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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. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
P02
Wegener's
Squat. Compression of femoral arteries - inc TPR - dec

2. moncekberg
Boot shaped heart
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Vasodilators - (hydrAlAzine)
RCA

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

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4. tearing chest pain radiation to the back - associated with marfan
Aortic disecction - intraluminal tear forming false lumen
Aortic and pulmonary closing
Hematocrit
Vasodilators

5. decrease stretch in baroreceptors leads to what response?
Increase contractility
Decreases
Increased efferent SANS and decreased efferent PANS
Subendocardial - fewer collaterals and higher pressure

6. EDV - ESV
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Stroke volume
Can progess to V fib
Viridans streptococci

7. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Coarcation of aorta
Viridans streptococci
Tempral arteritis - may cause irreversible blindness
Non

8. What are the complications of atherosclerosis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
2nd degree AV block - mobitz type 1
Stroke volume
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

9. Which murmur is heard with mitral prolapse?
During HF from microhemorrhages from inc pulm cap pressure
The first 4 days
Late systolic crescendo murmur with a midsystolic click
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

10. What does an isoelectric ST segment indicate?
3rd degree block - pacemaker - Lyme disease
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Ventricles are depolarized
Mitral>aortic>>tricuspid - high pressure valves affected most

11. PCWP > LV diastolic pressure
Mitral stenosis
Granuloma with giant cells
Venodilators (nitrogylcerine)
Microscopic polyangiitis - like wegener's without granulomas

12. What are common causes of mitral regurg?
RV contraction (closed tricuspid valve bulding into atrium
Purkingee>atria>ventricles>AV node
Mitral valve
Ischemic heart dz - mitral valve prolapse - LV dilation

13. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Afterload (proportional to peripheral resistance)
Arteriorles
Cardiac tamponde

14. Central chemoreceptors do not respond directly to which parameter?
Raynaud's
Decreases
P02
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

15. What are tendinous xanthoma - atheromas - and corneal arcus signs of?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
S. aureus
Kaposi's sarcoma
Hyperlipidemia

16. When do you find hemosiderin laden macrophages in the lungs?
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
During HF from microhemorrhages from inc pulm cap pressure
Lower right - MC - upper right - AO - upper right AC - lower left MO
Postinfarction fibrinous pericarditis

17. absecnce of tricuspid valve - hypoplastic RV
Tricuspid atresia - requires ASD and VSD
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
During diastole
Decrease in activity of Na/Ca exhanger and increase in contractility

18. What are aschoff bodies
Granuloma with giant cells
Inc venous return exaccerbates pulm vasc congestion
Metastasis from melanoma or lymphoma
Pulmonic stenosis and RBBB

19. When do you see extensive coagulative necrosis in an MI
Aortic disecction - intraluminal tear forming false lumen
2-4 day - early coag necrosis on the first day
Left heart failure
Patent ductus arteriosus - congenital rubella or prematurity

20. What murmur is heard with aortic regurg?
Rapid upstroke - voltage gated Na channels open
Mitral valve prolapse
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

21. In an EKG - What is the T wave?
Ventricular repolarization
Inc TPR and LA return (expiration)
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Aortic/pulmonic stenosis and mitral/tricuspid regurg

22. Which sympathetic receptors raise MAP
Early deaths from myocarditis
Holosystoiic
Turners
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

23. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
5-10 days - macs have degraded structural components
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
The first 4 days
Indomethacin closes - and pge keeps it open

24. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Pos inotropy - exercise
Lower right - MC - upper right - AO - upper right AC - lower left MO
Atherosclerosis
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

25. Mitral stenosis is most often secondary to which condition?
Sudden tensing of chordae tendinae
Atrial contraction
RF
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

26. What channels do the the pacemaker cells lack?
The first 4 days
TAPVR
During diastole
Fast volatge gated Na channels

27. What is the danger of torsades to pointes?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Can progess to V fib
LAD - V1 - V4
LCX - V4- V6

28. dyspnea - fatigue - edema and rales - multiple causes
CHF
Mitral valve prolapse
Hematocrit
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

29. Why is there edema after burns or during infection
Inc Kf - capillary perm
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Ventricles are depolarized

30. What does mitral prolapse predeispose to?
Inc venous return exaccerbates pulm vasc congestion
MI
Infective endocarditis
Inc central venous pressure - inc resistance to portal flow

31. Fatal arrhythmia
The first 4 days
V fib
Indomethacin closes - and pge keeps it open
Cherry hemangioma

32. Expiration causes an increase in which sided heart sounds
7 weeks
Sudden tensing of chordae tendinae
HTN - bradycardia - and respiratory depression
Left sided

33. What are the complications from bacterial endocarditis?
Preload
Chordae rupture - GN - suppurative pericarditis - emboli
Troponin I
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

34. What other sign is often present with congenital long QT syndrome - why?
Posterior descending (80% off the RCA - 20% off the circumflex)
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
RF
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

35. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Proportional to viscosity and inversely proportional to the radius to the 4th power
Failure of LV to in CO during exercise
No
Pulse pressure

36. What causes ankle - sacral edema - jugular venous distention
RV failure - in venous pressure
Microscopic polyangiitis - like wegener's without granulomas
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Aortic/pulmonic stenosis and mitral/tricuspid regurg

37. When does extracellular calcium enter the cardiac muscle cells during contraction?
Left atrial pressure
In series
The plateau period
CO

38. What is association with fixed S2 splitting - does not increase with inspiration
ASD
ANP
S. aureus
P02

39. Which area of the endocardium is especially vulnerable to infarction? Why?
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Total anomalous pulmonary trunk venous return
Myxoma
Subendocardial - fewer collaterals and higher pressure

40. When is the scar completely formed in an MI?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Boot shaped heart
Crescendo - decrescendo systolic ejection murmur following ejection click
7 weeks

41. Which channel accounts for automaticity of the SA and AV nodes?
If sodium channel
Raynaud's
Mitral valve prolapse
The operating point of the heart

42. What happens in phase 2 of the cardiac ventricular action potential?
Tricuspid atresia - requires ASD and VSD
7 weeks
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

43. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Right sided
Rapid upstroke - voltage gated Na channels open
TAPVR
Transfusion

44. How does a patient with Tet of fallot learn to improve symptoms?
Squat. Compression of femoral arteries - inc TPR - dec
Myxoma
Cardiac tamponde
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

45. How does digitatlis increase contractility?
Mitral valve prolapse
Mean arterial pressure
Increase intracellular Na - resulting in increased Ca
Pulmonic stenosis and RBBB

46. serum marker for wegener's
C - ANCA
LCX - V4- V6
LAD
Decreased

47. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Rapid upstroke - voltage gated Na channels open
Patent ductus arteriosus - congenital rubella or prematurity
Stable angina
Afterload (proportional to peripheral resistance)

48. Why is contractility decreased in heart failure?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Systolic dysfunction
V fib arrhythima
Hematocrit

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

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50. Where are pacemaker cells?
Left heart failure
SA and AV nodes
Mitral and tricuspid closure
Acute thrombosis of coronary artery