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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 does T wave inversion indicated?
Transfusion
MI
LAD - V1- V2
Resting potential high K perm

2. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Afterload (proportional to peripheral resistance)
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Purkingee>atria>ventricles>AV node
Failure of LV to in CO during exercise

3. What causes the murmur heard in MR to enhance?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
LV failure - pulm venous distention transudation of fluid
Ischemic heart dz - mitral valve prolapse - LV dilation
Inc TPR and LA return (expiration)

4. Expiration causes an increase in which sided heart sounds
Left sided
Prinzmetal angina
Aortic/pulmonic regurg and mitral/tricuspid stenosis
MI

5. most common heart tumor
Inc venous return exaccerbates pulm vasc congestion
LAD - V1- V2
Metastasis from melanoma or lymphoma
Arteriolosclerosis in malignant hypertension

6. Which vessels account for the most total peripheral resistance
C - ANCA
Arteriorles
Glossopharyngeal to soliary nucleus of medulla
Decrease in cAMP

7. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Aortic disecction - intraluminal tear forming false lumen
MI
S. aureus
CO

8. When does extracellular calcium enter the cardiac muscle cells during contraction?
Extracellular calcium - calcium induced calcium release
Left sided
Dilated cardiomyopathy
The plateau period

9. PCWP > LV diastolic pressure
Kidney
Eccentric - concentric hypertrophy causes diastolic disfunction
Mitral stenosis
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

10. When do you find hemosiderin laden macrophages in the lungs?
Arteriolosclerosis in malignant hypertension
Wegener's
During HF from microhemorrhages from inc pulm cap pressure
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

11. What is the formula for EF?
10%
The operating point of the heart
MI
SV/ EDV

12. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Vasodilators
Preload
Decreased
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

13. What is the progression of atherosclerosis?
Increase - increase the chance the If are open
Kaposi's sarcoma
Mean arterial pressure
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

14. How does aldosterone raise MAP
Inc blood volume
Ventricles are depolarized
Increase intracellular Na - resulting in increased Ca
Buerger's disease

15. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Polyarteritis nodosum
S. epidermidis
Wolff - Parkinson white syndrome
Torsades de pointes

16. What supplies the posterior left ventricle?
Preload
10%
CFX
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

17. What does hypoxia cause in the lung versus other tissues?
ASD
Fluid movement through capillaries
Vasocxn - while other tissues it causes vasodilation
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

18. Which organ gets the largest share of systemic cardiac output
Liver
LAD - V1- V2
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Activated histiocytes

19. In an EKG - What is the QRS complex?
Ventricular depolarization - nl < 120 msec
Lymphangiosarcoma
Increased efferent SANS and decreased efferent PANS
Dressler's - autoimmune

20. In an inferior wall infarct - which artery is affected and which leads show Q waves
RCA - II - III - aVF
Atherosclerosis
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Inc central venous pressure - inc resistance to portal flow

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

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22. Where are pacemaker cells?
Lymphangiosarcoma
S. aureus
SA and AV nodes
In RA return (inspiration)

23. What is the characteristic pulse in aortic stenosis?
Increase contractility
Late diastolic murmur following an opening snap
Pulsus parvus and tardus - weak - can lead to syncope
Dressler's - autoimmune

24. What happens in phase 2 of the cardiac ventricular action potential?
Strawberry hemangioma
Increase contractility
Neg inotropy - HF - narcotic overdose
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

25. In an EKG - What is the PR interval?
Boot shaped heart
Conduction delay through AV node - nl < 200 msec
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Fast volatge gated Na channels

26. In an EKG - What is the QT interval?
Decrease in activity of Na/Ca exhanger and increase in contractility
Dec plasma proteins
Mechanican contraction of the ventricles
Pulse pressure

27. in the JVP - What is the a wave?
Hyperlipidemia
Atrial contraction
Fast volatge gated Na channels
Inc interstitial osmotic pressure pulling fliud out of capillaries

28. How are sarcomeres added in concentric hypertrophy?
In parallel
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
The operating point of the heart
Aortic and pulmonary closing

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

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30. What is the machine like murmur? What is the heart pathology and the predisposing causes
Decreases
Patent ductus arteriosus - congenital rubella or prematurity
Increasing activity of Ca pump in SR
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

31. Inspiration causes an increase in which sided heart sounds?
Microscopic polyangiitis - like wegener's without granulomas
Myxomatous degeneration - RF - chordae rupture
3rd degree block - pacemaker - Lyme disease
Right sided

32. Exercise - overtransfusiion and excitiment causes and increase in...?
Inc Kf - capillary perm
Greater ventricular EDV
Preload
Left heart failure

33. What are common causes of mitral regurg?
Ischemic heart dz - mitral valve prolapse - LV dilation
Black > white > asian
Vagus to medulla
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

34. In an EKG - What is the p wave?
Crescendo - decrescendo systolic ejection murmur following ejection click
Atrial contraction
Preload
Glossopharyngeal to soliary nucleus of medulla

35. What does an isoelectric ST segment indicate?
Dressler's - autoimmune
Viridans streptococci
Ventricles are depolarized
140/90

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

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37. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LCX - I - aVL
1st degree AV blodck
Age related calcifications or bicuspid aortic valve
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

38. In terms of starling forces - why does heart failure cause edema?
Decrease in activity of Na/Ca exhanger and increase in contractility
Increase in Pc
Rhabdomyomas
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

39. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Chordae rupture - GN - suppurative pericarditis - emboli
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Hemorrhage
Fast volatge gated Na channels

40. What do the starling forces determine
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Boot shaped heart
Fluid movement through capillaries
Varicose veins - thromboembolism rare

41. Which lab value indicates blood viscosity?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Hematocrit
LCX - V4- V6
Vasocxn

42. How does digitatlis increase contractility?
Transfusion
Increase intracellular Na - resulting in increased Ca
Vasocxn - while other tissues it causes vasodilation
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

43. congenital heart defect with marfan's
Aortic insuffic - late
Isovolumetric contraction
MAP
In parallel

44. Which two mechanisms sense decrease MAP?
Stable angina
CO
Tricuspid atresia - requires ASD and VSD
Medullary vasomotor center senses baroreceptors and JGA

45. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Infective endocarditis
Hematocrit
Polyarteritis nodosum
Pulmonary flow murmur and diastolic rumble

46. what conditions are associated with pulsus paradoxus
Extracellular calcium - calcium induced calcium release
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

47. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Infective endocarditis
Hyperlipidemia
Ventricular repolarization
Increasing activity of Ca pump in SR

48. in the JVP - What is the c wave?
SA and AV nodes
Dilation
During diastole
RV contraction (closed tricuspid valve bulding into atrium

49. Mitral stenosis is most often secondary to which condition?
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Pulse pressure
RF
Mitral stenosis

50. What happens in phase 4 of the cardiac ventricular action potential?
Ventricular depolarization - nl < 120 msec
Resting potential high K perm
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Decrease in cAMP