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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. exaggerated decrease in pulse during inspiration.

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2. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
Mitral valve prolapse
Lymphangiosarcoma
Mitral and tricuspid closure

3. Why is there edema after burns or during infection
Inc Kf - capillary perm
Preload
Preload
Eisenmenger's syndrome

4. What causes the murmur heard in tricuspid regurg to enhance
In RA return (inspiration)
Neg inotropy - HF - narcotic overdose
Posterior descending (80% off the RCA - 20% off the circumflex)
Ventricles are depolarized

5. polypoid capillary hemangioma that can ulcerate and bleed
During HF from microhemorrhages from inc pulm cap pressure
The operating point of the heart
Pyogenic granuloma - associated with trauma and pregnancy
Inc blood volume

6. The 7 complications of MI

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7. EDV - ESV
140/90
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Stroke volume
Decrease in activity of Na/Ca exhanger and increase in contractility

8. What does an isoelectric ST segment indicate?
Left atrial pressure
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
140/90
Ventricles are depolarized

9. CO x Total peripheral resistance
Ventricular depolarization - nl < 120 msec
No - no pressure gradient
Left sided
Mean arterial pressure

10. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Viridans streptococci
Lower right - MC - upper right - AO - upper right AC - lower left MO
LCX - V4- V6
Aortic stenosis or LBBB

11. What are the complications from bacterial endocarditis?
Metastasis from melanoma or lymphoma
Chordae rupture - GN - suppurative pericarditis - emboli
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Temporal arteritis

12. What other sign is often present with congenital long QT syndrome - why?
Dressler's - autoimmune
Septal defects - PDA - pulm art stenosis
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Inc venous return exaccerbates pulm vasc congestion

13. What is the classic X ray finding for tet of fallot?
Boot shaped heart
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Libman - sacks endocarditis
Increase contractility

14. What is the association with wide S2 splitting?
Pulmonic stenosis and RBBB
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Squat. Compression of femoral arteries - inc TPR - dec

15. What other syndrom is associated with infantile aortic coarctation
Turners
MI
Coarcation of aorta
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

16. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Kidney
Preload
Venodilators (nitrogylcerine)
Polyarteritis nodosum

17. What is sudden cardiac death most commonly due to...
Systolic dysfunction
MI
Sturge weber - vasculitis of caps
V fib arrhythima

18. What is the S1 sound?
Left sided
Mitral and tricuspid closure
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Venodilators (nitrogylcerine)

19. Hyperplastic onion skinning
If sodium channel
Maintain blood flow to organ over wide range of perfussion pressures
Arteriolosclerosis in malignant hypertension
2-4 day - early coag necrosis on the first day

20. Which organ has the largest arteriovenous difference
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Heart - 02 extraction is always around 100%
Lymphangiosarcoma
Hematocrit

21. What is the most common cause of right heart failure
Anterosuperior displacement of the infundibular septum
Left heart failure
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Hypertrophied cardiomyopathy

22. Mitral stenosis is most often secondary to which condition?
Increase intracellular Na - resulting in increased Ca
Metastasis from melanoma or lymphoma
RF
Decreases

23. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
S. bovis
Liver
SV/ EDV
Cardiac tamponde

24. Given P = QR - what factors influence resistance?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
S. epidermidis
Proportional to viscosity and inversely proportional to the radius to the 4th power

25. sawtooth wave

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26. which ethnic groups have higher association with HTN?
Increased SV
Hyperlipidemia
Black > white > asian
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

27. what conditions are associated with pulsus paradoxus
Decreased
Libman - sacks endocarditis
Inc central venous pressure - inc resistance to portal flow
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

28. What kind of infarct show ST depression
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Subendocardial
...
CFX

29. Which murmur is heard with mitral prolapse?
Chordae rupture - GN - suppurative pericarditis - emboli
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Inc Kf - capillary perm
Late systolic crescendo murmur with a midsystolic click

30. What does HTN predispose to?
Dilated cardiomyopathy
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
3rd degree block - pacemaker - Lyme disease
Postinfarction fibrinous pericarditis

31. What is the time frame for arrhythmia risk in the evolution of MI
Troponin I
RV contraction (closed tricuspid valve bulding into atrium
The first 4 days
Arteriolosclerosis in malignant hypertension

32. The aortic arch receptors transmit along which nerve?
Resting potential high K perm
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Buerger's disease
Vagus to medulla

33. What causes hepatomegaly?
Inc central venous pressure - inc resistance to portal flow
Arteriorles
Indomethacin closes - and pge keeps it open
Coarcation of aorta

34. no change in PR interval followed by dropped beat
Kids
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Inc TPR and LA return (expiration)

35. How does digitatlis increase contractility?
CK- MB
Patent ductus arteriosus - congenital rubella or prematurity
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Increase intracellular Na - resulting in increased Ca

36. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
RV failure - in venous pressure
Varicose veins - thromboembolism rare
Transfusion

37. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
At least 55%
HypoK and bradycardia
Atherosclerosis
Viridans streptococci

38. What does the atria release in response to inc blood volume and atrial pressure
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Postinfarction fibrinous pericarditis
ANP
Posterior descending (80% off the RCA - 20% off the circumflex)

39. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Mitral valve
SA and AV nodes
No
S. bovis

40. serum marker for wegener's
Stroke volume
SA>AV>bundle of His>ventricles
C - ANCA
The aortic before pulmonic - inspiration increases diff

41. bening capillary hemangioma of elderly - does not regress
Squat. Compression of femoral arteries - inc TPR - dec
Wegener's
Cherry hemangioma
Dilated cardiomyopathy

42. Central chemoreceptors do not respond directly to which parameter?
Henoch - Schlonlein purpura
P02
Late diastolic murmur following an opening snap
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

43. What are the systolic heart sounds
Aortic/pulmonic stenosis and mitral/tricuspid regurg
The aortic before pulmonic - inspiration increases diff
Left sided
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

44. When do coronary arteries fill?
Increased SV
Torsades de pointes
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
During diastole

45. Where does coronary artery occlusion occur most commonly?
During HF from microhemorrhages from inc pulm cap pressure
Lymphangiosarcoma
Hematocrit
LAD

46. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Hyperlipidemia
Increase contractility
Fick principle
Venodilators (nitrogylcerine)

47. In an EKG - What is the p wave?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Pulsus parvus and tardus - weak - can lead to syncope
Atrial contraction
Decrease in activity of Na/Ca exhanger and increase in contractility

48. PCWP is an estimate of...
Vasocxn
PDA
Left atrial pressure
S. aureus

49. What kind of dysfunction ensues in restrictive cardiomyopathy
Adult type aortic coarctation
Babies
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Diastolic

50. Which bacteria causes endocarditis in the presence of colon cancer
Raynaud's
Boot shaped heart
S. bovis
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis