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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. How does asprin/heparin tx MI?
Preductal - post aortic arch
Limits thrombosis
Infectious
Pancarditis

2. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Pulsating nail bed
1%
Squat in response to cyanotic spell

3. Large vegetations on tricuspid valve?
Positive blood cultures anemia of chronic disease
S aureus
Prinzmetal angina
Holosystolic machine like murmur

4. Which angina is relieved by Ca channel blockers?
Within the first day
Mitral and tricuspid regurg - arrhythmia
Decreases LV dilation by decreasing volume
Prinzmetal

5. What always follows necrosis?
Maternal diabetes
Acute inflammation
Right side - serotonin and other secretory products detoxified in the lung
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

6. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Ostium secundum (90%)
Ehlers - Danlow and Marfan syndrome
Decrease preload -->lowers myocardial stress

7. What compensatory mechanism do tetralogy of fallot pts learn?
MI
Squat in response to cyanotic spell
Metastasis
Minimizes ischemia

8. Friction rub and chest pain.
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Stable and unstable prinzmetal
Pericarditits
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

9. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
White scar fibrosis
Ventricular arrhythmia
PGE
Myxoma - benign

10. What are complications of dilated cardiomyopathy?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Fibrosis and dystrophic calcification
Mitral and tricuspid regurg - arrhythmia

11. What are Osler nodes?
Plump fibroblasts - collagen - blood vessels
Kawasaki disease
Tender lesions on fingers or toes.
Decrease preload -->lowers myocardial stress

12. Which congenital heart defect is associated with maternal diabetes?
Opening snap followed by diastolic rumble
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Ventricle
Transposition of the great vessels

13. How does adult coarctation of the aorta present?
Infantile coarctation of the aorta PDA
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Hypertophy of RV atrophy of LV
Sterile vegetations on mitral valve along lines of closure

14. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Fibrosis and dystrophic calcification
Spontaneous
Tricuspid

15. What drugs can cause dilated cardiomyopathy?
Libman - Sacks endocarditis
Doxorubicin - cocaine
S aureus
Shunt - PGE to maintain PDA until surgical repair can be performed

16. What characterizes acute rheumatic fever endocarditiis?
Troponin I
Hypertrophic cardiomyopathy
Small vegetations along the line of closure
Valve replacement AFTER the onset of complications

17. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Annular - non pruritic rash w/erythematous borders trunks and limbs
PDA

18. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Mitral insufficiency
Adult coarctation of the aorta
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

19. What type of shunt does truncus arteriosus cause?
Gelatinous - abundant ground substance
Valve scarring that arises as a consequence of rheumatic fever
Thickening of chrodae tendinae and cusps - mitral stenosis
R-->L

20. What complications occur within 4 hrs post MI?
Ventricular arrhythmia
Cardiogenic shock - CHF - arrhythmia
Squat in response to cyanotic spell
Holosystolic blowing murmur

21. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Harmartoma
>60 years - bicuspid aortic valve
Tetralogy of fallot

22. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Pump failure
Nitroglycerin

23. How does dilated cardiomyopathy cause LHF?
Mid - systolic click followed by regurgitation murmur
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Stretched muscle loses contractility
Small vegetations along the line of closure

24. How does contraction band necrosis occur?
Louder - increased systemic resistence decreases LV emptying
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Inability to maintain systemic pressure w/lack of O2 to vital organs
Spontaneous

25. In which chamber of the heart are rhabdomyomas found?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Ventricle
When a bacterial protein resembles a protein in human tissue
Backward LHF pulm htn and RHF - afib and associated mural thombis

26. What does a biopsy of hypertrophic cardiomyopathy look like?
Ventricular arrhythmia
Myofiber hypertrophy with disarray
When a bacterial protein resembles a protein in human tissue
R-->L

27. Ostium primum ASD is associated with what congenital disorder?
Louder - increased systemic resistence decreases LV emptying
Increased blood in right heart delays closure of P valve
Reversible
Trisomy 21

28. What are the sx of cardiac myxoma?
First 4 hours
1%
Pedunculated mass in the LA that causes syncope due to obstruction of MV
MI

29. What is the gold standard blood marker for MI?
LV dilation and eccentric hypertrophy
Myocarditis in acute rheumatic heart fever
Troponin I
Acute inflammation

30. What is the cause of restrictive cardiomyopathy in children?
Reversible
Red border granulation tissue
Endocardial fibroelastosis (rare)
S aureus

31. When do neutrophils infiltrate the myocardium post MI?
Tuberous sclerosis
Ostium secundum (90%)
1-3 days
When a bacterial protein resembles a protein in human tissue

32. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Holosystolic machine like murmur
Regurg vs stenosis
Bounding pulse
MI

33. What is the most common cause of endocarditis in IV drug users?
Anterior wall of LV and anterior septum
S aureus
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
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

34. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Myofiber hypertrophy with disarray
Prinzmetal angina
Aschoff bodies
CHF

35. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
LA
Months out fibrosis
Hemosiderin laden macrophages
Degree of pulmonary artery stenosis

36. Sudden death in a young athlete.
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Hypertrophic cardiomyopathy
Circumflex
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

37. What is diastolic dysfx?
VSD
Inability to fill ventricles
Louder - increased systemic resistence decreases LV emptying
Contraction band necrosis - reperfusion injury

38. What is the rate of mitral valve prolapse in the US?
Elevated ASO anti - DNase B titers
Ischemic heart disease
2-3%
Gelatinous - abundant ground substance

39. Systolic ejection click followed by crescendo - decrescendo murmur.
Myofiber hypertrophy with disarray
Volume overload and LHF
Ostium secundum (90%)
Aortic stenosis

40. What does rupture of a papillary muscle cause?
Anitschow cell
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 insufficiency
Colon cancer

41. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Small vegetations along the line of closure
Concentric LV hypertophy
VSD
PDA

42. With what endocarditis is S epidermidis associated?
Decrease preload -->lowers myocardial stress
Systemic venous congestion
Endocarditis of prosthetic valves
Sterile vegetations on mitral valve along lines of closure

43. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Harmartoma
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral regurgitation due to vegetations
R-->L

44. What is the cause of the red border around granulation tissue?
Prinzmetal
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
NG or Ca channel blocker
Blood vessels coming in from normal tissue

45. Opening snap followed by diastolic rumble.
Mitral stenosis
LAD
Stable and unstable prinzmetal
Mitral mitral+aortic

46. Tx for PDA?
Shunt
Myocarditis
Breast and lung carcinoma - melanoma - lymphoma
Indomethacin - decreases PGE

47. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Squatting - increased systemic resistence decreases LV emptying
Atria and RV
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

48. What is typically the mechanims of sudden cardiac death?
Hypertophy of RV atrophy of LV
Surgical closure small defects may close spontaneously
Migratory polyarthritis
Ventricular arrhythmia

49. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Pericarditits
1-3 days out

50. What does chronic ischemic heart disease progress to?
CHF
VSD
Endocardial fibroelastosis (rare)
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib