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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 does prolonged QT predispose to?
Torsades de pointes
Prinzmetal angina
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Boot shaped heart

2. What happens in phase 3 of the cardiac ventricular action potential?
RV failure - in venous pressure
Myxoma
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
S. bovis

3. Given P = QR - what factors influence resistance?
Conduction delay through AV node - nl < 200 msec
Proportional to viscosity and inversely proportional to the radius to the 4th power
Dec P02 - inc PC02 and dec pH
Left atrial pressure

4. What are the diastolic heart sounds?
Buerger's disease
Aortic dilation - bicuspid aortic valve - RF -
SA and AV nodes
Aortic/pulmonic regurg and mitral/tricuspid stenosis

5. What cardiac change occurs in pregnancy?
Tempral arteritis - may cause irreversible blindness
...
Increased SV
The aortic before pulmonic - inspiration increases diff

6. In what disease states is blood viscosity increased?
Posterior descending (80% off the RCA - 20% off the circumflex)
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
SA and AV nodes

7. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Prinzmetal angina
LCX - I - aVL
Granuloma with giant cells
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

8. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Transmural
Wolff - Parkinson white syndrome
Raynaud's

9. What happens with a decrease of extracellular Na
Dilated cardiomyopathy
Decrease in activity of Na/Ca exhanger and increase in contractility
CHF
Crescendo - decrescendo systolic ejection murmur following ejection click

10. What kind of infarct show ST depression
Fluid movement through capillaries
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Subendocardial
S. epidermidis

11. decrease stretch in baroreceptors leads to what response?
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
RF
Increased efferent SANS and decreased efferent PANS
Early deaths from myocarditis

12. What happens in phase 2 of the cardiac ventricular action potential?
PDA
CO
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
S. bovis

13. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
SV/ EDV
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Strawberry hemangioma
Dilated cardiomyopathy

14. Expiration causes an increase in which sided heart sounds
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Left sided
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
S. bovis

15. Which vessels account for the most total peripheral resistance
Libman - sacks endocarditis
Cyclophosphamide and corticosteroids
RV contraction (closed tricuspid valve bulding into atrium
Arteriorles

16. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
2nd degree AV block - mobitz type 1
Pyogenic granuloma - associated with trauma and pregnancy
Mechanican contraction of the ventricles
Hyperlipidemia

17. What can cause mitral prolapse?
Myxomatous degeneration - RF - chordae rupture
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
No
Arteriolosclerosis in malignant hypertension

18. In an acute MI - are there any visible changes via LM in the first 2-4 hours
No
Transposition of great vessels
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Left sided

19. PCWP is an estimate of...
HTN - bradycardia - and respiratory depression
Troponin I
Total anomalous pulmonary trunk venous return
Left atrial pressure

20. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Conduction delay through AV node - nl < 200 msec
Prinzmetal angina
Myxoma
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

21. What 4 things drive myocardial 02 demand?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Purkingee>atria>ventricles>AV node
LCX - I - aVL
In parallel

22. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
TAPVR
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Acute thrombosis of coronary artery
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

23. What is the gold standard for dx of MI in the first 6 hours
SA and AV nodes
Increasing activity of Ca pump in SR
EKG
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

24. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Polyarteritis nodosum
Lymphangiosarcoma
Neg inotropy - HF - narcotic overdose
Eisenmenger's syndrome

25. What stimulates release of calcium from the SR?
Afterload (proportional to peripheral resistance)
Group a beta hemolytic strep
Fetal right to left - neonate left to right leading to RVH and failure
Extracellular calcium - calcium induced calcium release

26. How does a patient with Tet of fallot learn to improve symptoms?
Pulse pressure
The aortic before pulmonic - inspiration increases diff
Coarcation of aorta
Squat. Compression of femoral arteries - inc TPR - dec

27. MAP is also known as
Afterload (proportional to peripheral resistance)
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Patent ductus arteriosus - congenital rubella or prematurity
Volatage gated Ca channels

28. The cause of cardiac dilation?
...
Cherry hemangioma
Infective endocarditis
Greater ventricular EDV

29. How does acidosis affect contractility?
C - ANCA
Raynaud's
Persistant truncus arteriosus
Decreased

30. When and why is the S3 sound heard?
In series
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Proportional to viscosity and inversely proportional to the radius to the 4th power
Holosystolic - harsh sounding murmur - loudest over tricuspid area

31. PCWP > LV diastolic pressure
Mitral stenosis
Inc TPR and LA return (expiration)
In parallel
Preload

32. What supplies the posterior left ventricle?
CFX
S. epidermidis
Dilated cardiomyopathy
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

33. What causes tet of fallot?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Anterosuperior displacement of the infundibular septum
Hematocrit
Vagus to medulla

34. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Stroke volume
Stable angina
Inc blood volume
S. aureus

35. list the coronary vessels most likely to be occluded
If sodium channel
Sturge weber - vasculitis of caps
LAD > RCA > circumflex
LCX - I - aVL

36. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Septal defects - PDA - pulm art stenosis
Adult type aortic coarctation
Raynaud's
Tricuspid atresia - requires ASD and VSD

37. congenital heart defect with turner's
Inc central venous pressure - inc resistance to portal flow
Tricuspid atresia - requires ASD and VSD
Kawasaki
Coarcation of aorta

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

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39. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
During diastole
Ischemic heart dz - mitral valve prolapse - LV dilation
Polyarteritis nodosum
Truncus - tet of fallot

40. What does TAPVR stand for
Aburpt halting of valve leaflets
Total anomalous pulmonary trunk venous return
Lymphangiosarcoma
Prinzmetal angina

41. What is the classic X ray finding for tet of fallot?
Wegener's
MI
Boot shaped heart
Late diastolic murmur following an opening snap

42. What is association with fixed S2 splitting - does not increase with inspiration
ASD
Buerger's disease
Strawberry hemangioma
Ischemic heart dz - mitral valve prolapse - LV dilation

43. How does angiotensin II raise MAP
Mean arterial pressure
Vasocxn
RF
2-4 day - early coag necrosis on the first day

44. Which class of drugs decrease preload
Vasodilators
Venodilators (nitrogylcerine)
C - ANCA
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

45. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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46. What is the S2 sound?
Pulsus parvus and tardus - weak - can lead to syncope
Dec plasma proteins
...
Aortic and pulmonary closing

47. congenital heart defect with marfan's
Aortic insuffic - late
Age related calcifications or bicuspid aortic valve
Persistant truncus arteriosus
S. bovis

48. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Proportional to viscosity and inversely proportional to the radius to the 4th power
Transposition of great vessels
Kidney
Cardiac tamponde

49. How does aldosterone raise MAP
140/90
Lymphangiosarcoma
Inc blood volume
RF

50. cavernous lymphangioma of the neck - associated with turner's
Pulse pressure
Libman - sacks endocarditis
SA>AV>bundle of His>ventricles
Cystic hygroma