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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 are anitschkow's cells
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Activated histiocytes
PDA
Granuloma with giant cells

2. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Isovolumetric contraction
Rhabdomyomas

3. What is the early and late lesion in rheumatic heart disease
Pyogenic granuloma - associated with trauma and pregnancy
Vasocxn - while other tissues it causes vasodilation
Mitral valve prolapse
Increasing activity of Ca pump in SR

4. What is the characteristic pulse in aortic stenosis?
Fluid movement through capillaries
Wegener's
Pulsus parvus and tardus - weak - can lead to syncope
Henoch - Schlonlein purpura

5. How does acidosis affect contractility?
Decreased
Early deaths from myocarditis
Cardiac tamponde
Anterosuperior displacement of the infundibular septum

6. fibrinous pericarditis several weeks post MI

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7. Why is contractility decreased in heart failure?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Medullary vasomotor center senses baroreceptors and JGA
Dec plasma proteins
Systolic dysfunction

8. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Left sided
Inc Kf - capillary perm
Purkingee>atria>ventricles>AV node
Increase contractility

9. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Lower right - MC - upper right - AO - upper right AC - lower left MO
TAPVR
Ischemic heart dz - mitral valve prolapse - LV dilation
Transmural

10. Which murmur is heard with VSD?
Volatage gated Ca channels
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Dec plasma proteins
MI

11. 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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12. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
MI
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Pulse pressure
MAP

13. How do beta blockers decrease contractility?
V fib
Vasocxn - while other tissues it causes vasodilation
Aortic stenosis or LBBB
Decrease in cAMP

14. machine murmer
PDA
Prinzmetal angina
Volatage gated Ca channels
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

15. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Non
Inc blood volume
Posterior descending (80% off the RCA - 20% off the circumflex)

16. What is the S1 sound?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Decreases
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Mitral and tricuspid closure

17. What are the four most common locations for atherosclerosis?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Dressler's - autoimmune
Boot shaped heart
S. aureus

18. What does prolonged QT predispose to?
Libman - sacks endocarditis
Acute thrombosis of coronary artery
Torsades de pointes
3rd degree block - pacemaker - Lyme disease

19. Which valve is most commonly involved in bacterial endocarditis?
Mitral valve
Pulse pressure
Sturge weber - vasculitis of caps
Aortic disecction - intraluminal tear forming false lumen

20. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Venodilators (nitrogylcerine)
Fetal right to left - neonate left to right leading to RVH and failure
Adult type aortic coarctation
CFX

21. What are common causes of mitral regurg?
Ischemic heart dz - mitral valve prolapse - LV dilation
Atrial contraction
Decrease in activity of Na/Ca exhanger and increase in contractility
If sodium channel

22. How does angiotensin II raise MAP
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
TAPVR
CFX
Vasocxn

23. congenital heart defect with turner's
Vasodilators - (hydrAlAzine)
CHF
Coarcation of aorta
Left sided

24. How does digitatlis increase contractility?
Takayasu's arteritis
Varicose veins - thromboembolism rare
Increase intracellular Na - resulting in increased Ca
RV contraction (closed tricuspid valve bulding into atrium

25. How does a patient with Tet of fallot learn to improve symptoms?
Fluid movement through capillaries
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Squat. Compression of femoral arteries - inc TPR - dec
Aortic stenosis or LBBB

26. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Angiosarcoma
LV failure - pulm venous distention transudation of fluid
Activated histiocytes

27. What causes the murmur heard in MR to enhance?
Torsades de pointes
Inc TPR and LA return (expiration)
Takayasu's arteritis
Glossopharyngeal to soliary nucleus of medulla

28. In an anterior wall infarct - which artery is effected and which leads show Q waves
LAD - V1 - V4
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Transposition of great vessels
RCA - II - III - aVF

29. Which murmur is characteristic of mitral/tricuspid regurg?
The aortic before pulmonic - inspiration increases diff
V fib arrhythima
Arteriorles
Holosystoiic

30. absecnce of tricuspid valve - hypoplastic RV
Tricuspid atresia - requires ASD and VSD
Total anomalous pulmonary trunk venous return
No - no pressure gradient
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

31. What are the complications from bacterial endocarditis?
Dressler's - autoimmune
Chordae rupture - GN - suppurative pericarditis - emboli
Mitral and tricuspid closure
Transfusion

32. cavernous lymphangioma of the neck - associated with turner's
Cystic hygroma
P02
Increase - increase the chance the If are open
Group a beta hemolytic strep

33. What does the LAD supply?
Apex and anterior interventricular septum
The operating point of the heart
Tempral arteritis - may cause irreversible blindness
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

34. The carotid sinus transmits along which nerve?
Troponin I
Glossopharyngeal to soliary nucleus of medulla
Dilated cardiomyopathy
Fick principle

35. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Glomus tumor
Posterior descending (80% off the RCA - 20% off the circumflex)
Increased SV
Increase contractility

36. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Viridans streptococci
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Dilated cardiomyopathy
Stroke volume

37. Restrictive cardiomyopathy causes
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Ventricular depolarization - nl < 120 msec
During HF from microhemorrhages from inc pulm cap pressure
V fib arrhythima

38. What is the progression of atherosclerosis?
Medullary vasomotor center senses baroreceptors and JGA
140/90
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
RCA - II - III - aVF

39. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Eccentric - concentric hypertrophy causes diastolic disfunction
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
SA and AV nodes
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

40. What causes the cushing reflex and why
Age related calcifications or bicuspid aortic valve
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Torsades de pointes
Indomethacin closes - and pge keeps it open

41. What happens in phase 3 of the cardiac ventricular action potential?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
V fib arrhythima
Lymphangiosarcoma
R to L shunt caused by stenoic pulmonic valve

42. stroke volume x HR =?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Postinfarction fibrinous pericarditis
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
CO

43. Which organ gets the largest share of systemic cardiac output
Raynaud's
Liver
Left heart failure
Kidney

44. What is the most common cause of right heart failure
Strawberry hemangioma
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
10%
Left heart failure

45. Right to left shunts are more common in babies or kids?
Glomus tumor
SA and AV nodes
Babies
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

46. What cardiac change occurs in pregnancy?
Extracellular calcium - calcium induced calcium release
Increased SV
Decreases
10%

47. Which vessels account for the most total peripheral resistance
Arteriorles
Non
CO
Decrease in cAMP

48. Most common vasculitis affecting medium and large arteries
Libman - sacks endocarditis
Black > white > asian
Temporal arteritis
C - ANCA

49. How are sarcomeres added in concentric hypertrophy?
In parallel
Inc Kf - capillary perm
Transmural
Vasodilators - (hydrAlAzine)

50. In an EKG - What is the PR interval?
Conduction delay through AV node - nl < 200 msec
RCA - II - III - aVF
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
140/90