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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 type of shunt dose PDA cause?
Adult coarctation of the aorta
Left -->right
Sterile vegetations on mitral valve along lines of closure
Atria and RV

2. What is the most common form of cardiomyopathy?
Dilated
Wear and tear
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Contraction band necrosis

3. What is dilated cardiomyopathy?
Months out fibrosis
Dilation of all four chambers of the heart
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Troponin I

4. What are the clinical features of RHF due to?
Infectious endocarditis
Preductal - post aortic arch
Wear and tear
Systemic venous congestion

5. L- to - R shunt switching to R- to - L shunt.
Limits thrombosis
Right -->left
Eisenmenger syndrome
>60 years - bicuspid aortic valve

6. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Ehlers - Danlow and Marfan syndrome
Myocardium
Plump fibroblasts - collagen - blood vessels

7. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
Contraction band necrosis - reperfusion injury
Ehlers - Danlow and Marfan syndrome
Mitral mitral+aortic

8. What are the causes of LHF?
Concentric LV hypertophy
Breast and lung carcinoma - melanoma - lymphoma
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
RHF

9. What imaging test is useful for detecting lesions on valves?
Turner syndrome
Transesophageal echo
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Nitroglycerin

10. What gross and microscopic changes occur months after an MI?
ST- segment depression
White scar fibrosis
Transposition of the great vessels
Reperfusion injury

11. What are Osler nodes?
Tender lesions on fingers or toes.
Small - nondestructive vegetations (subacute endocarditis)
Increased hydrostatic pressure
Libman - Sacks endocarditis

12. What tests show prior group A beta - hemolytic strep infection?
Chronic rheumatic heart disease
Regurg vs stenosis
Elevated ASO anti - DNase B titers
Contraction band necrosis - reperfusion injury

13. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
PDA
4-7 days
Infantile coarctation of the aorta

14. What is the most common cause of endocarditis in IV drug users?
S aureus
Boot shaped heart
Adult coarctation of the aorta
VSD

15. What is the most common type of endocarditis?
Infectious
Large - destructive vegetations
Boot shaped heart
Chest pain <20 min brought on by exertion or emotional stress

16. What are the laboratory findings of bacterial endocarditis?
VSD
Boot shaped heart
Right to left
Positive blood cultures anemia of chronic disease

17. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
1-3 days out
Stable angina
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Myxoma - benign

18. How does ischemia cause LHF?
Loss of fx
CHF
Right to left
Atria and RV

19. Large vegetations on tricuspid valve?
Spontaneous
S aureus
Membrane damage
45%

20. With what endocarditis is S epidermidis associated?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Chest pain <20 min brought on by exertion or emotional stress
Endocarditis of prosthetic valves
Autoimmune pericarditis 6-8 wks post MI

21. What does granulation tissue contain?
Mitral mitral+aortic
Posterior wall of LV - posterior septum - papillary muscles
S aureus
Plump fibroblasts - collagen - blood vessels

22. What are the four defects in tetralogy of fallot?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Mitral regurg
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Holosystolic blowing murmur

23. Opening snap followed by diastolic rumble.
Months out fibrosis
Volume overload and LHF
Harmartoma
Mitral stenosis

24. What is the most common type of ASD? What %?
Ostium secundum (90%)
Trisomy 21
S epidermidis
Rhabdomyoma

25. What type of ASD is associated w/Down syndrome?
Large - destructive vegetations
Intercostal arteries enlarged due to collateral circulation
Ostium primum
Mitral valve prolapse

26. What increases the risk for chronic rheumatic heart disease?
Rupture of free wall - IV septum - or papillary muscle
Aortic regurg
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Reperfusion injury

27. What is an Anitschow cell?
Increased blood in right heart delays closure of P valve
Reactive histiocyte with caterpillar nucleus
Tuberous sclerosis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

28. Pericarditis 6-8 wks post MI.
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Dressler syndrome
Months out fibrosis
Infantile coarctation of the aorta

29. What is the most common cause of dilated cardiomyopathy? What are other causes?
Left -->right
Reversible
Stretched muscle loses contractility
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

30. What causes an early - blowing diastolic murmur?
Aortic regurg
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Loss of LV fx
PGE

31. What are the sx of PDA at birth?
Asymptomatic
Tetralogy of fallot
Slow HR - decreasing O2 demand and risk for arrhythmia
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

32. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
LA dilation
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Increased blood in right heart delays closure of P valve
Inability to maintain systemic pressure w/lack of O2 to vital organs

33. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Yellow pallor macrophages
Mitral and tricuspid regurg - arrhythmia
Myocarditis

34. What does rupture of the LV free wall cause?
Cardiac tamponade
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
PDA
Large vegetations of S aureus

35. At what point in development do congenital heart defects arise?
Day 1-7
Stable and unstable prinzmetal
Mitral regurg
3-8 wks

36. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Within the first day
Shunt
S epidermidis
Colon cancer

37. When does the heart have dark discoloration post MI?
Fetal alcohol syndrome
4-24 hours
Hypertrophic cardiomyopathy
Myxoid degeneration

38. Boot - shaped heart on x- ray?
Bounding pulse
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Tetralogy of fallot
Sudden cardiac death

39. How does squating decrease hypoxemia in tetralogy of fallot?
Right to left
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
R-->L
Inability to fill ventricles

40. In what pt population does S aureus commonly cause valvular disease?
Rhadbomyoma - benign
IV drug users
Aortic regurg
Positive blood cultures anemia of chronic disease

41. What is Loeffler syndrome?
Pump failure
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Myxoma - benign
Congenital rubella

42. Which congenital heart defect is associated with congenital rubella?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
PDA
Membrane damage
Ventricles cannot pump

43. What is the major cause of MI?
Thickening of chrodae tendinae and cusps - mitral stenosis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
R-->L
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

44. What is eythema marginatum? What parts of the body does it commonly involve?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Tetralogy of fallot
Granulation tissue
Annular - non pruritic rash w/erythematous borders trunks and limbs

45. Why are cardiac enzymes elevated after an MI?
Harmartoma
Red border granulation tissue
Membrane damage
Bacterial endocarditis

46. What causes endocarditis of prosthetic valves?
Pancarditis
4-24 hours
S epidermidis
Months out fibrosis

47. Holosystolic blowing murmur that increases w/expiration?
1-3 days out
AD mutation in sarcomere proteins
Mitral regurg
Intercostal arteries enlarged due to collateral circulation

48. With what virus is PDA associated?
Congenital rubella
Acute inflammation
Ischemic heart disease
S viridans

49. What % of MIs involve the LAD?
Fibrosis and dystrophic calcification
45%
Nonspecific - eg fever and elevated ESR
Type I

50. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Hypertophy of RV atrophy of LV
Ventricles cannot pump
Intercostal arteries enlarged due to collateral circulation
Adult coarctation of the aorta