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. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Kawasaki disease
Nonspecific - eg fever and elevated ESR
Months out fibrosis
20 min

2. What type of vegetations are associated with Libman - Sacks endocarditis?
Opening snap followed by diastolic rumble
MI
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Sterile vegetations on surface and undersurface on mitral valve

3. What is the most common cause of aortic stenosis?
Wear and tear
Rhabdomyoma
NG or Ca channel blocker
Decreases LV dilation by decreasing volume

4. What are the two effects of ATII?
Shunt - PGE to maintain PDA until surgical repair can be performed
Large - destructive vegetations
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Ehlers - Danlow and Marfan syndrome

5. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
First 4 hours
1-3 days
Colon cancer

6. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Mitral valve prolapse
Spontaneous
VSD

7. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Mitral and tricuspid regurg - arrhythmia
LA dilation
Mid - systolic click followed by regurgitation murmur

8. What type of shunt does a VSD cause?
Decreased forward perfusion pulmonary congestion
L->R
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Paradoxical emboli

9. What is the most common valve infected by S aureus?
Fetal alcohol syndrome
Tricuspid
Myocardium
AD mutation in sarcomere proteins

10. What are the sx of aortic regurg?
PDA
Mitral regurg
R-->L
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

11. In transposition of the great vessels - What is required for survival? How is this achieved?
Volume overload and LHF
Months out fibrosis
Concentric LV hypertophy
Shunt - PGE to maintain PDA until surgical repair can be performed

12. When does the heart have dark discoloration post MI?
4-6 hours - 24 hours - 72 hours
2-4 hours - 24 hours - 7-10 days
4-24 hours
Thickening of chrodae tendinae and cusps - mitral stenosis

13. How does squating decrease hypoxemia in tetralogy of fallot?
Trisomy 21
Yellow pallor macrophages
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

14. When does the heart have a yellow pallor post MI?
Breast and lung carcinoma - melanoma - lymphoma
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Rupture of free wall - IV septum - or papillary muscle
Day 1-7

15. What type of tumor is a rhabdomyoma?
Increased hydrostatic pressure
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Slow HR - decreasing O2 demand and risk for arrhythmia
Harmartoma

16. What complications occur within 4 hrs post MI?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Cardiogenic shock - CHF - arrhythmia
Mitral regurg

17. In which pts does S viridans cause endocarditits?
CK- MB
Pts w/previously damaged valves
RHF
LAD

18. Erythematous nontender lesions on palms and soles.
Reperfusion injury
Janeway lesions
Reperfusion injury
Holosystolic machine like murmur

19. Where is the coarctation in infantile coarctation of the aorta?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Pulsating nail bed
LAD
Preductal - post aortic arch

20. How does MI cause LHF?
Positive blood cultures anemia of chronic disease
Chronic rheumatic heart disease
Infantile coarctation of the aorta PDA
Loss of LV fx

21. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Reperfusion injury
Anitschow cell
Wear and tear

22. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Mitral valve prolapse
Rhabdomyoma
Degree of pulmonary artery stenosis
Heart transplant

23. What are heart failure cells?
Loss of fx
Hemosiderin laden macrophages
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
2-3 weeks

24. Which chambers of the heart are generally spared in an MI?
Sterile vegetations on mitral valve along lines of closure
Atria and RV
Gelatinous - abundant ground substance
Ostium primum

25. What is diastolic dysfx?
Bounding pulse
Inability to fill ventricles
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Loss of fx

26. EKG for stable angina?
Prinzmetal
Nitroglycerin
Kawasaki disease
ST- segment depression

27. Which angina is relieved by Ca channel blockers?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Prinzmetal
First 4 hours
Ventricles cannot pump

28. What gross and microscopic changes occur months after an MI?
Large - destructive vegetations
White scar fibrosis
Heart transplant
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

29. With what condition are rhabdomyomas associated?
Pericarditits
Tuberous sclerosis
4-7 days macrophage infiltration
NG or Ca channel blocker

30. What is the rate of mitral valve prolapse in the US?
Decrease preload -->lowers myocardial stress
Harmartoma
Nonbacterial thrombotic endocarditis (marantic endocarditis)
2-3%

31. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
4-7 days macrophage infiltration
Adult coarctation of the aorta
Large vegetations of S aureus
Harmartoma

32. What is the basic principle of CHF?
Dark discoloration coagulative necrosis
Coxsackie A or B
Indomethacin - decreases PGE
Pump failure

33. What is the foundation of a scar?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Stable angina
Granulation tissue
Infantile coarctation of the aorta PDA

34. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
Troponin I
Nitroglycerin
CK- MB

35. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
PDA
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Infectious

36. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Reactive histiocyte with caterpillar nucleus
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Hypercoagulable state or underlying adenocarcinoma

37. At what point in development do congenital heart defects arise?
Loeffler syndrome
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
Turner syndrome
3-8 wks

38. What effect does transposition of the great vessels have on the ventricles?
Right side - serotonin and other secretory products detoxified in the lung
Hypertophy of RV atrophy of LV
Heart transplant
Breast and lung carcinoma - melanoma - lymphoma

39. What effect does squatting have on the murmur of mitral valve prolapse? Why?
ST- segment depression
Louder - increased systemic resistence decreases LV emptying
Hemosiderin laden macrophages
Migratory polyarthritis

40. What is the tx for dilated cardiomyopathy?
Heart transplant
Infantile coarctation of the aorta
Tricuspid
Coexisting mitral stenosis and fusion of commisures exist

41. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Squatting - increased systemic resistence decreases LV emptying
4-7 days
Shunt - PGE to maintain PDA until surgical repair can be performed

42. What cardiac disease is associated with tuberous sclerosis?
4-6 hours - 24 hours - 72 hours
Minimizes ischemia
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Rhabdomyoma

43. What is a common complication of cardiac metastasis?
PDA
Atherosclerosis of coronary arteries
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Pericardial effusion due to pericardial involvement

44. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
First 4 hours
Colon cancer
VSD

45. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Pericardial effusion due to pericardial involvement
Bounding pulse
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

46. Is scar tissue or myocardium stronger?
Myocardium
Troponin I
Chronic ischemic heart disease
Reperfusion injury

47. How does asprin/heparin tx MI?
Limits thrombosis
Mitral mitral+aortic
Myxoma - benign
R-->L

48. What is the definition of ischemia?
Surgical closure small defects may close spontaneously
Myofiber hypertrophy with disarray
Decrease in blood flow to an organ
Indomethacin - decreases PGE

49. Pericarditis 6-8 wks post MI.
CK- MB
Chronic ischemic heart disease
Congenital rubella
Dressler syndrome

50. What is the most common cause of RHF? What are others?
S epidermidis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Low voltage EKG w/diminished QRS amplitude
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)