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Cardiology

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Answer 50 questions in 15 minutes.
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1. What is associated with paradoxical spliting of S2
Atrial contraction
During diastole
Aortic stenosis or LBBB
Arteriolosclerosis in malignant hypertension

2. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Indomethacin closes - and pge keeps it open
Purkingee>atria>ventricles>AV node
Maintain blood flow to organ over wide range of perfussion pressures
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

3. In terms of starling forces - why does heart failure cause edema?
7 weeks
Hemorrhage
Increase in Pc
Activated histiocytes

4. What causes the murmur heard in tricuspid regurg to enhance
In RA return (inspiration)
Mitral stenosis
Ventricles are depolarized
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

5. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
ASD - VSD - AV septal defect (endocardial cushion defect)
Maintain blood flow to organ over wide range of perfussion pressures
Failure of LV to in CO during exercise

6. What does mitral prolapse predeispose to?
Infective endocarditis
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Atrial contraction
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

7. In an EKG - What is the QRS complex?
...
Henoch - Schlonlein purpura
Ventricular depolarization - nl < 120 msec
In parallel

8. Where is the most posterior portion of the heart and What can it cause?
LV failure - pulm venous distention transudation of fluid
Cystic hygroma
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

9. What causes the early cyanosis in Tet of Fallot?
Squat. Compression of femoral arteries - inc TPR - dec
R to L shunt caused by stenoic pulmonic valve
Rapid upstroke - voltage gated Na channels open
Inc TPR and LA return (expiration)

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

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11. When and why is the S3 sound heard?
Troponin I
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Aortic and pulmonary closing

12. EDV - ESV
Stroke volume
Lymphangiosarcoma
Inc blood volume
Ventricles are depolarized

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

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14. What is the S2 sound?
Pulsus parvus and tardus - weak - can lead to syncope
Persistant truncus arteriosus
Chordae rupture - GN - suppurative pericarditis - emboli
Aortic and pulmonary closing

15. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Posterior descending (80% off the RCA - 20% off the circumflex)
Hypertrophied cardiomyopathy
Mitral valve prolapse

16. When and why do you hear the S4 sound
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Posterior descending (80% off the RCA - 20% off the circumflex)
Babies
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

17. What happends in phase 1 of the ventricular cardiac action potential?
Transmural
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Inc Kf - capillary perm
Inc central venous pressure - inc resistance to portal flow

18. Why is contractility decreased in heart failure?
Aortic and pulmonary closing
Systolic dysfunction
In HF
1st degree AV blodck

19. What does the starling curve show?
Lymphangiosarcoma
Changes in CO as a function of preload
Granuloma with giant cells
Cyclophosphamide and corticosteroids

20. What is the cushing triad?
Aortic and pulmonary closing
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
HTN - bradycardia - and respiratory depression

21. What is the characteristic pulse in aortic stenosis?
Transmural
Pulsus parvus and tardus - weak - can lead to syncope
Inc central venous pressure - inc resistance to portal flow
Stroke volume affected by contractility - afterload - and preload

22. Which bacteria can cause endocarditis from prosthetic valves?
Rapid upstroke - voltage gated Na channels open
10%
S. epidermidis
Transposition of great vessels

23. In an inferior wall infarct - which artery is affected and which leads show Q waves
RCA - II - III - aVF
Aortic dilation - bicuspid aortic valve - RF -
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Crescendo - decrescendo systolic ejection murmur following ejection click

24. What is the association with wide S2 splitting?
Cyclophosphamide and corticosteroids
The first 4 days
Pulmonic stenosis and RBBB
Metastasis from melanoma or lymphoma

25. which heart valves are afected most in rheumatic heart diseease
S. epidermidis
Troponin I
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Mitral>aortic>>tricuspid - high pressure valves affected most

26. What do the carotid and aortic bodies respond to?
Myxomatous degeneration - RF - chordae rupture
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Dec P02 - inc PC02 and dec pH
Coarcation of aorta

27. which medications are used to maintain patency or close the ductus arteriosus?
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Indomethacin closes - and pge keeps it open
Age related calcifications or bicuspid aortic valve
Transposition of great vessels

28. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Anterosuperior displacement of the infundibular septum
Purkingee>atria>ventricles>AV node
Cystic hygroma
SV/ EDV

29. no relation between p waves and QRS intervals - treatment and predisposing factor
3rd degree block - pacemaker - Lyme disease
Aortic dilation - bicuspid aortic valve - RF -
Pulmonic stenosis and RBBB
CFX

30. stroke volume x HR =?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Wegener's
CO
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

31. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Anterosuperior displacement of the infundibular septum
Holosystoiic
Eisenmenger's syndrome
Hyperlipidemia

32. What are the complications from bacterial endocarditis?
Chordae rupture - GN - suppurative pericarditis - emboli
Decreased
CK- MB
Increase contractility

33. In what disease states is blood viscosity increased?
Medullary vasomotor center senses baroreceptors and JGA
LAD
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Atherosclerosis

34. Which bacteria causes rheumatic heart disease
Hypertrophied cardiomyopathy
Takayasu's arteritis
Cardiac tamponde
Group a beta hemolytic strep

35. no change in PR interval followed by dropped beat
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Stable angina
Acute thrombosis of coronary artery
SA>AV>bundle of His>ventricles

36. Chronic mitral stenosis can lead to what changes in size of the LA
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
LCX - I - aVL
Dilation
Dec P02 - inc PC02 and dec pH

37. What murmur is heard with aortic regurg?
Mechanican contraction of the ventricles
QRS complex
Transfusion
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

38. Which area of the endocardium is especially vulnerable to infarction? Why?
CK- MB
Subendocardial - fewer collaterals and higher pressure
PDA
LAD

39. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Hypertrophied cardiomyopathy
Ventricular depolarization - nl < 120 msec
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Stroke volume

40. How does angiotensin II raise MAP
S. epidermidis
Transmural
Eccentric - concentric hypertrophy causes diastolic disfunction
Vasocxn

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

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42. serum marker for wegener's
Left atrial pressure
Holosystolic - harsh sounding murmur - loudest over tricuspid area
C - ANCA
LAD - V1 - V4

43. What are the complications of atherosclerosis?
Right sided
Vasocxn
2-4 day - early coag necrosis on the first day
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

44. Rank the pacemakers cells
SA>AV>bundle of His>ventricles
Isovolumetric contraction
LAD > RCA > circumflex
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

45. What does FAN MY SKIN On Wednesday stand for?
Patent ductus arteriosus - congenital rubella or prematurity
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Unstable/crescendo angina
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

46. in the JVP - What is the a wave?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Atrial contraction
Libman - sacks endocarditis
Left heart failure

47. Hyperplastic onion skinning
Vasocxn
Arteriolosclerosis in malignant hypertension
V fib
Diastolic

48. Which murmur is heard with mitral prolapse?
Ventricular depolarization - nl < 120 msec
Late systolic crescendo murmur with a midsystolic click
Mitral>aortic>>tricuspid - high pressure valves affected most
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

49. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
Ischemic heart dz - mitral valve prolapse - LV dilation
Neg inotropy - HF - narcotic overdose
2nd degree AV block - mobitz type 1
Ventricles are depolarized

50. Fatal arrhythmia
V fib
Torsades de pointes
Wegener's
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

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Cardiology

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