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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. The cause of cardiac dilation?
MI
Greater ventricular EDV
Rapid upstroke - voltage gated Na channels open
Viridans streptococci

2. What does prolonged QT predispose to?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Pos inotropy - exercise
Changes in CO as a function of preload
Torsades de pointes

3. Which bacteria can cause endocarditis from prosthetic valves?
S. epidermidis
Vasodilators - (hydrAlAzine)
Fluid movement through capillaries
Temporal arteritis

4. What causes orthopnea?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Inc venous return exaccerbates pulm vasc congestion
Infective endocarditis
Decrease in cAMP

5. Which murmur is characteristic of mitral/tricuspid regurg?
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Holosystoiic
Mean arterial pressure
Septal defects - PDA - pulm art stenosis

6. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Hypertrophied cardiomyopathy
3rd degree block - pacemaker - Lyme disease
Wegener's
At least 55%

7. congenital heart defect with congenital rubella
Septal defects - PDA - pulm art stenosis
Black > white > asian
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Greater ventricular EDV

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

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9. Which vessels account for the most total peripheral resistance
Changes in CO as a function of preload
Mechanican contraction of the ventricles
Arteriorles
Anterosuperior displacement of the infundibular septum

10. What causes hepatomegaly?
Inc central venous pressure - inc resistance to portal flow
Inc RA pressure - due to filling against closed tricupsid valve
Stable angina
CK- MB

11. What are common causes of mitral regurg?
Ischemic heart dz - mitral valve prolapse - LV dilation
Tricuspid atresia - requires ASD and VSD
Conduction delay through AV node - nl < 200 msec
Vagus to medulla

12. In what disease states is blood viscosity increased?
CO
LV failure - pulm venous distention transudation of fluid
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Increased efferent SANS and decreased efferent PANS

13. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Decreases
MI
Aortic dilation - bicuspid aortic valve - RF -
Eisenmenger's syndrome

14. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Stable angina
Left sided
Kids
Can progess to V fib

15. What 4 things drive myocardial 02 demand?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Unstable/crescendo angina
Wegener's
V fib

16. systolic - diastolic
S. epidermidis
Pulse pressure
Mitral>aortic>>tricuspid - high pressure valves affected most
Yes

17. 2/3 diastolic + 1/3 systolic
MAP
Buerger's disease
Subendocardial
RV failure - in venous pressure

18. What causes the early cyanosis in Tet of Fallot?
R to L shunt caused by stenoic pulmonic valve
Vagus to medulla
Persistant truncus arteriosus
Heart - 02 extraction is always around 100%

19. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Squat. Compression of femoral arteries - inc TPR - dec
Stroke volume
5-10 days - macs have degraded structural components
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

20. Exercise - overtransfusiion and excitiment causes and increase in...?
Infective endocarditis
CFX
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Preload

21. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
2nd degree AV block - mobitz type 1
Coarcation of aorta
CK- MB
Fetal right to left - neonate left to right leading to RVH and failure

22. The aortic arch receptors transmit along which nerve?
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Gap junctions
Vagus to medulla
Ventricles are depolarized

23. p - anca

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24. What causes ankle - sacral edema - jugular venous distention
Conduction delay through AV node - nl < 200 msec
SV/ EDV
Holosystoiic
RV failure - in venous pressure

25. What kind of infarct show ST depression
S. bovis
Torsades de pointes
Subendocardial
LAD

26. What is association with fixed S2 splitting - does not increase with inspiration
Inc central venous pressure - inc resistance to portal flow
Fast volatge gated Na channels
Ventricular repolarization
ASD

27. When does extracellular calcium enter the cardiac muscle cells during contraction?
The plateau period
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
HTN - bradycardia - and respiratory depression
SV/ EDV

28. Which murmur do you hear in mitral stenosis?
Mitral valve prolapse
Dec P02 - inc PC02 and dec pH
RCA
Late diastolic murmur following an opening snap

29. EDV - ESV
Stroke volume
Decreases
Pulmonary flow murmur and diastolic rumble
LAD - V1- V2

30. fibrinous pericarditis several weeks post MI

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31. How are sarcomeres added in concentric hypertrophy?
Aortic disecction - intraluminal tear forming false lumen
Eisenmenger's syndrome
In parallel
Lymphangiosarcoma

32. what happens to capillaries in lymphatic blockage
Inc interstitial osmotic pressure pulling fliud out of capillaries
Resting potential high K perm
Inc venous return exaccerbates pulm vasc congestion
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

33. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
HypoK and bradycardia
Purkingee>atria>ventricles>AV node
Transposition of great vessels
Inc TPR and LA return (expiration)

34. Restrictive cardiomyopathy causes
Babies
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Inc TPR and LA return (expiration)
Postinfarction fibrinous pericarditis

35. Chronic mitral stenosis can lead to what changes in size of the LA
Crescendo - decrescendo systolic ejection murmur following ejection click
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Dilation
S. epidermidis

36. Fatal arrhythmia
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
V fib
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Dilated cardiomyopathy

37. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Vasocxn
Myxoma
1st degree AV blodck
Vasodilators

38. What kind of dysfunction ensues in restrictive cardiomyopathy
Filling is incomplete and CO falls
Diastolic
V fib arrhythima
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

39. What causes the murmur heard in MR to enhance?
Rhabdomyomas
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Inc TPR and LA return (expiration)
Septal defects - PDA - pulm art stenosis

40. Which valve is commonly involved in bacterial endocarditis from IV drug use and Which bacteria are most common?

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41. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
LV failure - pulm venous distention transudation of fluid
Kids
CK- MB
Neg inotropy - HF - narcotic overdose

42. In the cardiac cycle - which period has the highest 02 consumption?
Isovolumetric contraction
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Dilated cardiomyopathy
Decreases

43. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Fast volatge gated Na channels
Preload
Lower right - MC - upper right - AO - upper right AC - lower left MO
Purkingee>atria>ventricles>AV node

44. Irregularly irregular ECG - no p waves: dx and treatment
...
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Decreases
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

45. What is the S2 sound?
Increased efferent SANS and decreased efferent PANS
Fetal right to left - neonate left to right leading to RVH and failure
LCX - V4- V6
Aortic and pulmonary closing

46. If HR is too fast (V tach) what happens during diastole?
Patent ductus arteriosus - congenital rubella or prematurity
Crescendo - decrescendo systolic ejection murmur following ejection click
Filling is incomplete and CO falls
LCX - I - aVL

47. What is a normal EF
Eccentric - concentric hypertrophy causes diastolic disfunction
Coarcation of aorta
At least 55%
Dec plasma proteins

48. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
Myxoma
Greater ventricular EDV
2nd degree AV block - mobitz type 1
Truncus - tet of fallot

49. What does the starling curve show?
Mean arterial pressure
Eccentric - concentric hypertrophy causes diastolic disfunction
Changes in CO as a function of preload
Viridans streptococci

50. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Vasodilators
Adult type aortic coarctation
RCA