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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. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Decreases
MI
Non
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

2. What does the atria release in response to inc blood volume and atrial pressure
Aortic insuffic - late
RCA - II - III - aVF
Mitral stenosis
ANP

3. What is the S2 sound?
Aortic and pulmonary closing
Late systolic crescendo murmur with a midsystolic click
Decreased
Pulse pressure

4. exaggerated decrease in pulse during inspiration.

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5. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Failure of LV to in CO during exercise
TAPVR
Aortic and pulmonary closing
Vasocxn

6. What can cause mitral prolapse?
Mechanican contraction of the ventricles
Left atrial pressure
Myxomatous degeneration - RF - chordae rupture
RV contraction (closed tricuspid valve bulding into atrium

7. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
PDA
Inc blood volume
Sturge weber - vasculitis of caps

8. What is the association with wide S2 splitting?
Pulmonic stenosis and RBBB
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Subendocardial
7 weeks

9. what conditions are associated with pulsus paradoxus
RCA
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
HypoK and bradycardia
Systolic dysfunction

10. What is the most common cause of MI
Acute thrombosis of coronary artery
Rapid upstroke - voltage gated Na channels open
In parallel
Pulse pressure

11. MAP is also known as
RCA
Postinfarction fibrinous pericarditis
Eccentric - concentric hypertrophy causes diastolic disfunction
Afterload (proportional to peripheral resistance)

12. When do you find hemosiderin laden macrophages in the lungs?
Transfusion
Increase intracellular Na - resulting in increased Ca
Raynaud's
During HF from microhemorrhages from inc pulm cap pressure

13. fibrous plaques and atheromas in intima of arteries
Atherosclerosis
2nd degree AV block - mobitz type 1
Persistant truncus arteriosus
RCA - II - III - aVF

14. Which two mechanisms sense decrease MAP?
Persistant truncus arteriosus
Ischemic heart dz - mitral valve prolapse - LV dilation
Mean arterial pressure
Medullary vasomotor center senses baroreceptors and JGA

15. no change in PR interval followed by dropped beat
Fluid movement through capillaries
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Myxomatous degeneration - RF - chordae rupture
Henoch - Schlonlein purpura

16. Expiration causes an increase in which sided heart sounds
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Left sided
Preload
Transposition of great vessels

17. serum marker for wegener's
Granuloma with giant cells
Inc blood volume
Boot shaped heart
C - ANCA

18. In an EKG - What is the QT interval?
Buerger's disease
Failure of LV to in CO during exercise
Mechanican contraction of the ventricles
Left atrial pressure

19. Where is the most posterior portion of the heart and What can it cause?
Rapid upstroke - voltage gated Na channels open
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Wegener's
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

20. PCWP > LV diastolic pressure
S. aureus
Inc RA pressure - due to filling against closed tricupsid valve
Mitral stenosis
Takayasu's arteritis

21. What is the time frame for arrhythmia risk in the evolution of MI
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
The first 4 days
Raynaud's
Inc RA pressure - due to filling against closed tricupsid valve

22. In the cardiac cycle - which period has the highest 02 consumption?
Pulmonary flow murmur and diastolic rumble
Isovolumetric contraction
Cyclophosphamide and corticosteroids
Granuloma with giant cells

23. When during cardiac nodal cells depolarize?
Venodilators (nitrogylcerine)
Fetal right to left - neonate left to right leading to RVH and failure
During diastole
In RA return (inspiration)

24. What kind of infarct show ST depression
Subendocardial
TAPVR
Decreases
Left atrial pressure

25. machine murmer
Fluid movement through capillaries
In parallel
Subendocardial - fewer collaterals and higher pressure
PDA

26. When is the scar completely formed in an MI?
Ischemic heart dz - mitral valve prolapse - LV dilation
Volatage gated Ca channels
Changes in CO as a function of preload
7 weeks

27. How does a patient with Tet of fallot learn to improve symptoms?
PDA
Squat. Compression of femoral arteries - inc TPR - dec
During HF from microhemorrhages from inc pulm cap pressure
Transposition of great vessels

28. What cardiac change occurs in pregnancy?
Purkingee>atria>ventricles>AV node
Increased SV
Libman - sacks endocarditis
2nd degree AV block - mobitz type 1

29. What 4 things drive myocardial 02 demand?
Venodilators (nitrogylcerine)
Increased efferent SANS and decreased efferent PANS
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

30. fibrinous pericarditis several weeks post MI

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31. What does prolonged QT predispose to?
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Vasocxn
Vasodilators - (hydrAlAzine)
Torsades de pointes

32. Do you see elevaged ASO titers in rheumatic heart disease
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Yes
Greater ventricular EDV
Ventricular repolarization

33. When does EF decrease
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Afterload (proportional to peripheral resistance)
In HF
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

34. What happends in phase 1 of the ventricular cardiac action potential?
PDA
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Dressler's - autoimmune
Ventricles are depolarized

35. What is the S1 sound?
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Mitral and tricuspid closure
Late diastolic murmur following an opening snap
Torsades de pointes

36. CO x Total peripheral resistance
Mean arterial pressure
Aortic disecction - intraluminal tear forming false lumen
Preload
Stroke volume affected by contractility - afterload - and preload

37. What is the progression of atherosclerosis?
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Pulse pressure

38. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Cystic hygroma
5-10 days - macs have degraded structural components
Non

39. When and why do you hear the S4 sound
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
RF
140/90
Tricuspid atresia - requires ASD and VSD

40. What does mitral prolapse predeispose to?
Late diastolic murmur following an opening snap
Mitral stenosis
Hyperlipidemia
Infective endocarditis

41. Chronic mitral stenosis can lead to what changes in size of the LA
Inc blood volume
Wolff - Parkinson white syndrome
7 weeks
Dilation

42. What causes the murmur heard in tricuspid regurg to enhance
In RA return (inspiration)
HTN - bradycardia - and respiratory depression
Systolic dysfunction
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

43. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
In RA return (inspiration)
Babies
Cardiac tamponde
Inc venous return exaccerbates pulm vasc congestion

44. What is the result of not have fast sodium channels in pacemaker cells?
Kaposi's sarcoma
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Decrease in cAMP
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli

45. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
Subendocardial - fewer collaterals and higher pressure
MI
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
10%

46. EDV - ESV
Aortic insuffic - late
Medullary vasomotor center senses baroreceptors and JGA
Stroke volume
Polyarteritis nodosum

47. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Dec plasma proteins
Pos inotropy - exercise
No
Inc TPR and LA return (expiration)

48. Given P = QR - what factors influence resistance?
Proportional to viscosity and inversely proportional to the radius to the 4th power
Afterload (proportional to peripheral resistance)
Apex and anterior interventricular septum
Sturge weber - vasculitis of caps

49. Which lab value indicates blood viscosity?
Granuloma with giant cells
S. epidermidis
Hematocrit
Posterior descending (80% off the RCA - 20% off the circumflex)

50. PCWP is an estimate of...
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Conduction delay through AV node - nl < 200 msec
Changes in CO as a function of preload
Left atrial pressure