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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. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LCX - I - aVL
Aortic/pulmonic regurg and mitral/tricuspid stenosis
TAPVR
Patent ductus arteriosus - congenital rubella or prematurity

2. EDV - ESV
If sodium channel
Pulmonic stenosis and RBBB
Stroke volume
Acute thrombosis of coronary artery

3. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Dilated cardiomyopathy
Kaposi's sarcoma
Libman - sacks endocarditis
Wegener's

4. Which murmur is heard with VSD?
Transfusion
RCA - II - III - aVF
RCA
Holosystolic - harsh sounding murmur - loudest over tricuspid area

5. When during cardiac nodal cells depolarize?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
5-10 days - macs have degraded structural components
Septal defects - PDA - pulm art stenosis
During diastole

6. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Left atrial pressure
LAD - V1- V2
Isovolumetric contraction

7. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Filling is incomplete and CO falls
Non
Dilated cardiomyopathy
Pulmonic stenosis and RBBB

8. What happens in phase 2 of the cardiac ventricular action potential?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
1st degree AV blodck
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Rhabdomyomas

9. What is the most common cause of MI
No
Right sided
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Acute thrombosis of coronary artery

10. What do the starling forces determine
Pos inotropy - exercise
10%
Fluid movement through capillaries
S. epidermidis

11. Which lab value indicates blood viscosity?
Varicose veins - thromboembolism rare
Hematocrit
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Mitral valve prolapse

12. What do patients die early from in rheumatic heart disease?
Anterosuperior displacement of the infundibular septum
Early deaths from myocarditis
Decreased
Conduction delay through AV node - nl < 200 msec

13. Which area of the endocardium is especially vulnerable to infarction? Why?
No - no pressure gradient
Stable angina
Subendocardial - fewer collaterals and higher pressure
Extracellular calcium - calcium induced calcium release

14. What are the systolic heart sounds
Increasing activity of Ca pump in SR
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Septal defects - PDA - pulm art stenosis
Aortic/pulmonic stenosis and mitral/tricuspid regurg

15. Right to left shunts are more common in babies or kids?
Late systolic crescendo murmur with a midsystolic click
The aortic before pulmonic - inspiration increases diff
Babies
SA>AV>bundle of His>ventricles

16. Where is the most posterior portion of the heart and What can it cause?
Stroke volume
Mitral valve
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Liver

17. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Increase - increase the chance the If are open
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Varicose veins - thromboembolism rare
Boot shaped heart

18. What does an isoelectric ST segment indicate?
10%
Ventricles are depolarized
Temporal arteritis
Tricuspid atresia - requires ASD and VSD

19. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Fick principle
S. aureus
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Kawasaki

20. Which murmur do you hear in mitral stenosis?
Late diastolic murmur following an opening snap
Left heart failure
Cyclophosphamide and corticosteroids
Tempral arteritis - may cause irreversible blindness

21. The cause of dyspnea on exertion?
Failure of LV to in CO during exercise
Vasodilators
7 weeks
Mean arterial pressure

22. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Henoch - Schlonlein purpura
Liver
Varicose veins - thromboembolism rare
Rapid upstroke - voltage gated Na channels open

23. How are sarcomeres added in concentric hypertrophy?
Subendocardial - fewer collaterals and higher pressure
Increased SV
Dilation
In parallel

24. In an EKG - What is the PR interval?
ASD - VSD - AV septal defect (endocardial cushion defect)
Atherosclerosis
Conduction delay through AV node - nl < 200 msec
10%

25. Wegener's tx
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Cyclophosphamide and corticosteroids
Volatage gated Ca channels
Stroke volume

26. In terms of starling forces - why does heart failure cause edema?
Increase in Pc
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
During diastole

27. In an EKG - What is the QRS complex?
R to L shunt caused by stenoic pulmonic valve
Vasodilators - (hydrAlAzine)
Ventricular depolarization - nl < 120 msec
140/90

28. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
CHF
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
During diastole
Henoch - Schlonlein purpura

29. What causes the midsystolic click
Mitral valve
Sudden tensing of chordae tendinae
Dec P02 - inc PC02 and dec pH
Vasodilators - (hydrAlAzine)

30. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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31. What are the diastolic heart sounds?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Inc central venous pressure - inc resistance to portal flow
Left heart failure
RV failure - in venous pressure

32. In an inferior wall infarct - which artery is affected and which leads show Q waves
Infective endocarditis
MI
RCA - II - III - aVF
EKG

33. What does FROM JANE stand for in bacterial endocarditis?

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34. What is the S1 sound?
In series
Mitral>aortic>>tricuspid - high pressure valves affected most
Babies
Mitral and tricuspid closure

35. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Pulmonic stenosis and RBBB
Aortic insuffic - late
Lymphangiosarcoma

36. In the cardiac cycle - which period has the highest 02 consumption?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Isovolumetric contraction
Glossopharyngeal to soliary nucleus of medulla
Holosystoiic

37. What is the progression of atherosclerosis?
SA>AV>bundle of His>ventricles
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
HTN - bradycardia - and respiratory depression
Fast volatge gated Na channels

38. Inspiration causes an increase in which sided heart sounds?
Myxoma
Chordae rupture - GN - suppurative pericarditis - emboli
Right sided
RV failure - in venous pressure

39. Which bacteria can cause endocarditis from prosthetic valves?
Kids
Troponin I
MI
S. epidermidis

40. Where does coronary artery occlusion occur most commonly?
Eisenmenger's syndrome
LAD
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Extracellular calcium - calcium induced calcium release

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

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42. Which class of drugs decreases afterload?
Hypertrophied cardiomyopathy
Vasodilators - (hydrAlAzine)
Atherosclerosis
Cherry hemangioma

43. in the JVP - What is the a wave?
Varicose veins - thromboembolism rare
Atrial contraction
140/90
Mitral valve prolapse

44. The carotid sinus transmits along which nerve?
Glossopharyngeal to soliary nucleus of medulla
Unstable/crescendo angina
Posterior descending (80% off the RCA - 20% off the circumflex)
Arteriolosclerosis in malignant hypertension

45. what percentage of HTN is secondary to renal disease?
S. aureus
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
10%
Hypertrophied cardiomyopathy

46. machine murmer
PDA
Atrial contraction
Increase intracellular Na - resulting in increased Ca
Raynaud's

47. What does increasing intracellular Ca do?
MI
Increase contractility
Inc blood volume
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

48. no relation between p waves and QRS intervals - treatment and predisposing factor
Troponin I
Myxomatous degeneration - RF - chordae rupture
ASD
3rd degree block - pacemaker - Lyme disease

49. What are the different etiologies of dialted cardiomyopathy
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Patent ductus arteriosus - congenital rubella or prematurity
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

50. What is sudden cardiac death most commonly due to...
LCX - V4- V6
Atrial contraction
Wolff - Parkinson white syndrome
V fib arrhythima