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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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1. What are the 5 T's of cyanoitc babies
Vasocxn - while other tissues it causes vasodilation
Right sided
Activated histiocytes
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

2. congenital heart defect in an infant with a diabetic mother?
Cardiac tamponde
Isovolumetric contraction
Transposition of great vessels
Hyperlipidemia

3. Most common vasculitis affecting medium and large arteries
Pyogenic granuloma - associated with trauma and pregnancy
Granuloma with giant cells
Temporal arteritis
Increased efferent SANS and decreased efferent PANS

4. Inspiration causes an increase in which sided heart sounds?
Atherosclerosis
Inc venous return exaccerbates pulm vasc congestion
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Right sided

5. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
During diastole
Aortic disecction - intraluminal tear forming false lumen
Libman - sacks endocarditis
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

6. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
10%
Fetal right to left - neonate left to right leading to RVH and failure

7. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Lower right - MC - upper right - AO - upper right AC - lower left MO
Angiosarcoma
Hematocrit

8. What is the characteristic pulse in aortic stenosis?
5-10 days - macs have degraded structural components
Pulsus parvus and tardus - weak - can lead to syncope
The operating point of the heart
Late diastolic murmur following an opening snap

9. What does HTN predispose to?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Yes
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
S. bovis

10. cavernous lymphangioma of the neck - associated with turner's
Cystic hygroma
Glossopharyngeal to soliary nucleus of medulla
Viridans streptococci
Aortic insuffic - late

11. with what heart sounds do ASD usually present?
The plateau period
Decreased
Pulmonary flow murmur and diastolic rumble
Preload

12. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
HypoK and bradycardia
Hypertrophied cardiomyopathy
Viridans streptococci
No - no pressure gradient

13. Given P = QR - what factors influence resistance?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Atrial contraction
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

14. exaggerated decrease in pulse during inspiration.

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15. What causes the early cyanosis in Tet of Fallot?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
R to L shunt caused by stenoic pulmonic valve
Troponin I
Patent ductus arteriosus - congenital rubella or prematurity

16. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
TAPVR
Persistant truncus arteriosus
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Fluid movement through capillaries

17. When during cardiac nodal cells depolarize?
C - ANCA
During diastole
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

18. Which area of the endocardium is especially vulnerable to infarction? Why?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Kidney
Subendocardial - fewer collaterals and higher pressure

19. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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20. What can cause mitral prolapse?
Myxomatous degeneration - RF - chordae rupture
Neg inotropy - HF - narcotic overdose
LAD - V1- V2
Anterosuperior displacement of the infundibular septum

21. tearing chest pain radiation to the back - associated with marfan
Hypertrophied cardiomyopathy
RF
Aortic disecction - intraluminal tear forming false lumen
Cherry hemangioma

22. Which artery supplies the SA and AV nodes?
RCA
Late diastolic murmur following an opening snap
Wegener's
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

23. most common primary cardiac tumor in children - associated with tuberous sclerosis
Hypertrophied cardiomyopathy
Rhabdomyomas
Sturge weber - vasculitis of caps
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

24. What other syndrom is associated with infantile aortic coarctation
Turners
Fluid movement through capillaries
RCA
Tricuspid atresia - requires ASD and VSD

25. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Tricuspid atresia - requires ASD and VSD
Fetal right to left - neonate left to right leading to RVH and failure
Fick principle
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

26. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Neg inotropy - HF - narcotic overdose
Aortic and pulmonary closing
CK- MB
MI

27. coronary artery spasm - ST elevation
SV/ EDV
Total anomalous pulmonary trunk venous return
Prinzmetal angina
RF

28. What is the difference between adult and infantile type aortic coarctation?
Black > white > asian
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Tricuspid atresia - requires ASD and VSD
SV/ EDV

29. How does aldosterone raise MAP
Inc blood volume
Takayasu's arteritis
Failure of LV to in CO during exercise
S. aureus

30. What does the LAD supply?
During diastole
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Apex and anterior interventricular septum
Stroke volume

31. What causes the murmur heard in tricuspid regurg to enhance
In RA return (inspiration)
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
P02
Infective endocarditis

32. Where are pacemaker cells?
SA and AV nodes
Eccentric - concentric hypertrophy causes diastolic disfunction
Polyarteritis nodosum
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

33. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Gap junctions
Mitral and tricuspid closure
Non
Tricuspid atresia - requires ASD and VSD

34. Which bacteria causes endocarditis in the presence of colon cancer
S. bovis
Hemorrhage
Holosystoiic
Increase contractility

35. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Henoch - Schlonlein purpura
Adult type aortic coarctation
Anterosuperior displacement of the infundibular septum

36. which ethnic groups have higher association with HTN?
Glomus tumor
Increase contractility
Black > white > asian
Raynaud's

37. When is the scar completely formed in an MI?
The operating point of the heart
Volatage gated Ca channels
Persistant truncus arteriosus
7 weeks

38. What is the association with wide S2 splitting?
SA and AV nodes
Pulmonic stenosis and RBBB
10%
Babies

39. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Mean arterial pressure
Hyperlipidemia
Pulmonary flow murmur and diastolic rumble
Atrial contraction

40. What constitues the upstroke in pacemaker cells?
CO
Volatage gated Ca channels
Stable angina
Kawasaki

41. machine murmer
The plateau period
PDA
Hyperlipidemia
ANP

42. congenital heart defect with marfan's
Transmural
Aortic insuffic - late
Chordae rupture - GN - suppurative pericarditis - emboli
Tempral arteritis - may cause irreversible blindness

43. What are common causes of mitral regurg?
Pulsus parvus and tardus - weak - can lead to syncope
Microscopic polyangiitis - like wegener's without granulomas
Ischemic heart dz - mitral valve prolapse - LV dilation
Aortic stenosis or LBBB

44. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Subendocardial
Increase intracellular Na - resulting in increased Ca
Purkingee>atria>ventricles>AV node
Decrease in cAMP

45. How are cadiac myocytes eltrically coupled?
Myxomatous degeneration - RF - chordae rupture
Gap junctions
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Patent ductus arteriosus - congenital rubella or prematurity

46. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
Septal defects - PDA - pulm art stenosis
Aortic stenosis or LBBB
7 weeks

47. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Inc blood volume
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
ASD
RCA

48. In an inferior wall infarct - which artery is affected and which leads show Q waves
Preload
Atherosclerosis
RCA - II - III - aVF
Atrial contraction

49. Wegener's presentation
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Lymphangiosarcoma
Can progess to V fib

50. dyspnea - fatigue - edema and rales - multiple causes
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Dressler's - autoimmune
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
CHF