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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. In an EKG - What is the PR interval?
Preload
LAD - V1 - V4
Conduction delay through AV node - nl < 200 msec
1st degree AV blodck

2. If HR is too fast (V tach) what happens during diastole?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Filling is incomplete and CO falls
Changes in CO as a function of preload
Increase contractility

3. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Crescendo - decrescendo systolic ejection murmur following ejection click
Stable angina
Kids
MI

4. What is the difference between adult and infantile type aortic coarctation?
2nd degree AV block - mobitz type 1
LCX - I - aVL
Rapid upstroke - voltage gated Na channels open
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

5. What are the diastolic heart sounds?
CFX
Aortic/pulmonic regurg and mitral/tricuspid stenosis
SA and AV nodes
Troponin I

6. Which lab value indicates blood viscosity?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
HTN - bradycardia - and respiratory depression
Left heart failure
Hematocrit

7. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Fick principle
SA>AV>bundle of His>ventricles
Indomethacin closes - and pge keeps it open
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

8. benign cap hemangioma of infancy - spont regresses
Tempral arteritis - may cause irreversible blindness
Dec P02 - inc PC02 and dec pH
Strawberry hemangioma
LCX - I - aVL

9. Which class of drugs decrease the murmur heard in aortic regurg?
5-10 days - macs have degraded structural components
Kaposi's sarcoma
Vasodilators
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

10. What happens in phase 0 of the cardiac ventricular action potential?
LCX - V4- V6
HypoK and bradycardia
Kawasaki
Rapid upstroke - voltage gated Na channels open

11. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Truncus - tet of fallot
Increase intracellular Na - resulting in increased Ca
Medullary vasomotor center senses baroreceptors and JGA

12. How are sarcomeres added in concentric hypertrophy?
CFX
Glomus tumor
In parallel
Apex and anterior interventricular septum

13. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Mitral>aortic>>tricuspid - high pressure valves affected most
Inc blood volume
Stroke volume
LCX - I - aVL

14. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Troponin I
Aortic/pulmonic stenosis and mitral/tricuspid regurg
SV/ EDV
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

15. What causes the CO curve to shift upwards?
Babies
Left heart failure
Pos inotropy - exercise
In HF

16. congenital heart defect withdown syndrome
Glossopharyngeal to soliary nucleus of medulla
Extracellular calcium - calcium induced calcium release
ASD - VSD - AV septal defect (endocardial cushion defect)
In series

17. In an EKG - What is the p wave?
Indomethacin closes - and pge keeps it open
Increasing activity of Ca pump in SR
Atrial contraction
Decreased

18. tearing chest pain radiation to the back - associated with marfan
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Coarcation of aorta
Increased SV
Aortic disecction - intraluminal tear forming false lumen

19. What is the most common cause of right heart failure
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Liver
Mitral valve
Left heart failure

20. MAP is also known as
Hematocrit
Afterload (proportional to peripheral resistance)
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
P02

21. PCWP > LV diastolic pressure
Right sided
Mitral stenosis
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

22. Which sympathetic receptors raise MAP
Kidney
Isovolumetric contraction
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Aortic and pulmonary closing

23. What does hypoxia cause in the lung versus other tissues?
Chordae rupture - GN - suppurative pericarditis - emboli
Vasocxn - while other tissues it causes vasodilation
Coarcation of aorta
Systolic dysfunction

24. When do you see extensive coagulative necrosis in an MI
LV failure - pulm venous distention transudation of fluid
2-4 day - early coag necrosis on the first day
Mean arterial pressure
The aortic before pulmonic - inspiration increases diff

25. no relation between p waves and QRS intervals - treatment and predisposing factor
Rhabdomyomas
3rd degree block - pacemaker - Lyme disease
Increased SV
LAD > RCA > circumflex

26. Rank the pacemakers cells
SA>AV>bundle of His>ventricles
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Right sided
TAPVR

27. disease of elastic arteries and large and medium sized muscular arteries
In RA return (inspiration)
Anterosuperior displacement of the infundibular septum
Atherosclerosis
Boot shaped heart

28. What are aschoff bodies
Changes in CO as a function of preload
Lower right - MC - upper right - AO - upper right AC - lower left MO
Granuloma with giant cells
Late diastolic murmur following an opening snap

29. What are the four most common locations for atherosclerosis?
Decrease in cAMP
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Vasocxn
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

30. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Diastolic
CK- MB
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Increase - increase the chance the If are open

31. The 7 complications of MI

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32. what percentage of HTN is secondary to renal disease?
Venodilators (nitrogylcerine)
Aortic/pulmonic stenosis and mitral/tricuspid regurg
3rd degree block - pacemaker - Lyme disease
10%

33. Which murmur do you hear in mitral stenosis?
ASD
Transmural
Volatage gated Ca channels
Late diastolic murmur following an opening snap

34. machine murmer
PDA
Turners
Inc central venous pressure - inc resistance to portal flow
Diastolic

35. 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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36. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Glomus tumor
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
RF
Vasodilators - (hydrAlAzine)

37. Where is the most posterior portion of the heart and What can it cause?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Takayasu's arteritis
Temporal arteritis

38. What are common causes of mitral regurg?
CO
RCA - II - III - aVF
Ischemic heart dz - mitral valve prolapse - LV dilation
Granuloma with giant cells

39. How are the sarcomeres added in eccentric hypertrophy?
Atrial contraction
In series
Libman - sacks endocarditis
LCX - I - aVL

40. congenital heart defect with 22q11
Resting potential high K perm
Myxoma
Truncus - tet of fallot
1st degree AV blodck

41. How does digitatlis increase contractility?
Early deaths from myocarditis
Increase intracellular Na - resulting in increased Ca
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
During diastole

42. How are cadiac myocytes eltrically coupled?
Gap junctions
V fib
Hematocrit
Truncus - tet of fallot

43. What are the complications of atherosclerosis?
Left atrial pressure
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Proportional to viscosity and inversely proportional to the radius to the 4th power
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

44. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kawasaki
CHF
Takayasu's arteritis
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

45. What causes aortic stenosis
Henoch - Schlonlein purpura
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Apex and anterior interventricular septum
Age related calcifications or bicuspid aortic valve

46. The aortic arch receptors transmit along which nerve?
Vagus to medulla
Liver
Varicose veins - thromboembolism rare
Microscopic polyangiitis - like wegener's without granulomas

47. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
Ventricular repolarization
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Arteriolosclerosis in malignant hypertension

48. Why is contractility decreased in heart failure?
Pyogenic granuloma - associated with trauma and pregnancy
Systolic dysfunction
Can progess to V fib
During HF from microhemorrhages from inc pulm cap pressure

49. In the cardiac cycle - which period has the highest 02 consumption?
Crescendo - decrescendo systolic ejection murmur following ejection click
Isovolumetric contraction
Mitral valve
Aortic insuffic - late

50. Which organ has the largest arteriovenous difference
Left atrial pressure
Unstable/crescendo angina
Heart - 02 extraction is always around 100%
Hematocrit