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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 iis the tx for aortic regurg?
Aortic regurg
ST- segment depression
Valve replacement once LV dysfx develops
Rhabdomyoma

2. What is the definition of ischemia?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Valve replacement AFTER the onset of complications
Intercostal arteries enlarged due to collateral circulation
Decrease in blood flow to an organ

3. How does ischemia cause LHF?
Loss of fx
Turner syndrome
>70%
Cyanosis - RV hypertrophy - polycythemia - clubbing

4. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Coronary artery vasospasm - emboli - vasculitis
Circumflex
Anitschow cell
Mid - systolic click followed by regurgitation murmur

5. At what point in development do congenital heart defects arise?
ST- segment depression
3-8 wks
Congestive heart failure
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

6. What makes the MV prolapse murmur louder? Why?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Squatting - increased systemic resistence decreases LV emptying
Chronic ischemic heart disease
Degree of pulmonary artery stenosis

7. What type of endocarditis is associated with SLE?
RCA
Prophylactic abx during dental procedures
Libman - Sacks endocarditis
Transesophageal echo

8. What are the cancers that most commonly metastasize to the heart?
Infantile coarctation of the aorta
Mitral regurg
Decrease in blood flow to an organ
Breast and lung carcinoma - melanoma - lymphoma

9. What effect does mitral stenosis have on the heart chambers?
Mitral mitral+aortic
LA dilation
Loss of LV fx
Coronary artery vasospasm

10. What coronary artery supplies the mitral valve papillary muscles?
Spontaneous
Membrane damage
RCA
Increased hydrostatic pressure

11. What is the most common tumor of the heart?
Metastasis
Inability to maintain systemic pressure w/lack of O2 to vital organs
Thickening of chrodae tendinae and cusps - mitral stenosis
LV dilation and eccentric hypertrophy

12. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Sterile vegetations on surface and undersurface on mitral valve
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Louder - increased systemic resistence decreases LV emptying
Small vegetations along the line of closure

13. Which coronary artery supplies the anterior wall and anterior septum?
Dilated
Transesophageal echo
Eisenmenger syndrome
LAD

14. What does rupture of the IV septum cause?
Shunt
S epidermidis
Dense layer of elastic and fibrotic tissue in the endocardium - children
Heart transplant

15. What causes the dependent pitting edema in RHF?
Coronary artery vasospasm - emboli - vasculitis
Adult coarctation of the aorta
Increased hydrostatic pressure
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

16. What congenital heart defect is associated with fetal alcohol syndrome?
Squatting - increased systemic resistence decreases LV emptying
VSD
Concentric LV hypertophy
Systolic ejection click followed by crescendo - decrescendo murmur

17. How does restrictive cardiomyopathy cause LHF?

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18. What is a common complication of cardiac metastasis?
ACE inhibitor
Pericardial effusion due to pericardial involvement
Endocardial fibroelastosis (rare)
4-6 hours - 24 hours - 72 hours

19. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Circumflex
Squatting - expiration
Mitral mitral+aortic
Colon cancer

20. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Infectious endocarditis
Hemosiderin laden macrophages
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Months out fibrosis

21. What is eythema marginatum? What parts of the body does it commonly involve?
Degree of pulmonary artery stenosis
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mitral valve prolapse
RCA

22. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Mitral regurgitation due to vegetations
1-3 days
Coronary artery vasospasm - emboli - vasculitis

23. What is the most common cause of endocarditis in IV drug users?
Mitral regurg
Bounding pulse
S aureus
Pulsating nail bed

24. What areas of the heart does the LAD supply?
Left -->right
Stable angina
Anterior wall of LV and anterior septum
Congestive heart failure

25. What maintains patency of the PDA?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
PGE
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

26. What generally causes ischemic heart disease?
Dilation of all four chambers of the heart
Atherosclerosis of coronary arteries
Coronary artery vasospasm
Libman - Sacks endocarditis

27. What complication occurs 1-3 days post MI?
Concentric LV hypertophy
Fibrinous pericarditis
Aneurysm - mural thrombus - Dressler syndrome
Friction rub and chest pain

28. What conditions can cause nonbacterial thrombotic endocarditis?
LAD
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Hypercoagulable state or underlying adenocarcinoma

29. What compensatory mechanism do tetralogy of fallot pts learn?
Streptococcus bovis/
Squat in response to cyanotic spell
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Concentric LV hypertophy

30. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
Months out fibrosis
VSD
Hemosiderin laden macrophages

31. What is the cause of the red border around granulation tissue?
Breast and lung carcinoma - melanoma - lymphoma
Blood vessels coming in from normal tissue
20 min
Mitral insufficiency

32. With what developmental disorder is VSD associated?
Rupture of free wall - IV septum - or papillary muscle
Mitral valve prolapse
Ehlers - Danlow and Marfan syndrome
Fetal alcohol syndrome

33. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
Rupture of free wall - IV septum - or papillary muscle
Infectious
ACE inhibitor

34. Friction rub and chest pain.
Mitral regurgitation due to vegetations
Pericarditits
Nonbacterial thrombotic endocarditis (marantic endocarditis)
1%

35. What is dilated cardiomyopathy?
Tetralogy of fallot
Dilation of all four chambers of the heart
Small - nondestructive vegetations (subacute endocarditis)
3-8 wks

36. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Stable angina
PGE
Hypertophy of RV atrophy of LV

37. What are the sx of PDA at birth?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Months out fibrosis
Ostium secundum (90%)
Asymptomatic

38. Myofiber hypertrophy with disarray.
Decreased forward perfusion pulmonary congestion
L->R
Hypertrophic cardiomyopathy
Slow HR - decreasing O2 demand and risk for arrhythmia

39. What is the basic principle of CHF?
Pump failure
Dressler syndrome
Type I
Myocarditis

40. What is the leading cause of death in the US?
Transesophageal echo
LAD
Ischemic heart disease
Myocarditis

41. What are Janeway lesions?
Months out fibrosis
Erythematous nontender lesions on palms and soles.
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

42. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Squatting - expiration
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Squat in response to cyanotic spell
Bacterial endocarditis

43. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
ST- segment elevation
Infectious
Gelatinous - abundant ground substance

44. What is the only Jones criteria that doesn't resolve with time?
Slow HR - decreasing O2 demand and risk for arrhythmia
Decrease in blood flow to an organ
Pancarditis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

45. Dilated cardiomyopathy is a late complication of what illness?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
LHF
Trisomy 21
Myocarditis

46. What causes acute endocarditis?
Cardiogenic shock - CHF - arrhythmia
Rhadbomyoma - benign
Large vegetations of S aureus
Bounding pulse

47. What are complications of dilated cardiomyopathy?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Colon cancer
Mitral and tricuspid regurg - arrhythmia
Myocarditis

48. What imaging test is useful for detecting lesions on valves?
Inability to fill ventricles
Mitral regurg
Transposition of the great vessels
Transesophageal echo

49. What type of shunt does ASD cause?
Left -->right
ST- segment depression
Aortic regurg
Regurg vs stenosis

50. What causes angina and syncope in aortic stenosis?

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