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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. Is scar tissue or myocardium stronger?
PDA
1-3 days
Decreased forward perfusion pulmonary congestion
Myocardium

2. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Trisomy 21
Osler nodes (ouch - ouch Osler)
Migratory polyarthritis
Elevated ASO anti - DNase B titers

3. What genetic conditions predispose a pt to mitral valve prolapse?
Rhadbomyoma - benign
Fibrinous pericarditis
Janeway lesions
Ehlers - Danlow and Marfan syndrome

4. What type of shunt does transposition of the great vessels cause?
Holosystolic machine like murmur
R-->L
Chest pain <20 min brought on by exertion or emotional stress
Prinzmetal stable and unstable

5. What is a common complication of cardiac metastasis?
Reversible
Prinzmetal angina
Coronary artery vasospasm - emboli - vasculitis
Pericardial effusion due to pericardial involvement

6. What causes endocarditis of prosthetic valves?
Mitral regurg
Restrictive cardiomyopathy
S epidermidis
Kawasaki disease

7. What are Janeway lesions?
4-7 days
Erythematous nontender lesions on palms and soles.
Tender lesions on fingers or toes.
Open blocked vessels

8. Which angina is relieved by Ca channel blockers?
Plump fibroblasts - collagen - blood vessels
Decreased forward perfusion pulmonary congestion
Tender lesions on fingers or toes.
Prinzmetal

9. What two things cause coronary artery vasospasm?
Atherosclerosis of coronary arteries
Myocardium
Months out fibrosis
Prinzmetal angina - cocaine

10. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Prinzmetal angina - cocaine
Myocardium
Prophylactic abx during dental procedures

11. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Infectious endocarditis
Sudden cardiac death
Chronic rheumatic heart disease

12. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Left -->right
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Louder - increased systemic resistence decreases LV emptying
Dilated

13. In which chamber of the heart are cardiac myxomas found?
Ehlers - Danlow and Marfan syndrome
LA
Bicuspid aortic valve
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

14. What are the minor critera of the Jones criteria?
Type I
Months out fibrosis
Nonspecific - eg fever and elevated ESR
Preductal - post aortic arch

15. What is the most common cause of dilated cardiomyopathy? What are other causes?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Reperfusion injury
Infantile coarctation of the aorta
Prinzmetal

16. What increases the risk for chronic rheumatic heart disease?
ST- segment depression
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Surgical closure small defects may close spontaneously
IV drug users

17. What type of tumor is a rhabdomyoma?
Harmartoma
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
S epidermidis
Mitral insufficiency

18. What are complications of dilated cardiomyopathy?
ST- segment depression
Small vegetations along the line of closure
Mitral and tricuspid regurg - arrhythmia
4-7 days macrophage infiltration

19. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Low voltage EKG w/diminished QRS amplitude
Subendocardial
Transesophageal echo

20. What gross and microscopic changes occur months after an MI?
White scar fibrosis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
S aureus
Infantile coarctation of the aorta

21. What are the clinical features of endocarditis? What causes each feature?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Coexisting mitral stenosis and fusion of commisures exist
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
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

22. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Bicuspid aortic valve
Congested central veins
Blood vessels coming in from normal tissue

23. When is an MI pt at greatest risk for cardiogenic shock?
4-7 days macrophage infiltration
First 4 hours
Elevated ASO anti - DNase B titers
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

24. How does Eisenmeger syndrome occur?
1-3 days
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
Plump fibroblasts - collagen - blood vessels
ASD - R-->L

25. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Limits thrombosis
Months out fibrosis
Left -->right
Loeffler syndrome

26. What are the clinical features of RHF due to?
PDA
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Systemic venous congestion
Eisenmenger syndrome

27. What drugs can cause dilated cardiomyopathy?
Anterior wall of LV and anterior septum
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Doxorubicin - cocaine
Small vegetations along the line of closure

28. What are the sx/complications of myocarditis?
Aortic stenosis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Louder - increased systemic resistence decreases LV emptying
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

29. When do neutrophils infiltrate the myocardium post MI?
Mitral regurg
1-3 days
Inability to maintain systemic pressure w/lack of O2 to vital organs
Janeway lesions

30. What is the most common cause of death during the acute phase of rheumatic fever?
Coxsackie A or B
Myocarditis
Eisenmenger syndrome
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

31. How does adult coarctation of the aorta present?
Regurg vs stenosis
Aortic regurg
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

32. Why are cardiac enzymes elevated after an MI?
White scar fibrosis
Mitral stenosis
Membrane damage
Pump failure

33. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Surgical closure small defects may close spontaneously
Maternal diabetes
VSD

34. What causes wear and tear aortic stenosis?
Asymptomatic
Fibrosis and dystrophic calcification
Hypertophy of RV atrophy of LV
ST- segment depression

35. What coronary arterysupplies the lateral wall of the LV?
Hypertrophic cardiomyopathy
Large vegetations of S aureus
Left -->right
Circumflex

36. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Aortic regurg
Spontaneous
Surgical closure small defects may close spontaneously

37. What type of shunt does ASD cause?
Restrictive cardiomyopathy
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Stable and unstable prinzmetal
Left -->right

38. What type of vegetations are associated with Libman - Sacks endocarditis?
Holosystolic machine like murmur
Aschoff bodies
Sterile vegetations on surface and undersurface on mitral valve
Reactive histiocyte with caterpillar nucleus

39. What is the most common cause of infectious endocarditis?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Large - destructive vegetations
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Streptococcus viridans

40. What is the tx for LHF?
ACE inhibitor
Friction rub and chest pain
S viridans
Thickening of chrodae tendinae and cusps - mitral stenosis

41. What causes an early - blowing diastolic murmur?
Friction rub and chest pain
Aortic regurg
Troponin I
Red border granulation tissue

42. How does hypertension cause LHF?

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43. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Yellow pallor neutrophils
Rhadbomyoma - benign
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Right -->left

44. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
First 4 hours
Aneurysm - mural thrombus - Dressler syndrome
Day 1-7
Anitschow cell

45. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Gelatinous - abundant ground substance
Hypertrophic cardiomyopathy
Nitroglycerin
Positive blood cultures anemia of chronic disease

46. What type of vegetations does Strep viridans cause?
LHF
Small - nondestructive vegetations (subacute endocarditis)
Valve replacement AFTER the onset of complications
Endocardial fibroelastosis (rare)

47. What is the gold standard blood marker for MI?
4-7 days macrophage infiltration
Troponin I
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Ventricles cannot pump

48. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
LA
Valve replacement
NG or Ca channel blocker

49. Friction rub and chest pain.
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Breast and lung carcinoma - melanoma - lymphoma
Chronic rheumatic heart disease
Pericarditits

50. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Elevated ASO anti - DNase B titers
Contraction band necrosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
LAD