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Cardiology

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Can progess to V fib
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Raynaud's
Polyarteritis nodosum

2. What 4 things drive myocardial 02 demand?
Black > white > asian
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Transmural
Aortic dilation - bicuspid aortic valve - RF -

3. What are the complications from bacterial endocarditis?
Torsades de pointes
Chordae rupture - GN - suppurative pericarditis - emboli
Fluid movement through capillaries
Wegener's

4. What does an isoelectric ST segment indicate?
Ventricles are depolarized
Mitral stenosis
Vasocxn
Anterosuperior displacement of the infundibular septum

5. What does the LAD supply?
Mean arterial pressure
Aortic and pulmonary closing
During diastole
Apex and anterior interventricular septum

6. What supplies the posterior left ventricle?
CFX
Tempral arteritis - may cause irreversible blindness
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Pulsus parvus and tardus - weak - can lead to syncope

7. congenital heart defect with 22q11
Truncus - tet of fallot
Kaposi's sarcoma
During diastole
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

8. CO x Total peripheral resistance
Stable angina
Fick principle
RV failure - in venous pressure
Mean arterial pressure

9. most common heart tumor
Metastasis from melanoma or lymphoma
Inc Kf - capillary perm
7 weeks
TAPVR

10. Inspiration causes an increase in which sided heart sounds?
Sturge weber - vasculitis of caps
Resting potential high K perm
Stable angina
Right sided

11. What cardiac change occurs in pregnancy?
Increased SV
MI
Liver
Polyarteritis nodosum

12. PROVe
Indomethacin closes - and pge keeps it open
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
EKG
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

13. What are the 5 T's of cyanoitc babies
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Inc interstitial osmotic pressure pulling fliud out of capillaries
Hematocrit
Tricuspid atresia - requires ASD and VSD

14. in the JVP - What is the c wave?
RV contraction (closed tricuspid valve bulding into atrium
Early deaths from myocarditis
During diastole
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

15. Where is the most posterior portion of the heart and What can it cause?
Eccentric - concentric hypertrophy causes diastolic disfunction
Cyclophosphamide and corticosteroids
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
In series

16. polypoid capillary hemangioma that can ulcerate and bleed
C - ANCA
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Pyogenic granuloma - associated with trauma and pregnancy
Crescendo - decrescendo systolic ejection murmur following ejection click

17. What does mitral prolapse predeispose to?
Group a beta hemolytic strep
SA>AV>bundle of His>ventricles
Infective endocarditis
Boot shaped heart

18. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Venodilators (nitrogylcerine)
Aortic/pulmonic stenosis and mitral/tricuspid regurg
R to L shunt caused by stenoic pulmonic valve
Non

19. 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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20. What are common causes of mitral regurg?
HypoK and bradycardia
Strawberry hemangioma
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Ischemic heart dz - mitral valve prolapse - LV dilation

21. What is the most common cause of right heart failure
MI
Diastolic
ASD - VSD - AV septal defect (endocardial cushion defect)
Left heart failure

22. What is the S1 sound?
Fluid movement through capillaries
Mitral and tricuspid closure
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

23. decrease stretch in baroreceptors leads to what response?
Persistant truncus arteriosus
Increased efferent SANS and decreased efferent PANS
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Systolic dysfunction

24. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
Fast volatge gated Na channels
Transfusion
...
Neg inotropy - HF - narcotic overdose

25. Which valve is most commonly involved in bacterial endocarditis?
Mitral valve
Cardiac tamponde
Neg inotropy - HF - narcotic overdose
LCX - V4- V6

26. What is association with fixed S2 splitting - does not increase with inspiration
QRS complex
RV failure - in venous pressure
ASD
In parallel

27. What is the progression of atherosclerosis?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Cherry hemangioma
Increase - increase the chance the If are open
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

28. What happends in phase 1 of the ventricular cardiac action potential?
Purkingee>atria>ventricles>AV node
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Inc Kf - capillary perm
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

29. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Decrease in activity of Na/Ca exhanger and increase in contractility
Angiosarcoma
Mitral valve prolapse
Left sided

30. most common primary cardiac tumor in children - associated with tuberous sclerosis
Hemorrhage
Ventricular depolarization - nl < 120 msec
CFX
Rhabdomyomas

31. which medications are used to maintain patency or close the ductus arteriosus?
Coarcation of aorta
Indomethacin closes - and pge keeps it open
SA and AV nodes
Wolff - Parkinson white syndrome

32. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Libman - sacks endocarditis
Decreased

33. In an EKG - What is the T wave?
In series
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
During diastole
Ventricular repolarization

34. machine murmer
Squat. Compression of femoral arteries - inc TPR - dec
PDA
S. epidermidis
Increase contractility

35. What are the systolic heart sounds
SA and AV nodes
PDA
Black > white > asian
Aortic/pulmonic stenosis and mitral/tricuspid regurg

36. The cause of dyspnea on exertion?
Failure of LV to in CO during exercise
Heart - 02 extraction is always around 100%
Persistant truncus arteriosus
Aburpt halting of valve leaflets

37. Do you see elevaged ASO titers in rheumatic heart disease
Yes
Subendocardial
Hematocrit
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

38. What is the characteristic pulse in aortic stenosis?
CFX
Pulsus parvus and tardus - weak - can lead to syncope
Wolff - Parkinson white syndrome
Aortic and pulmonary closing

39. What does TAPVR stand for
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Total anomalous pulmonary trunk venous return
Mechanican contraction of the ventricles
Pos inotropy - exercise

40. Irregularly irregular ECG - no p waves: dx and treatment
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Aortic and pulmonary closing
In RA return (inspiration)

41. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Hyperlipidemia
10%
LAD
Unstable/crescendo angina

42. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
No - no pressure gradient
Medullary vasomotor center senses baroreceptors and JGA
Age related calcifications or bicuspid aortic valve
Indomethacin closes - and pge keeps it open

43. Which organ gets the largest share of systemic cardiac output
Liver
Decreased
Libman - sacks endocarditis
Microscopic polyangiitis - like wegener's without granulomas

44. What is the cushing triad?
HTN - bradycardia - and respiratory depression
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Mechanican contraction of the ventricles
S. epidermidis

45. What is the classic X ray finding for tet of fallot?
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Boot shaped heart
Decreased
Squat. Compression of femoral arteries - inc TPR - dec

46. What are the complications of atherosclerosis?
Turners
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Aortic dilation - bicuspid aortic valve - RF -
Conduction delay through AV node - nl < 200 msec

47. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
LAD
Inc TPR and LA return (expiration)
Myxoma
LAD - V1 - V4

48. How does a patient with Tet of fallot learn to improve symptoms?
Decrease in activity of Na/Ca exhanger and increase in contractility
Inc venous return exaccerbates pulm vasc congestion
Squat. Compression of femoral arteries - inc TPR - dec
Can progess to V fib

49. what percentage of HTN is secondary to renal disease?
Systolic dysfunction
10%
Mitral stenosis
Group a beta hemolytic strep

50. Which class of drugs decrease preload
Neg inotropy - HF - narcotic overdose
Mitral>aortic>>tricuspid - high pressure valves affected most
Mean arterial pressure
Venodilators (nitrogylcerine)