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. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
VSD
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
Left -->right
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

2. What does chronic ischemic heart disease progress to?
CHF
Hypertrophic cardiomyopathy
Myocarditis
4-7 days

3. What does Libman - Sacks endocarditis cause?
Prinzmetal angina
Increased hydrostatic pressure
Mitral regurg
Restrictive cardiomyopathy

4. What is the etiology of S viridans endocarditis?
Infectious
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
First 4 hours

5. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Anitschow cell
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Reperfusion injury
Large vegetations of S aureus

6. Tender lesions on fingers or toes.
Annular - non pruritic rash w/erythematous borders trunks and limbs
Indomethacin - decreases PGE
Osler nodes (ouch - ouch Osler)
Mitral regurg

7. What is the cause of restrictive cardiomyopathy in children?
ST- segment depression
Right side - serotonin and other secretory products detoxified in the lung
Endocardial fibroelastosis (rare)
Nonbacterial thrombotic endocarditis (marantic endocarditis)

8. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Prinzmetal angina
Decreases LV dilation by decreasing volume
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

9. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Hemosiderin laden macrophages
Rhadbomyoma - benign
Thickening of chrodae tendinae and cusps - mitral stenosis

10. Which coronary artery supplies the anterior wall and anterior septum?
Hypertophy of RV atrophy of LV
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
LAD
Inability to fill ventricles

11. How does asprin/heparin tx MI?
Concentric LV hypertophy
Stretched muscle loses contractility
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Limits thrombosis

12. What is a complication of chronic rheumatic heart disease?
Loeffler syndrome
Reperfusion injury
Nitroglycerin
Infectious endocarditis

13. What are the clinical features of RHF?
Pts w/previously damaged valves
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Minimizes ischemia
Colon cancer

14. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Myocarditis in acute rheumatic heart fever
Minimizes ischemia
Pancarditis

15. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Decrease in blood flow to an organ
Dilated
Adult coarctation of the aorta
Sudden cardiac death

16. How do you prevent S viridans endocarditis?
Turner syndrome
Decreases LV dilation by decreasing volume
Months out fibrosis
Prophylactic abx during dental procedures

17. When do neutrophils infiltrate the myocardium post MI?
LA dilation
Prinzmetal stable and unstable
Opening snap followed by diastolic rumble
1-3 days

18. What is diastolic dysfx?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
ST- segment elevation
Inability to fill ventricles
20 min

19. Ostium primum ASD is associated with what congenital disorder?
Trisomy 21
ST- segment elevation
ST- segment depression
Myofiber hypertrophy with disarray

20. What two things happen when a blocked vessel is opened after an MI?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Contraction band necrosis - reperfusion injury
NG or Ca channel blocker
Red border granulation tissue

21. What type of vegetations are associated with Libman - Sacks endocarditis?
Open blocked vessels
Sterile vegetations on surface and undersurface on mitral valve
Reactive histiocyte with caterpillar nucleus
Squatting - increased systemic resistence decreases LV emptying

22. How do you tx prinzmetal angina?
Inability to maintain systemic pressure w/lack of O2 to vital organs
CHF
NG or Ca channel blocker
Myocarditis

23. What is systolic dysfx?
Ventricles cannot pump
S viridans
Squatting - expiration
Louder - increased systemic resistence decreases LV emptying

24. What two things cause coronary artery vasospasm?
2-4 hours - 24 hours - 7-10 days
Prinzmetal angina - cocaine
Doxorubicin - cocaine
Ventricle

25. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Janeway lesions
CHF
Endocardial fibroelastosis (rare)

26. What is the rate of mitral valve prolapse in the US?
Ostium primum
2-3%
Ischemic heart disease
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

27. EKG for stable angina?
LV dilation and eccentric hypertrophy
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
ST- segment depression

28. What type of ischemia does stable angina cause?
Subendocardial
L->R
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
S viridans

29. What is the gross and microscopic appearance of cardiac myxomas?
PDA
Tuberous sclerosis
When a bacterial protein resembles a protein in human tissue
Gelatinous - abundant ground substance

30. What are the clinical features of LHF due to?
Day 1-7
Decreased forward perfusion pulmonary congestion
Low voltage EKG w/diminished QRS amplitude
Papillary muscle - free wall - IV septum

31. How does adult coarctation of the aorta present?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Stretched muscle loses contractility

32. What is an Aschoff body?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
LA dilation
Mitral mitral+aortic

33. What heart sound manifest with an ASD?
Acute inflammation
Split S2 on auscultation
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Left -->right

34. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Loss of LV fx
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Minimizes ischemia

35. What causes an early - blowing diastolic murmur?
Aortic stenosis
Papillary muscle - free wall - IV septum
Myocarditis
Aortic regurg

36. What are the HACEK organisms? With what condition are they associated?
Group A beta - hemolytic streptococci
Infectious endocarditis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
When a bacterial protein resembles a protein in human tissue

37. What characterizes acute rheumatic fever endocarditiis?
Open blocked vessels
Small vegetations along the line of closure
3-8 wks
Mitral insufficiency

38. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Months out fibrosis
Loss of fx
Myxoid degeneration

39. What causes a mid - systolic click followed by a regurgitation murmur?
LV dilation and eccentric hypertrophy
Mitral valve prolapse
Squatting - increased systemic resistence decreases LV emptying
Prinzmetal angina

40. What coronary artery supplies the mitral valve papillary muscles?
RCA
PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Chest pain <20 min brought on by exertion or emotional stress

41. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Fetal alcohol syndrome
Concentric LV hypertophy
Coronary artery vasospasm
Degree of pulmonary artery stenosis

42. What are Osler nodes?
Tender lesions on fingers or toes.
Atherosclerosis of coronary arteries
Eisenmenger syndrome
4-24 hours

43. Erythematous nontender lesions on palms and soles.
2-4 hours - 24 hours - 7-10 days
Janeway lesions
Months out fibrosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

44. What effect does squatting have on the murmur of mitral valve prolapse? Why?
2-3 weeks
Louder - increased systemic resistence decreases LV emptying
Ischemic heart disease
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

45. What causes endocarditis of prosthetic valves?
S epidermidis
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
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
Endocardial fibroelastosis

46. What congenital heart defect is associated with fetal alcohol syndrome?
VSD
SLE
Ostium secundum (90%)
Decrease in blood flow to an organ

47. What are the four defects in tetralogy of fallot?
Shunt - PGE to maintain PDA until surgical repair can be performed
Doxorubicin - cocaine
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

48. What gross and microscopic changes occur months after an MI?
White scar fibrosis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
S epidermidis
Regurg vs stenosis

49. What causes mitral valve prolapse?
Myxoid degeneration
Yellow pallor neutrophils
Hemosiderin laden macrophages
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

50. What is the cause of the red border around granulation tissue?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Infectious endocarditis - arrythmias - severe mitral regurg no
Bacterial endocarditis
Blood vessels coming in from normal tissue