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Cardiac

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 are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Valve scarring that arises as a consequence of rheumatic fever
Dilated
Myocarditis

2. Infects predamaged valves after transient bacteremia?
S viridans
>60 years - bicuspid aortic valve
First 4 hours
R-->L

3. What does rupture of the LV free wall cause?
Cardiac tamponade
Myocarditis
Yellow pallor neutrophils
Surgical closure small defects may close spontaneously

4. How does restrictive cardiomyopathy cause LHF?

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5. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
Aortic stenosis
Coexisting mitral stenosis and fusion of commisures exist
Fetal alcohol syndrome

6. What gross and microscopic changes occur 1-3 weeks after an MI?
Fibrosis and dystrophic calcification
Red border granulation tissue
Pump failure
Coexisting mitral stenosis and fusion of commisures exist

7. What is the most common cause of mitral stenosis?
S viridans
Chronic rheumatic heart disease
Ventricles cannot pump
Reversible

8. Tender lesions on fingers or toes.
Inability to fill ventricles
Osler nodes (ouch - ouch Osler)
Circumflex
R-->L

9. What are Janeway lesions?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Coexisting mitral stenosis and fusion of commisures exist
Nonspecific - eg fever and elevated ESR
Erythematous nontender lesions on palms and soles.

10. Are most congenital heart defects spontaneous or inherited?
Transesophageal echo
Congestive heart failure
Spontaneous
Anitschow cell

11. When does the heart have a yellow pallor post MI?
First 4 hours
Positive blood cultures anemia of chronic disease
Day 1-7
Nitroglycerin

12. L- to - R shunt switching to R- to - L shunt.
When a bacterial protein resembles a protein in human tissue
4-7 days macrophage infiltration
Eisenmenger syndrome
Type I

13. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Months out fibrosis
Infectious
Trisomy 21

14. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Shunt - PGE to maintain PDA until surgical repair can be performed
Contraction band necrosis
>60 years - bicuspid aortic valve
LHF

15. In which chamber of the heart are cardiac myxomas found?
LA
PGE
Heart can't fill
Prinzmetal angina - cocaine

16. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
1-3 days out
Annular - non pruritic rash w/erythematous borders trunks and limbs
Squatting - increased systemic resistence decreases LV emptying
Stable and unstable prinzmetal

17. What are Osler nodes?
Tender lesions on fingers or toes.
Aschoff bodies
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
White scar fibrosis

18. What causes heart failure cells?
Decrease preload -->lowers myocardial stress
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Metastasis

19. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Nonspecific - eg fever and elevated ESR
Reversible
Transposition of the great vessels

20. How do ACE inhibitors tx MI?
Atria and RV
Decreases LV dilation by decreasing volume
Ventricular arrhythmia
S viridans

21. What are the sx of aortic regurg?
S viridans
VSD
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Mitral mitral+aortic

22. What type of endocarditis is associated with SLE?
Pts w/previously damaged valves
Left -->right
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Libman - Sacks endocarditis

23. What type of ischemia does stable angina cause?
Limits thrombosis
Reversible
ST- segment elevation
Subendocardial

24. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Eisenmenger syndrome
20 min
Hypertrophic cardiomyopathy
Rupture of free wall - IV septum - or papillary muscle

25. What gross and microscopic changes occur months after an MI?
Mitral mitral+aortic
Wear and tear
Rhadbomyoma - benign
White scar fibrosis

26. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Plump fibroblasts - collagen - blood vessels
2-3 weeks
Coexisting mitral stenosis and fusion of commisures exist

27. With what congenital heart defect is ADULT coarctation of the aorta associated?
Systolic dysfx leading to biventricular CHF
Spontaneous
Bicuspid aortic valve
Hypertophy of RV atrophy of LV

28. What valves are involved in rhuematic endocarditis?
Tender lesions on fingers or toes.
RHF
Mitral mitral+aortic
Bicuspid aortic valve

29. What is the murmur of mitral regurg?
Nitroglycerin
Prinzmetal
CK- MB
Holosystolic blowing murmur

30. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
R-->L
R-->L
Wear and tear

31. When do troponin levels rise - peak - and return to normal?
Months out fibrosis
Wear and tear
2-4 hours - 24 hours - 7-10 days
Decreased forward perfusion pulmonary congestion

32. Boot - shaped heart on x- ray?
Tetralogy of fallot
Systolic ejection click followed by crescendo - decrescendo murmur
Loeffler syndrome
ACE inhibitor

33. How do you prevent S viridans endocarditis?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Prophylactic abx during dental procedures
Stable and unstable prinzmetal
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

34. What coronary artery supplies the mitral valve papillary muscles?
RCA
Squat in response to cyanotic spell
Posterior wall of LV - posterior septum - papillary muscles
Minimizes ischemia

35. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Stable angina
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
ST- segment depression
LHF

36. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Coexisting mitral stenosis and fusion of commisures exist
Ehlers - Danlow and Marfan syndrome
ST- segment elevation

37. What is the tx for LHF?
Ehlers - Danlow and Marfan syndrome
Prinzmetal stable and unstable
Membrane damage
ACE inhibitor

38. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
R-->L
1-3 days
Prinzmetal angina
Subendocardial

39. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Minimizes ischemia
Loeffler syndrome
Fibrosis and dystrophic calcification
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

40. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
PDA
2-3 weeks
RHF
Aortic stenosis

41. Which congenital heart defect is associated with congenital rubella?
Mitral mitral+aortic
Endocardial fibroelastosis
VSD
PDA

42. How does fibrinolysis/angioplasty tx MI?
Ventricle
Open blocked vessels
1-3 days
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

43. What drug relieves stable angina?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Degree of pulmonary artery stenosis
Contraction band necrosis
Nitroglycerin

44. What increases the volume of mitral regurg murmur?
Fetal alcohol syndrome
Paradoxical emboli
Osler nodes (ouch - ouch Osler)
Squatting - expiration

45. What does nonbacterial thrombotic endocarditis cause?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Right to left
Mitral regurg
Aortic regurg

46. What bug causes acute rheumatic fever?
Libman - Sacks endocarditis
LA dilation
Mitral stenosis
Group A beta - hemolytic streptococci

47. What type of shunt results in cyanosis at birth?
Squat in response to cyanotic spell
Infantile coarctation of the aorta PDA
Ehlers - Danlow and Marfan syndrome
Right to left

48. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Hemosiderin laden macrophages
Pulsating nail bed
Mitral valve prolapse
Anitschow cell

49. With what disease is infantile coarctation of the aorta associated?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Infantile coarctation of the aorta
Turner syndrome
Spontaneous

50. What is the 1day-1wk -1mo mneumonic for MI?
Kawasaki disease
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Within the first day
PDA