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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
Troponin I
LCX - V4- V6
Mitral valve

2. What causes hepatomegaly?
HTN - bradycardia - and respiratory depression
Inc central venous pressure - inc resistance to portal flow
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Posterior descending (80% off the RCA - 20% off the circumflex)

3. When is the scar completely formed in an MI?
RV failure - in venous pressure
Unstable/crescendo angina
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
7 weeks

4. What do patients die early from in rheumatic heart disease?
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Mean arterial pressure
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Early deaths from myocarditis

5. 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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6. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Dilation
No
Acute thrombosis of coronary artery
Medullary vasomotor center senses baroreceptors and JGA

7. What does hypoxia cause in the lung versus other tissues?
Vasocxn - while other tissues it causes vasodilation
V fib arrhythima
ASD - VSD - AV septal defect (endocardial cushion defect)
Left atrial pressure

8. congenital heart defect with congenital rubella
Septal defects - PDA - pulm art stenosis
Strawberry hemangioma
V fib arrhythima
Changes in CO as a function of preload

9. How does angiotensin II raise MAP
ANP
Takayasu's arteritis
Vasocxn
Atherosclerosis

10. Unilateral headache - jaw claudication - impaired vision
Tempral arteritis - may cause irreversible blindness
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Fetal right to left - neonate left to right leading to RVH and failure

11. What channels do the the pacemaker cells lack?
Patent ductus arteriosus - congenital rubella or prematurity
Fast volatge gated Na channels
Libman - sacks endocarditis
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

12. What causes aortic regurg
Aortic dilation - bicuspid aortic valve - RF -
Dec plasma proteins
Increasing activity of Ca pump in SR
Turners

13. What causes the cushing reflex and why
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Adult type aortic coarctation
Dec P02 - inc PC02 and dec pH
No

14. What causes the midsystolic click
Neg inotropy - HF - narcotic overdose
Sudden tensing of chordae tendinae
LAD > RCA > circumflex
Left sided

15. sawtooth wave

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16. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Varicose veins - thromboembolism rare
The first 4 days
Arteriorles

17. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
LV failure - pulm venous distention transudation of fluid
Vasocxn
Rhabdomyomas
Pos inotropy - exercise

18. What are the 5 T's of cyanoitc babies
Vagus to medulla
Increase - increase the chance the If are open
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Venodilators (nitrogylcerine)

19. Right to left shunts are more common in babies or kids?
Apex and anterior interventricular septum
Babies
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
ANP

20. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
LV failure - pulm venous distention transudation of fluid
Adult type aortic coarctation
Dilated cardiomyopathy
Conduction delay through AV node - nl < 200 msec

21. Which enzymes are useful for diagnosing reinfarction
Arteriorles
LAD
Total anomalous pulmonary trunk venous return
CK- MB

22. What is the S2 sound?
Aortic and pulmonary closing
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
In RA return (inspiration)
Increased efferent SANS and decreased efferent PANS

23. cavernous lymphangioma of the neck - associated with turner's
Wegener's
Eisenmenger's syndrome
Cystic hygroma
Aortic/pulmonic regurg and mitral/tricuspid stenosis

24. What are the systolic heart sounds
Stable angina
Increase intracellular Na - resulting in increased Ca
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Aortic/pulmonic stenosis and mitral/tricuspid regurg

25. In the cardiac cycle - which period has the highest 02 consumption?
Mitral stenosis
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Eccentric - concentric hypertrophy causes diastolic disfunction
Isovolumetric contraction

26. What does mitral prolapse predeispose to?
LCX - I - aVL
Infective endocarditis
Inc interstitial osmotic pressure pulling fliud out of capillaries
Hematocrit

27. stroke volume x HR =?
CO
Increase - increase the chance the If are open
Granuloma with giant cells
Increase contractility

28. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
If sodium channel
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Age related calcifications or bicuspid aortic valve

29. What causes aortic stenosis
Dilated cardiomyopathy
Anterosuperior displacement of the infundibular septum
Age related calcifications or bicuspid aortic valve
Transmural

30. In an EKG - What is the p wave?
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Atrial contraction
Myxomatous degeneration - RF - chordae rupture
Changes in CO as a function of preload

31. In an anterior wall infarct - which artery is effected and which leads show Q waves
Hypertrophied cardiomyopathy
LAD - V1 - V4
Increased SV
Proportional to viscosity and inversely proportional to the radius to the 4th power

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

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33. How are cadiac myocytes eltrically coupled?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Gap junctions
Increase contractility
Activated histiocytes

34. What does HTN predispose to?
Vasocxn
In series
Kids
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

35. in the JVP - What is the v wave?
Patent ductus arteriosus - congenital rubella or prematurity
Inc RA pressure - due to filling against closed tricupsid valve
2-4 day - early coag necrosis on the first day
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

36. What are common causes of mitral regurg?
Left sided
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Ischemic heart dz - mitral valve prolapse - LV dilation

37. disease of elastic arteries and large and medium sized muscular arteries
SA and AV nodes
Apex and anterior interventricular septum
Atherosclerosis
Libman - sacks endocarditis

38. What is the difference between adult and infantile type aortic coarctation?
V fib
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Isovolumetric contraction

39. PCWP is an estimate of...
Vagus to medulla
Kids
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Left atrial pressure

40. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Atherosclerosis
Pulsus parvus and tardus - weak - can lead to syncope
Polyarteritis nodosum
Yes

41. What kind of infarct show ST depression
Aortic dilation - bicuspid aortic valve - RF -
Right sided
Total anomalous pulmonary trunk venous return
Subendocardial

42. exaggerated decrease in pulse during inspiration.

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43. Which organ gets the largest share of systemic cardiac output
V fib
Liver
Boot shaped heart
Fick principle

44. Which murmur is characteristic of mitral/tricuspid regurg?
Can progess to V fib
Hypertrophied cardiomyopathy
Holosystoiic
Adult type aortic coarctation

45. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
Microscopic polyangiitis - like wegener's without granulomas
Increase - increase the chance the If are open
...

46. PROVe
Fetal right to left - neonate left to right leading to RVH and failure
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Raynaud's

47. How are sarcomeres added in concentric hypertrophy?
In parallel
Changes in CO as a function of preload
Isovolumetric contraction
Increase - increase the chance the If are open

48. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Decreased
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Can progess to V fib
S. aureus

49. What causes the murmur heard in MR to enhance?
Hyperlipidemia
Inc TPR and LA return (expiration)
S. epidermidis
Kaposi's sarcoma

50. In an EKG - What is the T wave?
Anterosuperior displacement of the infundibular septum
LAD - V1- V2
Ventricular repolarization
Aortic stenosis or LBBB