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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. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Eccentric - concentric hypertrophy causes diastolic disfunction
Truncus - tet of fallot
Sturge weber - vasculitis of caps
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

2. MAP is also known as
Troponin I
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Afterload (proportional to peripheral resistance)
Temporal arteritis

3. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
SA>AV>bundle of His>ventricles
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Raynaud's

4. What happens in phase 3 of the cardiac ventricular action potential?
Aortic insuffic - late
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Increased SV
LAD

5. absecnce of tricuspid valve - hypoplastic RV
Tricuspid atresia - requires ASD and VSD
Eisenmenger's syndrome
Group a beta hemolytic strep
SA>AV>bundle of His>ventricles

6. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
Left heart failure
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

7. What are the 5 T's of cyanoitc babies
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Mitral valve prolapse
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Troponin I

8. If HR is too fast (V tach) what happens during diastole?
Postinfarction fibrinous pericarditis
Filling is incomplete and CO falls
3rd degree block - pacemaker - Lyme disease
Strawberry hemangioma

9. Given P = QR - what factors influence resistance?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Inc blood volume
Proportional to viscosity and inversely proportional to the radius to the 4th power
Medullary vasomotor center senses baroreceptors and JGA

10. Which murmur is heard with mitral prolapse?
Late systolic crescendo murmur with a midsystolic click
Black > white > asian
The operating point of the heart
Kidney

11. Restrictive cardiomyopathy causes
Coarcation of aorta
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

12. What is association with fixed S2 splitting - does not increase with inspiration
Conduction delay through AV node - nl < 200 msec
Ventricles are depolarized
ASD
Fluid movement through capillaries

13. Which organ has the largest arteriovenous difference
Vasodilators
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Heart - 02 extraction is always around 100%
QRS complex

14. in the JVP - What is the v wave?
Hematocrit
Inc RA pressure - due to filling against closed tricupsid valve
Ventricles are depolarized
Varicose veins - thromboembolism rare

15. What is the most common cause of MI
Lymphangiosarcoma
Acute thrombosis of coronary artery
Polyarteritis nodosum
Strawberry hemangioma

16. fibrinous pericarditis several weeks post MI

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17. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
V fib
Wolff - Parkinson white syndrome
Viridans streptococci
Mitral and tricuspid closure

18. In an EKG - What is the p wave?
Atrial contraction
ASD - VSD - AV septal defect (endocardial cushion defect)
Fick principle
Afterload (proportional to peripheral resistance)

19. What is the early and late lesion in rheumatic heart disease
Mitral valve prolapse
Crescendo - decrescendo systolic ejection murmur following ejection click
Inc venous return exaccerbates pulm vasc congestion
Subendocardial - fewer collaterals and higher pressure

20. How does a patient with Tet of fallot learn to improve symptoms?
LV failure - pulm venous distention transudation of fluid
Dec plasma proteins
Strawberry hemangioma
Squat. Compression of femoral arteries - inc TPR - dec

21. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Dec plasma proteins
Dressler's - autoimmune
In series
P02

22. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Ischemic heart dz - mitral valve prolapse - LV dilation
Right sided
Inc RA pressure - due to filling against closed tricupsid valve
Dilated cardiomyopathy

23. What kind of infarct show ST depression
No
CO
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Subendocardial

24. How are the sarcomeres added in eccentric hypertrophy?
Squat. Compression of femoral arteries - inc TPR - dec
V fib
Aortic/pulmonic stenosis and mitral/tricuspid regurg
In series

25. How are sarcomeres added in concentric hypertrophy?
Pyogenic granuloma - associated with trauma and pregnancy
Aortic and pulmonary closing
In parallel
Posterior descending (80% off the RCA - 20% off the circumflex)

26. What do the starling forces determine
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Eisenmenger's syndrome
Aortic insuffic - late
Fluid movement through capillaries

27. Do you see elevaged ASO titers in rheumatic heart disease
Patent ductus arteriosus - congenital rubella or prematurity
Granuloma with giant cells
Mitral valve
Yes

28. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Preload
Libman - sacks endocarditis
C - ANCA
RF

29. p - anca

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30. What causes the early cyanosis in Tet of Fallot?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
140/90
MI
R to L shunt caused by stenoic pulmonic valve

31. How do beta blockers decrease contractility?
Decrease in cAMP
Prinzmetal angina
Pyogenic granuloma - associated with trauma and pregnancy
Decreased

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

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33. which ethnic groups have higher association with HTN?
Black > white > asian
Kids
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Cyclophosphamide and corticosteroids

34. Irregularly irregular ECG - no p waves: dx and treatment
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Postinfarction fibrinous pericarditis
Mitral>aortic>>tricuspid - high pressure valves affected most
Angiosarcoma

35. What are common causes of mitral regurg?
Ischemic heart dz - mitral valve prolapse - LV dilation
Greater ventricular EDV
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Preload

36. What does increasing intracellular Ca do?
Increase contractility
Subendocardial
LAD - V1 - V4
Babies

37. What happens with a decrease of extracellular Na
Total anomalous pulmonary trunk venous return
Decrease in activity of Na/Ca exhanger and increase in contractility
Eccentric - concentric hypertrophy causes diastolic disfunction
Increase in Pc

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

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39. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Angiosarcoma
Transfusion
Stable angina
Kidney

40. What supplies the posterior left ventricle?
No - no pressure gradient
Heart - 02 extraction is always around 100%
Raynaud's
CFX

41. In the cardiac cycle - which period has the highest 02 consumption?
Diastolic
Isovolumetric contraction
Hyperlipidemia
SA>AV>bundle of His>ventricles

42. The aortic arch receptors transmit along which nerve?
Vagus to medulla
Arteriorles
Rapid upstroke - voltage gated Na channels open
Pulsus parvus and tardus - weak - can lead to syncope

43. bening capillary hemangioma of elderly - does not regress
Atrial contraction
Cardiac tamponde
Cherry hemangioma
2-4 day - early coag necrosis on the first day

44. What is a normal EF
Varicose veins - thromboembolism rare
At least 55%
Decreased
Increasing activity of Ca pump in SR

45. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Greater ventricular EDV
If sodium channel
R to L shunt caused by stenoic pulmonic valve
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

46. What does TAPVR stand for
Decrease in cAMP
Anterosuperior displacement of the infundibular septum
Volatage gated Ca channels
Total anomalous pulmonary trunk venous return

47. failure of truncus arteriosus to divide?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Cherry hemangioma
Persistant truncus arteriosus
Ventricular repolarization

48. What is the most common cause of right heart failure
Left heart failure
2-4 day - early coag necrosis on the first day
Sudden tensing of chordae tendinae
Fluid movement through capillaries

49. The cause of dyspnea on exertion?
Atherosclerosis
Failure of LV to in CO during exercise
Inc TPR and LA return (expiration)
EKG

50. 2/3 diastolic + 1/3 systolic
MAP
Microscopic polyangiitis - like wegener's without granulomas
Proportional to viscosity and inversely proportional to the radius to the 4th power
Granuloma with giant cells