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Cardiac
Start Test
Study First
Subject
:
health-sciences
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. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Myocardium
Loeffler syndrome
Congested central veins
VSD
2. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Stable angina
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Aortic stenosis
Congenital rubella
3. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Red border granulation tissue
Adult coarctation of the aorta
Tricuspid
Loeffler syndrome
4. Which artery is most often occluded in an MI?
Valve scarring that arises as a consequence of rheumatic fever
Ventricle
Libman - Sacks endocarditis
LAD
5. With what disease is Libman - Sacks endocarditis associated?
SLE
Systemic venous congestion
Increased hydrostatic pressure
Migratory polyarthritis
6. What congenital heart defect is associated with fetal alcohol syndrome?
4-7 days
VSD
Systemic venous congestion
Bacterial endocarditis
7. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Ostium primum
Maternal diabetes
Contraction band necrosis
>60 years - bicuspid aortic valve
8. Large vegetations on tricuspid valve?
S aureus
>70%
Right -->left
Opening snap followed by diastolic rumble
9. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Chronic rheumatic heart disease
Prinzmetal angina
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Dilation of all four chambers of the heart
10. What conditions can cause nonbacterial thrombotic endocarditis?
Streptococcus bovis/
Small - nondestructive vegetations (subacute endocarditis)
Chest pain <20 min brought on by exertion or emotional stress
Hypercoagulable state or underlying adenocarcinoma
11. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Decreased forward perfusion pulmonary congestion
Endocarditis of prosthetic valves
S aureus
12. What disesase has Aschoff bodies?
1%
Infectious endocarditis - arrythmias - severe mitral regurg no
Mitral insufficiency
Myocarditis in acute rheumatic heart fever
13. What is the cause of the red border around granulation tissue?
Large vegetations of S aureus
Restrictive cardiomyopathy
Nonspecific - eg fever and elevated ESR
Blood vessels coming in from normal tissue
14. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
AD mutation in sarcomere proteins
Osler nodes (ouch - ouch Osler)
Contraction band necrosis - reperfusion injury
15. What causes endocarditis of prosthetic valves?
S epidermidis
Dense layer of elastic and fibrotic tissue in the endocardium - children
Hypertrophic cardiomyopathy
Right -->left
16. What is the murmur of mitral regurg?
RCA
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Holosystolic blowing murmur
Low voltage EKG w/diminished QRS amplitude
17. How do ACE inhibitors tx MI?
Months out fibrosis
Decreases LV dilation by decreasing volume
Tetralogy of fallot
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
18. What is the tx for dilated cardiomyopathy?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Heart transplant
Dressler syndrome
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
19. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Degree of pulmonary artery stenosis
Decreases LV dilation by decreasing volume
Infectious endocarditis - arrythmias - severe mitral regurg no
ST- segment depression
20. What % of MIs involve the LAD?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
45%
Hypercoagulable state or underlying adenocarcinoma
Nonspecific - eg fever and elevated ESR
21. What drugs can cause dilated cardiomyopathy?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Reactive histiocyte with caterpillar nucleus
S viridans
Doxorubicin - cocaine
22. What typically causes hypertrophic cardiomyopathy?
Systolic dysfx leading to biventricular CHF
AD mutation in sarcomere proteins
Prinzmetal
PDA
23. How does restrictive cardiomyopathy present?
Hypertophy of RV atrophy of LV
Congestive heart failure
3-8 wks
Restrictive cardiomyopathy
24. What gross and microscopic changes occur 1-3 days after an MI?
Stable and unstable prinzmetal
Yellow pallor neutrophils
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
25. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Acute inflammation
Left -->right
AD mutation in sarcomere proteins
26. When do troponin levels rise - peak - and return to normal?
AD mutation in sarcomere proteins
2-4 hours - 24 hours - 7-10 days
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Dressler syndrome
27. What heart sound manifest with an ASD?
Inability to fill ventricles
Wear and tear
Split S2 on auscultation
Doxorubicin - cocaine
28. What % stenosis causes stable angina?
Volume overload and LHF
PDA
>70%
Nonspecific - eg fever and elevated ESR
29. What type of ASD is associated w/Down syndrome?
Increased hydrostatic pressure
Ostium primum
Ventricles cannot pump
4-7 days macrophage infiltration
30. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Fibrosis and dystrophic calcification
Small vegetations along the line of closure
Aortic regurg
LA
31. What is the rate of congenital heart defects?
Concentric LV hypertophy
1%
Plump fibroblasts - collagen - blood vessels
Increased blood in right heart delays closure of P valve
32. Turner syndrome is associated with which congenital heart defect?
Stable and unstable prinzmetal
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Infantile coarctation of the aorta
Hypertrophic cardiomyopathy
33. Why would cardiac enzymes continue to increase after the initial MI?
LA
Reperfusion injury
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Pancarditis
34. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
Opening snap followed by diastolic rumble
CK- MB
Decrease preload -->lowers myocardial stress
35. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Bacterial endocarditis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Nonbacterial thrombotic endocarditis (marantic endocarditis)
36. When do neutrophils infiltrate the myocardium post MI?
Erythematous nontender lesions on palms and soles.
Reperfusion injury
Ischemic heart disease
1-3 days
37. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Concentric LV hypertophy
Months out fibrosis
Large - destructive vegetations
Pump failure
38. Why are cardiac enzymes elevated after an MI?
Right side - serotonin and other secretory products detoxified in the lung
>60 years - bicuspid aortic valve
Myxoma - benign
Membrane damage
39. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Sudden cardiac death
Coronary artery vasospasm - emboli - vasculitis
S epidermidis
40. In which chamber of the heart are rhabdomyomas found?
Anterior wall of LV and anterior septum
LAD
Ventricle
Sterile vegetations on mitral valve along lines of closure
41. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Libman - Sacks endocarditis
L->R
Restrictive cardiomyopathy
42. What effect does aortic stenosis have on the chambers of the heart?
Opening snap followed by diastolic rumble
Membrane damage
Concentric LV hypertophy
Decreased forward perfusion pulmonary congestion
43. What causes the dependent pitting edema in RHF?
Bacterial endocarditis
Preductal - post aortic arch
Increased hydrostatic pressure
Osler nodes (ouch - ouch Osler)
44. Is scar tissue or myocardium stronger?
Myocardium
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
Systolic ejection click followed by crescendo - decrescendo murmur
Decreased forward perfusion pulmonary congestion
45. What shunt does tetralogy of fallot produce?
Right -->left
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
Mitral mitral+aortic
Dilation of all four chambers of the heart
46. What is the most common primary cardiac tumor in children? Is it malignant or benign?
NG or Ca channel blocker
Infectious endocarditis
Rhadbomyoma - benign
IV drug users
47. With what disease is transposition of the great vessels associated?
ASD - R-->L
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Nonspecific - eg fever and elevated ESR
Maternal diabetes
48. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Hypertrophic cardiomyopathy
Decrease in blood flow to an organ
Cyanosis - RV hypertrophy - polycythemia - clubbing
49. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Small vegetations along the line of closure
Systolic ejection click followed by crescendo - decrescendo murmur
Systolic dysfx leading to biventricular CHF
Louder - increased systemic resistence decreases LV emptying
50. What valves are most commonly involved in chronic rheumatic heart disease?
Ventricular arrhythmia
Mitral regurg
Mitral mitral+aortic
Stable and unstable prinzmetal
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