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Cardiology

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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 cardiac change occurs in pregnancy?
Infective endocarditis
R to L shunt caused by stenoic pulmonic valve
Increased SV
Coarcation of aorta

2. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
10%
Polyarteritis nodosum

3. which medications are used to maintain patency or close the ductus arteriosus?
Posterior descending (80% off the RCA - 20% off the circumflex)
Indomethacin closes - and pge keeps it open
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
HypoK and bradycardia

4. What is the danger of torsades to pointes?
Can progess to V fib
Apex and anterior interventricular septum
Polyarteritis nodosum
RV contraction (closed tricuspid valve bulding into atrium

5. In an EKG - What is the p wave?
Atrial contraction
Kidney
V fib arrhythima
Crescendo - decrescendo systolic ejection murmur following ejection click

6. What does the starling curve show?
Libman - sacks endocarditis
Changes in CO as a function of preload
Mitral>aortic>>tricuspid - high pressure valves affected most
During diastole

7. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Torsades de pointes
Pulmonary flow murmur and diastolic rumble
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Fetal right to left - neonate left to right leading to RVH and failure

8. congenital heart defect with turner's
Coarcation of aorta
Inc RA pressure - due to filling against closed tricupsid valve
Wegener's
Atrial contraction

9. failure of truncus arteriosus to divide?
Increased efferent SANS and decreased efferent PANS
Persistant truncus arteriosus
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Viridans streptococci

10. When do you see extensive coagulative necrosis in an MI
During HF from microhemorrhages from inc pulm cap pressure
Venodilators (nitrogylcerine)
Tempral arteritis - may cause irreversible blindness
2-4 day - early coag necrosis on the first day

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

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12. machine murmer
PDA
Anterosuperior displacement of the infundibular septum
Left heart failure
The aortic before pulmonic - inspiration increases diff

13. Which bacteria causes endocarditis in the presence of colon cancer
Rhabdomyomas
S. aureus
S. bovis
Decreases

14. What happens in phase 2 of the cardiac ventricular action potential?
Aortic disecction - intraluminal tear forming false lumen
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Stable angina
Babies

15. What other syndrom is associated with infantile aortic coarctation
Aortic and pulmonary closing
Turners
Mitral valve prolapse
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

16. What are the diastolic heart sounds?
CO
Postinfarction fibrinous pericarditis
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Rapid upstroke - voltage gated Na channels open

17. How does angiotensin II raise MAP
2nd degree AV block - mobitz type 1
Babies
Vasocxn
Dec plasma proteins

18. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Adult type aortic coarctation
S. aureus
Increasing activity of Ca pump in SR
Maintain blood flow to organ over wide range of perfussion pressures

19. When is the scar completely formed in an MI?
7 weeks
Volatage gated Ca channels
Liver
Late systolic crescendo murmur with a midsystolic click

20. disease of elastic arteries and large and medium sized muscular arteries
Proportional to viscosity and inversely proportional to the radius to the 4th power
SA>AV>bundle of His>ventricles
Pyogenic granuloma - associated with trauma and pregnancy
Atherosclerosis

21. What stimulates release of calcium from the SR?
MAP
Infective endocarditis
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Extracellular calcium - calcium induced calcium release

22. Which vessels account for the most total peripheral resistance
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Stable angina
Arteriorles
Cyclophosphamide and corticosteroids

23. Churg Strauss - presentation and test
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Proportional to viscosity and inversely proportional to the radius to the 4th power
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

24. congenital heart defect with congenital rubella
In HF
Patent ductus arteriosus - congenital rubella or prematurity
RCA
Septal defects - PDA - pulm art stenosis

25. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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26. serum marker for wegener's
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
C - ANCA
Persistant truncus arteriosus
Atrial contraction

27. What kind of infarct show ST depression
Subendocardial
Cardiac tamponde
Ventricles are depolarized
Transmural

28. When do coronary arteries fill?
During diastole
2-4 day - early coag necrosis on the first day
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Stroke volume

29. What causes the CO curve to shift upwards?
Sudden tensing of chordae tendinae
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
MI
Pos inotropy - exercise

30. What is indicated when CO and venous return are equal?
The operating point of the heart
Myxoma
Eisenmenger's syndrome
During diastole

31. What is the progression of atherosclerosis?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Increased efferent SANS and decreased efferent PANS
Inc venous return exaccerbates pulm vasc congestion
ASD

32. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Increased efferent SANS and decreased efferent PANS
Vasocxn - while other tissues it causes vasodilation
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Eccentric - concentric hypertrophy causes diastolic disfunction

33. What is the early and late lesion in rheumatic heart disease
Rhabdomyomas
Mitral valve prolapse
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Vasocxn

34. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Pulse pressure
Infective endocarditis
Sturge weber - vasculitis of caps
Transfusion

35. Chronic mitral stenosis can lead to what changes in size of the LA
Dilation
Yes
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

36. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Stroke volume affected by contractility - afterload - and preload
Postinfarction fibrinous pericarditis
LV failure - pulm venous distention transudation of fluid

37. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Fick principle
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Non

38. What does FAN MY SKIN On Wednesday stand for?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Decrease in activity of Na/Ca exhanger and increase in contractility
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Subendocardial

39. prolonged PR interval
During HF from microhemorrhages from inc pulm cap pressure
ASD - VSD - AV septal defect (endocardial cushion defect)
1st degree AV blodck
Cardiac tamponde

40. What does mitral prolapse predeispose to?
Infective endocarditis
Increasing activity of Ca pump in SR
Vasodilators
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

41. What causes the CO curve to shift downwards?
Neg inotropy - HF - narcotic overdose
140/90
During diastole
SA and AV nodes

42. in the JVP - What is the a wave?
Inc RA pressure - due to filling against closed tricupsid valve
Atrial contraction
S. epidermidis
Pulse pressure

43. In an EKG - What is the T wave?
V fib arrhythima
Atrial contraction
Ventricular repolarization
Sudden tensing of chordae tendinae

44. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Sturge weber - vasculitis of caps
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

45. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Troponin I
MI
Mechanican contraction of the ventricles
Vasodilators

46. What causes aortic stenosis
Age related calcifications or bicuspid aortic valve
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Mitral and tricuspid closure

47. Irregularly irregular ECG - no p waves: dx and treatment
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Boot shaped heart
Rhabdomyomas
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

48. Which murmur is heard with VSD?
MAP
CHF
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Rhabdomyomas

49. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Maintain blood flow to organ over wide range of perfussion pressures
Pyogenic granuloma - associated with trauma and pregnancy
QRS complex
Libman - sacks endocarditis

50. Wegener's tx
Dressler's - autoimmune
Vasocxn
Cyclophosphamide and corticosteroids
Indomethacin closes - and pge keeps it open