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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. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
LAD > RCA > circumflex
Fick principle
Activated histiocytes
Inc interstitial osmotic pressure pulling fliud out of capillaries

2. What masks atrial repolarization?
QRS complex
Granuloma with giant cells
Fluid movement through capillaries
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

3. serum marker for wegener's
Proportional to viscosity and inversely proportional to the radius to the 4th power
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Fast volatge gated Na channels
C - ANCA

4. machine murmer
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Purkingee>atria>ventricles>AV node
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
PDA

5. The cause of cardiac dilation?
Mitral stenosis
Greater ventricular EDV
Subendocardial
V fib arrhythima

6. What does the starling curve show?
Pulsus parvus and tardus - weak - can lead to syncope
Changes in CO as a function of preload
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
In parallel

7. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Libman - sacks endocarditis
The plateau period
Vasodilators
Diastolic

8. Inspiration causes an increase in which sided heart sounds?
Right sided
QRS complex
Mitral and tricuspid closure
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

9. What does TAPVR stand for
Stable angina
Atrial contraction
Total anomalous pulmonary trunk venous return
S. aureus

10. Which class of drugs decreases afterload?
Failure of LV to in CO during exercise
Group a beta hemolytic strep
LAD > RCA > circumflex
Vasodilators - (hydrAlAzine)

11. 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
LAD - V1 - V4
No
LV failure - pulm venous distention transudation of fluid

12. Chronic mitral stenosis can lead to what changes in size of the LA
Dilation
Sturge weber - vasculitis of caps
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Rapid upstroke - voltage gated Na channels open

13. What does the U wave indicated?
HypoK and bradycardia
If sodium channel
Greater ventricular EDV
ANP

14. What cardiac change occurs in pregnancy?
In RA return (inspiration)
Systolic dysfunction
Kids
Increased SV

15. What is the definition of HTN?
3rd degree block - pacemaker - Lyme disease
Changes in CO as a function of preload
140/90
LAD

16. What is the danger of torsades to pointes?
SA>AV>bundle of His>ventricles
Can progess to V fib
During diastole
Rapid upstroke - voltage gated Na channels open

17. which medications are used to maintain patency or close the ductus arteriosus?
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Aburpt halting of valve leaflets
Indomethacin closes - and pge keeps it open
SV/ EDV

18. 2/3 diastolic + 1/3 systolic
Increase in Pc
MAP
Fetal right to left - neonate left to right leading to RVH and failure
Isovolumetric contraction

19. When do you see extensive coagulative necrosis in an MI
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
2-4 day - early coag necrosis on the first day
ASD
Transmural

20. In the cardiac cycle - which period has the highest 02 consumption?
Eisenmenger's syndrome
RCA - II - III - aVF
Varicose veins - thromboembolism rare
Isovolumetric contraction

21. PCWP is an estimate of...
Left atrial pressure
7 weeks
Varicose veins - thromboembolism rare
Black > white > asian

22. What are aschoff bodies
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Granuloma with giant cells
2nd degree AV block - mobitz type 1
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

23. Which enzymes are useful for diagnosing reinfarction
SA>AV>bundle of His>ventricles
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
S. bovis
CK- MB

24. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
CO
Polyarteritis nodosum
Increased SV
Myxoma

25. Churg Strauss - presentation and test
Vasocxn
Libman - sacks endocarditis
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Cystic hygroma

26. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Temporal arteritis
MAP
Cystic hygroma
Eccentric - concentric hypertrophy causes diastolic disfunction

27. What is the classic X ray finding for tet of fallot?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Boot shaped heart
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Stroke volume

28. Which bacteria can cause endocarditis from prosthetic valves?
5-10 days - macs have degraded structural components
RCA
S. epidermidis
Can progess to V fib

29. congenital heart defect withdown syndrome
LCX - I - aVL
ASD - VSD - AV septal defect (endocardial cushion defect)
Babies
C - ANCA

30. Which class of drugs decrease the murmur heard in aortic regurg?
Ventricular depolarization - nl < 120 msec
Coarcation of aorta
CK- MB
Vasodilators

31. Which organ has ht highest blood flow per gram of tissue
Boot shaped heart
Atherosclerosis
Decrease in activity of Na/Ca exhanger and increase in contractility
Kidney

32. How does digitatlis increase contractility?
Increase intracellular Na - resulting in increased Ca
Crescendo - decrescendo systolic ejection murmur following ejection click
ASD
140/90

33. exaggerated decrease in pulse during inspiration.

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34. What causes the cushing reflex and why
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
S. aureus
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

35. What is the formula for EF?
SV/ EDV
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Transposition of great vessels
Hematocrit

36. Central chemoreceptors do not respond directly to which parameter?
Pulmonary flow murmur and diastolic rumble
Filling is incomplete and CO falls
Greater ventricular EDV
P02

37. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Increase - increase the chance the If are open
Squat. Compression of femoral arteries - inc TPR - dec
Raynaud's
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

38. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Atherosclerosis
LV failure - pulm venous distention transudation of fluid
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

39. In an anterolateral infarct - which artery is effected and which leads show Q waves
Ventricles are depolarized
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
LCX - V4- V6
Dec P02 - inc PC02 and dec pH

40. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
S. aureus
CO
Pulsus parvus and tardus - weak - can lead to syncope
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

41. stroke volume x HR =?
Dilation
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
CO
Decrease in cAMP

42. Which bacteria causes rheumatic heart disease
RCA
Septal defects - PDA - pulm art stenosis
TAPVR
Group a beta hemolytic strep

43. What channels do the the pacemaker cells lack?
Fast volatge gated Na channels
Late diastolic murmur following an opening snap
Atherosclerosis
Myxomatous degeneration - RF - chordae rupture

44. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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45. Where does coronary artery occlusion occur most commonly?
LAD
Buerger's disease
During HF from microhemorrhages from inc pulm cap pressure
The operating point of the heart

46. Which valve is most commonly involved in bacterial endocarditis?
Mitral valve
Cardiac tamponde
Arteriorles
Venodilators (nitrogylcerine)

47. congenital heart defect in an infant with a diabetic mother?
Dilation
Systolic dysfunction
Transposition of great vessels
Volatage gated Ca channels

48. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Wolff - Parkinson white syndrome
LAD

49. What causes the midsystolic click
Sudden tensing of chordae tendinae
Increasing activity of Ca pump in SR
Crescendo - decrescendo systolic ejection murmur following ejection click
The plateau period

50. Which murmur is heard with VSD?
Neg inotropy - HF - narcotic overdose
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Venodilators (nitrogylcerine)

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