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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 is the classic X ray finding for tet of fallot?
CO
Boot shaped heart
Liver
C - ANCA

2. What causes the CO curve to shift upwards?
Can progess to V fib
Pos inotropy - exercise
Strawberry hemangioma
Aortic/pulmonic regurg and mitral/tricuspid stenosis

3. What 4 things drive myocardial 02 demand?
LCX - I - aVL
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
S. aureus
Myxoma

4. machine murmer
Increasing activity of Ca pump in SR
Stroke volume
Vasocxn - while other tissues it causes vasodilation
PDA

5. When and why is the S3 sound heard?
Greater ventricular EDV
CO
RCA - II - III - aVF
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

6. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Inc RA pressure - due to filling against closed tricupsid valve
CO
Pulsus parvus and tardus - weak - can lead to syncope
...

7. Fatal arrhythmia
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Heart - 02 extraction is always around 100%
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
V fib

8. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Takayasu's arteritis
Metastasis from melanoma or lymphoma
Adult type aortic coarctation

9. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Sturge weber - vasculitis of caps
Vasodilators
Non
Eisenmenger's syndrome

10. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
At least 55%
Mean arterial pressure
Wolff - Parkinson white syndrome
MI

11. congenital heart defect with turner's
No
Black > white > asian
Coarcation of aorta
Failure of LV to in CO during exercise

12. EDV is also known as
Preload
In parallel
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Mitral stenosis

13. 2/3 diastolic + 1/3 systolic
Mechanican contraction of the ventricles
Mitral and tricuspid closure
MAP
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

14. congenital heart defect withdown syndrome
In HF
Myxoma
Arteriorles
ASD - VSD - AV septal defect (endocardial cushion defect)

15. What causes tet of fallot?
Anterosuperior displacement of the infundibular septum
Hematocrit
Increase intracellular Na - resulting in increased Ca
Vasocxn - while other tissues it causes vasodilation

16. In an EKG - What is the QT interval?
Vasodilators
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Mechanican contraction of the ventricles
Strawberry hemangioma

17. What does TAPVR stand for
Purkingee>atria>ventricles>AV node
Total anomalous pulmonary trunk venous return
Posterior descending (80% off the RCA - 20% off the circumflex)
Activated histiocytes

18. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Squat. Compression of femoral arteries - inc TPR - dec
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
LV failure - pulm venous distention transudation of fluid
Posterior descending (80% off the RCA - 20% off the circumflex)

19. What causes the midsystolic click
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
ANP
Liver
Sudden tensing of chordae tendinae

20. Which two mechanisms sense decrease MAP?
Mechanican contraction of the ventricles
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Medullary vasomotor center senses baroreceptors and JGA
Indomethacin closes - and pge keeps it open

21. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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

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23. What is the formula for EF?
Atherosclerosis
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
SV/ EDV

24. What happens in phase 0 of the cardiac ventricular action potential?
LAD > RCA > circumflex
Pulmonic stenosis and RBBB
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Rapid upstroke - voltage gated Na channels open

25. What happens in phase 4 of the cardiac ventricular action potential?
EKG
Resting potential high K perm
RCA - II - III - aVF
...

26. What is the association with wide S2 splitting?
1st degree AV blodck
Pulmonic stenosis and RBBB
Metastasis from melanoma or lymphoma
Torsades de pointes

27. What is indicated when CO and venous return are equal?
The operating point of the heart
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
2nd degree AV block - mobitz type 1
Aortic insuffic - late

28. which medications are used to maintain patency or close the ductus arteriosus?
Eccentric - concentric hypertrophy causes diastolic disfunction
Indomethacin closes - and pge keeps it open
Holosystoiic
Mean arterial pressure

29. What is the S1 sound?
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Atherosclerosis
10%
Mitral and tricuspid closure

30. What are aschoff bodies
Granuloma with giant cells
Inc Kf - capillary perm
Non
Decreases

31. How does acidosis affect contractility?
Mitral valve prolapse
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Decreased
Gap junctions

32. What causes hepatomegaly?
Inc central venous pressure - inc resistance to portal flow
Microscopic polyangiitis - like wegener's without granulomas
At least 55%
Fetal right to left - neonate left to right leading to RVH and failure

33. What does T wave inversion indicated?
The operating point of the heart
MI
Libman - sacks endocarditis
At least 55%

34. Why is there edema after burns or during infection
...
Heart - 02 extraction is always around 100%
Inc Kf - capillary perm
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

35. Which murmur do you hear in mitral stenosis?
Preload
Cherry hemangioma
Decreases
Late diastolic murmur following an opening snap

36. dyspnea - fatigue - edema and rales - multiple causes
Chordae rupture - GN - suppurative pericarditis - emboli
3rd degree block - pacemaker - Lyme disease
Eisenmenger's syndrome
CHF

37. sawtooth wave

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38. What do the carotid and aortic bodies respond to?
In parallel
Dec P02 - inc PC02 and dec pH
Maintain blood flow to organ over wide range of perfussion pressures
LV failure - pulm venous distention transudation of fluid

39. What happens in phase 2 of the cardiac ventricular action potential?
Infective endocarditis
LAD
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

40. in the JVP - What is the v wave?
Inc RA pressure - due to filling against closed tricupsid valve
Septal defects - PDA - pulm art stenosis
LCX - V4- V6
Raynaud's

41. What causes aortic regurg
V fib arrhythima
Subendocardial
Aortic dilation - bicuspid aortic valve - RF -
S. bovis

42. What other syndrom is associated with infantile aortic coarctation
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Turners
Libman - sacks endocarditis
Vasodilators

43. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Hemorrhage
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Hypertrophied cardiomyopathy
7 weeks

44. most common primary cardiac tumor in children - associated with tuberous sclerosis
Rhabdomyomas
Aortic disecction - intraluminal tear forming false lumen
Kaposi's sarcoma
Ventricles are depolarized

45. Which artery supplies the SA and AV nodes?
Persistant truncus arteriosus
Adult type aortic coarctation
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
RCA

46. When do you find hemosiderin laden macrophages in the lungs?
140/90
EKG
During HF from microhemorrhages from inc pulm cap pressure
Inc TPR and LA return (expiration)

47. What causes the cushing reflex and why
Purkingee>atria>ventricles>AV node
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Can progess to V fib
S. aureus

48. When during cardiac nodal cells depolarize?
Systolic dysfunction
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
During diastole
In series

49. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
HypoK and bradycardia
Kawasaki
Fluid movement through capillaries
Vagus to medulla

50. How does digitatlis increase contractility?
Increase intracellular Na - resulting in increased Ca
Posterior descending (80% off the RCA - 20% off the circumflex)
CK- MB
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR