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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
VSD
Dilation of all four chambers of the heart
Large - destructive vegetations

2. What type of shunt dose PDA cause?
Tuberous sclerosis
Left -->right
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Valve scarring that arises as a consequence of rheumatic fever

3. Pericarditis 6-8 wks post MI.
Dressler syndrome
Regurg vs stenosis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Hemosiderin laden macrophages

4. Erythematous nontender lesions on palms and soles.
20 min
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Janeway lesions
Pedunculated mass in the LA that causes syncope due to obstruction of MV

5. What shunt does tetralogy of fallot produce?
LAD
Right -->left
Pulsating nail bed
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

6. What is the main cause of MV regurg? What are other causes?
Bounding pulse
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Chronic ischemic heart disease
Small - nondestructive vegetations (subacute endocarditis)

7. What are the clinical features of RHF?
Stable angina
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Ostium primum
Squat in response to cyanotic spell

8. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
RBC damaged while crossing the calcified valve causing schistocytes
Hypercoagulable state or underlying adenocarcinoma
Aneurysm - mural thrombus - Dressler syndrome

9. Which angina is relieved by Ca channel blockers?
Prinzmetal
IV drug users
Infantile coarctation of the aorta
Fibrosis and dystrophic calcification

10. Turner syndrome is associated with which congenital heart defect?
R-->L
Chest pain <20 min brought on by exertion or emotional stress
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Infantile coarctation of the aorta

11. What effect does aortic stenosis have on the chambers of the heart?
Infectious endocarditis - arrythmias - severe mitral regurg no
Nonspecific - eg fever and elevated ESR
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Concentric LV hypertophy

12. What are the clinical features of endocarditis? What causes each feature?
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Tetralogy of fallot
Papillary muscle - free wall - IV septum
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

13. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Osler nodes (ouch - ouch Osler)
IV drug users
RCA

14. What artery is the 2nd most often occluded in an MI?
Atria and RV
Left -->right
RCA
Stable and unstable prinzmetal

15. Where is the coarctation in infantile coarctation of the aorta?
1-3 days out
Cardiac tamponade
Reperfusion injury
Preductal - post aortic arch

16. What does rupture of a papillary muscle cause?
Asymptomatic
Heart transplant
Mitral insufficiency
Tetralogy of fallot

17. What are the complications of mitral valve prolapse? Are they common?
Mitral regurg
Shunt
Nitroglycerin
Infectious endocarditis - arrythmias - severe mitral regurg no

18. What are the complications that occur months after an MI?
Mitral valve prolapse
Aneurysm - mural thrombus - Dressler syndrome
Granulation tissue
Low voltage EKG w/diminished QRS amplitude

19. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Squatting - increased systemic resistence decreases LV emptying
Maternal diabetes
Papillary muscle - free wall - IV septum

20. What drug relieves stable angina?
Nitroglycerin
Rhadbomyoma - benign
Anitschow cell
Aortic regurg

21. What creates the immune reaction in acute rhuematic fever?

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22. What is the rate of congenital heart defects?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Right -->left
1%
Transesophageal echo

23. What causes mitral valve prolapse?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Myxoid degeneration
Squatting - expiration
Squat in response to cyanotic spell

24. What is a common complication of cardiac metastasis?
White scar fibrosis
Day 1-7
Reperfusion injury
Pericardial effusion due to pericardial involvement

25. What % of MIs involve the LAD?
45%
Loeffler syndrome
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

26. What does a biopsy of hypertrophic cardiomyopathy look like?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Reperfusion injury
Myofiber hypertrophy with disarray
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

27. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Reactive histiocyte with caterpillar nucleus
Large - destructive vegetations
ASD - R-->L

28. What is the basic principle of CHF?
Pump failure
Elevated ASO anti - DNase B titers
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Coronary artery vasospasm - emboli - vasculitis

29. What are the sx/complications of myocarditis?
Surgical closure small defects may close spontaneously
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Infantile coarctation of the aorta
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. What causes a mid - systolic click followed by a regurgitation murmur?
Endocarditis of prosthetic valves
3-8 wks
Mitral and tricuspid regurg - arrhythmia
Mitral valve prolapse

31. What type of shunt does a VSD cause?
L->R
SLE
Split S2 on auscultation
Congenital rubella

32. What gross and microscopic changes occur 4-24 hours after an MI?
Migratory polyarthritis
1-3 days out
Large vegetations of S aureus
Dark discoloration coagulative necrosis

33. What are other (not atherosclerotic) causes of MI?
LAD
Large vegetations of S aureus
Coronary artery vasospasm - emboli - vasculitis
Regurg vs stenosis

34. What causes prinzmetal angina?
White scar fibrosis
Coronary artery vasospasm
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Mitral stenosis

35. What effect does mitral stenosis have on the heart chambers?
LA dilation
Chronic ischemic heart disease
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
ST- segment elevation

36. What characterizes acute rheumatic fever endocarditiis?
Transesophageal echo
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Small vegetations along the line of closure
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

37. What is migratory polyarthritis?
Congestive heart failure
Fibrinous pericarditis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Dark discoloration coagulative necrosis

38. What is the foundation of a scar?
RCA
Granulation tissue
Mitral regurgitation due to vegetations
Red border granulation tissue

39. What is the characteristic murmur of aortic stenosis?
L->R
Systolic ejection click followed by crescendo - decrescendo murmur
LA
Holosystolic machine like murmur

40. How does MI cause LHF?
Loss of LV fx
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Valve replacement once LV dysfx develops
LA

41. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
ASD - R-->L
>60 years - bicuspid aortic valve
Aortic stenosis
Libman - Sacks endocarditis

42. What are the sx of PDA at birth?
Yellow pallor macrophages
Regurg vs stenosis
Asymptomatic
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

43. What is the major cause of MI?
S epidermidis
Libman - Sacks endocarditis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

44. What is a complication of chronic rheumatic heart disease?
ST- segment elevation
VSD
Myocardium
Infectious endocarditis

45. What type of shunt does transposition of the great vessels cause?
Heart can't fill
White scar fibrosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
R-->L

46. Dilated cardiomyopathy is a late complication of what illness?
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
Day 1-7
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

47. How does hypertension cause LHF?

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48. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Reversible
Mitral mitral+aortic
LHF

49. Friction rub and chest pain.
Breast and lung carcinoma - melanoma - lymphoma
Right to left
RBC damaged while crossing the calcified valve causing schistocytes
Pericarditits

50. With what disease is transposition of the great vessels associated?
Heart can't fill
Hypercoagulable state or underlying adenocarcinoma
Hypertophy of RV atrophy of LV
Maternal diabetes