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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 an isoelectric ST segment indicate?
Ventricles are depolarized
Eccentric - concentric hypertrophy causes diastolic disfunction
If sodium channel
Persistant truncus arteriosus

2. In normal S2 splitting - which valve closes first? What increases it?
Changes in CO as a function of preload
Filling is incomplete and CO falls
Inc interstitial osmotic pressure pulling fliud out of capillaries
The aortic before pulmonic - inspiration increases diff

3. coronary artery spasm - ST elevation
HTN - bradycardia - and respiratory depression
Prinzmetal angina
ASD
Septal defects - PDA - pulm art stenosis

4. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Kaposi's sarcoma
Ventricular repolarization
Posterior descending (80% off the RCA - 20% off the circumflex)
Venodilators (nitrogylcerine)

5. Left to right shunts are more common in babies or kids?
Turners
Mean arterial pressure
Kids
Strawberry hemangioma

6. What are aschoff bodies
Granuloma with giant cells
MI
Lymphangiosarcoma
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

7. How does a patient with Tet of fallot learn to improve symptoms?
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Increased efferent SANS and decreased efferent PANS
Apex and anterior interventricular septum
Squat. Compression of femoral arteries - inc TPR - dec

8. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Turners
Kawasaki
...
Eccentric - concentric hypertrophy causes diastolic disfunction

9. When do coronary arteries fill?
During diastole
RCA
TAPVR
Aortic insuffic - late

10. Why is there edema after burns or during infection
Inc Kf - capillary perm
Fick principle
Torsades de pointes
Inc central venous pressure - inc resistance to portal flow

11. polypoid capillary hemangioma that can ulcerate and bleed
Pyogenic granuloma - associated with trauma and pregnancy
R to L shunt caused by stenoic pulmonic valve
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Gap junctions

12. When do you find hemosiderin laden macrophages in the lungs?
During HF from microhemorrhages from inc pulm cap pressure
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Resting potential high K perm
Sudden tensing of chordae tendinae

13. machine murmer
R to L shunt caused by stenoic pulmonic valve
PDA
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
ASD - VSD - AV septal defect (endocardial cushion defect)

14. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
RCA - II - III - aVF
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Failure of LV to in CO during exercise
Stable angina

15. What causes the CO curve to shift upwards?
Mitral stenosis
Microscopic polyangiitis - like wegener's without granulomas
Left sided
Pos inotropy - exercise

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

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17. Which kind of infarct show ST elevation - and/or pathologic Q waves
Transmural
Acute thrombosis of coronary artery
ANP
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

18. prolonged PR interval
Inc central venous pressure - inc resistance to portal flow
1st degree AV blodck
Vagus to medulla
Tempral arteritis - may cause irreversible blindness

19. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
Lower right - MC - upper right - AO - upper right AC - lower left MO
Fluid movement through capillaries
Vasodilators

20. What happends in phase 1 of the ventricular cardiac action potential?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Afterload (proportional to peripheral resistance)
Activated histiocytes

21. What does increasing intracellular Ca do?
Increase contractility
Venodilators (nitrogylcerine)
Holosystoiic
LAD - V1- V2

22. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
No
LCX - I - aVL
Increase in Pc
Babies

23. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Filling is incomplete and CO falls
Eisenmenger's syndrome
3rd degree block - pacemaker - Lyme disease
Lymphangiosarcoma

24. What does hypoxia cause in the lung versus other tissues?
The operating point of the heart
Metastasis from melanoma or lymphoma
Dilation
Vasocxn - while other tissues it causes vasodilation

25. in the JVP - What is the v wave?
Wolff - Parkinson white syndrome
Inc RA pressure - due to filling against closed tricupsid valve
Left sided
Decrease in cAMP

26. EDV - ESV
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Total anomalous pulmonary trunk venous return
Stroke volume
The operating point of the heart

27. What is the most common cause of right heart failure
Left heart failure
Right sided
Kids
Mitral and tricuspid closure

28. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Henoch - Schlonlein purpura
No - no pressure gradient
Mechanican contraction of the ventricles

29. What causes ankle - sacral edema - jugular venous distention
Conduction delay through AV node - nl < 200 msec
V fib
RV failure - in venous pressure
Atherosclerosis

30. benign cap hemangioma of infancy - spont regresses
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Arteriorles
Strawberry hemangioma
Kaposi's sarcoma

31. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Hypertrophied cardiomyopathy

32. Which murmur is heard with mitral prolapse?
Eccentric - concentric hypertrophy causes diastolic disfunction
Late systolic crescendo murmur with a midsystolic click
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

33. Which artery supplies the SA and AV nodes?
RCA
Volatage gated Ca channels
Group a beta hemolytic strep
Posterior descending (80% off the RCA - 20% off the circumflex)

34. Wegener's presentation
EKG
Arteriorles
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
In parallel

35. In an EKG - What is the T wave?
Group a beta hemolytic strep
Preload
Septal defects - PDA - pulm art stenosis
Ventricular repolarization

36. What kind of infarct show ST depression
CHF
Raynaud's
CK- MB
Subendocardial

37. Which class of drugs decrease the murmur heard in aortic regurg?
Ventricles are depolarized
Vasodilators
ANP
Atrial contraction

38. Which channel accounts for automaticity of the SA and AV nodes?
If sodium channel
7 weeks
ANP
Neg inotropy - HF - narcotic overdose

39. What is the characteristic pulse in aortic stenosis?
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Pulsus parvus and tardus - weak - can lead to syncope
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

40. In an anterolateral infarct - which artery is effected and which leads show Q waves
Hemorrhage
Myxomatous degeneration - RF - chordae rupture
LCX - V4- V6
Kawasaki

41. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Group a beta hemolytic strep
Purkingee>atria>ventricles>AV node
Decrease in cAMP
Atherosclerosis

42. most common heart tumor
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
ASD - VSD - AV septal defect (endocardial cushion defect)
V fib arrhythima
Metastasis from melanoma or lymphoma

43. in the JVP - What is the c wave?
Mitral valve prolapse
LAD - V1 - V4
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
RV contraction (closed tricuspid valve bulding into atrium

44. Hyperplastic onion skinning
Infective endocarditis
Takayasu's arteritis
Left atrial pressure
Arteriolosclerosis in malignant hypertension

45. What happens in phase 3 of the cardiac ventricular action potential?
Crescendo - decrescendo systolic ejection murmur following ejection click
Infective endocarditis
MI
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

46. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Tricuspid atresia - requires ASD and VSD
Strawberry hemangioma
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

47. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Mean arterial pressure
Glomus tumor
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Apex and anterior interventricular septum

48. How does digitatlis increase contractility?
Increase intracellular Na - resulting in increased Ca
3rd degree block - pacemaker - Lyme disease
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
LAD > RCA > circumflex

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

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50. What does FROM JANE stand for in bacterial endocarditis?

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