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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 the four most common locations for atherosclerosis?
Vasocxn
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Apex and anterior interventricular septum
Lower right - MC - upper right - AO - upper right AC - lower left MO

2. Do you see elevaged ASO titers in rheumatic heart disease
Yes
Cystic hygroma
If sodium channel
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

3. What causes ankle - sacral edema - jugular venous distention
Activated histiocytes
Non
2-4 day - early coag necrosis on the first day
RV failure - in venous pressure

4. What causes the midsystolic click
Granuloma with giant cells
Filling is incomplete and CO falls
Sudden tensing of chordae tendinae
SV/ EDV

5. Which vessels account for the most total peripheral resistance
Purkingee>atria>ventricles>AV node
PDA
Arteriorles
Mitral and tricuspid closure

6. Which valve is most commonly involved in bacterial endocarditis?
Fast volatge gated Na channels
Vasodilators
Mitral valve
Diastolic

7. Which valve is commonly involved in bacterial endocarditis from IV drug use and Which bacteria are most common?

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8. exaggerated decrease in pulse during inspiration.

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9. What is indicated when CO and venous return are equal?
S. epidermidis
Stroke volume affected by contractility - afterload - and preload
The operating point of the heart
During diastole

10. Which bacteria can cause endocarditis from prosthetic valves?
QRS complex
Isovolumetric contraction
ASD - VSD - AV septal defect (endocardial cushion defect)
S. epidermidis

11. What is the association with wide S2 splitting?
HTN - bradycardia - and respiratory depression
Pulse pressure
Pulmonic stenosis and RBBB
Posterior descending (80% off the RCA - 20% off the circumflex)

12. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Viridans streptococci
Conduction delay through AV node - nl < 200 msec
1st degree AV blodck
S. aureus

13. How does angiotensin II raise MAP
Fick principle
LCX - V4- V6
Boot shaped heart
Vasocxn

14. Which artery supplies the inferior portion of the left ventricle and posterior septum?
1st degree AV blodck
Myxomatous degeneration - RF - chordae rupture
LV failure - pulm venous distention transudation of fluid
Posterior descending (80% off the RCA - 20% off the circumflex)

15. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
140/90
Hemorrhage
Aortic disecction - intraluminal tear forming false lumen
Henoch - Schlonlein purpura

16. In an EKG - What is the p wave?
Raynaud's
Atrial contraction
Glomus tumor
Aortic/pulmonic regurg and mitral/tricuspid stenosis

17. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Pyogenic granuloma - associated with trauma and pregnancy
Adult type aortic coarctation
Increasing activity of Ca pump in SR

18. What does increasing intracellular Ca do?
Libman - sacks endocarditis
Filling is incomplete and CO falls
Dressler's - autoimmune
Increase contractility

19. How does digitatlis increase contractility?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Left heart failure
Increase intracellular Na - resulting in increased Ca
Stable angina

20. What are the systolic heart sounds
Increased efferent SANS and decreased efferent PANS
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Vasocxn
Pyogenic granuloma - associated with trauma and pregnancy

21. What causes aortic regurg
Crescendo - decrescendo systolic ejection murmur following ejection click
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Fast volatge gated Na channels
Aortic dilation - bicuspid aortic valve - RF -

22. PROVe
Mechanican contraction of the ventricles
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
MI
HTN - bradycardia - and respiratory depression

23. What is a normal EF
Eisenmenger's syndrome
At least 55%
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Preload

24. no relation between p waves and QRS intervals - treatment and predisposing factor
3rd degree block - pacemaker - Lyme disease
Transposition of great vessels
RCA - II - III - aVF
MI

25. Which murmur is heard with mitral prolapse?
Wolff - Parkinson white syndrome
Late systolic crescendo murmur with a midsystolic click
Inc central venous pressure - inc resistance to portal flow
ASD

26. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Babies
Ventricular repolarization
Dilated cardiomyopathy

27. congenital heart defect with 22q11
Truncus - tet of fallot
In HF
Inc blood volume
MAP

28. Which lab value indicates blood viscosity?
Raynaud's
Systolic dysfunction
Hematocrit
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

29. What is the classic X ray finding for tet of fallot?
Granuloma with giant cells
Boot shaped heart
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Subendocardial

30. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
Wolff - Parkinson white syndrome
PDA
Mitral stenosis

31. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Extracellular calcium - calcium induced calcium release
Mitral valve
Fetal right to left - neonate left to right leading to RVH and failure

32. What causes tet of fallot?
Left sided
Anterosuperior displacement of the infundibular septum
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Myxoma

33. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
ANP
Stroke volume affected by contractility - afterload - and preload
Buerger's disease
Viridans streptococci

34. In normal S2 splitting - which valve closes first? What increases it?
Lower right - MC - upper right - AO - upper right AC - lower left MO
The aortic before pulmonic - inspiration increases diff
Varicose veins - thromboembolism rare
During HF from microhemorrhages from inc pulm cap pressure

35. Which artery supplies the SA and AV nodes?
Varicose veins - thromboembolism rare
RCA
The plateau period
Pos inotropy - exercise

36. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Dec P02 - inc PC02 and dec pH
Lymphangiosarcoma
No
Venodilators (nitrogylcerine)

37. Churg Strauss - presentation and test
If sodium channel
Medullary vasomotor center senses baroreceptors and JGA
Inc venous return exaccerbates pulm vasc congestion
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

38. which heart valves are afected most in rheumatic heart diseease
ANP
Group a beta hemolytic strep
Mitral>aortic>>tricuspid - high pressure valves affected most
Conduction delay through AV node - nl < 200 msec

39. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Varicose veins - thromboembolism rare
Chordae rupture - GN - suppurative pericarditis - emboli
Boot shaped heart
Increased SV

40. PCWP > LV diastolic pressure
Mitral stenosis
Arteriorles
LAD - V1 - V4
C - ANCA

41. necrotizing granulomas in lung and upper airways - nectrotizing GN - small vessel vasculitis

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42. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
PDA
Kawasaki
LAD - V1- V2
Black > white > asian

43. What is the time frame for arrhythmia risk in the evolution of MI
...
QRS complex
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
The first 4 days

44. What is the most common cause of right heart failure
Ischemic heart dz - mitral valve prolapse - LV dilation
Left heart failure
Mechanican contraction of the ventricles
Decreased

45. What do patients die early from in rheumatic heart disease?
S. epidermidis
Transfusion
Early deaths from myocarditis
The aortic before pulmonic - inspiration increases diff

46. PCWP is an estimate of...
Dilation
In parallel
Increased SV
Left atrial pressure

47. What does the U wave indicated?
1st degree AV blodck
Stable angina
SA>AV>bundle of His>ventricles
HypoK and bradycardia

48. What are common causes of mitral regurg?
Mitral valve prolapse
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Fluid movement through capillaries
Ischemic heart dz - mitral valve prolapse - LV dilation

49. When and why do you hear the S4 sound
Metastasis from melanoma or lymphoma
V fib arrhythima
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Lymphangiosarcoma

50. What does autoregulation do?
...
Pulsus parvus and tardus - weak - can lead to syncope
Maintain blood flow to organ over wide range of perfussion pressures
Failure of LV to in CO during exercise