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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 are the causes of LHF?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Pts w/previously damaged valves
Bicuspid aortic valve
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

2. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Infectious endocarditis
Ventricular arrhythmia
LA

3. What is the gold standard blood marker for MI?
Troponin I
Pulsating nail bed
Hemosiderin laden macrophages
Atria and RV

4. What is an Aschoff body?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
RBC damaged while crossing the calcified valve causing schistocytes
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Positive blood cultures anemia of chronic disease

5. What are complications of dilated cardiomyopathy?
Right to left
Mitral and tricuspid regurg - arrhythmia
Preductal - post aortic arch
PGE

6. Large vegetations on tricuspid valve?
Months out fibrosis
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
S aureus
Left -->right

7. What effect does chronic rheumatic heart disease have on the aortic valve?

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8. What causes acute endocarditis?
Membrane damage
Large vegetations of S aureus
Harmartoma
Louder - increased systemic resistence decreases LV emptying

9. What type of shunt does truncus arteriosus cause?
R-->L
Posterior wall of LV - posterior septum - papillary muscles
Decrease in blood flow to an organ
Circumflex

10. How does aortic regurg affect the heart chambers?
Pts w/previously damaged valves
Mitral mitral+aortic
Janeway lesions
LV dilation and eccentric hypertrophy

11. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Limits thrombosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
Wear and tear

12. What type of ASD is associated w/Down syndrome?
Increased hydrostatic pressure
Ostium primum
Hypertrophic cardiomyopathy
Transesophageal echo

13. What causes mitral valve prolapse?
Ostium primum
Mitral and tricuspid regurg - arrhythmia
Friction rub and chest pain
Myxoid degeneration

14. What heart sound manifest with an ASD?
Breast and lung carcinoma - melanoma - lymphoma
Mitral regurg
Months out fibrosis
Split S2 on auscultation

15. What is molecular mimicry?
When a bacterial protein resembles a protein in human tissue
Aortic regurg
Mid - systolic click followed by regurgitation murmur
Pulsating nail bed

16. Turner syndrome is associated with which congenital heart defect?
Pancarditis
Squatting - increased systemic resistence decreases LV emptying
20 min
Infantile coarctation of the aorta

17. 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)
Osler nodes (ouch - ouch Osler)
Rupture of free wall - IV septum - or papillary muscle
Rhabdomyoma

18. How does dilated cardiomyopathy cause LHF?
S aureus
Dense layer of elastic and fibrotic tissue in the endocardium - children
S epidermidis
Stretched muscle loses contractility

19. How does hypertension cause LHF?

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20. What is dilated cardiomyopathy?
Contraction band necrosis - reperfusion injury
Elevated ASO anti - DNase B titers
Dilation of all four chambers of the heart
Myocarditis in acute rheumatic heart fever

21. How does O2 tx MI?
Minimizes ischemia
Indomethacin - decreases PGE
Myxoma - benign
Circumflex

22. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Squatting - expiration
Streptococcus viridans
Prinzmetal

23. What is the definition of ischemia?
Hemosiderin laden macrophages
Decrease in blood flow to an organ
Ventricular arrhythmia
Spontaneous

24. What are the tx for MI?
Subendocardial
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Ventricles cannot pump
Tricuspid

25. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Infectious endocarditis - arrythmias - severe mitral regurg no
Concentric LV hypertophy
Reperfusion injury
Rhabdomyoma

26. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Loeffler syndrome
Paradoxical emboli
Contraction band necrosis - reperfusion injury

27. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Harmartoma
PDA
Nonspecific - eg fever and elevated ESR

28. What is the tx for dilated cardiomyopathy?
Streptococcus viridans
Heart transplant
Mitral stenosis
Reperfusion injury

29. What murmur ccan be heard in PDA?
Coronary artery vasospasm - emboli - vasculitis
Tender lesions on fingers or toes.
Holosystolic machine like murmur
S viridans

30. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
RHF
Circumflex
Adult coarctation of the aorta
RBC damaged while crossing the calcified valve causing schistocytes

31. What is migratory polyarthritis?
Infectious endocarditis - arrythmias - severe mitral regurg no
Degree of pulmonary artery stenosis
Myxoid degeneration
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

32. What gross and microscopic changes occur 4-24 hours after an MI?
Sterile vegetations on surface and undersurface on mitral valve
Dark discoloration coagulative necrosis
S aureus
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

33. What are the sx of cardiac myxoma?
1-3 days out
PGE
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Rupture of free wall - IV septum - or papillary muscle

34. What are the clinical features of endocarditis? What causes each feature?
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
S aureus
LV dilation and eccentric hypertrophy
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

35. How does fibrinolysis/angioplasty tx MI?
Aneurysm - mural thrombus - Dressler syndrome
Pump failure
Open blocked vessels
Migratory polyarthritis

36. What is the main cause of MV regurg? What are other causes?
Coronary artery vasospasm - emboli - vasculitis
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Ostium primum

37. How does ischemia cause LHF?
Loss of fx
Rhadbomyoma - benign
Pancarditis
Within the first day

38. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Pericarditits
Squatting - increased systemic resistence decreases LV emptying
Stable and unstable prinzmetal

39. Which vasculitis can cause MI?
Paradoxical emboli
Kawasaki disease
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Loss of fx

40. Are most congenital heart defects spontaneous or inherited?
Spontaneous
Squatting - increased systemic resistence decreases LV emptying
Friction rub and chest pain
Prinzmetal

41. When does the heart have a yellow pallor post MI?
Stable angina
ASD - R-->L
Day 1-7
PDA

42. In which chamber of the heart are cardiac myxomas found?
SLE
PDA
LA
Nonspecific - eg fever and elevated ESR

43. Pericarditis 6-8 wks post MI.
LAD
Dressler syndrome
Coronary artery vasospasm - emboli - vasculitis
PDA

44. What causes wear and tear aortic stenosis?
Erythematous nontender lesions on palms and soles.
Fibrosis and dystrophic calcification
Mitral regurg
Positive blood cultures anemia of chronic disease

45. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Yellow pallor neutrophils
Intercostal arteries enlarged due to collateral circulation

46. What congenital heart defect does indomethacin tx?
PDA
Gelatinous - abundant ground substance
Decrease in blood flow to an organ
Ischemic heart disease

47. What is the murmur of mitral valve prolapse?
Red border granulation tissue
Infantile coarctation of the aorta
VSD
Mid - systolic click followed by regurgitation murmur

48. What causes angina and syncope in aortic stenosis?

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49. What is cardiogenic shock?
S viridans
Red border granulation tissue
Inability to maintain systemic pressure w/lack of O2 to vital organs
Mitral regurg

50. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Plump fibroblasts - collagen - blood vessels
S aureus