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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. Fatal arrhythmia
Mitral stenosis
Proportional to viscosity and inversely proportional to the radius to the 4th power
V fib
140/90

2. Which murmur is heard with VSD?
Extracellular calcium - calcium induced calcium release
Medullary vasomotor center senses baroreceptors and JGA
2nd degree AV block - mobitz type 1
Holosystolic - harsh sounding murmur - loudest over tricuspid area

3. What happens with a decrease of extracellular Na
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Decrease in activity of Na/Ca exhanger and increase in contractility
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Venodilators (nitrogylcerine)

4. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
EKG
Takayasu's arteritis
Atrial contraction
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

5. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Viridans streptococci
Hypertrophied cardiomyopathy
During HF from microhemorrhages from inc pulm cap pressure
LV failure - pulm venous distention transudation of fluid

6. Wegener's tx
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Microscopic polyangiitis - like wegener's without granulomas
Cyclophosphamide and corticosteroids
ASD - VSD - AV septal defect (endocardial cushion defect)

7. What is the most common cause of MI
Left sided
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Hemorrhage
Acute thrombosis of coronary artery

8. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Arteriorles
Volatage gated Ca channels
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Lymphangiosarcoma

9. Unilateral headache - jaw claudication - impaired vision
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Tempral arteritis - may cause irreversible blindness
QRS complex
Greater ventricular EDV

10. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Changes in CO as a function of preload
LAD - V1- V2
S. bovis

11. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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12. Wegener's presentation
Pyogenic granuloma - associated with trauma and pregnancy
10%
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

13. What does hypoxia cause in the lung versus other tissues?
Vasocxn - while other tissues it causes vasodilation
In series
Arteriolosclerosis in malignant hypertension
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

14. What is the early and late lesion in rheumatic heart disease
Babies
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Mitral valve prolapse
Increase intracellular Na - resulting in increased Ca

15. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Myxoma
Septal defects - PDA - pulm art stenosis
Persistant truncus arteriosus
Infective endocarditis

16. What do the starling forces determine
Fluid movement through capillaries
Preload
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Persistant truncus arteriosus

17. What are the systolic heart sounds
Heart - 02 extraction is always around 100%
Aortic/pulmonic stenosis and mitral/tricuspid regurg
V fib arrhythima
S. epidermidis

18. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Failure of LV to in CO during exercise
Fluid movement through capillaries
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

19. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Ischemic heart dz - mitral valve prolapse - LV dilation
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Microscopic polyangiitis - like wegener's without granulomas
Decreases

20. congenital heart defect with turner's
Pyogenic granuloma - associated with trauma and pregnancy
Aburpt halting of valve leaflets
5-10 days - macs have degraded structural components
Coarcation of aorta

21. absecnce of tricuspid valve - hypoplastic RV
The first 4 days
Pulmonary flow murmur and diastolic rumble
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Tricuspid atresia - requires ASD and VSD

22. Where does coronary artery occlusion occur most commonly?
Purkingee>atria>ventricles>AV node
LAD
Preload
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

23. How are the sarcomeres added in eccentric hypertrophy?
In series
Posterior descending (80% off the RCA - 20% off the circumflex)
Liver
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

24. Which organ has ht highest blood flow per gram of tissue
Fick principle
Kidney
Hyperlipidemia
Proportional to viscosity and inversely proportional to the radius to the 4th power

25. stroke volume x HR =?
CO
Atrial contraction
Cherry hemangioma
Torsades de pointes

26. which heart valves are afected most in rheumatic heart diseease
LAD
Mitral>aortic>>tricuspid - high pressure valves affected most
Viridans streptococci
Resting potential high K perm

27. Why is contractility decreased in heart failure?
5-10 days - macs have degraded structural components
Tempral arteritis - may cause irreversible blindness
HTN - bradycardia - and respiratory depression
Systolic dysfunction

28. What is the most common cause of right heart failure
Postinfarction fibrinous pericarditis
Pulsus parvus and tardus - weak - can lead to syncope
Kidney
Left heart failure

29. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Glomus tumor
The aortic before pulmonic - inspiration increases diff
5-10 days - macs have degraded structural components
RF

30. How does angiotensin II raise MAP
The plateau period
Boot shaped heart
Inc TPR and LA return (expiration)
Vasocxn

31. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Angiosarcoma
PDA
Left atrial pressure
S. aureus

32. The cause of cardiac dilation?
Vasocxn - while other tissues it causes vasodilation
Fluid movement through capillaries
Metastasis from melanoma or lymphoma
Greater ventricular EDV

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

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34. Which organ has the largest arteriovenous difference
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Subendocardial - fewer collaterals and higher pressure
Heart - 02 extraction is always around 100%
Ventricular repolarization

35. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Kawasaki
LCX - V4- V6
Increase - increase the chance the If are open

36. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
S. bovis
Fetal right to left - neonate left to right leading to RVH and failure
Indomethacin closes - and pge keeps it open

37. What is a normal EF
At least 55%
RV contraction (closed tricuspid valve bulding into atrium
Non
Acute thrombosis of coronary artery

38. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Varicose veins - thromboembolism rare
Truncus - tet of fallot
Maintain blood flow to organ over wide range of perfussion pressures
Aortic/pulmonic stenosis and mitral/tricuspid regurg

39. in the JVP - What is the v wave?
Inc RA pressure - due to filling against closed tricupsid valve
Volatage gated Ca channels
Gap junctions
Metastasis from melanoma or lymphoma

40. What is indicated when CO and venous return are equal?
Filling is incomplete and CO falls
Adult type aortic coarctation
The operating point of the heart
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

41. In the cardiac cycle - which period has the highest 02 consumption?
Isovolumetric contraction
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Dilated cardiomyopathy
SA>AV>bundle of His>ventricles

42. What does FEVERSS stand for in rheumatic heart disease
Eccentric - concentric hypertrophy causes diastolic disfunction
Eisenmenger's syndrome
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Wolff - Parkinson white syndrome

43. congenital heart defect in an infant with a diabetic mother?
At least 55%
Age related calcifications or bicuspid aortic valve
140/90
Transposition of great vessels

44. How do catecholamines increase contractility?
Glomus tumor
Increasing activity of Ca pump in SR
Subendocardial - fewer collaterals and higher pressure
Indomethacin closes - and pge keeps it open

45. What channels do the the pacemaker cells lack?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Fast volatge gated Na channels
LAD > RCA > circumflex

46. most common primary cardiac tumor in children - associated with tuberous sclerosis
Rhabdomyomas
Hyperlipidemia
Increase in Pc
Left atrial pressure

47. sawtooth wave

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48. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Activated histiocytes
Posterior descending (80% off the RCA - 20% off the circumflex)
Greater ventricular EDV
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

49. What happens in phase 4 of the cardiac ventricular action potential?
Can progess to V fib
Increasing activity of Ca pump in SR
Granuloma with giant cells
Resting potential high K perm

50. no change in PR interval followed by dropped beat
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
PDA
Temporal arteritis
LCX - I - aVL