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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. How do beta blockers decrease contractility?
Viridans streptococci
Decrease in cAMP
Myxomatous degeneration - RF - chordae rupture
Filling is incomplete and CO falls

2. PROVe
7 weeks
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Holosystolic - harsh sounding murmur - loudest over tricuspid area

3. How does a patient with Tet of fallot learn to improve symptoms?
Squat. Compression of femoral arteries - inc TPR - dec
Increase contractility
Total anomalous pulmonary trunk venous return
Mitral stenosis

4. What constitues the upstroke in pacemaker cells?
Glossopharyngeal to soliary nucleus of medulla
Septal defects - PDA - pulm art stenosis
Volatage gated Ca channels
Aortic/pulmonic stenosis and mitral/tricuspid regurg

5. Which lab value indicates blood viscosity?
Tempral arteritis - may cause irreversible blindness
Stable angina
Mitral valve prolapse
Hematocrit

6. clinical signs of cardiac tamponade
Hyperlipidemia
Vasodilators - (hydrAlAzine)
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Angiosarcoma

7. What other sign is often present with congenital long QT syndrome - why?
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Posterior descending (80% off the RCA - 20% off the circumflex)
Hyperlipidemia
Decrease in cAMP

8. What does increasing intracellular Ca do?
Unstable/crescendo angina
Subendocardial - fewer collaterals and higher pressure
Cherry hemangioma
Increase contractility

9. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
S. aureus
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
HypoK and bradycardia
Aortic insuffic - late

10. The cause of dyspnea on exertion?
Chordae rupture - GN - suppurative pericarditis - emboli
Failure of LV to in CO during exercise
S. epidermidis
Can progess to V fib

11. progressive lengthening of PR until beat is dropped - a p wave not followed by QRS
Transposition of great vessels
2nd degree AV block - mobitz type 1
Age related calcifications or bicuspid aortic valve
Sudden tensing of chordae tendinae

12. What are common causes of mitral regurg?
Ischemic heart dz - mitral valve prolapse - LV dilation
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
QRS complex
Transposition of great vessels

13. Which organ has the largest arteriovenous difference
Heart - 02 extraction is always around 100%
Rhabdomyomas
Liver
Medullary vasomotor center senses baroreceptors and JGA

14. which ethnic groups have higher association with HTN?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Black > white > asian
Atrial contraction
LCX - V4- V6

15. congenital heart defect in an infant with a diabetic mother?
Filling is incomplete and CO falls
Dec P02 - inc PC02 and dec pH
Transposition of great vessels
If sodium channel

16. what conditions are associated with pulsus paradoxus
Vasodilators - (hydrAlAzine)
Dilation
QRS complex
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

17. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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18. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Isovolumetric contraction
Fetal right to left - neonate left to right leading to RVH and failure
Inc central venous pressure - inc resistance to portal flow
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

19. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
LAD - V1 - V4
Henoch - Schlonlein purpura
Non
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

20. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
Septal defects - PDA - pulm art stenosis
Left sided
LAD

21. What are aschoff bodies
Wegener's
QRS complex
Turners
Granuloma with giant cells

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

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23. What is a normal EF
Cardiac tamponde
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Persistant truncus arteriosus
At least 55%

24. Which artery supplies the SA and AV nodes?
RCA
At least 55%
LAD - V1- V2
Eccentric - concentric hypertrophy causes diastolic disfunction

25. Central chemoreceptors do not respond directly to which parameter?
QRS complex
P02
Kawasaki
Pulsus parvus and tardus - weak - can lead to syncope

26. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Stable angina
Inc interstitial osmotic pressure pulling fliud out of capillaries
2-4 day - early coag necrosis on the first day
Purkingee>atria>ventricles>AV node

27. What are the diastolic heart sounds?
Ischemic heart dz - mitral valve prolapse - LV dilation
Fluid movement through capillaries
Aortic/pulmonic regurg and mitral/tricuspid stenosis
3rd degree block - pacemaker - Lyme disease

28. What are the different etiologies of dialted cardiomyopathy
SA and AV nodes
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Filling is incomplete and CO falls
Neg inotropy - HF - narcotic overdose

29. In an EKG - What is the QT interval?
Transfusion
Mechanican contraction of the ventricles
LCX - V4- V6
Takayasu's arteritis

30. Hyperplastic onion skinning
Inc blood volume
Arteriolosclerosis in malignant hypertension
Cystic hygroma
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

31. What do patients die early from in rheumatic heart disease?
Granuloma with giant cells
Early deaths from myocarditis
Pulmonic stenosis and RBBB
7 weeks

32. MAP is also known as
Transmural
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Afterload (proportional to peripheral resistance)
Heart - 02 extraction is always around 100%

33. What does the starling curve show?
Subendocardial
Changes in CO as a function of preload
Vasodilators
Systolic dysfunction

34. What are the 5 T's of cyanoitc babies
In parallel
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Unstable/crescendo angina
...

35. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Cyclophosphamide and corticosteroids
Adult type aortic coarctation
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Increase in Pc

36. most common primary cardiac tumor in children - associated with tuberous sclerosis
Tempral arteritis - may cause irreversible blindness
QRS complex
Rhabdomyomas
Atrial contraction

37. How do catecholamines increase contractility?
Systolic dysfunction
Aortic and pulmonary closing
Increasing activity of Ca pump in SR
LAD - V1 - V4

38. congenital heart defect with marfan's
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Afterload (proportional to peripheral resistance)
Atrial contraction
Aortic insuffic - late

39. What does TAPVR stand for
Total anomalous pulmonary trunk venous return
Liver
Hematocrit
Eisenmenger's syndrome

40. In an inferior wall infarct - which artery is affected and which leads show Q waves
Total anomalous pulmonary trunk venous return
Kidney
RCA - II - III - aVF
Boot shaped heart

41. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Unstable/crescendo angina
Pulmonary flow murmur and diastolic rumble
Dilated cardiomyopathy
Mechanican contraction of the ventricles

42. Which murmur is heard in aortic stenosis?
Subendocardial - fewer collaterals and higher pressure
Gap junctions
RF
Crescendo - decrescendo systolic ejection murmur following ejection click

43. most common heart tumor
Metastasis from melanoma or lymphoma
In RA return (inspiration)
Adult type aortic coarctation
MAP

44. What is the danger of torsades to pointes?
Can progess to V fib
Transmural
Stroke volume
Maintain blood flow to organ over wide range of perfussion pressures

45. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kawasaki
Kidney
Inc venous return exaccerbates pulm vasc congestion
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

46. What is the S2 sound?
Patent ductus arteriosus - congenital rubella or prematurity
Maintain blood flow to organ over wide range of perfussion pressures
R to L shunt caused by stenoic pulmonic valve
Aortic and pulmonary closing

47. In an EKG - What is the T wave?
Maintain blood flow to organ over wide range of perfussion pressures
Holosystoiic
PDA
Ventricular repolarization

48. systolic - diastolic
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Pulse pressure

49. What are the complications of atherosclerosis?
Aortic dilation - bicuspid aortic valve - RF -
LAD - V1 - V4
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

50. 2/3 diastolic + 1/3 systolic
Late diastolic murmur following an opening snap
MAP
LV failure - pulm venous distention transudation of fluid
Prinzmetal angina