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Cardiology

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Which class of drugs decrease preload
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Increase intracellular Na - resulting in increased Ca
Unstable/crescendo angina
Venodilators (nitrogylcerine)

2. most common heart tumor
RV failure - in venous pressure
Metastasis from melanoma or lymphoma
During diastole
Age related calcifications or bicuspid aortic valve

3. CO x Total peripheral resistance
Inc TPR and LA return (expiration)
Decreased
Metastasis from melanoma or lymphoma
Mean arterial pressure

4. clinical signs of cardiac tamponade
Left atrial pressure
3rd degree block - pacemaker - Lyme disease
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Preload

5. Where does coronary artery occlusion occur most commonly?
Conduction delay through AV node - nl < 200 msec
LAD
Glomus tumor
Aortic insuffic - late

6. in the JVP - What is the a wave?
Liver
Atrial contraction
Aortic insuffic - late
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

7. What causes the murmur heard in MR to enhance?
Inc TPR and LA return (expiration)
Chordae rupture - GN - suppurative pericarditis - emboli
The aortic before pulmonic - inspiration increases diff
Cystic hygroma

8. How does acidosis affect contractility?
Decreased
Myxomatous degeneration - RF - chordae rupture
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Aortic/pulmonic stenosis and mitral/tricuspid regurg

9. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Fluid movement through capillaries
Glomus tumor
Mitral stenosis

10. p - anca

11. The cause of dyspnea on exertion?
RV contraction (closed tricuspid valve bulding into atrium
RCA - II - III - aVF
Failure of LV to in CO during exercise
Coarcation of aorta

12. in the JVP - What is the v wave?
Postinfarction fibrinous pericarditis
CO
Inc RA pressure - due to filling against closed tricupsid valve
RF

13. Which class of drugs decrease the murmur heard in aortic regurg?
Vasodilators
Ischemic heart dz - mitral valve prolapse - LV dilation
Pulmonary flow murmur and diastolic rumble
Fetal right to left - neonate left to right leading to RVH and failure

14. Given P = QR - what factors influence resistance?
Aortic and pulmonary closing
RCA
Proportional to viscosity and inversely proportional to the radius to the 4th power
Inc interstitial osmotic pressure pulling fliud out of capillaries

15. In an anterolateral infarct - which artery is effected and which leads show Q waves
LCX - V4- V6
Kidney
Subendocardial - fewer collaterals and higher pressure
2-4 day - early coag necrosis on the first day

16. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Inc blood volume
Inc venous return exaccerbates pulm vasc congestion
Kawasaki
Takayasu's arteritis

17. When does EF decrease
Hypertrophied cardiomyopathy
Inc RA pressure - due to filling against closed tricupsid valve
In HF
Anterosuperior displacement of the infundibular septum

18. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Aortic and pulmonary closing
Hemorrhage
Aortic insuffic - late
Myxomatous degeneration - RF - chordae rupture

19. When do you see extensive coagulative necrosis in an MI
Glossopharyngeal to soliary nucleus of medulla
RV failure - in venous pressure
2-4 day - early coag necrosis on the first day
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

20. What can cause mitral prolapse?
Increase intracellular Na - resulting in increased Ca
HypoK and bradycardia
Myxomatous degeneration - RF - chordae rupture
Stroke volume

21. polypoid capillary hemangioma that can ulcerate and bleed
Medullary vasomotor center senses baroreceptors and JGA
Rapid upstroke - voltage gated Na channels open
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Pyogenic granuloma - associated with trauma and pregnancy

22. What does HTN predispose to?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
In RA return (inspiration)

23. serum marker for wegener's
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
C - ANCA
Tricuspid atresia - requires ASD and VSD
SA and AV nodes

24. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Varicose veins - thromboembolism rare
In RA return (inspiration)
Myxomatous degeneration - RF - chordae rupture
Left atrial pressure

25. Irregularly irregular ECG - no p waves: dx and treatment
5-10 days - macs have degraded structural components
Tricuspid atresia - requires ASD and VSD
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Resting potential high K perm

26. When do you find hemosiderin laden macrophages in the lungs?
During HF from microhemorrhages from inc pulm cap pressure
Decrease in activity of Na/Ca exhanger and increase in contractility
Strawberry hemangioma
Ventricular repolarization

27. What do patients die early from in rheumatic heart disease?
CFX
Early deaths from myocarditis
Changes in CO as a function of preload
Pulse pressure

28. decrease stretch in baroreceptors leads to what response?
Ventricles are depolarized
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Increased efferent SANS and decreased efferent PANS
Greater ventricular EDV

29. fibrous plaques and atheromas in intima of arteries
Atherosclerosis
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
If sodium channel
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

30. The 7 complications of MI

31. Which bacteria can cause endocarditis from prosthetic valves?
Hyperlipidemia
Changes in CO as a function of preload
S. epidermidis
HypoK and bradycardia

32. In terms of starling forces - why does heart failure cause edema?
Pulmonic stenosis and RBBB
Increase in Pc
Aortic insuffic - late
Coarcation of aorta

33. What other syndrom is associated with infantile aortic coarctation
Purkingee>atria>ventricles>AV node
Group a beta hemolytic strep
Aortic insuffic - late
Turners

34. What are the complications from bacterial endocarditis?
Hypertrophied cardiomyopathy
Polyarteritis nodosum
Infective endocarditis
Chordae rupture - GN - suppurative pericarditis - emboli

35. What causes the midsystolic click
Sudden tensing of chordae tendinae
Hyperlipidemia
Dressler's - autoimmune
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

36. Which kind of infarct show ST elevation - and/or pathologic Q waves
Transmural
Myxoma
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Arteriolosclerosis in malignant hypertension

37. What happens in phase 3 of the cardiac ventricular action potential?
LAD - V1- V2
Stable angina
Crescendo - decrescendo systolic ejection murmur following ejection click
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

38. What causes aortic regurg
Aortic dilation - bicuspid aortic valve - RF -
Heart - 02 extraction is always around 100%
HTN - bradycardia - and respiratory depression
P02

39. What does FAN MY SKIN On Wednesday stand for?
Microscopic polyangiitis - like wegener's without granulomas
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Resting potential high K perm

40. What does the LAD supply?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Adult type aortic coarctation
Granuloma with giant cells
Apex and anterior interventricular septum

41. What causes tet of fallot?
MI
Subendocardial - fewer collaterals and higher pressure
Anterosuperior displacement of the infundibular septum
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

42. Hyperplastic onion skinning
No - no pressure gradient
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Arteriolosclerosis in malignant hypertension
Stroke volume affected by contractility - afterload - and preload

43. If HR is too fast (V tach) what happens during diastole?
Myxomatous degeneration - RF - chordae rupture
Ventricles are depolarized
Filling is incomplete and CO falls
Granuloma with giant cells

44. What is the S1 sound?
Mitral and tricuspid closure
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Venodilators (nitrogylcerine)
Increased efferent SANS and decreased efferent PANS

45. what percentage of HTN is secondary to renal disease?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
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
10%

46. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Sudden tensing of chordae tendinae
MI
Decreased
LV failure - pulm venous distention transudation of fluid

47. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
CFX
Buerger's disease
Dilated cardiomyopathy
CK- MB

48. no change in PR interval followed by dropped beat
Hyperlipidemia
Lymphangiosarcoma
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Arteriorles

49. which heart valves are afected most in rheumatic heart diseease
1st degree AV blodck
Lower right - MC - upper right - AO - upper right AC - lower left MO
Mitral>aortic>>tricuspid - high pressure valves affected most
Systolic dysfunction

50. with what heart sounds do ASD usually present?
Arteriolosclerosis in malignant hypertension
ASD
Pulmonary flow murmur and diastolic rumble
Glossopharyngeal to soliary nucleus of medulla