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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. Unilateral headache - jaw claudication - impaired vision
Tempral arteritis - may cause irreversible blindness
Left heart failure
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Volatage gated Ca channels

2. Which bacteria causes rheumatic heart disease
Group a beta hemolytic strep
Postinfarction fibrinous pericarditis
Resting potential high K perm
Torsades de pointes

3. congenital heart defect in an infant with a diabetic mother?
V fib
Transposition of great vessels
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
If sodium channel

4. Which class of drugs decrease preload
Venodilators (nitrogylcerine)
Adult type aortic coarctation
Prinzmetal angina
Increase in Pc

5. sawtooth wave

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6. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Decreases
Mean arterial pressure
Lymphangiosarcoma
Inc TPR and LA return (expiration)

7. most common heart tumor
Hyperlipidemia
Lower right - MC - upper right - AO - upper right AC - lower left MO
Metastasis from melanoma or lymphoma
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

8. benign cap hemangioma of infancy - spont regresses
Vagus to medulla
Anterosuperior displacement of the infundibular septum
Strawberry hemangioma
S. aureus

9. EDV - ESV
Atherosclerosis
Stroke volume
Gap junctions
Subendocardial

10. What are the diastolic heart sounds?
ASD
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Inc central venous pressure - inc resistance to portal flow
Stable angina

11. The carotid sinus transmits along which nerve?
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Dec P02 - inc PC02 and dec pH
Glossopharyngeal to soliary nucleus of medulla

12. Which vessels account for the most total peripheral resistance
Metastasis from melanoma or lymphoma
Arteriorles
If sodium channel
RV contraction (closed tricuspid valve bulding into atrium

13. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
The plateau period
Dilated cardiomyopathy
Angiosarcoma

14. What channels do the the pacemaker cells lack?
Fast volatge gated Na channels
LAD > RCA > circumflex
Failure of LV to in CO during exercise
Increasing activity of Ca pump in SR

15. in the JVP - What is the v wave?
Rhabdomyomas
Subendocardial - fewer collaterals and higher pressure
Inc RA pressure - due to filling against closed tricupsid valve
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

16. Which two mechanisms sense decrease MAP?
Arteriolosclerosis in malignant hypertension
Medullary vasomotor center senses baroreceptors and JGA
Conduction delay through AV node - nl < 200 msec
Persistant truncus arteriosus

17. exaggerated decrease in pulse during inspiration.

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18. Which lab value indicates blood viscosity?
Hematocrit
LCX - V4- V6
Fluid movement through capillaries
SA>AV>bundle of His>ventricles

19. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Postinfarction fibrinous pericarditis
RV contraction (closed tricuspid valve bulding into atrium
Filling is incomplete and CO falls

20. Wegener's tx
140/90
Cyclophosphamide and corticosteroids
Increase contractility
Early deaths from myocarditis

21. What are the different etiologies of dialted cardiomyopathy
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Mean arterial pressure
LAD > RCA > circumflex
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

22. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
Inc interstitial osmotic pressure pulling fliud out of capillaries
Buerger's disease
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

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

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24. What does hypoxia cause in the lung versus other tissues?
Vasocxn - while other tissues it causes vasodilation
Metastasis from melanoma or lymphoma
Aortic insuffic - late
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

25. failure of truncus arteriosus to divide?
Acute thrombosis of coronary artery
LAD > RCA > circumflex
Persistant truncus arteriosus
During HF from microhemorrhages from inc pulm cap pressure

26. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Posterior descending (80% off the RCA - 20% off the circumflex)
Aburpt halting of valve leaflets
HTN - bradycardia - and respiratory depression
Inc interstitial osmotic pressure pulling fliud out of capillaries

27. which medications are used to maintain patency or close the ductus arteriosus?
Maintain blood flow to organ over wide range of perfussion pressures
Fick principle
Indomethacin closes - and pge keeps it open
Dec P02 - inc PC02 and dec pH

28. What is the characteristic pulse in aortic stenosis?
Unstable/crescendo angina
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Mitral and tricuspid closure
Pulsus parvus and tardus - weak - can lead to syncope

29. What does HTN predispose to?
Pos inotropy - exercise
Vasodilators - (hydrAlAzine)
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Non

30. Chronic mitral stenosis can lead to what changes in size of the LA
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Left heart failure
Dilation
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

31. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Increase contractility
Arteriolosclerosis in malignant hypertension
Medullary vasomotor center senses baroreceptors and JGA
Varicose veins - thromboembolism rare

32. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Cherry hemangioma
Fetal right to left - neonate left to right leading to RVH and failure
Kaposi's sarcoma
Group a beta hemolytic strep

33. congenital heart defect with 22q11
Truncus - tet of fallot
Polyarteritis nodosum
Isovolumetric contraction
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

34. In an EKG - What is the T wave?
Diastolic
Ventricular repolarization
Conduction delay through AV node - nl < 200 msec
Transfusion

35. What stimulates release of calcium from the SR?
Crescendo - decrescendo systolic ejection murmur following ejection click
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Extracellular calcium - calcium induced calcium release
Adult type aortic coarctation

36. Why is there edema after burns or during infection
Inc Kf - capillary perm
Vasocxn - while other tissues it causes vasodilation
2nd degree AV block - mobitz type 1
Liver

37. How do catecholamines increase contractility?
...
Tricuspid atresia - requires ASD and VSD
Increasing activity of Ca pump in SR
Eisenmenger's syndrome

38. congenital heart defect with congenital rubella
Mitral stenosis
Rhabdomyomas
Septal defects - PDA - pulm art stenosis
Inc central venous pressure - inc resistance to portal flow

39. In what disease states is blood viscosity increased?
P02
RCA - II - III - aVF
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

40. What other sign is often present with congenital long QT syndrome - why?
RCA
Microscopic polyangiitis - like wegener's without granulomas
Eccentric - concentric hypertrophy causes diastolic disfunction
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

41. What kind of infarct show ST depression
SV/ EDV
5-10 days - macs have degraded structural components
During diastole
Subendocardial

42. What is associated with paradoxical spliting of S2
1st degree AV blodck
Aortic stenosis or LBBB
Postinfarction fibrinous pericarditis
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

43. systolic - diastolic
Pulse pressure
Mitral and tricuspid closure
TAPVR
LAD > RCA > circumflex

44. How does digitatlis increase contractility?
Increase intracellular Na - resulting in increased Ca
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Sturge weber - vasculitis of caps
10%

45. machine murmer
Venodilators (nitrogylcerine)
PDA
Decreased
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

46. in the JVP - What is the c wave?
Fluid movement through capillaries
RV contraction (closed tricuspid valve bulding into atrium
P02
SA and AV nodes

47. Where does coronary artery occlusion occur most commonly?
S. aureus
LAD
Buerger's disease
Liver

48. decrease stretch in baroreceptors leads to what response?
Increased efferent SANS and decreased efferent PANS
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Aortic insuffic - late
Maintain blood flow to organ over wide range of perfussion pressures

49. What are the systolic heart sounds
Pos inotropy - exercise
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Pulmonary flow murmur and diastolic rumble

50. What happens in phase 3 of the cardiac ventricular action potential?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Inc central venous pressure - inc resistance to portal flow
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Heart - 02 extraction is always around 100%

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