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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 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
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Aortic disecction - intraluminal tear forming false lumen
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

2. polypoid capillary hemangioma that can ulcerate and bleed
Left heart failure
Failure of LV to in CO during exercise
Pyogenic granuloma - associated with trauma and pregnancy
Hypertrophied cardiomyopathy

3. How are the sarcomeres added in eccentric hypertrophy?
HTN - bradycardia - and respiratory depression
In series
P02
Mitral stenosis

4. When during cardiac nodal cells depolarize?
During diastole
Aortic/pulmonic stenosis and mitral/tricuspid regurg
LAD
QRS complex

5. PCWP is an estimate of...
Varicose veins - thromboembolism rare
Left atrial pressure
Torsades de pointes
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

6. Which vessels account for the most total peripheral resistance
R to L shunt caused by stenoic pulmonic valve
LAD - V1 - V4
Arteriorles
Libman - sacks endocarditis

7. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Pyogenic granuloma - associated with trauma and pregnancy
Right sided
Stable angina
C - ANCA

8. what percentage of HTN is secondary to renal disease?
Squat. Compression of femoral arteries - inc TPR - dec
Kids
Rhabdomyomas
10%

9. What are aschoff bodies
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Increase in Pc
PDA
Granuloma with giant cells

10. Which bacteria causes endocarditis in the presence of colon cancer
Metastasis from melanoma or lymphoma
Indomethacin closes - and pge keeps it open
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
S. bovis

11. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Posterior descending (80% off the RCA - 20% off the circumflex)
Eisenmenger's syndrome
Decrease in activity of Na/Ca exhanger and increase in contractility
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

12. Do you see elevaged ASO titers in rheumatic heart disease
LCX - V4- V6
Ventricular repolarization
Yes
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

13. What kind of infarct show ST depression
Subendocardial
Hemorrhage
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Decreases

14. Exercise - overtransfusiion and excitiment causes and increase in...?
Aortic disecction - intraluminal tear forming false lumen
EKG
Afterload (proportional to peripheral resistance)
Preload

15. What is the characteristic pulse in aortic stenosis?
Pulsus parvus and tardus - weak - can lead to syncope
CHF
Increase intracellular Na - resulting in increased Ca
Transposition of great vessels

16. Which sympathetic receptors raise MAP
Stable angina
The first 4 days
Aortic stenosis or LBBB
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

17. Fatal arrhythmia
Extracellular calcium - calcium induced calcium release
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
V fib
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

18. What does increasing intracellular Ca do?
LAD - V1 - V4
Aortic stenosis or LBBB
Increase contractility
Acute thrombosis of coronary artery

19. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Transmural
140/90
S. aureus
In HF

20. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Temporal arteritis
Gap junctions
Myxoma
Mitral valve prolapse

21. Which bacteria causes rheumatic heart disease
Group a beta hemolytic strep
Pulsus parvus and tardus - weak - can lead to syncope
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Crescendo - decrescendo systolic ejection murmur following ejection click

22. What causes ankle - sacral edema - jugular venous distention
EKG
Posterior descending (80% off the RCA - 20% off the circumflex)
RV failure - in venous pressure
Mechanican contraction of the ventricles

23. PROVe
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Inc blood volume
Rhabdomyomas
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

24. When does extracellular calcium enter the cardiac muscle cells during contraction?
The plateau period
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Henoch - Schlonlein purpura
Wegener's

25. benign cap hemangioma of infancy - spont regresses
Strawberry hemangioma
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Eisenmenger's syndrome

26. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Mitral valve prolapse
Squat. Compression of femoral arteries - inc TPR - dec
Dec plasma proteins
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

27. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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28. What causes the murmur heard in MR to enhance?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Ventricles are depolarized
Inc TPR and LA return (expiration)

29. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
During HF from microhemorrhages from inc pulm cap pressure
Pulsus parvus and tardus - weak - can lead to syncope
No - no pressure gradient
SV/ EDV

30. How does aldosterone raise MAP
Inc blood volume
Kidney
LCX - V4- V6
Eccentric - concentric hypertrophy causes diastolic disfunction

31. Which channel accounts for automaticity of the SA and AV nodes?
Myxoma
Stable angina
If sodium channel
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

32. What supplies the posterior left ventricle?
HypoK and bradycardia
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
CFX
Strawberry hemangioma

33. congenital heart defect with marfan's
V fib arrhythima
Liver
Aortic insuffic - late
ASD

34. What happens in phase 2 of the cardiac ventricular action potential?
Holosystoiic
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Late diastolic murmur following an opening snap
Vasodilators

35. What is the cushing triad?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Eccentric - concentric hypertrophy causes diastolic disfunction
Aburpt halting of valve leaflets
HTN - bradycardia - and respiratory depression

36. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
Volatage gated Ca channels
Wolff - Parkinson white syndrome
Increase in Pc

37. what conditions are associated with pulsus paradoxus
Ischemic heart dz - mitral valve prolapse - LV dilation
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Inc blood volume
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

38. What is sudden cardiac death most commonly due to...
V fib arrhythima
The plateau period
Sturge weber - vasculitis of caps
Pulsus parvus and tardus - weak - can lead to syncope

39. How does a patient with Tet of fallot learn to improve symptoms?
The plateau period
S. bovis
RF
Squat. Compression of femoral arteries - inc TPR - dec

40. congenital heart defect with 22q11
Septal defects - PDA - pulm art stenosis
In series
Truncus - tet of fallot
SA and AV nodes

41. Which two mechanisms sense decrease MAP?
Failure of LV to in CO during exercise
Medullary vasomotor center senses baroreceptors and JGA
Glossopharyngeal to soliary nucleus of medulla
Cardiac tamponde

42. no relation between p waves and QRS intervals - treatment and predisposing factor
3rd degree block - pacemaker - Lyme disease
Atherosclerosis
MI
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

43. p - anca

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44. Which organ gets the largest share of systemic cardiac output
Increasing activity of Ca pump in SR
HypoK and bradycardia
During diastole
Liver

45. failure of truncus arteriosus to divide?
Prinzmetal angina
Aburpt halting of valve leaflets
Persistant truncus arteriosus
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

46. What are the 5 T's of cyanoitc babies
Troponin I
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Myxomatous degeneration - RF - chordae rupture
Dec plasma proteins

47. What do the starling forces determine
C - ANCA
Fluid movement through capillaries
Cardiac tamponde
Decrease in cAMP

48. with what heart sounds do ASD usually present?
Fluid movement through capillaries
Pulmonary flow murmur and diastolic rumble
Arteriolosclerosis in malignant hypertension
Fetal right to left - neonate left to right leading to RVH and failure

49. What does FROM JANE stand for in bacterial endocarditis?

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50. sawtooth wave

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