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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. Tender lesions on fingers or toes.
Right side - serotonin and other secretory products detoxified in the lung
Osler nodes (ouch - ouch Osler)
Cyanosis - RV hypertrophy - polycythemia - clubbing
IV drug users

2. What effect does mitral stenosis have on the heart chambers?
Small vegetations along the line of closure
2-3 weeks
ASD - R-->L
LA dilation

3. What disesase has Aschoff bodies?
Stretched muscle loses contractility
Concentric LV hypertophy
Myocarditis in acute rheumatic heart fever
Nitroglycerin

4. With what endocarditis is S epidermidis associated?
LV dilation and eccentric hypertrophy
First 4 hours
Group A beta - hemolytic streptococci
Endocarditis of prosthetic valves

5. What is the murmur of mitral valve prolapse?
Yellow pallor neutrophils
Mid - systolic click followed by regurgitation murmur
S epidermidis
Chest pain <20 min brought on by exertion or emotional stress

6. What is the etiology of S viridans endocarditis?
Infantile coarctation of the aorta
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Loeffler syndrome

7. What does a biopsy of hypertrophic cardiomyopathy look like?
Indomethacin - decreases PGE
Coronary artery vasospasm - emboli - vasculitis
Myofiber hypertrophy with disarray
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

8. What type of collagen is involved in fibrosis?
Type I
20 min
Aortic stenosis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

9. What effect does chronic rheumatic heart disease have the mitral valve?
Janeway lesions
Pancarditis
Thickening of chrodae tendinae and cusps - mitral stenosis
Papillary muscle - free wall - IV septum

10. In which chamber of the heart are rhabdomyomas found?
IV drug users
Decreased forward perfusion pulmonary congestion
Ventricle
Left -->right

11. What type of vegetations are associated with Libman - Sacks endocarditis?
Increased hydrostatic pressure
Valve replacement once LV dysfx develops
Reversible
Sterile vegetations on surface and undersurface on mitral valve

12. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Myxoid degeneration
S viridans
Dilated

13. What is the 1day-1wk -1mo mneumonic for MI?
Blood vessels coming in from normal tissue
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Mitral mitral+aortic
Mitral insufficiency

14. How does squating decrease hypoxemia in tetralogy of fallot?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
RCA
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Mitral mitral+aortic

15. At what point in development do congenital heart defects arise?
Coxsackie A or B
3-8 wks
Volume overload and LHF
LA

16. What is the most common valve infected by S aureus?
Tricuspid
Prophylactic abx during dental procedures
Aneurysm - mural thrombus - Dressler syndrome
Endocardial fibroelastosis (rare)

17. What are the complications of mitral valve prolapse? Are they common?
Transesophageal echo
Reperfusion injury
Fetal alcohol syndrome
Infectious endocarditis - arrythmias - severe mitral regurg no

18. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Restrictive cardiomyopathy
Months out fibrosis
LV dilation and eccentric hypertrophy
Myxoma - benign

19. What type of shunt does a VSD cause?
L->R
Ventricles cannot pump
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

20. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Troponin I
Prinzmetal angina
Maternal diabetes
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

21. What does rupture of a papillary muscle cause?
Myocarditis
Mitral insufficiency
S epidermidis
Pancarditis

22. What type of shunt results in cyanosis at birth?
Right to left
Blood vessels coming in from normal tissue
Squat in response to cyanotic spell
Tetralogy of fallot

23. What congenital heart defect presents later in life with lower extremity cyanosis?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Colon cancer
PDA
When a bacterial protein resembles a protein in human tissue

24. Are most congenital heart defects spontaneous or inherited?
3-8 wks
Aneurysm - mural thrombus - Dressler syndrome
Spontaneous
Red border granulation tissue

25. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Pericardial effusion due to pericardial involvement
Volume overload and LHF
Colon cancer
Dense layer of elastic and fibrotic tissue in the endocardium - children

26. What shunt does tetralogy of fallot produce?
Stable angina
Right -->left
Myofiber hypertrophy with disarray
Restrictive cardiomyopathy

27. What does Libman - Sacks endocarditis cause?
Ischemic heart disease
Right to left
Mitral regurg
Congested central veins

28. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Pericardial effusion due to pericardial involvement
Adult coarctation of the aorta
Large - destructive vegetations
Atherosclerosis of coronary arteries

29. Which congenital heart defect is associated with maternal diabetes?
Shunt
Eisenmenger syndrome
Prinzmetal angina
Transposition of the great vessels

30. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Months out fibrosis
Mitral stenosis
Mitral regurg

31. What is the JOneS mneumonic?
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
Squatting - expiration
Backward LHF pulm htn and RHF - afib and associated mural thombis
VSD

32. What is the most common cause of endocarditis in IV drug users?
>70%
PDA
S aureus
Myocarditis in acute rheumatic heart fever

33. What tests show prior group A beta - hemolytic strep infection?
Coronary artery vasospasm - emboli - vasculitis
2-4 hours - 24 hours - 7-10 days
Atherosclerosis of coronary arteries
Elevated ASO anti - DNase B titers

34. How do nitrates tx MI?
>60 years - bicuspid aortic valve
Myocarditis in acute rheumatic heart fever
Decrease preload -->lowers myocardial stress
Opening snap followed by diastolic rumble

35. What are the sx of aortic regurg?
SLE
Spontaneous
Ostium secundum (90%)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

36. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Systolic dysfx leading to biventricular CHF
1-3 days
Doxorubicin - cocaine

37. What is Dressler syndrome? When does it occur?
Metastasis
Autoimmune pericarditis 6-8 wks post MI
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Mitral stenosis

38. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Stable angina
Degree of pulmonary artery stenosis
Loss of fx
LAD

39. What is the most comon cause of aortic regurg? What are the other causes?
Large - destructive vegetations
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Shunt

40. EKG for stable angina?
Mitral valve prolapse
ST- segment depression
Harmartoma
Prinzmetal

41. Tx for PDA?
Plump fibroblasts - collagen - blood vessels
Contraction band necrosis - reperfusion injury
Indomethacin - decreases PGE
Heart transplant

42. What does chronic ischemic heart disease progress to?
Myocardium
Janeway lesions
CHF
Maternal diabetes

43. What is the most common type of ASD? What %?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Libman - Sacks endocarditis
Ostium secundum (90%)

44. What are Osler nodes?
Open blocked vessels
LHF
Tender lesions on fingers or toes.
Friction rub and chest pain

45. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Infectious endocarditis - arrythmias - severe mitral regurg no
Bacterial endocarditis
Atria and RV
RCA

46. What increases the volume of mitral regurg murmur?
Squatting - expiration
Breast and lung carcinoma - melanoma - lymphoma
Hypertrophic cardiomyopathy
Opening snap followed by diastolic rumble

47. What congenital heart defect is associated with fetal alcohol syndrome?
VSD
Valve replacement once LV dysfx develops
Nonbacterial thrombotic endocarditis (marantic endocarditis)
L->R

48. What type of shunt does ASD cause?
Coronary artery vasospasm - emboli - vasculitis
Pts w/previously damaged valves
Left -->right
Posterior wall of LV - posterior septum - papillary muscles

49. How does Eisenmeger syndrome occur?
Contraction band necrosis - reperfusion injury
LA
Dressler syndrome
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt

50. What drugs can cause dilated cardiomyopathy?
Pancarditis
Slow HR - decreasing O2 demand and risk for arrhythmia
Yellow pallor macrophages
Doxorubicin - cocaine