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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
SA and AV nodes
Transmural
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

2. fibrinous pericarditis several weeks post MI

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3. What causes aortic stenosis
ASD
Ventricular depolarization - nl < 120 msec
Heart - 02 extraction is always around 100%
Age related calcifications or bicuspid aortic valve

4. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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5. What are common causes of mitral regurg?
Ischemic heart dz - mitral valve prolapse - LV dilation
Sudden tensing of chordae tendinae
RCA
HTN - bradycardia - and respiratory depression

6. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Wolff - Parkinson white syndrome
The first 4 days
Apex and anterior interventricular septum
Cyclophosphamide and corticosteroids

7. What is associated with paradoxical spliting of S2
Transmural
Fick principle
Apex and anterior interventricular septum
Aortic stenosis or LBBB

8. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
LCX - I - aVL
2-4 day - early coag necrosis on the first day
Stable angina
Inc interstitial osmotic pressure pulling fliud out of capillaries

9. What other sign is often present with congenital long QT syndrome - why?
Purkingee>atria>ventricles>AV node
Boot shaped heart
Postinfarction fibrinous pericarditis
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

10. What can cause mitral prolapse?
10%
Myxomatous degeneration - RF - chordae rupture
Subendocardial
Infective endocarditis

11. In normal S2 splitting - which valve closes first? What increases it?
Persistant truncus arteriosus
Inc TPR and LA return (expiration)
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
The aortic before pulmonic - inspiration increases diff

12. Which class of drugs decrease the murmur heard in aortic regurg?
Vasodilators
Venodilators (nitrogylcerine)
Postinfarction fibrinous pericarditis
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

13. The aortic arch receptors transmit along which nerve?
Vagus to medulla
Volatage gated Ca channels
Pulmonic stenosis and RBBB
RCA - II - III - aVF

14. Which murmur is heard with mitral prolapse?
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Transmural
Late systolic crescendo murmur with a midsystolic click
Varicose veins - thromboembolism rare

15. list the coronary vessels most likely to be occluded
Medullary vasomotor center senses baroreceptors and JGA
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Atherosclerosis
LAD > RCA > circumflex

16. what happens to capillaries in lymphatic blockage
RV contraction (closed tricuspid valve bulding into atrium
Postinfarction fibrinous pericarditis
Inc interstitial osmotic pressure pulling fliud out of capillaries
Dec plasma proteins

17. Restrictive cardiomyopathy causes
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Apex and anterior interventricular septum
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Fluid movement through capillaries

18. In an inferior wall infarct - which artery is affected and which leads show Q waves
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
RCA - II - III - aVF
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Systolic dysfunction

19. Churg Strauss - presentation and test
Tricuspid atresia - requires ASD and VSD
Adult type aortic coarctation
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Afterload (proportional to peripheral resistance)

20. What does increasing intracellular Ca do?
Ventricular repolarization
Postinfarction fibrinous pericarditis
Increase contractility
R to L shunt caused by stenoic pulmonic valve

21. What causes aortic regurg
Temporal arteritis
Angiosarcoma
At least 55%
Aortic dilation - bicuspid aortic valve - RF -

22. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Varicose veins - thromboembolism rare
Arteriolosclerosis in malignant hypertension
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
HypoK and bradycardia

23. What is the early and late lesion in rheumatic heart disease
Decreases
Atherosclerosis
C - ANCA
Mitral valve prolapse

24. Do you see elevaged ASO titers in rheumatic heart disease
Activated histiocytes
Yes
Mechanican contraction of the ventricles
Mitral stenosis

25. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Aburpt halting of valve leaflets
Hemorrhage
Chordae rupture - GN - suppurative pericarditis - emboli
The aortic before pulmonic - inspiration increases diff

26. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Vasodilators
Posterior descending (80% off the RCA - 20% off the circumflex)
Increasing activity of Ca pump in SR

27. What happens in phase 3 of the cardiac ventricular action potential?
Holosystoiic
Age related calcifications or bicuspid aortic valve
10%
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

28. When and why is the S3 sound heard?
Cyclophosphamide and corticosteroids
Conduction delay through AV node - nl < 200 msec
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

29. which medications are used to maintain patency or close the ductus arteriosus?
LAD > RCA > circumflex
Increasing activity of Ca pump in SR
Sturge weber - vasculitis of caps
Indomethacin closes - and pge keeps it open

30. What does FEVERSS stand for in rheumatic heart disease
Coarcation of aorta
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
LCX - I - aVL
Pos inotropy - exercise

31. What are anitschkow's cells
Activated histiocytes
Atherosclerosis
SV/ EDV
Increased efferent SANS and decreased efferent PANS

32. Wegener's tx
RV contraction (closed tricuspid valve bulding into atrium
Holosystolic - harsh sounding murmur - loudest over tricuspid area
CHF
Cyclophosphamide and corticosteroids

33. What does autoregulation do?
Persistant truncus arteriosus
Metastasis from melanoma or lymphoma
Maintain blood flow to organ over wide range of perfussion pressures
Pulmonic stenosis and RBBB

34. What is sudden cardiac death most commonly due to...
Indomethacin closes - and pge keeps it open
V fib arrhythima
Gap junctions
SA>AV>bundle of His>ventricles

35. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Libman - sacks endocarditis
Mean arterial pressure
Fluid movement through capillaries
Dec P02 - inc PC02 and dec pH

36. What causes hepatomegaly?
Granuloma with giant cells
LV failure - pulm venous distention transudation of fluid
Inc central venous pressure - inc resistance to portal flow
Anterosuperior displacement of the infundibular septum

37. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Mitral valve
Henoch - Schlonlein purpura
Preload
Dec plasma proteins

38. The carotid sinus transmits along which nerve?
Stroke volume
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Glossopharyngeal to soliary nucleus of medulla
Torsades de pointes

39. What causes the CO curve to shift upwards?
Diastolic
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Pos inotropy - exercise
Early deaths from myocarditis

40. EDV - ESV
Granuloma with giant cells
Stroke volume affected by contractility - afterload - and preload
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Stroke volume

41. 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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42. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
LV failure - pulm venous distention transudation of fluid
Troponin I
Increasing activity of Ca pump in SR
Maintain blood flow to organ over wide range of perfussion pressures

43. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Septal defects - PDA - pulm art stenosis
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Glomus tumor
Polyarteritis nodosum

44. Which artery supplies the SA and AV nodes?
Fetal right to left - neonate left to right leading to RVH and failure
RCA
MI
Microscopic polyangiitis - like wegener's without granulomas

45. What is the most common cause of right heart failure
The operating point of the heart
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Left heart failure
Postinfarction fibrinous pericarditis

46. sawtooth wave

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47. What cardiac change occurs in pregnancy?
Increased SV
During HF from microhemorrhages from inc pulm cap pressure
Inc RA pressure - due to filling against closed tricupsid valve
Black > white > asian

48. CO x Total peripheral resistance
Mean arterial pressure
Dec P02 - inc PC02 and dec pH
Increase in Pc
Group a beta hemolytic strep

49. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
R to L shunt caused by stenoic pulmonic valve
Lower right - MC - upper right - AO - upper right AC - lower left MO
Decrease in cAMP
Preload

50. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
During diastole
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Pulmonary flow murmur and diastolic rumble
LV failure - pulm venous distention transudation of fluid