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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 is the tx for dilated cardiomyopathy?
Myxoid degeneration
Heart transplant
1-3 days out
Congested central veins

2. How does asprin/heparin tx MI?
Limits thrombosis
LAD
PDA
CHF

3. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Coronary artery vasospasm
Osler nodes (ouch - ouch Osler)
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Prinzmetal stable and unstable

4. What % of MIs involve the LAD?
Group A beta - hemolytic streptococci
45%
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Yellow pallor neutrophils

5. Which congenital heart defect is associated with maternal diabetes?
VSD
Dilated
Transposition of the great vessels
VSD

6. What is the most common cause of RHF? What are others?
2-3 weeks
2-4 hours - 24 hours - 7-10 days
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Valve replacement

7. What type of vegetations does Strep viridans cause?
Stable angina
Systemic venous congestion
Small - nondestructive vegetations (subacute endocarditis)
Group A beta - hemolytic streptococci

8. What bug causes acute rheumatic fever?
Dilated
Inability to fill ventricles
Group A beta - hemolytic streptococci
Anterior wall of LV and anterior septum

9. What is the rate of congenital heart defects?
Subendocardial
1%
Mitral insufficiency
Infectious endocarditis

10. What congenital heart defect presents later in life with lower extremity cyanosis?
Prophylactic abx during dental procedures
Mid - systolic click followed by regurgitation murmur
PDA
Decreases LV dilation by decreasing volume

11. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Loss of fx
Ventricle
Preductal - post aortic arch

12. What is the leading cause of death in the US?
LHF
Day 1-7
Pump failure
Ischemic heart disease

13. What makes the MV prolapse murmur louder? Why?
Chest pain <20 min brought on by exertion or emotional stress
Nonspecific - eg fever and elevated ESR
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Squatting - increased systemic resistence decreases LV emptying

14. What effect does mitral stenosis have on the heart chambers?
RCA
VSD
LA dilation
Chronic ischemic heart disease

15. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Day 1-7
Tricuspid
Coexisting mitral stenosis and fusion of commisures exist
LAD

16. What areas of the heart does the RCA supply?
1-3 days out
IV drug users
Posterior wall of LV - posterior septum - papillary muscles
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

17. How does restrictive cardiomyopathy present?
Circumflex
Congestive heart failure
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Nonspecific - eg fever and elevated ESR

18. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Day 1-7
Anitschow cell
Hypertrophic cardiomyopathy
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

19. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
1%
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

20. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Trisomy 21
Dilated
Pericarditits

21. What is the most common cause of aortic stenosis?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Split S2 on auscultation
Wear and tear
Ventricular arrhythmia

22. Holosystolic blowing murmur that increases w/expiration?
Mitral valve prolapse
Plump fibroblasts - collagen - blood vessels
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Mitral regurg

23. What are complications of dilated cardiomyopathy?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mitral and tricuspid regurg - arrhythmia
AD mutation in sarcomere proteins
Fibrinous pericarditis

24. What effect does dilated cardiomyopathy have on the heart?
SLE
L->R
Friction rub and chest pain
Systolic dysfx leading to biventricular CHF

25. What is molecular mimicry?
Heart transplant
Open blocked vessels
When a bacterial protein resembles a protein in human tissue
Subendocardial

26. What is the effect of mitral regurg on the heart?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Volume overload and LHF
Migratory polyarthritis
Ventricles cannot pump

27. What characterizes acute rheumatic fever endocarditiis?
Indomethacin - decreases PGE
Small vegetations along the line of closure
Reversible
Reactive histiocyte with caterpillar nucleus

28. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
PDA
Coronary artery vasospasm
Decrease preload -->lowers myocardial stress

29. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Concentric LV hypertophy
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Tricuspid

30. What are Janeway lesions?
Autoimmune pericarditis 6-8 wks post MI
Harmartoma
Posterior wall of LV - posterior septum - papillary muscles
Erythematous nontender lesions on palms and soles.

31. Poor myocardial fx due to chronic ischemic damage?
Decrease preload -->lowers myocardial stress
Chronic ischemic heart disease
ST- segment elevation
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

32. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Sterile vegetations on surface and undersurface on mitral valve
Ostium secundum (90%)
Left -->right

33. When do macrophagess infiltrate the myocardium post MI?
Loss of fx
Colon cancer
4-7 days
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

34. How does transmural MI/ischemia present on EKG?
CHF
Volume overload and LHF
Myocarditis in acute rheumatic heart fever
ST- segment elevation

35. Pericarditis 6-8 wks post MI.
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Stable angina
Dressler syndrome
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

36. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
3-8 wks
Pts w/previously damaged valves
Pancarditis

37. What is typically the mechanims of sudden cardiac death?
Degree of pulmonary artery stenosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Reversible
Ventricular arrhythmia

38. Myofiber hypertrophy with disarray.
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Hypertrophic cardiomyopathy
Boot shaped heart
Indomethacin - decreases PGE

39. What type of tumor is a rhabdomyoma?
Harmartoma
Stable and unstable prinzmetal
Nitroglycerin
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

40. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
Streptococcus bovis/
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
1-3 days

41. What are Osler nodes?
Congested central veins
Kawasaki disease
Tender lesions on fingers or toes.
Colon cancer

42. What causes mitral valve prolapse?
Myxoid degeneration
First 4 hours
Hypercoagulable state or underlying adenocarcinoma
Coxsackie A or B

43. How does adult coarctation of the aorta present?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Doxorubicin - cocaine

44. What are the complications of aortic stenosis?
Boot shaped heart
Membrane damage
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Posterior wall of LV - posterior septum - papillary muscles

45. When is an MI pt at greatest risk for cardiogenic shock?
4-24 hours
Acute inflammation
RBC damaged while crossing the calcified valve causing schistocytes
First 4 hours

46. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
Ventricle
Contraction band necrosis - reperfusion injury
Congenital rubella

47. What is the only Jones criteria that doesn't resolve with time?
Troponin I
Pancarditis
Hypertrophic cardiomyopathy
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

48. What is the most comon cause of aortic regurg? What are the other causes?
Small vegetations along the line of closure
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
S epidermidis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

49. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Heart can't fill
Elevated ASO anti - DNase B titers
Migratory polyarthritis

50. What effect does squatting have on the murmur of mitral valve prolapse? Why?
1%
Nitroglycerin
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Louder - increased systemic resistence decreases LV emptying