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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 type of endocarditis is associated with SLE?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
3-8 wks
Erythematous nontender lesions on palms and soles.
Libman - Sacks endocarditis

2. Which angina is relieved by Ca channel blockers?
Mitral mitral+aortic
Prinzmetal
LAD
L->R

3. L- to - R shunt switching to R- to - L shunt.
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Atherosclerosis of coronary arteries
Membrane damage
Eisenmenger syndrome

4. What does rupture of the LV free wall cause?
Cardiac tamponade
Papillary muscle - free wall - IV septum
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
S epidermidis

5. What are the complications of mitral stenosis?
VSD
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Backward LHF pulm htn and RHF - afib and associated mural thombis
Mitral and tricuspid regurg - arrhythmia

6. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
First 4 hours
Membrane damage
4-7 days macrophage infiltration
Contraction band necrosis

7. Friction rub and chest pain.
Myocarditis
Pericarditits
ST- segment elevation
Bicuspid aortic valve

8. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Fetal alcohol syndrome
Paradoxical emboli

9. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Cyanosis - RV hypertrophy - polycythemia - clubbing
Loss of LV fx
Anitschow cell
Boot shaped heart

10. How long after pharyngitis does acute rheumatic fever occur?
Annular - non pruritic rash w/erythematous borders trunks and limbs
2-3 weeks
Stable and unstable prinzmetal
Contraction band necrosis - reperfusion injury

11. What are the clinical features of RHF due to?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Squatting - increased systemic resistence decreases LV emptying
Systemic venous congestion
PDA

12. What are the clinical features of LHF due to?
LAD
Turner syndrome
PDA
Decreased forward perfusion pulmonary congestion

13. What are other (not atherosclerotic) causes of MI?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Yellow pallor macrophages
Coronary artery vasospasm - emboli - vasculitis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

14. What are the causes of LHF?
Streptococcus viridans
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Fetal alcohol syndrome
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

15. What murmur ccan be heard in PDA?
Hypertrophic cardiomyopathy
Holosystolic machine like murmur
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Mitral stenosis

16. In which chamber of the heart are rhabdomyomas found?
RCA
Ventricle
Streptococcus bovis/
Nonspecific - eg fever and elevated ESR

17. When do macrophagess infiltrate the myocardium post MI?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Myxoma - benign
4-7 days

18. What is cardiogenic shock?
Reactive histiocyte with caterpillar nucleus
Inability to maintain systemic pressure w/lack of O2 to vital organs
Ischemic heart disease
Fibrosis and dystrophic calcification

19. What is Loeffler syndrome?
Hypertophy of RV atrophy of LV
Valve replacement
Mitral regurgitation due to vegetations
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

20. What are the sx/complications of myocarditis?
Infectious
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Pulsating nail bed
AD mutation in sarcomere proteins

21. What is the most common form of cardiomyopathy?
Mitral mitral+aortic
Dilated
LHF
Months out fibrosis

22. What is the tx for LHF?
Louder - increased systemic resistence decreases LV emptying
Thickening of chrodae tendinae and cusps - mitral stenosis
Indomethacin - decreases PGE
ACE inhibitor

23. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Squat in response to cyanotic spell
Valve replacement
Tuberous sclerosis

24. What is the only Jones criteria that doesn't resolve with time?
Opening snap followed by diastolic rumble
Pancarditis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

25. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Breast and lung carcinoma - melanoma - lymphoma
Degree of pulmonary artery stenosis
Myxoma - benign

26. What does rupture of a papillary muscle cause?
Myofiber hypertrophy with disarray
LA
Anitschow cell
Mitral insufficiency

27. Which chambers of the heart are generally spared in an MI?
Atria and RV
LAD
Prinzmetal angina - cocaine
Infectious

28. How does restrictive cardiomyopathy cause LHF?

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29. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Right -->left
Decreased forward perfusion pulmonary congestion
Squatting - expiration

30. What is the most common type of ASD? What %?
Coxsackie A or B
Anterior wall of LV and anterior septum
Ostium secundum (90%)
Infectious endocarditis

31. What conditions can cause nonbacterial thrombotic endocarditis?
LA dilation
Months out fibrosis
Paradoxical emboli
Hypercoagulable state or underlying adenocarcinoma

32. What is the most common cause of endocarditis in IV drug users?
LV dilation and eccentric hypertrophy
Tuberous sclerosis
Stable and unstable prinzmetal
S aureus

33. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Migratory polyarthritis
Myxoma - benign
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
R-->L

34. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
2-3%
Restrictive cardiomyopathy

35. 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.
Valve scarring that arises as a consequence of rheumatic fever
Surgical closure small defects may close spontaneously
Stable angina
4-6 hours - 24 hours - 72 hours

36. When would arrhythmia occur after MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
PDA
Within the first day
Left -->right

37. What always follows necrosis?
Surgical closure small defects may close spontaneously
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
Low voltage EKG w/diminished QRS amplitude
Acute inflammation

38. What are the forward and backward sx of LHF?
Systolic dysfx leading to biventricular CHF
Elevated ASO anti - DNase B titers
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
Chronic rheumatic heart disease

39. Which vasculitis can cause MI?
Ventricles cannot pump
Aortic regurg
Kawasaki disease
Ehlers - Danlow and Marfan syndrome

40. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Valve scarring that arises as a consequence of rheumatic fever
Aortic stenosis
RCA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

41. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Prinzmetal angina - cocaine
Granulation tissue
Wear and tear

42. What causes an early - blowing diastolic murmur?
Aortic regurg
Acute inflammation
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Bounding pulse

43. How do you prevent S viridans endocarditis?
Split S2 on auscultation
Tetralogy of fallot
Prophylactic abx during dental procedures
Mitral stenosis

44. With what disease is Libman - Sacks endocarditis associated?
SLE
Aortic regurg
Heart transplant
Congestive heart failure

45. What is a water - hammer pulse?
Right -->left
Bounding pulse
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Loss of fx

46. What generally causes ischemic heart disease?
Hypercoagulable state or underlying adenocarcinoma
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Atherosclerosis of coronary arteries
Pancarditis

47. What makes the MV prolapse murmur louder? Why?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Nonspecific - eg fever and elevated ESR
Congested central veins
Squatting - increased systemic resistence decreases LV emptying

48. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Left -->right
Adult coarctation of the aorta
Inability to maintain systemic pressure w/lack of O2 to vital organs
Janeway lesions

49. What is the most common tumor of the heart?
PDA
Tender lesions on fingers or toes.
Metastasis
S viridans

50. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Dark discoloration coagulative necrosis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Opening snap followed by diastolic rumble