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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. cavernous lymphangioma of the neck - associated with turner's
S. aureus
Cystic hygroma
Dilation
Liver

2. What is the formula for EF?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Systolic dysfunction
SV/ EDV
Turners

3. What is the early and late lesion in rheumatic heart disease
Mitral valve prolapse
Hemorrhage
Atherosclerosis
Wolff - Parkinson white syndrome

4. In an anterolateral infarct - which artery is effected and which leads show Q waves
Buerger's disease
Raynaud's
LCX - V4- V6
Aortic stenosis or LBBB

5. stroke volume x HR =?
Pos inotropy - exercise
Cherry hemangioma
CO
Liver

6. In an EKG - What is the QRS complex?
Kaposi's sarcoma
Ventricular depolarization - nl < 120 msec
Wegener's
RV contraction (closed tricuspid valve bulding into atrium

7. 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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8. Which bacteria causes rheumatic heart disease
HTN - bradycardia - and respiratory depression
Anterosuperior displacement of the infundibular septum
Group a beta hemolytic strep
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection

9. What causes aortic stenosis
Age related calcifications or bicuspid aortic valve
Apex and anterior interventricular septum
Inc interstitial osmotic pressure pulling fliud out of capillaries
Atrial contraction

10. What does an isoelectric ST segment indicate?
Ventricles are depolarized
ASD - VSD - AV septal defect (endocardial cushion defect)
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Microscopic polyangiitis - like wegener's without granulomas

11. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Fetal right to left - neonate left to right leading to RVH and failure
R to L shunt caused by stenoic pulmonic valve
Greater ventricular EDV
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

12. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
HTN - bradycardia - and respiratory depression
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Liver
In HF

13. What is the machine like murmur? What is the heart pathology and the predisposing causes
Patent ductus arteriosus - congenital rubella or prematurity
Kidney
Lower right - MC - upper right - AO - upper right AC - lower left MO
Early deaths from myocarditis

14. When and why is the S3 sound heard?
Increase contractility
Postinfarction fibrinous pericarditis
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Total anomalous pulmonary trunk venous return

15. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
MI
10%
Troponin I
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

16. What are the four most common locations for atherosclerosis?
LCX - I - aVL
CHF
Wolff - Parkinson white syndrome
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

17. Where does coronary artery occlusion occur most commonly?
Maintain blood flow to organ over wide range of perfussion pressures
Age related calcifications or bicuspid aortic valve
The first 4 days
LAD

18. What are aschoff bodies
Inc interstitial osmotic pressure pulling fliud out of capillaries
MAP
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Granuloma with giant cells

19. What happends in phase 1 of the ventricular cardiac action potential?
Angiosarcoma
Sudden tensing of chordae tendinae
Group a beta hemolytic strep
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

20. What is the association with wide S2 splitting?
Black > white > asian
Increased efferent SANS and decreased efferent PANS
Pulmonic stenosis and RBBB
Can progess to V fib

21. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Vasodilators
Fick principle
Decreases
Cherry hemangioma

22. In terms of starling forces - why does heart failure cause edema?
Hemorrhage
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Increase in Pc
Hyperlipidemia

23. What is association with fixed S2 splitting - does not increase with inspiration
S. bovis
ASD
Aortic insuffic - late
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

24. How are cadiac myocytes eltrically coupled?
Gap junctions
Cyclophosphamide and corticosteroids
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Activated histiocytes

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

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26. How does a patient with Tet of fallot learn to improve symptoms?
Squat. Compression of femoral arteries - inc TPR - dec
Fluid movement through capillaries
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
In HF

27. which ethnic groups have higher association with HTN?
Greater ventricular EDV
Black > white > asian
SA>AV>bundle of His>ventricles
Hypertrophied cardiomyopathy

28. What kind of dysfunction ensues in restrictive cardiomyopathy
S. aureus
Diastolic
Fast volatge gated Na channels
Rapid upstroke - voltage gated Na channels open

29. What does prolonged QT predispose to?
P02
Subendocardial - fewer collaterals and higher pressure
Torsades de pointes
Henoch - Schlonlein purpura

30. What is the S1 sound?
Ischemic heart dz - mitral valve prolapse - LV dilation
Mitral and tricuspid closure
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Afterload (proportional to peripheral resistance)

31. congenital heart defect with marfan's
Aortic insuffic - late
Increasing activity of Ca pump in SR
Wegener's
Total anomalous pulmonary trunk venous return

32. What cardiac change occurs in pregnancy?
Increased SV
Varicose veins - thromboembolism rare
Increased efferent SANS and decreased efferent PANS
3rd degree block - pacemaker - Lyme disease

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

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34. Do you see elevaged ASO titers in rheumatic heart disease
Cardiac tamponde
Yes
In HF
Pos inotropy - exercise

35. Which organ has the largest arteriovenous difference
SV/ EDV
Kaposi's sarcoma
Raynaud's
Heart - 02 extraction is always around 100%

36. What causes tet of fallot?
Angiosarcoma
MAP
Anterosuperior displacement of the infundibular septum
In parallel

37. What is sudden cardiac death most commonly due to...
V fib arrhythima
Cystic hygroma
Cardiac tamponde
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

38. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Cystic hygroma
The first 4 days
Polyarteritis nodosum

39. tearing chest pain radiation to the back - associated with marfan
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Failure of LV to in CO during exercise
Left sided
Aortic disecction - intraluminal tear forming false lumen

40. Which murmur is heard with mitral prolapse?
Late systolic crescendo murmur with a midsystolic click
Black > white > asian
Henoch - Schlonlein purpura
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

41. Which class of drugs decreases afterload?
In series
Diastolic
Vasodilators - (hydrAlAzine)
Torsades de pointes

42. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Coarcation of aorta
During diastole
Atherosclerosis
Angiosarcoma

43. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Varicose veins - thromboembolism rare
Medullary vasomotor center senses baroreceptors and JGA
Filling is incomplete and CO falls
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

44. What does FAN MY SKIN On Wednesday stand for?
Aortic disecction - intraluminal tear forming false lumen
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Pulmonic stenosis and RBBB
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

45. What do the starling forces determine
CK- MB
Fluid movement through capillaries
7 weeks
Resting potential high K perm

46. Rank the pacemakers cells
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Viridans streptococci
SA>AV>bundle of His>ventricles
Resting potential high K perm

47. 2/3 diastolic + 1/3 systolic
MAP
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Indomethacin closes - and pge keeps it open
Aortic dilation - bicuspid aortic valve - RF -

48. prolonged PR interval
Viridans streptococci
LAD
1st degree AV blodck
Pos inotropy - exercise

49. What is the characteristic pulse in aortic stenosis?
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Purkingee>atria>ventricles>AV node
Pulsus parvus and tardus - weak - can lead to syncope

50. Which murmur is heard in aortic stenosis?
Pulse pressure
Crescendo - decrescendo systolic ejection murmur following ejection click
Volatage gated Ca channels
Late systolic crescendo murmur with a midsystolic click