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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. In an EKG - What is the T wave?
Prinzmetal angina
Ventricular repolarization
Proportional to viscosity and inversely proportional to the radius to the 4th power
The first 4 days

2. What are aschoff bodies
Granuloma with giant cells
Varicose veins - thromboembolism rare
Lower right - MC - upper right - AO - upper right AC - lower left MO
Atrial contraction

3. What causes orthopnea?
Transmural
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Decrease in cAMP
Inc venous return exaccerbates pulm vasc congestion

4. What is the most common cause of MI
Apex and anterior interventricular septum
Acute thrombosis of coronary artery
Babies
R to L shunt caused by stenoic pulmonic valve

5. What do the starling forces determine
Pulmonic stenosis and RBBB
LCX - V4- V6
Fluid movement through capillaries
Extracellular calcium - calcium induced calcium release

6. If HR is too fast (V tach) what happens during diastole?
Crescendo - decrescendo systolic ejection murmur following ejection click
2-4 day - early coag necrosis on the first day
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Filling is incomplete and CO falls

7. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
CK- MB
Decreases
RV failure - in venous pressure
Rhabdomyomas

8. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Indomethacin closes - and pge keeps it open
Hemorrhage
S. epidermidis
Tricuspid atresia - requires ASD and VSD

9. dyspnea - fatigue - edema and rales - multiple causes
Postinfarction fibrinous pericarditis
CHF
Mitral stenosis
Vasodilators - (hydrAlAzine)

10. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
RV failure - in venous pressure
Kawasaki
Sudden tensing of chordae tendinae
Transmural

11. What is the S1 sound?
CFX
2-4 day - early coag necrosis on the first day
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Mitral and tricuspid closure

12. In an EKG - What is the QRS complex?
Ventricular depolarization - nl < 120 msec
Myxomatous degeneration - RF - chordae rupture
SA and AV nodes
Temporal arteritis

13. list the coronary vessels most likely to be occluded
LAD > RCA > circumflex
2nd degree AV block - mobitz type 1
Late diastolic murmur following an opening snap
Inc venous return exaccerbates pulm vasc congestion

14. Given P = QR - what factors influence resistance?
S. aureus
Proportional to viscosity and inversely proportional to the radius to the 4th power
Chordae rupture - GN - suppurative pericarditis - emboli
Persistant truncus arteriosus

15. What are common causes of mitral regurg?
Increase - increase the chance the If are open
Pulmonary flow murmur and diastolic rumble
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Ischemic heart dz - mitral valve prolapse - LV dilation

16. in the JVP - What is the c wave?
RV contraction (closed tricuspid valve bulding into atrium
HypoK and bradycardia
Septal defects - PDA - pulm art stenosis
Increase intracellular Na - resulting in increased Ca

17. serum marker for wegener's
Dec plasma proteins
C - ANCA
CFX
Increased efferent SANS and decreased efferent PANS

18. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Mitral and tricuspid closure
LV failure - pulm venous distention transudation of fluid
Purkingee>atria>ventricles>AV node
During diastole

19. Which enzymes are useful for diagnosing reinfarction
RCA - II - III - aVF
Atherosclerosis
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
CK- MB

20. CO x Total peripheral resistance
Mean arterial pressure
Ventricular depolarization - nl < 120 msec
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Arteriorles

21. In an anterior wall infarct - which artery is effected and which leads show Q waves
Kawasaki
Aortic/pulmonic stenosis and mitral/tricuspid regurg
The plateau period
LAD - V1 - V4

22. Why is there edema after burns or during infection
Inc Kf - capillary perm
Hemorrhage
Decrease in activity of Na/Ca exhanger and increase in contractility
5-10 days - macs have degraded structural components

23. Mitral stenosis is most often secondary to which condition?
Increasing activity of Ca pump in SR
Aortic insuffic - late
RF
RV failure - in venous pressure

24. What murmur is heard with aortic regurg?
Ventricular depolarization - nl < 120 msec
Decrease in cAMP
Ventricles are depolarized
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

25. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Transmural
Lymphangiosarcoma
Increase intracellular Na - resulting in increased Ca
TAPVR

26. What are the diastolic heart sounds?
Dilation
Medullary vasomotor center senses baroreceptors and JGA
Aortic/pulmonic regurg and mitral/tricuspid stenosis
ASD

27. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Stable angina
Tricuspid atresia - requires ASD and VSD
Mitral and tricuspid closure
LCX - V4- V6

28. What happens in phase 3 of the cardiac ventricular action potential?
Arteriolosclerosis in malignant hypertension
Lymphangiosarcoma
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Activated histiocytes

29. cavernous lymphangioma of the neck - associated with turner's
7 weeks
Pulmonic stenosis and RBBB
Volatage gated Ca channels
Cystic hygroma

30. PCWP is an estimate of...
During HF from microhemorrhages from inc pulm cap pressure
Ventricular repolarization
Left atrial pressure
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

31. What is the cushing triad?
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
HTN - bradycardia - and respiratory depression
ASD - VSD - AV septal defect (endocardial cushion defect)
Fluid movement through capillaries

32. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Aburpt halting of valve leaflets
Posterior descending (80% off the RCA - 20% off the circumflex)
Granuloma with giant cells

33. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Left heart failure
S. aureus
PDA
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

34. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
S. bovis
Fetal right to left - neonate left to right leading to RVH and failure
3rd degree block - pacemaker - Lyme disease
Liver

35. machine murmer
Transfusion
PDA
Wolff - Parkinson white syndrome
Holosystolic - harsh sounding murmur - loudest over tricuspid area

36. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
The plateau period
Cardiac tamponde
Dilated cardiomyopathy
Crescendo - decrescendo systolic ejection murmur following ejection click

37. What is the machine like murmur? What is the heart pathology and the predisposing causes
Increase contractility
Patent ductus arteriosus - congenital rubella or prematurity
RCA
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

38. The carotid sinus transmits along which nerve?
Neg inotropy - HF - narcotic overdose
Glossopharyngeal to soliary nucleus of medulla
10%
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

39. fibrinous pericarditis several weeks post MI

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40. Left to right shunts are more common in babies or kids?
ASD - VSD - AV septal defect (endocardial cushion defect)
Kids
SA and AV nodes
Babies

41. The 7 complications of MI

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42. What happens in phase 0 of the cardiac ventricular action potential?
Rapid upstroke - voltage gated Na channels open
Aortic stenosis or LBBB
Angiosarcoma
Vasocxn - while other tissues it causes vasodilation

43. What causes the CO curve to shift upwards?
Gap junctions
LAD > RCA > circumflex
Dressler's - autoimmune
Pos inotropy - exercise

44. Which organ gets the largest share of systemic cardiac output
Inc Kf - capillary perm
Hemorrhage
Transfusion
Liver

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 does an isoelectric ST segment indicate?
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Ventricular depolarization - nl < 120 msec
Ventricles are depolarized
Early deaths from myocarditis

47. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
No - no pressure gradient
No
Adult type aortic coarctation

48. What causes the midsystolic click
Sturge weber - vasculitis of caps
Black > white > asian
Pyogenic granuloma - associated with trauma and pregnancy
Sudden tensing of chordae tendinae

49. 2/3 diastolic + 1/3 systolic
Pos inotropy - exercise
MAP
Vasocxn - while other tissues it causes vasodilation
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

50. What cardiac change occurs in pregnancy?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Increased SV
Gap junctions
Hemorrhage