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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. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Congestive heart failure
Inability to maintain systemic pressure w/lack of O2 to vital organs
Prinzmetal angina

2. What effect does chronic rheumatic heart disease have on the aortic valve?

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3. What does Libman - Sacks endocarditis cause?
Subendocardial
Mitral regurg
RCA
Myxoma - benign

4. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Prinzmetal
Decreased forward perfusion pulmonary congestion
Tender lesions on fingers or toes.

5. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
Congested central veins
Day 1-7
Systemic venous congestion

6. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
S viridans
Asymptomatic

7. What causes acute endocarditis?
Intercostal arteries enlarged due to collateral circulation
Acute inflammation
Myocarditis in acute rheumatic heart fever
Large vegetations of S aureus

8. Myofiber hypertrophy with disarray.
Tuberous sclerosis
Hypertrophic cardiomyopathy
Streptococcus viridans
PDA

9. What is the characteristic finding on CXR in tetralogy of fallot?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Erythematous nontender lesions on palms and soles.
RHF
Boot shaped heart

10. What endocarditis is commonly found in patients with colon cancer?
20 min
Yellow pallor macrophages
Streptococcus bovis/
Migratory polyarthritis

11. In which chamber of the heart are cardiac myxomas found?
LA
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Myocarditis in acute rheumatic heart fever

12. What is Loeffler syndrome?
Mitral valve prolapse
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Loss of fx

13. When is an MI patent at highest risk for fibrionous pericarditis?
Surgical closure small defects may close spontaneously
1-3 days out
Type I
Streptococcus bovis/

14. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Paradoxical emboli
Gelatinous - abundant ground substance
Friction rub and chest pain

15. Lower extremity cyanosis in infants? In adults?
Coronary artery vasospasm - emboli - vasculitis
Hemosiderin laden macrophages
Rupture of free wall - IV septum - or papillary muscle
Infantile coarctation of the aorta PDA

16. What gross and microscopic changes occur 4-7 days after an MI?
Prinzmetal angina
Myocarditis in acute rheumatic heart fever
Yellow pallor macrophages
Mitral insufficiency

17. Which angina is relieved by Ca channel blockers?
Squatting - expiration
Prinzmetal
Louder - increased systemic resistence decreases LV emptying
Stretched muscle loses contractility

18. What is molecular mimicry?
Congestive heart failure
Ventricle
PDA
When a bacterial protein resembles a protein in human tissue

19. How does contraction band necrosis occur?
Erythematous nontender lesions on palms and soles.
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Anterior wall of LV and anterior septum
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

20. What is the leading cause of death in the US?
Trisomy 21
2-3%
Maternal diabetes
Ischemic heart disease

21. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Stable and unstable prinzmetal
Myxoid degeneration

22. In which chamber of the heart are rhabdomyomas found?
Ventricle
Slow HR - decreasing O2 demand and risk for arrhythmia
Split S2 on auscultation
RCA

23. How long after pharyngitis does acute rheumatic fever occur?
Mitral mitral+aortic
SLE
2-3 weeks
1-3 days out

24. Is scar tissue or myocardium stronger?
Anterior wall of LV and anterior septum
Myocardium
Posterior wall of LV - posterior septum - papillary muscles
PDA

25. What disesase has Aschoff bodies?
Libman - Sacks endocarditis
Myocarditis in acute rheumatic heart fever
MI
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea

26. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Chronic rheumatic heart disease
Papillary muscle - free wall - IV septum

27. In what pt population does S aureus commonly cause valvular disease?
Boot shaped heart
Large - destructive vegetations
IV drug users
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

28. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Limits thrombosis
Myxoma - benign
Opening snap followed by diastolic rumble
PDA

29. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
SLE
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Contraction band necrosis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

30. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
ASD - R-->L
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Holosystolic blowing murmur

31. With what disease is infantile coarctation of the aorta associated?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Infectious endocarditis
Turner syndrome
Sterile vegetations on mitral valve along lines of closure

32. Opening snap followed by diastolic rumble.
Libman - Sacks endocarditis
Hypertophy of RV atrophy of LV
Mitral stenosis
4-7 days

33. Where is the coarctation in infantile coarctation of the aorta?
Dark discoloration coagulative necrosis
Preductal - post aortic arch
Doxorubicin - cocaine
Autoimmune pericarditis 6-8 wks post MI

34. What causes the split S2 in ASD?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Increased blood in right heart delays closure of P valve
2-3%
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

35. When is an MI pt at greatest risk for cardiogenic shock?
Dressler syndrome
First 4 hours
PDA
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

36. What effect does mitral stenosis have on the heart chambers?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
LA dilation
RCA
Mitral insufficiency

37. What are the Jones criteria?
Tender lesions on fingers or toes.
IV drug users
White scar fibrosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

38. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Prinzmetal stable and unstable
Bacterial endocarditis
Bicuspid aortic valve
Reactive histiocyte with caterpillar nucleus

39. What creates the immune reaction in acute rhuematic fever?

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40. Dense layer of elastic and fibrotic tissue in the endocardium.
Spontaneous
Endocardial fibroelastosis
Membrane damage
Pts w/previously damaged valves

41. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Tricuspid
Fibrinous pericarditis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

42. What is the most common type of endocarditis?
Infectious
Myocarditis
Day 1-7
When a bacterial protein resembles a protein in human tissue

43. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
1-3 days
Valve replacement once LV dysfx develops
MI
Autoimmune pericarditis 6-8 wks post MI

44. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Tuberous sclerosis
Limits thrombosis
Mitral valve prolapse

45. How does fibrinolysis/angioplasty tx MI?
Bounding pulse
Transesophageal echo
Open blocked vessels
Pancarditis

46. What type of ASD is associated w/Down syndrome?
R-->L
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Stable angina
Ostium primum

47. What type of vegetations are associated with Libman - Sacks endocarditis?
Posterior wall of LV - posterior septum - papillary muscles
Sterile vegetations on surface and undersurface on mitral valve
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
ST- segment depression

48. Which congenital heart defect is associated with congenital rubella?
PDA
Loss of fx
Prophylactic abx during dental procedures
Shunt

49. What causes heart failure cells?
Sterile vegetations on surface and undersurface on mitral valve
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
PDA
Cyanosis - RV hypertrophy - polycythemia - clubbing

50. What valves are involved in rhuematic endocarditis?
NG or Ca channel blocker
Endocardial fibroelastosis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Mitral mitral+aortic