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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 is the most common cause of infectious endocarditis?
Circumflex
Streptococcus viridans
IV drug users
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

2. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Hypertrophic cardiomyopathy
Squatting - expiration
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

3. What are Osler nodes?
Tender lesions on fingers or toes.
Trisomy 21
Spontaneous
Pancarditis

4. What causes a mid - systolic click followed by a regurgitation murmur?
Colon cancer
Papillary muscle - free wall - IV septum
Mitral valve prolapse
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

5. What congenital heart defect is associated with fetal alcohol syndrome?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
4-6 hours - 24 hours - 72 hours
Pericarditits
VSD

6. What gross and microscopic changes occur 4-7 days after an MI?
Streptococcus bovis/
Doxorubicin - cocaine
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Yellow pallor macrophages

7. What are the Jones criteria?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
White scar fibrosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Chronic rheumatic heart disease

8. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Nonspecific - eg fever and elevated ESR
Louder - increased systemic resistence decreases LV emptying
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Shunt

9. What does nonbacterial thrombotic endocarditis cause?
Chest pain <20 min brought on by exertion or emotional stress
Dark discoloration coagulative necrosis
Turner syndrome
Mitral regurg

10. Vegetations on surface and undersurface of mitral valve.
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Metastasis
Libman - Sacks endocarditis
Reversible

11. What congenital heart defect does indomethacin tx?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Atherosclerosis of coronary arteries
PDA
Mitral regurg

12. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
PDA
Months out fibrosis
Pump failure

13. What causes heart failure cells?
Regurg vs stenosis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
White scar fibrosis
Surgical closure small defects may close spontaneously

14. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Paradoxical emboli
ACE inhibitor
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Loeffler syndrome

15. Erythematous nontender lesions on palms and soles.
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Janeway lesions
R-->L
Ventricles cannot pump

16. What is the main cause of MV regurg? What are other causes?
Coxsackie A or B
Asymptomatic
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
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

17. When would arrhythmia occur after MI?
Within the first day
Congestive heart failure
CK- MB
Inability to maintain systemic pressure w/lack of O2 to vital organs

18. What type of shunt does truncus arteriosus cause?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Infectious endocarditis
Large - destructive vegetations
R-->L

19. How does fibrinolysis/angioplasty tx MI?
Dark discoloration coagulative necrosis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Open blocked vessels
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

20. What genetic conditions predispose a pt to mitral valve prolapse?
Ehlers - Danlow and Marfan syndrome
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Myxoma - benign
Rhabdomyoma

21. What is the murmur of mitral regurg?
Aneurysm - mural thrombus - Dressler syndrome
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Pulsating nail bed
Holosystolic blowing murmur

22. What is the cause of restrictive cardiomyopathy in children?
S epidermidis
Dense layer of elastic and fibrotic tissue in the endocardium - children
1-3 days out
Endocardial fibroelastosis (rare)

23. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Pulsating nail bed
Mitral regurg
Bacterial endocarditis
Preductal - post aortic arch

24. What endocarditis is commonly found in patients with colon cancer?
Thickening of chrodae tendinae and cusps - mitral stenosis
Mitral insufficiency
Streptococcus bovis/
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

25. What bug causes acute rheumatic fever?
Posterior wall of LV - posterior septum - papillary muscles
Rhabdomyoma
Split S2 on auscultation
Group A beta - hemolytic streptococci

26. Is scar tissue or myocardium stronger?
Myocardium
RHF
Troponin I
Friction rub and chest pain

27. What compensatory mechanism do tetralogy of fallot pts learn?
Degree of pulmonary artery stenosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Transesophageal echo
Squat in response to cyanotic spell

28. What is an Aschoff body?
Metastasis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Valve replacement
Prinzmetal angina

29. When does the heart have dark discoloration post MI?
Pts w/previously damaged valves
Heart can't fill
4-24 hours
Concentric LV hypertophy

30. What complication occurs 1-3 days post MI?
Decrease preload -->lowers myocardial stress
Slow HR - decreasing O2 demand and risk for arrhythmia
Cardiac tamponade
Fibrinous pericarditis

31. How does reperfusion injury occur?
Transposition of the great vessels
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Atherosclerosis of coronary arteries
Chronic ischemic heart disease

32. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Harmartoma
Sudden cardiac death
Inability to fill ventricles
Atherosclerosis of coronary arteries

33. What type of endocarditis is associated with SLE?
Myocarditis in acute rheumatic heart fever
Hypertrophic cardiomyopathy
Libman - Sacks endocarditis
Chronic ischemic heart disease

34. What is the most common cause of mitral stenosis?
Squatting - expiration
Paradoxical emboli
Chronic rheumatic heart disease
Transposition of the great vessels

35. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Fetal alcohol syndrome
L->R
Day 1-7

36. What causes the split S2 in ASD?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Sudden cardiac death
Loss of LV fx
Increased blood in right heart delays closure of P valve

37. What causes prinzmetal angina?
Pulsating nail bed
Coronary artery vasospasm
Prinzmetal
Fetal alcohol syndrome

38. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
MI
Preductal - post aortic arch
Reperfusion injury
Volume overload and LHF

39. Why are cardiac enzymes elevated after an MI?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Systemic venous congestion
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Membrane damage

40. What type of ischemia does stable angina cause?
Mitral mitral+aortic
4-7 days macrophage infiltration
Subendocardial
Janeway lesions

41. What is the tx for mitral valve prolapse?
Osler nodes (ouch - ouch Osler)
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
Valve replacement
Pump failure

42. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Shunt - PGE to maintain PDA until surgical repair can be performed
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
MI
Valve scarring that arises as a consequence of rheumatic fever

43. Dilated cardiomyopathy is a late complication of what illness?
Mitral regurgitation due to vegetations
Libman - Sacks endocarditis
Indomethacin - decreases PGE
Myocarditis

44. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Fibrosis and dystrophic calcification
Heart transplant
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

45. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Cyanosis - RV hypertrophy - polycythemia - clubbing
Months out fibrosis
Positive blood cultures anemia of chronic disease

46. Which congenital heart defect is associated with maternal diabetes?
Decreased forward perfusion pulmonary congestion
Transposition of the great vessels
PDA
Pulsating nail bed

47. What effect does mitral stenosis have on the heart chambers?
1-3 days
LA dilation
Reversible
Preductal - post aortic arch

48. What is a common complication of cardiac metastasis?
R-->L
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
PGE
Pericardial effusion due to pericardial involvement

49. What is an important complication of ASD?
Endocardial fibroelastosis (rare)
Rupture of free wall - IV septum - or papillary muscle
Paradoxical emboli
Prinzmetal

50. What is the 1day-1wk -1mo mneumonic for MI?
S viridans
Papillary muscle - free wall - IV septum
Concentric LV hypertophy
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar