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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 gross and microscopic changes occur months after an MI?
White scar fibrosis
Aortic regurg
When a bacterial protein resembles a protein in human tissue
Chronic rheumatic heart disease

2. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Prophylactic abx during dental procedures
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Kawasaki disease

3. What increases the volume of mitral regurg murmur?
LAD
Asymptomatic
Wear and tear
Squatting - expiration

4. What is the definition of ischemia?
Decrease in blood flow to an organ
NG or Ca channel blocker
Myocardium
Valve replacement AFTER the onset of complications

5. Pericarditis 6-8 wks post MI.
Chronic rheumatic heart disease
Dressler syndrome
PDA
Large - destructive vegetations

6. With what disease is Libman - Sacks endocarditis associated?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
SLE
Prinzmetal angina
RBC damaged while crossing the calcified valve causing schistocytes

7. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Months out fibrosis
Large vegetations of S aureus
ASD - R-->L

8. What side of the heart do carcinoid tumors affect? Why?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Thickening of chrodae tendinae and cusps - mitral stenosis
Atherosclerosis of coronary arteries
Right side - serotonin and other secretory products detoxified in the lung

9. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
RHF
Nonbacterial thrombotic endocarditis (marantic endocarditis)
2-3 weeks
RCA

10. What type of vegetations form in nonbacterial thrombotic endocarditis?
Opening snap followed by diastolic rumble
Sterile vegetations on mitral valve along lines of closure
Wear and tear
Chronic ischemic heart disease

11. How does squating decrease hypoxemia in tetralogy of fallot?
4-7 days macrophage infiltration
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Small - nondestructive vegetations (subacute endocarditis)
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

12. What causes prinzmetal angina?
Decrease in blood flow to an organ
Myxoma - benign
Coronary artery vasospasm
MI

13. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Months out fibrosis
Tender lesions on fingers or toes.
Months out fibrosis

14. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Large - destructive vegetations
Months out fibrosis
PDA

15. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Troponin I
Hypercoagulable state or underlying adenocarcinoma
Stable angina

16. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Spontaneous
Transposition of the great vessels
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Yellow pallor macrophages

17. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Stretched muscle loses contractility
Split S2 on auscultation
Ostium primum
Nitroglycerin

18. What cardiac enzyme is useful for detecting reinfarction?
Small vegetations along the line of closure
Doxorubicin - cocaine
CK- MB
Nitroglycerin

19. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
L->R
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

20. What does chronic ischemic heart disease progress to?
CHF
2-3%
Pancarditis
S viridans

21. What causes the nutmeg color in nutmeg liver?
Tetralogy of fallot
Congested central veins
Bacterial endocarditis
Tender lesions on fingers or toes.

22. How does subendocardial MI/ischemia present on EKG?
R-->L
Dark discoloration coagulative necrosis
ST- segment depression
Atria and RV

23. What is the leading cause of death in the US?
Squat in response to cyanotic spell
Ischemic heart disease
ASD - R-->L
Atherosclerosis of coronary arteries

24. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Day 1-7
Gelatinous - abundant ground substance
Right -->left
Coexisting mitral stenosis and fusion of commisures exist

25. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Cyanosis - RV hypertrophy - polycythemia - clubbing
Low voltage EKG w/diminished QRS amplitude
Pericardial effusion due to pericardial involvement
Loeffler syndrome

26. What is the characteristic murmurr of mitral stenosis?
1-3 days
MI
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Opening snap followed by diastolic rumble

27. What gross and microscopic changes occur 1-3 days after an MI?
Holosystolic machine like murmur
Yellow pallor neutrophils
PDA
Squat in response to cyanotic spell

28. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Thickening of chrodae tendinae and cusps - mitral stenosis
Membrane damage
Reperfusion injury
>60 years - bicuspid aortic valve

29. What is the tx for LHF?
Stable angina
Cardiac tamponade
Anterior wall of LV and anterior septum
ACE inhibitor

30. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
LAD
Fibrosis and dystrophic calcification
RCA

31. What causes an early - blowing diastolic murmur?
Aortic regurg
Tetralogy of fallot
Colon cancer
Sterile vegetations on surface and undersurface on mitral valve

32. What is the tx for mitral valve prolapse?
Valve replacement
Janeway lesions
Acute inflammation
Pancarditis

33. How do you prevent S viridans endocarditis?
Tender lesions on fingers or toes.
1-3 days out
Prophylactic abx during dental procedures
Aortic regurg

34. What are the major criteria of the Jones criteria?
2-4 hours - 24 hours - 7-10 days
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Bacterial endocarditis
Aneurysm - mural thrombus - Dressler syndrome

35. What is a water - hammer pulse?
ST- segment depression
Sudden cardiac death
Bounding pulse
Tetralogy of fallot

36. What artery is the 2nd most often occluded in an MI?
RCA
Shunt - PGE to maintain PDA until surgical repair can be performed
Myxoma - benign
S aureus

37. How does transmural MI/ischemia present on EKG?
Months out fibrosis
Right to left
ST- segment elevation
Kawasaki disease

38. What does rupture of the IV septum cause?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Elevated ASO anti - DNase B titers
Metastasis
Shunt

39. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Bacterial endocarditis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
PDA

40. How does adult coarctation of the aorta present?
L->R
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
RCA
Shunt

41. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
ST- segment depression
VSD
Adult coarctation of the aorta
CK- MB

42. What are the clinical features of LHF due to?
When a bacterial protein resembles a protein in human tissue
Decreased forward perfusion pulmonary congestion
Bicuspid aortic valve
Ventricles cannot pump

43. What congenital heart defect often is present with infantile coarctation of the aorta?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
L->R
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
PDA

44. What valves are involved in rhuematic endocarditis?
Mitral mitral+aortic
PDA
Hypertophy of RV atrophy of LV
Sterile vegetations on surface and undersurface on mitral valve

45. What is the most common type of ASD? What %?
MI
Right -->left
Libman - Sacks endocarditis
Ostium secundum (90%)

46. How does restrictive cardiomyopathy present?
Congestive heart failure
Regurg vs stenosis
Myofiber hypertrophy with disarray
Dark discoloration coagulative necrosis

47. With what disease is infantile coarctation of the aorta associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Slow HR - decreasing O2 demand and risk for arrhythmia
Pericardial effusion due to pericardial involvement
Turner syndrome

48. What is molecular mimicry?
Bacterial endocarditis
PDA
When a bacterial protein resembles a protein in human tissue
Opening snap followed by diastolic rumble

49. What causes endocarditis of prosthetic valves?
RHF
Troponin I
S epidermidis
Colon cancer

50. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Pts w/previously damaged valves
Asymptomatic
Atherosclerosis of coronary arteries