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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. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
QRS complex
LAD
Non
Stable angina

2. congenital heart defect with marfan's
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Aortic insuffic - late
Age related calcifications or bicuspid aortic valve
Unstable/crescendo angina

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

4. The cause of cardiac dilation?
Greater ventricular EDV
RV contraction (closed tricuspid valve bulding into atrium
Transposition of great vessels
Polyarteritis nodosum

5. In what disease states is blood viscosity increased?
Right sided
Postinfarction fibrinous pericarditis
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Lymphangiosarcoma

6. which medications are used to maintain patency or close the ductus arteriosus?
Increase - increase the chance the If are open
Indomethacin closes - and pge keeps it open
C - ANCA
Wolff - Parkinson white syndrome

7. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Decreases
Crescendo - decrescendo systolic ejection murmur following ejection click
Sudden tensing of chordae tendinae
Aburpt halting of valve leaflets

8. What can cause mitral prolapse?
Varicose veins - thromboembolism rare
Myxomatous degeneration - RF - chordae rupture
Pyogenic granuloma - associated with trauma and pregnancy
The aortic before pulmonic - inspiration increases diff

9. What does prolonged QT predispose to?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Wegener's
Torsades de pointes
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

10. When and why is the S3 sound heard?
Mitral stenosis
Proportional to viscosity and inversely proportional to the radius to the 4th power
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Posterior descending (80% off the RCA - 20% off the circumflex)

11. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
2-4 day - early coag necrosis on the first day
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Increase in Pc
Polyarteritis nodosum

12. Wegener's tx
SV/ EDV
Inc central venous pressure - inc resistance to portal flow
Pulse pressure
Cyclophosphamide and corticosteroids

13. Fatal arrhythmia
7 weeks
V fib
Lower right - MC - upper right - AO - upper right AC - lower left MO
Vasodilators

14. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kawasaki
Mean arterial pressure
Aortic disecction - intraluminal tear forming false lumen
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

15. CO x Total peripheral resistance
Aortic/pulmonic stenosis and mitral/tricuspid regurg
The aortic before pulmonic - inspiration increases diff
At least 55%
Mean arterial pressure

16. What does TAPVR stand for
S. epidermidis
Total anomalous pulmonary trunk venous return
Pulmonary flow murmur and diastolic rumble
LCX - I - aVL

17. What are the complications from bacterial endocarditis?
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
The first 4 days
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Chordae rupture - GN - suppurative pericarditis - emboli

18. What does increasing intracellular Ca do?
Increase contractility
SV/ EDV
RCA
Transposition of great vessels

19. what percentage of HTN is secondary to renal disease?
Decreased
Failure of LV to in CO during exercise
10%
Polyarteritis nodosum

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

21. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Acute thrombosis of coronary artery
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Myxoma

22. Which organ has the largest arteriovenous difference
Ischemic heart dz - mitral valve prolapse - LV dilation
Ventricles are depolarized
Heart - 02 extraction is always around 100%
Group a beta hemolytic strep

23. What is association with fixed S2 splitting - does not increase with inspiration
Sturge weber - vasculitis of caps
ASD
Transposition of great vessels
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

24. What are aschoff bodies
Systolic dysfunction
Left sided
Granuloma with giant cells
Decrease in cAMP

25. What is the machine like murmur? What is the heart pathology and the predisposing causes
Crescendo - decrescendo systolic ejection murmur following ejection click
Increasing activity of Ca pump in SR
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Patent ductus arteriosus - congenital rubella or prematurity

26. Which two mechanisms sense decrease MAP?
During diastole
Inc venous return exaccerbates pulm vasc congestion
LAD - V1 - V4
Medullary vasomotor center senses baroreceptors and JGA

27. What does T wave inversion indicated?
Ventricles are depolarized
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
MI
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

28. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Sturge weber - vasculitis of caps
Vasodilators - (hydrAlAzine)
Decreases
Aortic insuffic - late

29. Which murmur is heard in aortic stenosis?
Turners
Late systolic crescendo murmur with a midsystolic click
CFX
Crescendo - decrescendo systolic ejection murmur following ejection click

30. prolonged PR interval
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
1st degree AV blodck
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Mitral valve prolapse

31. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LCX - I - aVL
Pulmonary flow murmur and diastolic rumble
ASD
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

32. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Persistant truncus arteriosus
R to L shunt caused by stenoic pulmonic valve
Lymphangiosarcoma
Mean arterial pressure

33. What does hypoxia cause in the lung versus other tissues?
Kawasaki
Inc venous return exaccerbates pulm vasc congestion
Microscopic polyangiitis - like wegener's without granulomas
Vasocxn - while other tissues it causes vasodilation

34. In an inferior wall infarct - which artery is affected and which leads show Q waves
LV failure - pulm venous distention transudation of fluid
RCA - II - III - aVF
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Dressler's - autoimmune

35. How are cadiac myocytes eltrically coupled?
Libman - sacks endocarditis
Failure of LV to in CO during exercise
Gap junctions
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

36. What does FROM JANE stand for in bacterial endocarditis?

37. dyspnea - fatigue - edema and rales - multiple causes
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
CHF
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Troponin I

38. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Hematocrit
No
Torsades de pointes
140/90

39. Which area of the endocardium is especially vulnerable to infarction? Why?
S. aureus
Lymphangiosarcoma
Aortic disecction - intraluminal tear forming false lumen
Subendocardial - fewer collaterals and higher pressure

40. serum marker for wegener's
Myxoma
Aortic stenosis or LBBB
Mitral valve
C - ANCA

41. How does acidosis affect contractility?
Resting potential high K perm
SA>AV>bundle of His>ventricles
Increasing activity of Ca pump in SR
Decreased

42. What is indicated when CO and venous return are equal?
1st degree AV blodck
Ventricular depolarization - nl < 120 msec
The operating point of the heart
Strawberry hemangioma

43. Which murmur is heard with mitral prolapse?
Late systolic crescendo murmur with a midsystolic click
Myxomatous degeneration - RF - chordae rupture
Dec plasma proteins
Medullary vasomotor center senses baroreceptors and JGA

44. Which organ gets the largest share of systemic cardiac output
Viridans streptococci
Liver
Maintain blood flow to organ over wide range of perfussion pressures
Failure of LV to in CO during exercise

45. In an anterolateral infarct - which artery is effected and which leads show Q waves
At least 55%
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Inc central venous pressure - inc resistance to portal flow
LCX - V4- V6

46. Rank the pacemakers cells
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
SA>AV>bundle of His>ventricles
Age related calcifications or bicuspid aortic valve
Kidney

47. What causes the CO curve to shift downwards?
Neg inotropy - HF - narcotic overdose
Group a beta hemolytic strep
In parallel
Volatage gated Ca channels

48. What is the association with wide S2 splitting?
Pulmonic stenosis and RBBB
PDA
Black > white > asian
Glossopharyngeal to soliary nucleus of medulla

49. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Cardiac tamponde
Cystic hygroma
Atherosclerosis
Wolff - Parkinson white syndrome

50. If HR is too fast (V tach) what happens during diastole?
3rd degree block - pacemaker - Lyme disease
Filling is incomplete and CO falls
Resting potential high K perm
Kaposi's sarcoma