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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 restrictive cardiomyopathy present?
Tetralogy of fallot
Hypercoagulable state or underlying adenocarcinoma
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Congestive heart failure

2. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Decreases LV dilation by decreasing volume
Pulsating nail bed
Turner syndrome

3. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Aneurysm - mural thrombus - Dressler syndrome
Granulation tissue
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

4. What are the major criteria of the Jones criteria?
Congested central veins
Aortic regurg
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Granulation tissue

5. What two things happen when a blocked vessel is opened after an MI?
Mitral regurg
Contraction band necrosis - reperfusion injury
Shunt
Anterior wall of LV and anterior septum

6. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
>70%
2-3%
LAD

7. What is the only Jones criteria that doesn't resolve with time?
Cardiac tamponade
Maternal diabetes
Tuberous sclerosis
Pancarditis

8. What is the most common congenital heart defect?
Heart transplant
VSD
Heart can't fill
LAD

9. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Loss of fx
Heart can't fill
Maternal diabetes

10. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Large vegetations of S aureus
Endocarditis of prosthetic valves
Autoimmune pericarditis 6-8 wks post MI

11. What effect does transposition of the great vessels have on the ventricles?
Congenital rubella
Valve replacement AFTER the onset of complications
White scar fibrosis
Hypertophy of RV atrophy of LV

12. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
4-7 days macrophage infiltration
Anterior wall of LV and anterior septum
Maternal diabetes
2-3 weeks

13. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Contraction band necrosis
Bacterial endocarditis
Prinzmetal stable and unstable
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

14. What type of vegetations does Strep viridans cause?
Small - nondestructive vegetations (subacute endocarditis)
Hemosiderin laden macrophages
Libman - Sacks endocarditis
Atria and RV

15. What is the basic principle of CHF?
Loss of LV fx
Right to left
Pump failure
Contraction band necrosis

16. What type of shunt does transposition of the great vessels cause?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
R-->L
Aortic regurg
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

17. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Contraction band necrosis - reperfusion injury
Months out fibrosis
Stable angina
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

18. What is an Anitschow cell?
LAD
Turner syndrome
Reactive histiocyte with caterpillar nucleus
Maternal diabetes

19. With what disease is transposition of the great vessels associated?
Libman - Sacks endocarditis
Opening snap followed by diastolic rumble
Maternal diabetes
Right side - serotonin and other secretory products detoxified in the lung

20. Are most congenital heart defects spontaneous or inherited?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Kawasaki disease
Congested central veins
Spontaneous

21. What conditions can cause nonbacterial thrombotic endocarditis?
S aureus
4-7 days macrophage infiltration
Backward LHF pulm htn and RHF - afib and associated mural thombis
Hypercoagulable state or underlying adenocarcinoma

22. What increases the risk for chronic rheumatic heart disease?
Decreases LV dilation by decreasing volume
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Libman - Sacks endocarditis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

23. What are other (not atherosclerotic) causes of MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Coronary artery vasospasm - emboli - vasculitis
Harmartoma
Concentric LV hypertophy

24. What is the murmur of mitral regurg?
Coronary artery vasospasm - emboli - vasculitis
Holosystolic blowing murmur
Turner syndrome
Blood vessels coming in from normal tissue

25. In transposition of the great vessels - What is required for survival? How is this achieved?
Decrease in blood flow to an organ
Congestive heart failure
Shunt - PGE to maintain PDA until surgical repair can be performed
Hypertophy of RV atrophy of LV

26. What cardiac disease is associated with tuberous sclerosis?
Dilated
Rhadbomyoma - benign
Loss of LV fx
Rhabdomyoma

27. What coronary artery supplies the mitral valve papillary muscles?
RCA
Dressler syndrome
Open blocked vessels
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

28. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Ostium secundum (90%)
Endocardial fibroelastosis
Mitral regurgitation due to vegetations
Nonbacterial thrombotic endocarditis (marantic endocarditis)

29. Holosystolic blowing murmur that increases w/expiration?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ventricles cannot pump
Mitral regurg
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

30. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
First 4 hours
Infectious endocarditis - arrythmias - severe mitral regurg no
RHF
Aortic regurg

31. What causes mitral valve prolapse?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Libman - Sacks endocarditis
R-->L
Myxoid degeneration

32. What % of MIs involve the LAD?
Myocarditis in acute rheumatic heart fever
45%
L->R
Rhabdomyoma

33. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Right to left
Mitral and tricuspid regurg - arrhythmia
Coexisting mitral stenosis and fusion of commisures exist
Inability to maintain systemic pressure w/lack of O2 to vital organs

34. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Streptococcus viridans
Infectious endocarditis - arrythmias - severe mitral regurg no
Adult coarctation of the aorta

35. What iis the tx for aortic regurg?
MI
Erythematous nontender lesions on palms and soles.
Aneurysm - mural thrombus - Dressler syndrome
Valve replacement once LV dysfx develops

36. What causes the nutmeg color in nutmeg liver?
Congested central veins
4-7 days
Chronic ischemic heart disease
Louder - increased systemic resistence decreases LV emptying

37. What increases the volume of mitral regurg murmur?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Rhadbomyoma - benign
Squatting - expiration
Infectious endocarditis

38. How do beta blockers tx MI?
Prinzmetal stable and unstable
Nitroglycerin
Myocarditis in acute rheumatic heart fever
Slow HR - decreasing O2 demand and risk for arrhythmia

39. Which angina is relieved by Ca channel blockers?
Pulsating nail bed
2-4 hours - 24 hours - 7-10 days
Prinzmetal
Chronic ischemic heart disease

40. What shunt does tetralogy of fallot produce?
Prinzmetal angina
Right -->left
1-3 days out
Mitral regurgitation due to vegetations

41. What is the rate of mitral valve prolapse in the US?
RCA
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
2-3%

42. What are the complications that occur months after an MI?
Bacterial endocarditis
Aneurysm - mural thrombus - Dressler syndrome
4-7 days macrophage infiltration
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

43. Which angina(s) show ST elevation on EKG? ST depression?
Dressler syndrome
Prinzmetal stable and unstable
LAD
Cardiac tamponade

44. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
ST- segment depression
Aortic stenosis
Osler nodes (ouch - ouch Osler)

45. When would arrhythmia occur after MI?
Within the first day
Shunt - PGE to maintain PDA until surgical repair can be performed
Preductal - post aortic arch
Osler nodes (ouch - ouch Osler)

46. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Months out fibrosis
Congested central veins

47. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
ST- segment depression
20 min
Fetal alcohol syndrome
Stable and unstable prinzmetal

48. What is the leading cause of death in the US?
SLE
ACE inhibitor
S aureus
Ischemic heart disease

49. In which chamber of the heart are cardiac myxomas found?
AD mutation in sarcomere proteins
Anterior wall of LV and anterior septum
R-->L
LA

50. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Colon cancer
Degree of pulmonary artery stenosis
Contraction band necrosis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing