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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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1. In an EKG - What is the QRS complex?
Ventricular depolarization - nl < 120 msec
ANP
MI
Extracellular calcium - calcium induced calcium release

2. Why is there edema after burns or during infection
Glomus tumor
Stroke volume
Inc Kf - capillary perm
Rhabdomyomas

3. What channels do the the pacemaker cells lack?
Ventricular depolarization - nl < 120 msec
Mitral stenosis
Preload
Fast volatge gated Na channels

4. What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
Increase - increase the chance the If are open
Hematocrit
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Vasocxn - while other tissues it causes vasodilation

5. which heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
Inc central venous pressure - inc resistance to portal flow
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Late diastolic murmur following an opening snap

6. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
In RA return (inspiration)
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Myxoma
S. epidermidis

7. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
HTN - bradycardia - and respiratory depression
Transfusion
Infective endocarditis
Angiosarcoma

8. Which organ has the largest arteriovenous difference
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Dressler's - autoimmune
Heart - 02 extraction is always around 100%
Medullary vasomotor center senses baroreceptors and JGA

9. Which organ has ht highest blood flow per gram of tissue
Hemorrhage
Inc blood volume
MI
Kidney

10. Why is contractility decreased in heart failure?
CFX
Systolic dysfunction
Fick principle
Ventricles are depolarized

11. PCWP > LV diastolic pressure
Volatage gated Ca channels
Inc RA pressure - due to filling against closed tricupsid valve
Mitral stenosis
LCX - V4- V6

12. What causes the CO curve to shift upwards?
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Pos inotropy - exercise
Dec plasma proteins
Non

13. Mitral stenosis is most often secondary to which condition?
Fick principle
RF
Temporal arteritis
HTN - bradycardia - and respiratory depression

14. Which organ gets the largest share of systemic cardiac output
10%
3rd degree block - pacemaker - Lyme disease
Atherosclerosis
Liver

15. Inspiration causes an increase in which sided heart sounds?
Right sided
Granuloma with giant cells
V fib arrhythima
Pulmonary flow murmur and diastolic rumble

16. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Buerger's disease
In series
Dec plasma proteins
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

17. p - anca

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18. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Dilated cardiomyopathy
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Persistant truncus arteriosus

19. MAP is also known as
Dec plasma proteins
Prinzmetal angina
Arteriolosclerosis in malignant hypertension
Afterload (proportional to peripheral resistance)

20. What does the U wave indicated?
Cyclophosphamide and corticosteroids
Left heart failure
HypoK and bradycardia
MI

21. The cause of dyspnea on exertion?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Failure of LV to in CO during exercise
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Fick principle

22. necrotizing granulomas in lung and upper airways - nectrotizing GN - small vessel vasculitis

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23. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Lymphangiosarcoma
Patent ductus arteriosus - congenital rubella or prematurity
RV contraction (closed tricuspid valve bulding into atrium
Preload

24. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Acute thrombosis of coronary artery
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
CO
S. aureus

25. In terms of starling forces - why does heart failure cause edema?
Mechanican contraction of the ventricles
Kidney
Increase in Pc
Sudden tensing of chordae tendinae

26. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
Hypertrophied cardiomyopathy
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
LAD > RCA > circumflex
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

27. which ethnic groups have higher association with HTN?
Kids
Inc TPR and LA return (expiration)
Late diastolic murmur following an opening snap
Black > white > asian

28. Irregularly irregular ECG - no p waves: dx and treatment
Increased SV
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
TAPVR
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

29. What is the classic X ray finding for tet of fallot?
Takayasu's arteritis
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Boot shaped heart
In parallel

30. benign cap hemangioma of infancy - spont regresses
QRS complex
Strawberry hemangioma
Increased efferent SANS and decreased efferent PANS
LAD

31. PCWP is an estimate of...
Greater ventricular EDV
Mitral and tricuspid closure
Lower right - MC - upper right - AO - upper right AC - lower left MO
Left atrial pressure

32. Which channel accounts for automaticity of the SA and AV nodes?
Polyarteritis nodosum
If sodium channel
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Aortic/pulmonic regurg and mitral/tricuspid stenosis

33. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Volatage gated Ca channels
Chordae rupture - GN - suppurative pericarditis - emboli
Viridans streptococci

34. What is the formula for EF?
Myxoma
Temporal arteritis
SV/ EDV
Atherosclerosis

35. Rank the pacemakers cells
Polyarteritis nodosum
SA>AV>bundle of His>ventricles
Inc venous return exaccerbates pulm vasc congestion
ANP

36. decrease stretch in baroreceptors leads to what response?
Volatage gated Ca channels
CO
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Increased efferent SANS and decreased efferent PANS

37. Which artery supplies the SA and AV nodes?
In RA return (inspiration)
EKG
Failure of LV to in CO during exercise
RCA

38. When and why is the S3 sound heard?
Takayasu's arteritis
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

39. Which lab value indicates blood viscosity?
Hematocrit
During diastole
Medullary vasomotor center senses baroreceptors and JGA
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

40. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Aortic dilation - bicuspid aortic valve - RF -
Glomus tumor
Subendocardial
Vasodilators

41. What is the S2 sound?
Dressler's - autoimmune
Transposition of great vessels
Aortic and pulmonary closing
Arteriorles

42. What kind of infarct show ST depression
SA and AV nodes
LV failure - pulm venous distention transudation of fluid
Subendocardial
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

43. How are sarcomeres added in concentric hypertrophy?
In parallel
LAD - V1- V2
LV failure - pulm venous distention transudation of fluid
Age related calcifications or bicuspid aortic valve

44. stroke volume x HR =?
Medullary vasomotor center senses baroreceptors and JGA
Wolff - Parkinson white syndrome
CO
Conduction delay through AV node - nl < 200 msec

45. Restrictive cardiomyopathy causes
Turners
Crescendo - decrescendo systolic ejection murmur following ejection click
Eccentric - concentric hypertrophy causes diastolic disfunction
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

46. polypoid capillary hemangioma that can ulcerate and bleed
LAD > RCA > circumflex
PDA
Pyogenic granuloma - associated with trauma and pregnancy
Takayasu's arteritis

47. 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
Inc interstitial osmotic pressure pulling fliud out of capillaries
Anterosuperior displacement of the infundibular septum
Persistant truncus arteriosus

48. How does angiotensin II raise MAP
Heart - 02 extraction is always around 100%
Transmural
Atherosclerosis
Vasocxn

49. Equilibration of diastolic pressures in all 4 chambers - decreased CO from compression of heart by fluid in pericardium
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Transposition of great vessels
7 weeks
Cardiac tamponde

50. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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