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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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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. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Chordae rupture - GN - suppurative pericarditis - emboli
Vagus to medulla
Hypertrophied cardiomyopathy
Subendocardial - fewer collaterals and higher pressure

2. What causes the ejection click in the Cres - decres murmur?
During diastole
The plateau period
Aburpt halting of valve leaflets
Viridans streptococci

3. 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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4. Churg Strauss - presentation and test
Changes in CO as a function of preload
Vasocxn
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Henoch - Schlonlein purpura

5. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
Polyarteritis nodosum
5-10 days - macs have degraded structural components
Decreased
Increase in Pc

6. What are the diastolic heart sounds?
RV contraction (closed tricuspid valve bulding into atrium
Patent ductus arteriosus - congenital rubella or prematurity
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Aortic/pulmonic regurg and mitral/tricuspid stenosis

7. which heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
Kids
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Mitral stenosis

8. What is the classic X ray finding for tet of fallot?
Boot shaped heart
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Metastasis from melanoma or lymphoma
...

9. Which murmur is heard with mitral prolapse?
Decrease in cAMP
Late systolic crescendo murmur with a midsystolic click
Stable angina
Arteriolosclerosis in malignant hypertension

10. What are the different etiologies of dialted cardiomyopathy
RCA
Neg inotropy - HF - narcotic overdose
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Dilation

11. What is the result of not have fast sodium channels in pacemaker cells?
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Stroke volume
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Truncus - tet of fallot

12. What is the early and late lesion in rheumatic heart disease
Metastasis from melanoma or lymphoma
Wegener's
Mitral valve prolapse
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

13. stroke volume x HR =?
Apex and anterior interventricular septum
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
CO
Inc Kf - capillary perm

14. Which organ has ht highest blood flow per gram of tissue
Kaposi's sarcoma
Pulsus parvus and tardus - weak - can lead to syncope
Increase in Pc
Kidney

15. decrease stretch in baroreceptors leads to what response?
Transposition of great vessels
3rd degree block - pacemaker - Lyme disease
Venodilators (nitrogylcerine)
Increased efferent SANS and decreased efferent PANS

16. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Medullary vasomotor center senses baroreceptors and JGA
Black > white > asian
Torsades de pointes
Fetal right to left - neonate left to right leading to RVH and failure

17. What does FAN MY SKIN On Wednesday stand for?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Rapid upstroke - voltage gated Na channels open
Sturge weber - vasculitis of caps
Dressler's - autoimmune

18. Exercise - overtransfusiion and excitiment causes and increase in...?
Preload
Maintain blood flow to organ over wide range of perfussion pressures
140/90
Rapid upstroke - voltage gated Na channels open

19. What are the systolic heart sounds
LCX - V4- V6
3rd degree block - pacemaker - Lyme disease
Tempral arteritis - may cause irreversible blindness
Aortic/pulmonic stenosis and mitral/tricuspid regurg

20. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
2nd degree AV block - mobitz type 1
In series
Sturge weber - vasculitis of caps
Increased efferent SANS and decreased efferent PANS

21. What is the difference between adult and infantile type aortic coarctation?
Stroke volume
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Liver
V fib

22. what percentage of HTN is secondary to renal disease?
SV/ EDV
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
SA and AV nodes
10%

23. What cardiac change occurs in pregnancy?
Decreases
Hypertrophied cardiomyopathy
Anterosuperior displacement of the infundibular septum
Increased SV

24. cavernous lymphangioma of the neck - associated with turner's
Cystic hygroma
Early deaths from myocarditis
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
LCX - V4- V6

25. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Troponin I
RF
If sodium channel
SV/ EDV

26. friction rub - 3-5 days post MI
Postinfarction fibrinous pericarditis
Granuloma with giant cells
Aortic stenosis or LBBB
Squat. Compression of femoral arteries - inc TPR - dec

27. What 4 things drive myocardial 02 demand?
Afterload (proportional to peripheral resistance)
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
EKG
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

28. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
V fib
Tricuspid atresia - requires ASD and VSD
Libman - sacks endocarditis
Stroke volume affected by contractility - afterload - and preload

29. In an EKG - What is the T wave?
Turners
Preload
Ventricular repolarization
Dressler's - autoimmune

30. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Filling is incomplete and CO falls
QRS complex
Posterior descending (80% off the RCA - 20% off the circumflex)

31. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Non
10%
Boot shaped heart
Afterload (proportional to peripheral resistance)

32. What is associated with paradoxical spliting of S2
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Aortic stenosis or LBBB
Greater ventricular EDV

33. Expiration causes an increase in which sided heart sounds
Left sided
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Stroke volume affected by contractility - afterload - and preload
Early deaths from myocarditis

34. What are aschoff bodies
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Increase in Pc
EKG
Granuloma with giant cells

35. What are the complications of atherosclerosis?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Inc central venous pressure - inc resistance to portal flow
Non

36. What kind of dysfunction ensues in restrictive cardiomyopathy
Increase - increase the chance the If are open
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Diastolic
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

37. bening capillary hemangioma of elderly - does not regress
Pyogenic granuloma - associated with trauma and pregnancy
Cherry hemangioma
Microscopic polyangiitis - like wegener's without granulomas
Cardiac tamponde

38. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Transfusion
Tempral arteritis - may cause irreversible blindness
SV/ EDV
No - no pressure gradient

39. What happens in phase 4 of the cardiac ventricular action potential?
Changes in CO as a function of preload
Resting potential high K perm
Volatage gated Ca channels
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

40. In an EKG - What is the p wave?
Atrial contraction
Stroke volume
Wegener's
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

41. What are the four most common locations for atherosclerosis?
Arteriolosclerosis in malignant hypertension
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Stroke volume affected by contractility - afterload - and preload
Proportional to viscosity and inversely proportional to the radius to the 4th power

42. Which artery supplies the SA and AV nodes?
RCA
Resting potential high K perm
Wolff - Parkinson white syndrome
Ventricular repolarization

43. When and why do you hear the S4 sound
Vagus to medulla
Ventricles are depolarized
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Tempral arteritis - may cause irreversible blindness

44. Where does coronary artery occlusion occur most commonly?
LAD
Granuloma with giant cells
Decrease in cAMP
Anterosuperior displacement of the infundibular septum

45. What does hypoxia cause in the lung versus other tissues?
Right sided
During diastole
Vasocxn - while other tissues it causes vasodilation
During diastole

46. How does acidosis affect contractility?
Decreased
Patent ductus arteriosus - congenital rubella or prematurity
Persistant truncus arteriosus
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

47. What causes the cushing reflex and why
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
LAD > RCA > circumflex
ASD - VSD - AV septal defect (endocardial cushion defect)
1st degree AV blodck

48. What can cause mitral prolapse?
Yes
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Myxomatous degeneration - RF - chordae rupture
Preload

49. systolic - diastolic
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Pulse pressure
Greater ventricular EDV
Hemorrhage

50. Which organ has the largest arteriovenous difference
CHF
Pulmonic stenosis and RBBB
Heart - 02 extraction is always around 100%
Cyclophosphamide and corticosteroids