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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. How does MI cause LHF?
Ventricle
Loss of LV fx
Nitroglycerin
Reactive histiocyte with caterpillar nucleus

2. How does ischemia cause LHF?
Loss of fx
LA dilation
Yellow pallor neutrophils
Restrictive cardiomyopathy

3. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Gelatinous - abundant ground substance
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

4. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Coexisting mitral stenosis and fusion of commisures exist
Paradoxical emboli
>60 years - bicuspid aortic valve

5. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Troponin I
Split S2 on auscultation
Nonbacterial thrombotic endocarditis (marantic endocarditis)
RCA

6. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
Small vegetations along the line of closure
Stable angina
Congested central veins

7. When does the heart have dark discoloration post MI?
SLE
Loss of LV fx
4-24 hours
Coronary artery vasospasm - emboli - vasculitis

8. What is the most common tumor of the heart?
Harmartoma
Months out fibrosis
Metastasis
Bounding pulse

9. What are the clinical features of LHF due to?
Tender lesions on fingers or toes.
Squatting - increased systemic resistence decreases LV emptying
Decreased forward perfusion pulmonary congestion
>70%

10. What causes prinzmetal angina?
Migratory polyarthritis
Restrictive cardiomyopathy
Limits thrombosis
Coronary artery vasospasm

11. Lower extremity cyanosis in infants? In adults?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Infantile coarctation of the aorta PDA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Dressler syndrome

12. What is the 1day-1wk -1mo mneumonic for MI?
Tender lesions on fingers or toes.
Yellow pallor macrophages
4-24 hours
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

13. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
4-6 hours - 24 hours - 72 hours

14. Which vasculitis can cause MI?
When a bacterial protein resembles a protein in human tissue
Kawasaki disease
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Gelatinous - abundant ground substance

15. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Left -->right
Chronic ischemic heart disease
Turner syndrome
PDA

16. What is the most common cause of infectious endocarditis?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Coexisting mitral stenosis and fusion of commisures exist
Volume overload and LHF
Streptococcus viridans

17. What is the JOneS mneumonic?
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea
Pts w/previously damaged valves
Eisenmenger syndrome
Mitral insufficiency

18. What is the tx for aortic stenosis?
Atherosclerosis of coronary arteries
Valve replacement AFTER the onset of complications
Mitral valve prolapse
Breast and lung carcinoma - melanoma - lymphoma

19. Sudden death in a young athlete.
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Hypertrophic cardiomyopathy
Decrease preload -->lowers myocardial stress
PGE

20. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Intercostal arteries enlarged due to collateral circulation
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Transposition of the great vessels
LHF

21. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Mitral valve prolapse
Louder - increased systemic resistence decreases LV emptying
Squat in response to cyanotic spell
Mitral insufficiency

22. L- to - R shunt switching to R- to - L shunt.
Mitral mitral+aortic
45%
Chronic ischemic heart disease
Eisenmenger syndrome

23. What causes endocarditis of prosthetic valves?
S epidermidis
Small vegetations along the line of closure
Heart transplant
Reperfusion injury

24. Which angina(s) show ST elevation on EKG? ST depression?
Fetal alcohol syndrome
Slow HR - decreasing O2 demand and risk for arrhythmia
Prinzmetal stable and unstable
Coronary artery vasospasm - emboli - vasculitis

25. What causes unstable angina?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Eisenmenger syndrome
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Stable angina

26. In which chamber of the heart are cardiac myxomas found?
Fibrinous pericarditis
ST- segment depression
LA
Nonbacterial thrombotic endocarditis (marantic endocarditis)

27. What compensatory mechanism do tetralogy of fallot pts learn?
NG or Ca channel blocker
Prinzmetal stable and unstable
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Squat in response to cyanotic spell

28. What is the definition of ischemia?
Hypercoagulable state or underlying adenocarcinoma
Louder - increased systemic resistence decreases LV emptying
2-3 weeks
Decrease in blood flow to an organ

29. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Months out fibrosis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Bacterial endocarditis
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

30. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Stable and unstable prinzmetal
PDA
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

31. How does subendocardial MI/ischemia present on EKG?
Atherosclerosis of coronary arteries
ST- segment depression
Reperfusion injury
L->R

32. What is dilated cardiomyopathy?
Infectious endocarditis - arrythmias - severe mitral regurg no
Dilation of all four chambers of the heart
Reperfusion injury
Aortic stenosis

33. What are the four defects in tetralogy of fallot?
Reactive histiocyte with caterpillar nucleus
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
S epidermidis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

34. When do macrophagess infiltrate the myocardium post MI?
Chest pain <20 min brought on by exertion or emotional stress
Cardiac tamponade
Bacterial endocarditis
4-7 days

35. What two things cause coronary artery vasospasm?
Limits thrombosis
Aneurysm - mural thrombus - Dressler syndrome
Cardiogenic shock - CHF - arrhythmia
Prinzmetal angina - cocaine

36. What is the basic principle of CHF?
Prophylactic abx during dental procedures
RCA
Aortic stenosis
Pump failure

37. Systolic ejection click followed by crescendo - decrescendo murmur.
S epidermidis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Aortic stenosis
Preductal - post aortic arch

38. What is the etiology of S viridans endocarditis?
Bounding pulse
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
LA dilation
Ventricular arrhythmia

39. What is the only Jones criteria that doesn't resolve with time?
Concentric LV hypertophy
S aureus
Pancarditis
Holosystolic blowing murmur

40. Infects predamaged valves after transient bacteremia?
Minimizes ischemia
S viridans
Streptococcus viridans
4-7 days

41. How does reperfusion injury occur?
Yellow pallor macrophages
Aschoff bodies
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Trisomy 21

42. Friction rub and chest pain.
Annular - non pruritic rash w/erythematous borders trunks and limbs
Stable angina
Pericarditits
Congenital rubella

43. How does transmural MI/ischemia present on EKG?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Hypertrophic cardiomyopathy
CHF
ST- segment elevation

44. What are the sx of pericardiits?
Right to left
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Ventricles cannot pump
Friction rub and chest pain

45. What are the sx of aortic regurg?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
PDA
LAD
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

46. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Yellow pallor neutrophils
Sterile vegetations on surface and undersurface on mitral valve
Rhadbomyoma - benign

47. What are the cancers that most commonly metastasize to the heart?
Tetralogy of fallot
Indomethacin - decreases PGE
>60 years - bicuspid aortic valve
Breast and lung carcinoma - melanoma - lymphoma

48. In which chamber of the heart are rhabdomyomas found?
Ventricle
Pericardial effusion due to pericardial involvement
Myocarditis
Opening snap followed by diastolic rumble

49. EKG for stable angina?
CK- MB
ST- segment depression
2-3 weeks
Intercostal arteries enlarged due to collateral circulation

50. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
MI
Cardiogenic shock - CHF - arrhythmia
LA dilation