Test your basic knowledge |

Cardiac

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. What gross and microscopic changes occur 4-7 days after an MI?
Large vegetations of S aureus
Yellow pallor macrophages
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

2. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
Dense layer of elastic and fibrotic tissue in the endocardium - children
Contraction band necrosis
Endocarditis of prosthetic valves

3. What is the tx for dilated cardiomyopathy?
Harmartoma
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Heart transplant
Endocarditis of prosthetic valves

4. What effect does aortic regurg have on the pulse pressure? Why?
Right side - serotonin and other secretory products detoxified in the lung
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Squatting - expiration
Endocardial fibroelastosis (rare)

5. What heart sound manifest with an ASD?
Split S2 on auscultation
Decrease in blood flow to an organ
Loss of fx
Minimizes ischemia

6. What is the cause of restrictive cardiomyopathy in children?
Ostium secundum (90%)
Endocardial fibroelastosis (rare)
RCA
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

7. What does a biopsy of hypertrophic cardiomyopathy look like?
Split S2 on auscultation
Pump failure
Myofiber hypertrophy with disarray
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

8. What is Dressler syndrome? When does it occur?
Stable and unstable prinzmetal
ASD - R-->L
Autoimmune pericarditis 6-8 wks post MI
Coexisting mitral stenosis and fusion of commisures exist

9. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Mitral regurg
Infectious
Hypercoagulable state or underlying adenocarcinoma

10. What type of shunt dose PDA cause?
Myocardium
Pts w/previously damaged valves
Left -->right
LAD

11. What type of shunt does a VSD cause?
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
Harmartoma
L->R
Friction rub and chest pain

12. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Limits thrombosis
Kawasaki disease
Acute inflammation

13. What are the clinical features of endocarditis? What causes each feature?
Rhadbomyoma - benign
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
R-->L

14. What artery is the 2nd most often occluded in an MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Squatting - expiration
Chronic ischemic heart disease
RCA

15. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Adult coarctation of the aorta
Congestive heart failure
Infectious endocarditis

16. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Streptococcus bovis/
RCA
Sterile vegetations on mitral valve along lines of closure

17. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Autoimmune pericarditis 6-8 wks post MI
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Transesophageal echo
Dark discoloration coagulative necrosis

18. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Ehlers - Danlow and Marfan syndrome
Degree of pulmonary artery stenosis
Doxorubicin - cocaine
Ventricles cannot pump

19. What gross and microscopic changes occur 1-3 days after an MI?
Gelatinous - abundant ground substance
Chest pain <20 min brought on by exertion or emotional stress
Yellow pallor neutrophils
ST- segment depression

20. What is an important complication of ASD?
LA
RCA
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Paradoxical emboli

21. How does dilated cardiomyopathy cause LHF?
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
Coronary artery vasospasm - emboli - vasculitis
Stretched muscle loses contractility
ASD - R-->L

22. What are the four defects in tetralogy of fallot?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
>60 years - bicuspid aortic valve
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
PGE

23. What are the sx of cardiac myxoma?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Fibrosis and dystrophic calcification
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Squat in response to cyanotic spell

24. How does ischemia cause LHF?
Holosystolic machine like murmur
Loss of fx
Dressler syndrome
Bounding pulse

25. What type of ischemia does stable angina cause?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Left -->right
Janeway lesions
Subendocardial

26. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Harmartoma
Coronary artery vasospasm - emboli - vasculitis
Janeway lesions

27. When would arrhythmia occur after MI?
Within the first day
When a bacterial protein resembles a protein in human tissue
Myocardium
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

28. What is the leading cause of death in the US?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Tuberous sclerosis
Limits thrombosis
Ischemic heart disease

29. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Thickening of chrodae tendinae and cusps - mitral stenosis
Turner syndrome
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

30. How do you prevent S viridans endocarditis?
Harmartoma
Myocarditis
Decrease in blood flow to an organ
Prophylactic abx during dental procedures

31. What is a complication of chronic rheumatic heart disease?
4-24 hours
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Systolic dysfx leading to biventricular CHF
Infectious endocarditis

32. What causes a mid - systolic click followed by a regurgitation murmur?
ASD - R-->L
Mitral valve prolapse
2-3%
Degree of pulmonary artery stenosis

33. What is the gold standard blood marker for MI?
Troponin I
Contraction band necrosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Myofiber hypertrophy with disarray

34. When do macrophagess infiltrate the myocardium post MI?
Thickening of chrodae tendinae and cusps - mitral stenosis
Tender lesions on fingers or toes.
4-7 days
Right to left

35. What characterizes acute rheumatic fever endocarditiis?
Osler nodes (ouch - ouch Osler)
Contraction band necrosis - reperfusion injury
Small vegetations along the line of closure
PDA

36. At what point in development do congenital heart defects arise?
Prinzmetal
>60 years - bicuspid aortic valve
Hemosiderin laden macrophages
3-8 wks

37. What cardiac disease is associated with tuberous sclerosis?
Doxorubicin - cocaine
Endocarditis of prosthetic valves
Rhabdomyoma
4-6 hours - 24 hours - 72 hours

38. What are complications of dilated cardiomyopathy?
RCA
LA dilation
Mitral and tricuspid regurg - arrhythmia
Mitral stenosis

39. Dense layer of elastic and fibrotic tissue in the endocardium.
Thickening of chrodae tendinae and cusps - mitral stenosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
RBC damaged while crossing the calcified valve causing schistocytes
Endocardial fibroelastosis

40. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Mitral stenosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Contraction band necrosis - reperfusion injury

41. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Trisomy 21
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Autoimmune pericarditis 6-8 wks post MI

42. What is the most common cause of infectious endocarditis?
Streptococcus viridans
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Volume overload and LHF
Day 1-7

43. What bug causes acute rheumatic fever?
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
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Group A beta - hemolytic streptococci
Systemic venous congestion

44. What is the rate of mitral valve prolapse in the US?
Thickening of chrodae tendinae and cusps - mitral stenosis
ST- segment elevation
Limits thrombosis
2-3%

45. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Increased blood in right heart delays closure of P valve
Months out fibrosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

46. What are the sx of pericardiits?
Surgical closure small defects may close spontaneously
Contraction band necrosis
Atria and RV
Friction rub and chest pain

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

48. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Anitschow cell
Adult coarctation of the aorta
Gelatinous - abundant ground substance
PDA

49. What is a Quincke pulse?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Right -->left
Pulsating nail bed
LA dilation

50. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
Myocarditis
LV dilation and eccentric hypertrophy
Concentric LV hypertophy