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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. Which congenital heart defect is associated with maternal diabetes?
Concentric LV hypertophy
Contraction band necrosis
Increased hydrostatic pressure
Transposition of the great vessels

2. What is chronic rheumatic heart disease?
Large - destructive vegetations
Fetal alcohol syndrome
Valve scarring that arises as a consequence of rheumatic fever
Tricuspid

3. What shunt does tetralogy of fallot produce?
Wear and tear
Mitral valve prolapse
4-7 days macrophage infiltration
Right -->left

4. What vavular defect results from acute rheumatic fever?
Acute inflammation
Infantile coarctation of the aorta
Contraction band necrosis - reperfusion injury
Mitral regurgitation due to vegetations

5. What does Libman - Sacks endocarditis cause?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral mitral+aortic
Turner syndrome
Mitral regurg

6. How does subendocardial MI/ischemia present on EKG?
Stable angina
Regurg vs stenosis
ST- segment depression
RCA

7. What is the most common form of cardiomyopathy?
Heart can't fill
Myocardium
Dilated
RCA

8. What is the murmur of mitral regurg?
Granulation tissue
AD mutation in sarcomere proteins
Dressler syndrome
Holosystolic blowing murmur

9. What are other (not atherosclerotic) causes of MI?
4-7 days
Mitral regurg
Preductal - post aortic arch
Coronary artery vasospasm - emboli - vasculitis

10. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
RBC damaged while crossing the calcified valve causing schistocytes
ST- segment depression
Anitschow cell
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

11. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Congenital rubella
Contraction band necrosis
PDA

12. Which artery is most often occluded in an MI?
Mitral regurgitation due to vegetations
Anterior wall of LV and anterior septum
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
LAD

13. Which congenital heart defect is associated with congenital rubella?
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
Positive blood cultures anemia of chronic disease
PDA
Heart can't fill

14. What are the two effects of ATII?
Membrane damage
Decrease in blood flow to an organ
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
S aureus

15. What are the clinical features of RHF due to?
1-3 days
AD mutation in sarcomere proteins
Systemic venous congestion
Granulation tissue

16. What type of collagen is involved in fibrosis?
>70%
IV drug users
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Type I

17. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Eisenmenger syndrome
Loeffler syndrome
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

18. What is the only Jones criteria that doesn't resolve with time?
2-3%
Pancarditis
S aureus
Decreased forward perfusion pulmonary congestion

19. What causes angina and syncope in aortic stenosis?
Large - destructive vegetations
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
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
Stable angina

20. What is the 1day-1wk -1mo mneumonic for MI?
Shunt - PGE to maintain PDA until surgical repair can be performed
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Nonbacterial thrombotic endocarditis (marantic endocarditis)

21. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
CK- MB
Mitral valve prolapse
Anitschow cell

22. What complications occur 4-7 days post MI?
Restrictive cardiomyopathy
Rupture of free wall - IV septum - or papillary muscle
Shunt - PGE to maintain PDA until surgical repair can be performed
PDA

23. What gross and microscopic changes occur 1-3 weeks after an MI?
Ventricle
Red border granulation tissue
Ehlers - Danlow and Marfan syndrome
2-4 hours - 24 hours - 7-10 days

24. Are most congenital heart defects spontaneous or inherited?
Preductal - post aortic arch
Tender lesions on fingers or toes.
Spontaneous
Bicuspid aortic valve

25. What type of shunt does transposition of the great vessels cause?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Coexisting mitral stenosis and fusion of commisures exist
R-->L
RCA

26. At what point in development do congenital heart defects arise?
Decrease in blood flow to an organ
Posterior wall of LV - posterior septum - papillary muscles
Transposition of the great vessels
3-8 wks

27. What compensatory mechanism do tetralogy of fallot pts learn?
ST- segment depression
Fibrosis and dystrophic calcification
Squat in response to cyanotic spell
Right side - serotonin and other secretory products detoxified in the lung

28. Erythematous nontender lesions on palms and soles.
Janeway lesions
Right -->left
Minimizes ischemia
Prinzmetal angina

29. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Squat in response to cyanotic spell
Rhadbomyoma - benign
Right to left

30. What bug causes acute rheumatic fever?
Pancarditis
Group A beta - hemolytic streptococci
Inability to maintain systemic pressure w/lack of O2 to vital organs
Coexisting mitral stenosis and fusion of commisures exist

31. How do beta blockers tx MI?
LHF
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
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
Slow HR - decreasing O2 demand and risk for arrhythmia

32. Is injury due angina reversible or irreversible?
ASD - R-->L
Reversible
Dressler syndrome
Trisomy 21

33. What gross and microscopic changes occur 1-3 days after an MI?
Troponin I
Annular - non pruritic rash w/erythematous borders trunks and limbs
Yellow pallor neutrophils
RCA

34. What characterizes acute rheumatic fever endocarditiis?
PDA
Small vegetations along the line of closure
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
L->R

35. When does the heart have dark discoloration post MI?
4-24 hours
R-->L
1-3 days out
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

36. What is the most common cause of endocarditis in IV drug users?
Congested central veins
Type I
S aureus
Systolic dysfx leading to biventricular CHF

37. Dense layer of elastic and fibrotic tissue in the endocardium.
Right side - serotonin and other secretory products detoxified in the lung
Plump fibroblasts - collagen - blood vessels
Endocardial fibroelastosis
Endocarditis of prosthetic valves

38. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Transposition of the great vessels
Colon cancer
Tuberous sclerosis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

39. What two things happen when a blocked vessel is opened after an MI?
Myofiber hypertrophy with disarray
Contraction band necrosis - reperfusion injury
Coexisting mitral stenosis and fusion of commisures exist
Boot shaped heart

40. Which chambers of the heart are generally spared in an MI?
Aschoff bodies
Loss of LV fx
Atria and RV
Decrease in blood flow to an organ

41. What conditions can cause nonbacterial thrombotic endocarditis?
Migratory polyarthritis
Myxoma - benign
Ventricles cannot pump
Hypercoagulable state or underlying adenocarcinoma

42. When is an MI patent at highest risk for fibrionous pericarditis?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
1-3 days out
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Breast and lung carcinoma - melanoma - lymphoma

43. What is the leading cause of death in the US?
Myxoid degeneration
Ischemic heart disease
Fibrosis and dystrophic calcification
LA dilation

44. Dilated cardiomyopathy is a late complication of what illness?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Myocarditis
Streptococcus viridans
Membrane damage

45. What areas of the heart does the LAD supply?
Holosystolic machine like murmur
Hypertrophic cardiomyopathy
Increased blood in right heart delays closure of P valve
Anterior wall of LV and anterior septum

46. What drugs can cause dilated cardiomyopathy?
CHF
Nonspecific - eg fever and elevated ESR
Nitroglycerin
Doxorubicin - cocaine

47. When does the heart have a yellow pallor post MI?
Day 1-7
LA dilation
When a bacterial protein resembles a protein in human tissue
Ischemic heart disease

48. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Loeffler syndrome
Right -->left
ST- segment depression

49. Friction rub and chest pain.
VSD
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Maternal diabetes
Pericarditits

50. What are the complications of mitral stenosis?
Plump fibroblasts - collagen - blood vessels
Myofiber hypertrophy with disarray
Backward LHF pulm htn and RHF - afib and associated mural thombis
Sterile vegetations on surface and undersurface on mitral valve

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Cardiac

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