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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. With what virus is PDA associated?
Libman - Sacks endocarditis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Congenital rubella
Degree of pulmonary artery stenosis

2. What are the major criteria of the Jones criteria?
Elevated ASO anti - DNase B titers
Mitral valve prolapse
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Coronary artery vasospasm - emboli - vasculitis

3. What causes an early - blowing diastolic murmur?
Aortic regurg
Chest pain <20 min brought on by exertion or emotional stress
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Holosystolic blowing murmur

4. What % of MIs involve the LAD?
Janeway lesions
Coexisting mitral stenosis and fusion of commisures exist
Spontaneous
45%

5. Ostium primum ASD is associated with what congenital disorder?
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
Trisomy 21
Large - destructive vegetations
Rupture of free wall - IV septum - or papillary muscle

6. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
20 min
Decrease preload -->lowers myocardial stress
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

7. What drugs can cause dilated cardiomyopathy?
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
Squatting - increased systemic resistence decreases LV emptying
Doxorubicin - cocaine
VSD

8. What conditions can cause nonbacterial thrombotic endocarditis?
SLE
Inability to fill ventricles
Contraction band necrosis - reperfusion injury
Hypercoagulable state or underlying adenocarcinoma

9. What is the definition of ischemia?
Hypertrophic cardiomyopathy
Contraction band necrosis
Day 1-7
Decrease in blood flow to an organ

10. Myofiber hypertrophy with disarray.
45%
Hypertrophic cardiomyopathy
Mitral regurg
CK- MB

11. What is the leading cause of death in the US?
Bicuspid aortic valve
RHF
Cyanosis - RV hypertrophy - polycythemia - clubbing
Ischemic heart disease

12. How do you prevent S viridans endocarditis?
Degree of pulmonary artery stenosis
Volume overload and LHF
Backward LHF pulm htn and RHF - afib and associated mural thombis
Prophylactic abx during dental procedures

13. How does squating decrease hypoxemia in tetralogy of fallot?
Surgical closure small defects may close spontaneously
LHF
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

14. What causes endocarditis of prosthetic valves?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Months out fibrosis
S epidermidis
Systolic ejection click followed by crescendo - decrescendo murmur

15. What effect does dilated cardiomyopathy have on the heart?
Regurg vs stenosis
Systolic dysfx leading to biventricular CHF
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

16. What is the tx for mitral valve prolapse?
Left -->right
Dressler syndrome
Valve replacement
Asymptomatic

17. How does restrictive cardiomyopathy present?
Rhabdomyoma
Congestive heart failure
Ehlers - Danlow and Marfan syndrome
Squat in response to cyanotic spell

18. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Transposition of the great vessels
Hypertrophic cardiomyopathy
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

19. What gross and microscopic changes occur 1-3 days after an MI?
Large - destructive vegetations
PGE
Yellow pallor neutrophils
RBC damaged while crossing the calcified valve causing schistocytes

20. What is the tx for dilated cardiomyopathy?
Coxsackie A or B
Heart transplant
Decrease in blood flow to an organ
LA dilation

21. What drug relieves stable angina?
Right -->left
Right to left
ACE inhibitor
Nitroglycerin

22. How does reperfusion injury occur?
ACE inhibitor
Tricuspid
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Contraction band necrosis

23. What is a Quincke pulse?
Pulsating nail bed
LHF
Systemic venous congestion
Months out fibrosis

24. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Indomethacin - decreases PGE
Nitroglycerin
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
RHF

25. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Kawasaki disease
Group A beta - hemolytic streptococci
First 4 hours

26. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
L->R
Adult coarctation of the aorta

27. What effect does aortic stenosis have on the chambers of the heart?
Ostium primum
Concentric LV hypertophy
Congested central veins
Migratory polyarthritis

28. What always follows necrosis?
RCA
S viridans
Acute inflammation
Open blocked vessels

29. What does rupture of a papillary muscle cause?
Mitral insufficiency
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Yellow pallor neutrophils
Ehlers - Danlow and Marfan syndrome

30. What iis the tx for aortic regurg?
>60 years - bicuspid aortic valve
Concentric LV hypertophy
2-4 hours - 24 hours - 7-10 days
Valve replacement once LV dysfx develops

31. What areas of the heart does the RCA supply?
Months out fibrosis
Left -->right
2-4 hours - 24 hours - 7-10 days
Posterior wall of LV - posterior septum - papillary muscles

32. With what condition are rhabdomyomas associated?
Streptococcus viridans
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Tuberous sclerosis

33. What is the murmur of mitral regurg?
Annular - non pruritic rash w/erythematous borders trunks and limbs
2-3%
Holosystolic blowing murmur
Coxsackie A or B

34. What endocarditis is commonly found in patients with colon cancer?
PDA
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Tuberous sclerosis
Streptococcus bovis/

35. In which chamber of the heart are rhabdomyomas found?
Anterior wall of LV and anterior septum
Metastasis
Ventricle
Tuberous sclerosis

36. What is the gold standard blood marker for MI?
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
Troponin I
Colon cancer
Increased blood in right heart delays closure of P valve

37. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Degree of pulmonary artery stenosis
Infectious
Infantile coarctation of the aorta
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

38. How does aortic regurg affect the heart chambers?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Blood vessels coming in from normal tissue
LV dilation and eccentric hypertrophy
PDA

39. What is diastolic dysfx?
Inability to fill ventricles
RCA
Pulsating nail bed
Bacterial endocarditis

40. What are the sx of PDA at birth?
Pump failure
Squat in response to cyanotic spell
Asymptomatic
Decreased forward perfusion pulmonary congestion

41. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Prinzmetal stable and unstable
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
Cardiac tamponade

42. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Maternal diabetes
Valve replacement AFTER the onset of complications
4-24 hours

43. Which vasculitis can cause MI?
Kawasaki disease
Infantile coarctation of the aorta
Pericarditits
Decreases LV dilation by decreasing volume

44. What causes unstable angina?
3-8 wks
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Mitral stenosis
Infantile coarctation of the aorta

45. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Ehlers - Danlow and Marfan syndrome
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Small vegetations along the line of closure

46. Which coronary artery supplies the anterior wall and anterior septum?
LAD
ACE inhibitor
Chronic ischemic heart disease
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

47. What disesase has Aschoff bodies?
Streptococcus viridans
LHF
Myocarditis in acute rheumatic heart fever
Endocardial fibroelastosis (rare)

48. What is the most comon cause of aortic regurg? What are the other causes?
Turner syndrome
Mitral stenosis
Maternal diabetes
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

49. How does MI cause LHF?
Yellow pallor macrophages
Loss of LV fx
Mitral insufficiency
Mitral regurg

50. What heart sound manifest with an ASD?
Reperfusion injury
Rhadbomyoma - benign
Split S2 on auscultation
First 4 hours