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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. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Aortic regurg
Asymptomatic
RBC damaged while crossing the calcified valve causing schistocytes

2. How does dilated cardiomyopathy cause LHF?
Holosystolic machine like murmur
Limits thrombosis
Stretched muscle loses contractility
RCA

3. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
>70%
Infectious endocarditis
Loss of fx

4. With what disease is transposition of the great vessels associated?
Contraction band necrosis
Maternal diabetes
Mitral and tricuspid regurg - arrhythmia
Trisomy 21

5. What coronary arterysupplies the lateral wall of the LV?
Prinzmetal angina
Circumflex
Infectious endocarditis
RHF

6. What is cardiogenic shock?
Mitral regurg
Mitral stenosis
ST- segment depression
Inability to maintain systemic pressure w/lack of O2 to vital organs

7. What are the clinical features of LHF due to?
Wear and tear
Decreased forward perfusion pulmonary congestion
PDA
When a bacterial protein resembles a protein in human tissue

8. What two things happen when a blocked vessel is opened after an MI?
Streptococcus viridans
Contraction band necrosis - reperfusion injury
Volume overload and LHF
Transposition of the great vessels

9. What is the most common tumor of the heart?
NG or Ca channel blocker
Metastasis
Colon cancer
LV dilation and eccentric hypertrophy

10. What are complications of dilated cardiomyopathy?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Nonspecific - eg fever and elevated ESR
Mitral and tricuspid regurg - arrhythmia
Squat in response to cyanotic spell

11. What is the most comon cause of aortic regurg? What are the other causes?
Myocarditis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Dilated

12. What is the tx for dilated cardiomyopathy?
RBC damaged while crossing the calcified valve causing schistocytes
Intercostal arteries enlarged due to collateral circulation
Heart transplant
Reperfusion injury

13. Vegetations on surface and undersurface of mitral valve.
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mitral mitral+aortic
Libman - Sacks endocarditis
Backward LHF pulm htn and RHF - afib and associated mural thombis

14. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Heart transplant
When a bacterial protein resembles a protein in human tissue
Aschoff bodies
Plump fibroblasts - collagen - blood vessels

15. How do you tx prinzmetal angina?
Contraction band necrosis - reperfusion injury
Coronary artery vasospasm - emboli - vasculitis
NG or Ca channel blocker
Infectious endocarditis - arrythmias - severe mitral regurg no

16. What is the basic principle of CHF?
Prinzmetal angina - cocaine
Mid - systolic click followed by regurgitation murmur
Volume overload and LHF
Pump failure

17. What type of shunt does transposition of the great vessels cause?
Dark discoloration coagulative necrosis
Coronary artery vasospasm
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
R-->L

18. How do ACE inhibitors tx MI?
Hypertrophic cardiomyopathy
Decreases LV dilation by decreasing volume
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Limits thrombosis

19. What is an Anitschow cell?
Indomethacin - decreases PGE
Holosystolic machine like murmur
Reactive histiocyte with caterpillar nucleus
1-3 days

20. Is scar tissue or myocardium stronger?
Streptococcus bovis/
ACE inhibitor
Turner syndrome
Myocardium

21. What side of the heart do carcinoid tumors affect? Why?
Kawasaki disease
Right side - serotonin and other secretory products detoxified in the lung
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Small vegetations along the line of closure

22. What is molecular mimicry?
Shunt
Transposition of the great vessels
When a bacterial protein resembles a protein in human tissue
Contraction band necrosis - reperfusion injury

23. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
Shunt
Acute inflammation
1%

24. What drug relieves stable angina?
Right side - serotonin and other secretory products detoxified in the lung
Nitroglycerin
Decreased forward perfusion pulmonary congestion
Cardiogenic shock - CHF - arrhythmia

25. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Inability to maintain systemic pressure w/lack of O2 to vital organs
LAD
Congestive heart failure

26. What is eythema marginatum? What parts of the body does it commonly involve?
Infectious endocarditis - arrythmias - severe mitral regurg no
3-8 wks
Annular - non pruritic rash w/erythematous borders trunks and limbs
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

27. What causes a mid - systolic click followed by a regurgitation murmur?
LAD
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Mitral valve prolapse
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

28. Infects predamaged valves after transient bacteremia?
Prinzmetal
S viridans
Harmartoma
Maternal diabetes

29. What is the tx for VSD?
Adult coarctation of the aorta
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Surgical closure small defects may close spontaneously
Infectious endocarditis

30. What bug causes acute rheumatic fever?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Group A beta - hemolytic streptococci
Ventricles cannot pump
Myxoid degeneration

31. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Turner syndrome
RHF
>60 years - bicuspid aortic valve

32. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ventricles cannot pump
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

33. What causes prinzmetal angina?
Troponin I
Coexisting mitral stenosis and fusion of commisures exist
Coronary artery vasospasm
Gelatinous - abundant ground substance

34. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Subendocardial
Prinzmetal angina
RBC damaged while crossing the calcified valve causing schistocytes

35. What does granulation tissue contain?
Pts w/previously damaged valves
Plump fibroblasts - collagen - blood vessels
Maternal diabetes
Intercostal arteries enlarged due to collateral circulation

36. Which coronary artery supplies the anterior wall and anterior septum?
NG or Ca channel blocker
Congenital rubella
Wear and tear
LAD

37. What are the clinical features of RHF due to?
Systemic venous congestion
Circumflex
SLE
Cardiogenic shock - CHF - arrhythmia

38. How long after pharyngitis does acute rheumatic fever occur?
Breast and lung carcinoma - melanoma - lymphoma
2-3 weeks
Infantile coarctation of the aorta PDA
Asymptomatic

39. What murmur ccan be heard in PDA?
Bicuspid aortic valve
Coronary artery vasospasm - emboli - vasculitis
Holosystolic machine like murmur
Nonbacterial thrombotic endocarditis (marantic endocarditis)

40. Why are cardiac enzymes elevated after an MI?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Membrane damage
When a bacterial protein resembles a protein in human tissue
R-->L

41. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
4-6 hours - 24 hours - 72 hours
Reperfusion injury
Coxsackie A or B

42. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Squat in response to cyanotic spell
Gelatinous - abundant ground substance
Left -->right

43. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Granulation tissue
Pump failure
Ischemic heart disease

44. What is the 1day-1wk -1mo mneumonic for MI?
NG or Ca channel blocker
Aortic stenosis
ASD - R-->L
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

45. What % stenosis causes stable angina?
>70%
Pericarditits
Mitral valve prolapse
LA dilation

46. What complications occur within 4 hrs post MI?
Myocarditis in acute rheumatic heart fever
Cardiogenic shock - CHF - arrhythmia
Dark discoloration coagulative necrosis
R-->L

47. What are the sx of aortic regurg?
Anterior wall of LV and anterior septum
Systolic ejection click followed by crescendo - decrescendo murmur
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Ventricles cannot pump

48. What is migratory polyarthritis?
Anitschow cell
2-3%
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Right to left

49. In which chamber of the heart are cardiac myxomas found?
LA
PDA
2-3%
Paradoxical emboli

50. How does ischemia cause LHF?
Congested central veins
Loss of fx
LHF
ASD - R-->L