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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 terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Kids
Kawasaki
CO
Dec plasma proteins

2. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Right sided
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Pyogenic granuloma - associated with trauma and pregnancy
Varicose veins - thromboembolism rare

3. what percentage of HTN is secondary to renal disease?
QRS complex
10%
Vasocxn
Prinzmetal angina

4. Do you see elevaged ASO titers in rheumatic heart disease
Dilation
Fetal right to left - neonate left to right leading to RVH and failure
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Yes

5. What is associated with paradoxical spliting of S2
Atherosclerosis
Aortic stenosis or LBBB
Gap junctions
In parallel

6. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Mean arterial pressure
Liver
2nd degree AV block - mobitz type 1
Kawasaki

7. In terms of starling forces - why does heart failure cause edema?
Boot shaped heart
The first 4 days
Increase in Pc
Preload

8. What are the diastolic heart sounds?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Viridans streptococci
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Black > white > asian

9. What is the characteristic pulse in aortic stenosis?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Fetal right to left - neonate left to right leading to RVH and failure
Pulsus parvus and tardus - weak - can lead to syncope
In series

10. What is the S1 sound?
Pulmonary flow murmur and diastolic rumble
Age related calcifications or bicuspid aortic valve
Mitral and tricuspid closure
Resting potential high K perm

11. What is the time frame for arrhythmia risk in the evolution of MI
Preload
Atrial contraction
The first 4 days
In RA return (inspiration)

12. Which class of drugs decreases afterload?
Vasodilators - (hydrAlAzine)
ASD
Left sided
Decreases

13. How are sarcomeres added in concentric hypertrophy?
Inc blood volume
Mechanican contraction of the ventricles
Apex and anterior interventricular septum
In parallel

14. decrease stretch in baroreceptors leads to what response?
Ischemic heart dz - mitral valve prolapse - LV dilation
Anterosuperior displacement of the infundibular septum
Increased efferent SANS and decreased efferent PANS
LCX - V4- V6

15. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Holosystoiic
CO
Libman - sacks endocarditis
Dilated cardiomyopathy

16. absecnce of tricuspid valve - hypoplastic RV
Tricuspid atresia - requires ASD and VSD
In parallel
Kids
Ventricular repolarization

17. prolonged PR interval
Decreased
1st degree AV blodck
Inc blood volume
Mean arterial pressure

18. In what disease states is blood viscosity increased?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Squat. Compression of femoral arteries - inc TPR - dec
Truncus - tet of fallot

19. Right to left shunts are more common in babies or kids?
Postinfarction fibrinous pericarditis
Sudden tensing of chordae tendinae
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Babies

20. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
7 weeks
Postinfarction fibrinous pericarditis
Transfusion
Adult type aortic coarctation

21. Exercise - overtransfusiion and excitiment causes and increase in...?
Aortic stenosis or LBBB
Pulse pressure
Preload
Glossopharyngeal to soliary nucleus of medulla

22. What causes the murmur heard in tricuspid regurg to enhance
Rapid upstroke - voltage gated Na channels open
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
In RA return (inspiration)

23. What is association with fixed S2 splitting - does not increase with inspiration
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
ASD
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

24. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Right sided
Mitral valve
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

25. Which murmur do you hear in mitral stenosis?
Metastasis from melanoma or lymphoma
Mean arterial pressure
Late diastolic murmur following an opening snap
CO

26. What happens in phase 3 of the cardiac ventricular action potential?
In parallel
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Increase - increase the chance the If are open
Pulmonary flow murmur and diastolic rumble

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

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28. which ethnic groups have higher association with HTN?
Tricuspid atresia - requires ASD and VSD
Black > white > asian
Arteriorles
Heart - 02 extraction is always around 100%

29. dyspnea - fatigue - edema and rales - multiple causes
CHF
Inc interstitial osmotic pressure pulling fliud out of capillaries
Buerger's disease
The first 4 days

30. What does hypoxia cause in the lung versus other tissues?
Dressler's - autoimmune
7 weeks
Group a beta hemolytic strep
Vasocxn - while other tissues it causes vasodilation

31. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
...
Transmural
Decrease in activity of Na/Ca exhanger and increase in contractility
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

32. What kind of infarct show ST depression
Aortic dilation - bicuspid aortic valve - RF -
Subendocardial
Dilation
Hyperlipidemia

33. Rank the pacemakers cells
...
Right sided
Activated histiocytes
SA>AV>bundle of His>ventricles

34. What is the association with wide S2 splitting?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Pulmonic stenosis and RBBB
Microscopic polyangiitis - like wegener's without granulomas
Varicose veins - thromboembolism rare

35. What does T wave inversion indicated?
Dec plasma proteins
MI
Fast volatge gated Na channels
Can progess to V fib

36. Churg Strauss - presentation and test
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Kidney
Wolff - Parkinson white syndrome

37. What is a normal EF
At least 55%
Atherosclerosis
Preload
140/90

38. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Rapid upstroke - voltage gated Na channels open
Filling is incomplete and CO falls
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
S. aureus

39. What does FAN MY SKIN On Wednesday stand for?
Myxoma
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Changes in CO as a function of preload
Decrease in cAMP

40. machine murmer
PDA
Late systolic crescendo murmur with a midsystolic click
Maintain blood flow to organ over wide range of perfussion pressures
Subendocardial

41. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
MAP
S. epidermidis
Myxoma

42. When do you see extensive coagulative necrosis in an MI
R to L shunt caused by stenoic pulmonic valve
In parallel
QRS complex
2-4 day - early coag necrosis on the first day

43. Which lab value indicates blood viscosity?
Raynaud's
Hematocrit
Venodilators (nitrogylcerine)
Vasodilators - (hydrAlAzine)

44. In normal S2 splitting - which valve closes first? What increases it?
The aortic before pulmonic - inspiration increases diff
Aortic disecction - intraluminal tear forming false lumen
Wolff - Parkinson white syndrome
Tempral arteritis - may cause irreversible blindness

45. sawtooth wave

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46. How does digitatlis increase contractility?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Late diastolic murmur following an opening snap
HTN - bradycardia - and respiratory depression
Increase intracellular Na - resulting in increased Ca

47. most common primary cardiac tumor in children - associated with tuberous sclerosis
At least 55%
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Rhabdomyomas
Temporal arteritis

48. coronary artery spasm - ST elevation
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Total anomalous pulmonary trunk venous return
Prinzmetal angina

49. When do coronary arteries fill?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
During diastole
Systolic dysfunction
Yes

50. PCWP is an estimate of...
Fluid movement through capillaries
Purkingee>atria>ventricles>AV node
Tricuspid atresia - requires ASD and VSD
Left atrial pressure