Test your basic knowledge |

Cardiac

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Which artery is most often occluded in an MI?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
20 min
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
LAD

2. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Months out fibrosis
Infectious
Congested central veins
RCA

3. What are the clinical features of endocarditis? What causes each feature?
Dressler syndrome
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Left -->right
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

4. 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
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
2-4 hours - 24 hours - 7-10 days
Hemosiderin laden macrophages

5. In which chamber of the heart are rhabdomyomas found?
Granulation tissue
Open blocked vessels
Ventricle
MI

6. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Reperfusion injury
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA
Systemic venous congestion

7. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
1-3 days out
Mitral regurgitation due to vegetations
Libman - Sacks endocarditis

8. What is the murmur of mitral regurg?
Mitral and tricuspid regurg - arrhythmia
Prinzmetal angina - cocaine
Holosystolic blowing murmur
Cardiogenic shock - CHF - arrhythmia

9. What is the most common cause of dilated cardiomyopathy? What are other causes?
LV dilation and eccentric hypertrophy
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Split S2 on auscultation
Colon cancer

10. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Autoimmune pericarditis 6-8 wks post MI
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Loeffler syndrome
Pump failure

11. What does rupture of a papillary muscle cause?
LA dilation
Mitral insufficiency
Anitschow cell
>70%

12. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Inability to maintain systemic pressure w/lack of O2 to vital organs
Left -->right
Group A beta - hemolytic streptococci

13. Why are cardiac enzymes elevated after an MI?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Right side - serotonin and other secretory products detoxified in the lung
Membrane damage
Myxoma - benign

14. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Loss of LV fx
Granulation tissue
Contraction band necrosis
Fibrosis and dystrophic calcification

15. When would arrhythmia occur after MI?
PDA
Within the first day
R-->L
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

16. What effect does transposition of the great vessels have on the ventricles?
LA dilation
Hypertophy of RV atrophy of LV
MI
Contraction band necrosis

17. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Increased blood in right heart delays closure of P valve
Yellow pallor macrophages
Tender lesions on fingers or toes.

18. What congenital heart defect does indomethacin tx?
Annular - non pruritic rash w/erythematous borders trunks and limbs
PDA
Bacterial endocarditis
MI

19. What are the HACEK organisms? With what condition are they associated?
Coronary artery vasospasm - emboli - vasculitis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Eisenmenger syndrome
Paradoxical emboli

20. How does adult coarctation of the aorta present?
Prophylactic abx during dental procedures
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Aneurysm - mural thrombus - Dressler syndrome
Nitroglycerin

21. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Mitral regurg
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Plump fibroblasts - collagen - blood vessels
Nonbacterial thrombotic endocarditis (marantic endocarditis)

22. What is the most common type of ASD? What %?
Ostium secundum (90%)
Janeway lesions
20 min
Mid - systolic click followed by regurgitation murmur

23. What heart sound manifest with an ASD?
Split S2 on auscultation
Anitschow cell
20 min
Positive blood cultures anemia of chronic disease

24. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Asymptomatic
Anitschow cell
Inability to maintain systemic pressure w/lack of O2 to vital organs

25. What increases the volume of mitral regurg murmur?
Dressler syndrome
45%
S aureus
Squatting - expiration

26. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
VSD
Limits thrombosis
Pump failure

27. How does stable angina present?
Hypertrophic cardiomyopathy
Pulsating nail bed
VSD
Chest pain <20 min brought on by exertion or emotional stress

28. What endocarditis is commonly found in patients with colon cancer?
Cardiogenic shock - CHF - arrhythmia
Atherosclerosis of coronary arteries
Endocarditis of prosthetic valves
Streptococcus bovis/

29. At what point in development do congenital heart defects arise?
Squatting - increased systemic resistence decreases LV emptying
Stable angina
3-8 wks
Prinzmetal angina

30. What typically causes hypertrophic cardiomyopathy?
Chest pain <20 min brought on by exertion or emotional stress
AD mutation in sarcomere proteins
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

31. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Valve scarring that arises as a consequence of rheumatic fever
When a bacterial protein resembles a protein in human tissue
Posterior wall of LV - posterior septum - papillary muscles

32. What is chronic rheumatic heart disease?
Slow HR - decreasing O2 demand and risk for arrhythmia
Valve scarring that arises as a consequence of rheumatic fever
Boot shaped heart
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

33. What does Libman - Sacks endocarditis cause?
Hypercoagulable state or underlying adenocarcinoma
Tetralogy of fallot
Tuberous sclerosis
Mitral regurg

34. When does the heart have dark discoloration post MI?
First 4 hours
Tetralogy of fallot
4-24 hours
20 min

35. What are the tx for MI?
Bacterial endocarditis
Minimizes ischemia
VSD
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

36. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Aortic stenosis
Myocarditis
CHF

37. What is the most common cause of RHF? What are others?
Nonspecific - eg fever and elevated ESR
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Atria and RV

38. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Endocardial fibroelastosis
First 4 hours
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Months out fibrosis

39. What effect does chronic rheumatic heart disease have on the aortic valve?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

40. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
PGE
MI

41. What is the gold standard blood marker for MI?
Intercostal arteries enlarged due to collateral circulation
AD mutation in sarcomere proteins
Troponin I
Squatting - increased systemic resistence decreases LV emptying

42. Myofiber hypertrophy with disarray.
Adult coarctation of the aorta
Hypertrophic cardiomyopathy
Pulsating nail bed
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

43. What is the most common form of cardiomyopathy?
Gelatinous - abundant ground substance
Dilated
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Systolic dysfx leading to biventricular CHF

44. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Posterior wall of LV - posterior septum - papillary muscles
Preductal - post aortic arch
Surgical closure small defects may close spontaneously

45. What is the tx for dilated cardiomyopathy?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Pump failure
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Heart transplant

46. What is the most common cause of death during the acute phase of rheumatic fever?
Congestive heart failure
Ischemic heart disease
Myocarditis
Hypertophy of RV atrophy of LV

47. What type of tumor is a rhabdomyoma?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Degree of pulmonary artery stenosis
Increased blood in right heart delays closure of P valve
Harmartoma

48. What are the forward and backward sx of LHF?
Hypertrophic cardiomyopathy
Limits thrombosis
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA
Doxorubicin - cocaine

49. What are Osler nodes?
1%
MI
Tender lesions on fingers or toes.
Valve replacement

50. What are heart failure cells?
Squatting - expiration
Inability to maintain systemic pressure w/lack of O2 to vital organs
Mitral insufficiency
Hemosiderin laden macrophages