and corticosteroids
MI
Yes
Tricuspid atresia - requires ASD and VSD

33. Which murmur is heard in aortic stenosis?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Crescendo - decrescendo systolic ejection murmur following ejection click
Can progess to V fib
In series

34. When and why is the S3 sound heard?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
LCX - I - aVL
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Decreased

35. In an EKG - What is the QRS complex?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Ventricular depolarization - nl < 120 msec
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Truncus - tet of fallot

36. When during cardiac nodal cells depolarize?
Strawberry hemangioma
During diastole
TAPVR
Boot shaped heart

37. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Vasodilators - (hydrAlAzine)
Purkingee>atria>ventricles>AV node
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Indomethacin closes - and pge keeps it open

38. What causes the cushing reflex and why
Activated histiocytes
MI
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

39. congenital heart defect withdown syndrome
Fast volatge gated Na channels
V fib arrhythima
Babies
ASD - VSD - AV septal defect (endocardial cushion defect)

40. Restrictive cardiomyopathy causes
Left atrial pressure
SA and AV nodes
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Pulse pressure

41. How does digitatlis increase contractility?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Wolff - Parkinson white syndrome
MAP
Increase intracellular Na - resulting in increased Ca

42. In an anterior wall infarct - which artery is effected and which leads show Q waves
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
During HF from microhemorrhages from inc pulm cap pressure
LAD - V1 - V4
RCA

43. congenital heart defect with turner's
LCX - I - aVL
Coarcation of aorta
140/90
Decreased

44. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
ASD
S. aureus
Varicose veins - thromboembolism rare

45. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
MI
5-10 days - macs have degraded structural components
Late diastolic murmur following an opening snap
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

46. EDV is also known as
Rapid upstroke - voltage gated Na channels open
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Preload
Age related calcifications or bicuspid aortic valve

47. Wegener's tx
Total anomalous pulmonary trunk venous return
Cyclophosphamide and corticosteroids
RF
Hemorrhage

48. What is the classic X ray finding for tet of fallot?
Atherosclerosis
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Boot shaped heart
Tricuspid atresia - requires ASD and VSD

49. How does angiotensin II raise MAP
Left sided
Vasocxn
Increase intracellular Na - resulting in increased Ca
Preload

50. When is the scar completely formed in an MI?
Transposition of great vessels
7 weeks
Cystic hygroma
RCA - II - III - aVF