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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. How does a patient with Tet of fallot learn to improve symptoms?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Isovolumetric contraction
Polyarteritis nodosum
Squat. Compression of femoral arteries - inc TPR - dec

2. congenital heart defect with 22q11
Henoch - Schlonlein purpura
Inc venous return exaccerbates pulm vasc congestion
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Truncus - tet of fallot

3. What 4 things drive myocardial 02 demand?
Filling is incomplete and CO falls
The aortic before pulmonic - inspiration increases diff
Increase intracellular Na - resulting in increased Ca
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

4. coronary artery spasm - ST elevation
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Prinzmetal angina
Fetal right to left - neonate left to right leading to RVH and failure
Inc interstitial osmotic pressure pulling fliud out of capillaries

5. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Stroke volume affected by contractility - afterload - and preload
Tricuspid atresia - requires ASD and VSD
Cardiac tamponde
Late systolic crescendo murmur with a midsystolic click

6. Do you see elevaged ASO titers in rheumatic heart disease
Increase - increase the chance the If are open
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Yes
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

7. What causes the murmur heard in MR to enhance?
SA and AV nodes
Maintain blood flow to organ over wide range of perfussion pressures
Inc TPR and LA return (expiration)
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

8. How are the sarcomeres added in eccentric hypertrophy?
Kawasaki
Decrease in activity of Na/Ca exhanger and increase in contractility
In series
Inc blood volume

9. When do coronary arteries fill?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Volatage gated Ca channels
Ischemic heart dz - mitral valve prolapse - LV dilation
During diastole

10. Which murmur do you hear in mitral stenosis?
Left atrial pressure
Late diastolic murmur following an opening snap
Increased efferent SANS and decreased efferent PANS
Rapid upstroke - voltage gated Na channels open

11. which heart valves are afected most in rheumatic heart diseease
Myxomatous degeneration - RF - chordae rupture
Mitral>aortic>>tricuspid - high pressure valves affected most
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
In parallel

12. Which murmur is heard with VSD?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Extracellular calcium - calcium induced calcium release
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Decrease in activity of Na/Ca exhanger and increase in contractility

13. What is the most common cause of right heart failure
Left heart failure
Rhabdomyomas
Left atrial pressure
MI

14. When and why is the S3 sound heard?
LCX - I - aVL
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Henoch - Schlonlein purpura
In parallel

15. What are the 5 T's of cyanoitc babies
Temporal arteritis
During diastole
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
2-4 day - early coag necrosis on the first day

16. Inspiration causes an increase in which sided heart sounds?
Stroke volume
Atrial contraction
Aburpt halting of valve leaflets
Right sided

17. How do beta blockers decrease contractility?
PDA
The plateau period
Rhabdomyomas
Decrease in cAMP

18. What is the cushing triad?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
HTN - bradycardia - and respiratory depression
Kidney
In parallel

19. Which organ has ht highest blood flow per gram of tissue
EKG
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Kidney

20. What is the danger of torsades to pointes?
Glomus tumor
Increase contractility
Can progess to V fib
If sodium channel

21. The aortic arch receptors transmit along which nerve?
Pyogenic granuloma - associated with trauma and pregnancy
MI
Patent ductus arteriosus - congenital rubella or prematurity
Vagus to medulla

22. What causes ankle - sacral edema - jugular venous distention
R to L shunt caused by stenoic pulmonic valve
RV failure - in venous pressure
Late systolic crescendo murmur with a midsystolic click
Inc blood volume

23. What is sudden cardiac death most commonly due to...
Late systolic crescendo murmur with a midsystolic click
V fib arrhythima
Torsades de pointes
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

24. What does the atria release in response to inc blood volume and atrial pressure
ANP
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Indomethacin closes - and pge keeps it open
Inc venous return exaccerbates pulm vasc congestion

25. What causes aortic regurg
Atherosclerosis
Aortic dilation - bicuspid aortic valve - RF -
Inc central venous pressure - inc resistance to portal flow
Glomus tumor

26. systolic - diastolic
S. aureus
Pulse pressure
Viridans streptococci
Increase contractility

27. sawtooth wave

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28. Which valve is commonly involved in bacterial endocarditis from IV drug use and Which bacteria are most common?

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29. Why is there edema after burns or during infection
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Fetal right to left - neonate left to right leading to RVH and failure
Inc Kf - capillary perm
Vasocxn

30. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Viridans streptococci
Dec plasma proteins
Venodilators (nitrogylcerine)
Chordae rupture - GN - suppurative pericarditis - emboli

31. What masks atrial repolarization?
QRS complex
Increased efferent SANS and decreased efferent PANS
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Right sided

32. congenital heart defect with marfan's
Non
MI
MAP
Aortic insuffic - late

33. When is the scar completely formed in an MI?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
140/90
Atrial contraction
7 weeks

34. clinical signs of cardiac tamponade
Purkingee>atria>ventricles>AV node
The operating point of the heart
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Glossopharyngeal to soliary nucleus of medulla

35. What happens in phase 0 of the cardiac ventricular action potential?
In RA return (inspiration)
Dilation
MAP
Rapid upstroke - voltage gated Na channels open

36. Which artery supplies the SA and AV nodes?
Raynaud's
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
RCA
Atherosclerosis

37. What is a normal EF
At least 55%
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
The first 4 days
Can progess to V fib

38. Which murmur is heard in aortic stenosis?
Crescendo - decrescendo systolic ejection murmur following ejection click
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Preload
Temporal arteritis

39. no relation between p waves and QRS intervals - treatment and predisposing factor
CO
Preload
3rd degree block - pacemaker - Lyme disease
RV failure - in venous pressure

40. Which bacteria causes endocarditis in the presence of colon cancer
...
S. bovis
Kawasaki
Indomethacin closes - and pge keeps it open

41. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Anterosuperior displacement of the infundibular septum
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

42. When does extracellular calcium enter the cardiac muscle cells during contraction?
The plateau period
LV failure - pulm venous distention transudation of fluid
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

43. Why is contractility decreased in heart failure?
Decrease in activity of Na/Ca exhanger and increase in contractility
Systolic dysfunction
LAD - V1 - V4
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

44. Left to right shunts are more common in babies or kids?
Septal defects - PDA - pulm art stenosis
Chordae rupture - GN - suppurative pericarditis - emboli
Kids
7 weeks

45. How does aldosterone raise MAP
Arteriolosclerosis in malignant hypertension
Inc blood volume
Temporal arteritis
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

46. p - anca

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47. benign - painful - red - blue tumor under fingernails from smooth muscle cells
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
LCX - I - aVL
Glomus tumor
Polyarteritis nodosum

48. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
Non
Chordae rupture - GN - suppurative pericarditis - emboli
Rapid upstroke - voltage gated Na channels open

49. What is the formula for EF?
Systolic dysfunction
SV/ EDV
Mitral valve prolapse
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

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

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