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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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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. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Annular - non pruritic rash w/erythematous borders trunks and limbs
Shunt - PGE to maintain PDA until surgical repair can be performed
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

2. In which pts does S viridans cause endocarditits?
White scar fibrosis
Hemosiderin laden macrophages
Annular - non pruritic rash w/erythematous borders trunks and limbs
Pts w/previously damaged valves

3. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Atria and RV
Split S2 on auscultation
Myofiber hypertrophy with disarray

4. Large vegetations on tricuspid valve?
Janeway lesions
Hypertophy of RV atrophy of LV
Libman - Sacks endocarditis
S aureus

5. Myofiber hypertrophy with disarray.
Fetal alcohol syndrome
Congested central veins
Spontaneous
Hypertrophic cardiomyopathy

6. What are the complications of mitral valve prolapse? Are they common?
4-6 hours - 24 hours - 72 hours
Ventricles cannot pump
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Infectious endocarditis - arrythmias - severe mitral regurg no

7. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Atherosclerosis of coronary arteries
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Posterior wall of LV - posterior septum - papillary muscles

8. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
NG or Ca channel blocker
Decrease preload -->lowers myocardial stress
Harmartoma

9. Which congenital heart defect is associated with maternal diabetes?
Posterior wall of LV - posterior septum - papillary muscles
Transposition of the great vessels
Concentric LV hypertophy
CK- MB

10. How does MI cause LHF?
Regurg vs stenosis
Loss of LV fx
Mitral regurg
2-3%

11. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Loeffler syndrome
Paradoxical emboli
Bacterial endocarditis

12. What does rupture of the IV septum cause?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Coronary artery vasospasm
Pts w/previously damaged valves
Shunt

13. What is the gold standard blood marker for MI?
Anitschow cell
Troponin I
Valve replacement AFTER the onset of complications
NG or Ca channel blocker

14. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Mitral insufficiency
Degree of pulmonary artery stenosis
Rhadbomyoma - benign
Myxoma - benign

15. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Degree of pulmonary artery stenosis
Rhadbomyoma - benign
Bacterial endocarditis
Valve replacement

16. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
CHF
Friction rub and chest pain
VSD

17. What is the most common cause of mitral stenosis?
Fibrosis and dystrophic calcification
Mitral regurg
Chronic rheumatic heart disease
Reperfusion injury

18. Which chambers of the heart are generally spared in an MI?
Atria and RV
Concentric LV hypertophy
Heart transplant
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

19. What causes a mid - systolic click followed by a regurgitation murmur?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Hemosiderin laden macrophages
Friction rub and chest pain
Mitral valve prolapse

20. What type of vegetations does Strep viridans cause?
Systolic ejection click followed by crescendo - decrescendo murmur
Preductal - post aortic arch
Small - nondestructive vegetations (subacute endocarditis)
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

21. What type of tumor is a rhabdomyoma?
Aschoff bodies
Circumflex
Harmartoma
Increased blood in right heart delays closure of P valve

22. Erythematous nontender lesions on palms and soles.
ACE inhibitor
Type I
Kawasaki disease
Janeway lesions

23. Which angina(s) show ST elevation on EKG? ST depression?
PDA
Autoimmune pericarditis 6-8 wks post MI
Myofiber hypertrophy with disarray
Prinzmetal stable and unstable

24. How does dilated cardiomyopathy cause LHF?
Mitral mitral+aortic
Stretched muscle loses contractility
Louder - increased systemic resistence decreases LV emptying
RCA

25. What causes prinzmetal angina?
Congenital rubella
Reperfusion injury
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Coronary artery vasospasm

26. With what condition are rhabdomyomas associated?
Bacterial endocarditis
Tuberous sclerosis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Prinzmetal

27. What iis the tx for aortic regurg?
Valve replacement once LV dysfx develops
Mitral regurgitation due to vegetations
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Ischemic heart disease

28. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
LAD
RHF
Aortic regurg
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

29. What congenital heart defect is associated with fetal alcohol syndrome?
VSD
Large - destructive vegetations
Dark discoloration coagulative necrosis
IV drug users

30. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Thickening of chrodae tendinae and cusps - mitral stenosis
Nitroglycerin
Valve scarring that arises as a consequence of rheumatic fever

31. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
Dilated
Fetal alcohol syndrome
Myocarditis

32. How does Eisenmeger syndrome occur?
Indomethacin - decreases PGE
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Concentric LV hypertophy
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

33. When do CK- MB levels rise - peak - and return to normal?
Coronary artery vasospasm
4-6 hours - 24 hours - 72 hours
Myocarditis in acute rheumatic heart fever
Harmartoma

34. What is the effect of mitral regurg on the heart?
CK- MB
Coronary artery vasospasm - emboli - vasculitis
Shunt - PGE to maintain PDA until surgical repair can be performed
Volume overload and LHF

35. What are the causes of LHF?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Dilated
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

36. What causes microangiopathic hemolytic anemia in aortic stenosis?
Right -->left
Anterior wall of LV and anterior septum
PDA
RBC damaged while crossing the calcified valve causing schistocytes

37. What is the cause of the red border around granulation tissue?
Ventricular arrhythmia
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Reversible
Blood vessels coming in from normal tissue

38. What does nonbacterial thrombotic endocarditis cause?
Valve scarring that arises as a consequence of rheumatic fever
Erythematous nontender lesions on palms and soles.
Mitral regurg
Intercostal arteries enlarged due to collateral circulation

39. What cardiac disease is associated with tuberous sclerosis?
Pts w/previously damaged valves
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Rhabdomyoma
IV drug users

40. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Mitral stenosis
Mitral valve prolapse
Nitroglycerin
Adult coarctation of the aorta

41. What is a water - hammer pulse?
Bounding pulse
Yellow pallor neutrophils
Loss of LV fx
VSD

42. What effect does aortic regurg have on the pulse pressure? Why?
Autoimmune pericarditis 6-8 wks post MI
S epidermidis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

43. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Aortic regurg
Erythematous nontender lesions on palms and soles.
Pericardial effusion due to pericardial involvement

44. When is an MI patent at highest risk for fibrionous pericarditis?
Nonspecific - eg fever and elevated ESR
1-3 days out
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Valve scarring that arises as a consequence of rheumatic fever

45. What are the sx/complications of myocarditis?
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
Hypertophy of RV atrophy of LV
Nitroglycerin
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

46. What gross and microscopic changes occur 1-3 days after an MI?
Gelatinous - abundant ground substance
Ventricle
Thickening of chrodae tendinae and cusps - mitral stenosis
Yellow pallor neutrophils

47. When do troponin levels rise - peak - and return to normal?
RCA
CK- MB
2-4 hours - 24 hours - 7-10 days
ST- segment elevation

48. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Regurg vs stenosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Coronary artery vasospasm

49. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Preductal - post aortic arch
4-24 hours
Tuberous sclerosis

50. What causes heart failure cells?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
ASD - R-->L
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Prinzmetal angina - cocaine