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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. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
PDA
SLE
Colon cancer
1%

2. What congenital heart defect presents later in life with lower extremity cyanosis?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
PDA
Reversible
1%

3. How does contraction band necrosis occur?
Systemic venous congestion
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Prinzmetal
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

4. What structures are susceptible to rupture post MI?
Indomethacin - decreases PGE
Tender lesions on fingers or toes.
Tetralogy of fallot
Papillary muscle - free wall - IV septum

5. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Tuberous sclerosis
Type I

6. Infects predamaged valves after transient bacteremia?
Eisenmenger syndrome
Increased hydrostatic pressure
S viridans
Decrease in blood flow to an organ

7. EKG for stable angina?
ST- segment elevation
PDA
Decrease in blood flow to an organ
ST- segment depression

8. With what disease is Libman - Sacks endocarditis associated?
Regurg vs stenosis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Yellow pallor neutrophils
SLE

9. What areas of the heart does the LAD supply?
Right side - serotonin and other secretory products detoxified in the lung
Anterior wall of LV and anterior septum
R-->L
Valve replacement once LV dysfx develops

10. What does rupture of a papillary muscle cause?
Mitral insufficiency
Myxoma - benign
First 4 hours
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

11. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
2-3%
PDA
Pulsating nail bed

12. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
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
Mitral regurg
Trisomy 21

13. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Adult coarctation of the aorta
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Mitral mitral+aortic

14. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
SLE
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
PDA

15. What is cardiogenic shock?
PDA
Inability to maintain systemic pressure w/lack of O2 to vital organs
ASD - R-->L
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

16. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
SLE
Regurg vs stenosis
Congenital rubella
Hypertrophic cardiomyopathy

17. What does rupture of the IV septum cause?
Loss of fx
Limits thrombosis
PDA
Shunt

18. What are the laboratory findings of bacterial endocarditis?
LV dilation and eccentric hypertrophy
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Positive blood cultures anemia of chronic disease
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

19. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
4-7 days macrophage infiltration
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Fibrosis and dystrophic calcification

20. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Pulsating nail bed
Reactive histiocyte with caterpillar nucleus
Trisomy 21

21. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Endocardial fibroelastosis (rare)
Contraction band necrosis - reperfusion injury
Opening snap followed by diastolic rumble

22. What type of shunt dose PDA cause?
LAD
Coexisting mitral stenosis and fusion of commisures exist
Ostium secundum (90%)
Left -->right

23. What congenital heart defect is associated with fetal alcohol syndrome?
Open blocked vessels
VSD
Fibrosis and dystrophic calcification
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

24. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Transesophageal echo
Mitral regurg
Indomethacin - decreases PGE

25. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Positive blood cultures anemia of chronic disease
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
RHF
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

26. What genetic conditions predispose a pt to mitral valve prolapse?
Minimizes ischemia
Mitral insufficiency
Pericardial effusion due to pericardial involvement
Ehlers - Danlow and Marfan syndrome

27. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Mitral regurg
2-4 hours - 24 hours - 7-10 days
Prinzmetal angina

28. What are the minor critera of the Jones criteria?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
2-3 weeks
Dilated
Nonspecific - eg fever and elevated ESR

29. With what endocarditis is S epidermidis associated?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Bacterial endocarditis
Endocarditis of prosthetic valves
Stable and unstable prinzmetal

30. Erythematous nontender lesions on palms and soles.
Breast and lung carcinoma - melanoma - lymphoma
R-->L
Janeway lesions
Anterior wall of LV and anterior septum

31. What type of shunt results in cyanosis at birth?
PDA
First 4 hours
Right to left
Wear and tear

32. What is the most common cause of aortic stenosis?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Wear and tear

33. What heart sound manifest with an ASD?
Large - destructive vegetations
Libman - Sacks endocarditis
Split S2 on auscultation
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

34. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Degree of pulmonary artery stenosis
Streptococcus bovis/
Endocardial fibroelastosis

35. What is dilated cardiomyopathy?
Nitroglycerin
Dilation of all four chambers of the heart
Dense layer of elastic and fibrotic tissue in the endocardium - children
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

36. What is the characteristic finding on CXR in tetralogy of fallot?
Right -->left
Hypertophy of RV atrophy of LV
Contraction band necrosis - reperfusion injury
Boot shaped heart

37. Are most congenital heart defects spontaneous or inherited?
PDA
Mitral mitral+aortic
Spontaneous
Ostium secundum (90%)

38. Which congenital heart defect is associated with congenital rubella?
PDA
Bounding pulse
Streptococcus viridans
Hypertrophic cardiomyopathy

39. What is migratory polyarthritis?
Metastasis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
4-6 hours - 24 hours - 72 hours

40. What gross and microscopic changes occur 4-24 hours after an MI?
Thickening of chrodae tendinae and cusps - mitral stenosis
S aureus
Dark discoloration coagulative necrosis
Inability to maintain systemic pressure w/lack of O2 to vital organs

41. What causes an early - blowing diastolic murmur?
3-8 wks
Aortic regurg
Myxoma - benign
Nitroglycerin

42. How does Eisenmeger syndrome occur?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Autoimmune pericarditis 6-8 wks post MI
Congested central veins
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

43. What murmur ccan be heard in PDA?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Loeffler syndrome
Holosystolic machine like murmur
Low voltage EKG w/diminished QRS amplitude

44. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Metastasis
Small vegetations along the line of closure
Rhadbomyoma - benign
Plump fibroblasts - collagen - blood vessels

45. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Slow HR - decreasing O2 demand and risk for arrhythmia
R-->L
Preductal - post aortic arch

46. Dilated cardiomyopathy is a late complication of what illness?
Large vegetations of S aureus
Months out fibrosis
Myocarditis
Streptococcus viridans

47. What is the rate of congenital heart defects?
Mitral insufficiency
ST- segment elevation
Months out fibrosis
1%

48. What always follows necrosis?
Myocarditis in acute rheumatic heart fever
2-3%
Streptococcus bovis/
Acute inflammation

49. What causes notching of the ribs in adult coarctation of the aorta?
Prinzmetal
Aschoff bodies
Intercostal arteries enlarged due to collateral circulation
PDA

50. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Rupture of free wall - IV septum - or papillary muscle
Myocarditis
Aortic regurg