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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. Large vegetations on tricuspid valve?
1%
Mitral valve prolapse
Loeffler syndrome
S aureus

2. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Aortic stenosis
20 min
Ventricles cannot pump
Right side - serotonin and other secretory products detoxified in the lung

3. What type of valvular vegetations does S aureus cause?
Transposition of the great vessels
PDA
Large - destructive vegetations
Prophylactic abx during dental procedures

4. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Mitral regurg
Bacterial endocarditis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

5. What vavular defect results from acute rheumatic fever?
SLE
Blood vessels coming in from normal tissue
S aureus
Mitral regurgitation due to vegetations

6. What two things cause coronary artery vasospasm?
Right side - serotonin and other secretory products detoxified in the lung
Troponin I
Prinzmetal angina - cocaine
Plump fibroblasts - collagen - blood vessels

7. What type of shunt does truncus arteriosus cause?
Type I
Mid - systolic click followed by regurgitation murmur
R-->L
Stable and unstable prinzmetal

8. Opening snap followed by diastolic rumble.
Friction rub and chest pain
Circumflex
Stretched muscle loses contractility
Mitral stenosis

9. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Nonbacterial thrombotic endocarditis (marantic endocarditis)
ACE inhibitor
Sudden cardiac death

10. What is the rate of mitral valve prolapse in the US?
Systolic ejection click followed by crescendo - decrescendo murmur
Atria and RV
Myocarditis
2-3%

11. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
VSD
Contraction band necrosis
Reperfusion injury

12. What is the tx for mitral valve prolapse?
ACE inhibitor
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Dark discoloration coagulative necrosis
Valve replacement

13. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
VSD
Mitral mitral+aortic
Granulation tissue

14. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Pump failure
Breast and lung carcinoma - melanoma - lymphoma
Aschoff bodies

15. When is an MI patent at highest risk for fibrionous pericarditis?
Nitroglycerin
1-3 days out
Valve scarring that arises as a consequence of rheumatic fever
PGE

16. What maintains patency of the PDA?
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
Hypertrophic cardiomyopathy
PGE
Stable and unstable prinzmetal

17. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Fibrinous pericarditis
4-7 days macrophage infiltration
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Degree of pulmonary artery stenosis

18. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
R-->L
LAD
LHF

19. What congenital heart defect is associated with fetal alcohol syndrome?
PDA
VSD
Intercostal arteries enlarged due to collateral circulation
2-3%

20. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Pulsating nail bed
Pancarditis

21. What increases the volume of mitral regurg murmur?
Congestive heart failure
Squatting - expiration
VSD
Decreases LV dilation by decreasing volume

22. Myofiber hypertrophy with disarray.
Decrease preload -->lowers myocardial stress
Hypertrophic cardiomyopathy
Open blocked vessels
Colon cancer

23. What gross and microscopic changes occur 1-3 days after an MI?
Chronic ischemic heart disease
Concentric LV hypertophy
Yellow pallor neutrophils
Mitral insufficiency

24. In which chamber of the heart are rhabdomyomas found?
1-3 days out
Ventricle
Migratory polyarthritis
Prinzmetal angina

25. What disesase has Aschoff bodies?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Myocarditis in acute rheumatic heart fever
Inability to fill ventricles
Atria and RV

26. What shunt does tetralogy of fallot produce?
Right -->left
Red border granulation tissue
IV drug users
Dressler syndrome

27. What structures are susceptible to rupture post MI?
Papillary muscle - free wall - IV septum
Libman - Sacks endocarditis
VSD
Asymptomatic

28. What type of ASD is associated w/Down syndrome?
Atria and RV
Ostium primum
S epidermidis
Blood vessels coming in from normal tissue

29. What is a Quincke pulse?
Minimizes ischemia
Decreases LV dilation by decreasing volume
Pulsating nail bed
Rhabdomyoma

30. What congenital heart defect does indomethacin tx?
Within the first day
Tuberous sclerosis
R-->L
PDA

31. What areas of the heart does the LAD supply?
Tetralogy of fallot
Bacterial endocarditis
Holosystolic machine like murmur
Anterior wall of LV and anterior septum

32. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Concentric LV hypertophy
Within the first day
Prinzmetal angina - cocaine

33. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Membrane damage
L->R
Tetralogy of fallot

34. What valves are most commonly involved in chronic rheumatic heart disease?
Nitroglycerin
CK- MB
Fetal alcohol syndrome
Mitral mitral+aortic

35. What is a water - hammer pulse?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Bounding pulse
Hypertrophic cardiomyopathy
Sterile vegetations on surface and undersurface on mitral valve

36. What is the most common cause of RHF? What are others?
Aschoff bodies
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Limits thrombosis
Aortic regurg

37. What complications occur 4-7 days post MI?
Dark discoloration coagulative necrosis
Large - destructive vegetations
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Rupture of free wall - IV septum - or papillary muscle

38. With what disease is Libman - Sacks endocarditis associated?
Loss of fx
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
SLE
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

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

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40. What is an Aschoff body?
PDA
Tricuspid
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Valve replacement AFTER the onset of complications

41. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myocarditis
Right -->left
Myxoma - benign
Split S2 on auscultation

42. What tests show prior group A beta - hemolytic strep infection?
Surgical closure small defects may close spontaneously
Elevated ASO anti - DNase B titers
Rhadbomyoma - benign
Congenital rubella

43. What typically causes hypertrophic cardiomyopathy?
Heart can't fill
Opening snap followed by diastolic rumble
AD mutation in sarcomere proteins
Systemic venous congestion

44. What are the complications of mitral valve prolapse? Are they common?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Mitral mitral+aortic
Infectious endocarditis - arrythmias - severe mitral regurg no
Myocarditis

45. Which angina is relieved by Ca channel blockers?
1-3 days
Anterior wall of LV and anterior septum
Prinzmetal
Bacterial endocarditis

46. What is the most common cause of endocarditis in IV drug users?
Prinzmetal angina
2-3 weeks
S aureus
R-->L

47. What is the tx for dilated cardiomyopathy?
Libman - Sacks endocarditis
Decreases LV dilation by decreasing volume
Heart transplant
20 min

48. What causes notching of the ribs in adult coarctation of the aorta?
Pericardial effusion due to pericardial involvement
Intercostal arteries enlarged due to collateral circulation
Mitral regurg
Nitroglycerin

49. What two things happen when a blocked vessel is opened after an MI?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Contraction band necrosis - reperfusion injury
Mitral and tricuspid regurg - arrhythmia
Endocarditis of prosthetic valves

50. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Day 1-7
Sterile vegetations on mitral valve along lines of closure
Nonbacterial thrombotic endocarditis (marantic endocarditis)