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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 is diastolic dysfx?
Large vegetations of S aureus
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Aortic stenosis
Inability to fill ventricles

2. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Rhabdomyoma
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Bounding pulse

3. What type of valvular vegetations does S aureus cause?
Trisomy 21
Hypercoagulable state or underlying adenocarcinoma
CK- MB
Large - destructive vegetations

4. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Streptococcus viridans
Pump failure
Harmartoma

5. What does Libman - Sacks endocarditis cause?
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
Dilation of all four chambers of the heart
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

6. What drug relieves stable angina?
20 min
Nitroglycerin
Tricuspid
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

7. Myofiber hypertrophy with disarray.
Reperfusion injury
Hypertrophic cardiomyopathy
Maternal diabetes
4-6 hours - 24 hours - 72 hours

8. What type of shunt does a VSD cause?
When a bacterial protein resembles a protein in human tissue
Aortic regurg
L->R
Mitral insufficiency

9. Sudden death in a young athlete.
Colon cancer
Hypertrophic cardiomyopathy
Mid - systolic click followed by regurgitation murmur
Type I

10. How does adult coarctation of the aorta present?
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
4-24 hours
MI
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

11. How does MI cause LHF?
Loss of LV fx
Valve replacement once LV dysfx develops
Streptococcus viridans
Within the first day

12. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Pancarditis
Preductal - post aortic arch
PGE

13. What coronary artery supplies the mitral valve papillary muscles?
Atherosclerosis of coronary arteries
RCA
Ehlers - Danlow and Marfan syndrome
Anitschow cell

14. How does hypertension cause LHF?

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15. What congenital heart defect does indomethacin tx?
PDA
Cardiac tamponade
Heart transplant
Loss of LV fx

16. What type of shunt results in cyanosis at birth?
Bacterial endocarditis
Ventricles cannot pump
Right to left
When a bacterial protein resembles a protein in human tissue

17. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Granulation tissue
Acute inflammation
R-->L

18. What are the complications of mitral valve prolapse? Are they common?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Sterile vegetations on surface and undersurface on mitral valve
When a bacterial protein resembles a protein in human tissue
Infectious endocarditis - arrythmias - severe mitral regurg no

19. What type of shunt does ASD cause?
Asymptomatic
Valve replacement
Left -->right
Within the first day

20. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
ST- segment elevation
Mitral mitral+aortic
L->R

21. Which angina(s) show ST elevation on EKG? ST depression?
1-3 days
Prinzmetal stable and unstable
First 4 hours
Mitral regurg

22. What typically causes hypertrophic cardiomyopathy?
1-3 days out
AD mutation in sarcomere proteins
Systemic venous congestion
LA dilation

23. What type of ischemia does stable angina cause?
Subendocardial
Cardiogenic shock - CHF - arrhythmia
Breast and lung carcinoma - melanoma - lymphoma
Mitral mitral+aortic

24. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Metastasis
Sterile vegetations on surface and undersurface on mitral valve
First 4 hours

25. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Rhabdomyoma
Open blocked vessels
S epidermidis

26. What is the rate of congenital heart defects?
SLE
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
1%
NG or Ca channel blocker

27. What is the murmur of mitral valve prolapse?
LAD
Mitral and tricuspid regurg - arrhythmia
Mid - systolic click followed by regurgitation murmur
Degree of pulmonary artery stenosis

28. What drugs can cause dilated cardiomyopathy?
1-3 days out
Doxorubicin - cocaine
Aschoff bodies
Eisenmenger syndrome

29. How does restrictive cardiomyopathy present?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Chronic ischemic heart disease
Circumflex
Congestive heart failure

30. What is an Anitschow cell?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Mitral mitral+aortic
Reactive histiocyte with caterpillar nucleus
NG or Ca channel blocker

31. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Rhabdomyoma
Preductal - post aortic arch
R-->L

32. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Tender lesions on fingers or toes.
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Nonbacterial thrombotic endocarditis (marantic endocarditis)

33. What is migratory polyarthritis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
When a bacterial protein resembles a protein in human tissue
Inability to maintain systemic pressure w/lack of O2 to vital organs
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

34. When is an MI pt at greatest risk for cardiogenic shock?
Prophylactic abx during dental procedures
Coronary artery vasospasm
First 4 hours
Loeffler syndrome

35. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Prinzmetal angina
Pericardial effusion due to pericardial involvement
Heart can't fill

36. What is the definition of ischemia?
Aneurysm - mural thrombus - Dressler syndrome
Decrease in blood flow to an organ
Osler nodes (ouch - ouch Osler)
Dilated

37. What compensatory mechanism do tetralogy of fallot pts learn?
Adult coarctation of the aorta
Anitschow cell
Squat in response to cyanotic spell
R-->L

38. In which chamber of the heart are cardiac myxomas found?
Cardiac tamponade
Breast and lung carcinoma - melanoma - lymphoma
LA
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

39. What is the gold standard blood marker for MI?
Tetralogy of fallot
Blood vessels coming in from normal tissue
Squatting - increased systemic resistence decreases LV emptying
Troponin I

40. What are the clinical features of endocarditis? What causes each feature?
Wear and tear
PDA
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Reperfusion injury

41. What is typically the mechanims of sudden cardiac death?
Dark discoloration coagulative necrosis
Autoimmune pericarditis 6-8 wks post MI
Aortic stenosis
Ventricular arrhythmia

42. What shunt does tetralogy of fallot produce?
Positive blood cultures anemia of chronic disease
S viridans
Reversible
Right -->left

43. With what virus is PDA associated?
First 4 hours
Congenital rubella
Streptococcus viridans
Tender lesions on fingers or toes.

44. What creates the immune reaction in acute rhuematic fever?

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45. What are the forward and backward sx of LHF?
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
Squatting - increased systemic resistence decreases LV emptying
Myxoid degeneration
Backward LHF pulm htn and RHF - afib and associated mural thombis

46. How do beta blockers tx MI?
Pts w/previously damaged valves
Reperfusion injury
Slow HR - decreasing O2 demand and risk for arrhythmia
Intercostal arteries enlarged due to collateral circulation

47. What are Janeway lesions?
Ventricle
Erythematous nontender lesions on palms and soles.
Months out fibrosis
Inability to fill ventricles

48. How do nitrates tx MI?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Decrease preload -->lowers myocardial stress
Mitral regurgitation due to vegetations
Squatting - increased systemic resistence decreases LV emptying

49. What is eythema marginatum? What parts of the body does it commonly involve?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Reactive histiocyte with caterpillar nucleus
Annular - non pruritic rash w/erythematous borders trunks and limbs
Myxoid degeneration

50. What gross and microscopic changes occur 1-3 days after an MI?
Minimizes ischemia
45%
RCA
Yellow pallor neutrophils