Test your basic knowledge |

Cardiac

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 structures are susceptible to rupture post MI?
Ehlers - Danlow and Marfan syndrome
Myxoid degeneration
2-3%
Papillary muscle - free wall - IV septum

2. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
ASD - R-->L
Asymptomatic
Doxorubicin - cocaine

3. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Coronary artery vasospasm
MI
Hemosiderin laden macrophages
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

4. What two things cause coronary artery vasospasm?
Libman - Sacks endocarditis
Prinzmetal angina - cocaine
Indomethacin - decreases PGE
VSD

5. What increases the risk for chronic rheumatic heart disease?
2-3 weeks
ST- segment depression
Concentric LV hypertophy
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

6. What is Dressler syndrome? When does it occur?
Papillary muscle - free wall - IV septum
Autoimmune pericarditis 6-8 wks post MI
Endocarditis of prosthetic valves
Prophylactic abx during dental procedures

7. What drug relieves stable angina?
Nitroglycerin
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Mitral regurg
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

8. What genetic conditions predispose a pt to mitral valve prolapse?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Ehlers - Danlow and Marfan syndrome
Libman - Sacks endocarditis
Pedunculated mass in the LA that causes syncope due to obstruction of MV

9. What is the tx for VSD?
Prinzmetal angina
Surgical closure small defects may close spontaneously
Squatting - increased systemic resistence decreases LV emptying
Shunt

10. What does rupture of the IV septum cause?
Hypercoagulable state or underlying adenocarcinoma
Degree of pulmonary artery stenosis
Fetal alcohol syndrome
Shunt

11. EKG for stable angina?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Tender lesions on fingers or toes.
Increased hydrostatic pressure
ST- segment depression

12. How do nitrates tx MI?
Day 1-7
Decrease preload -->lowers myocardial stress
Concentric LV hypertophy
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

13. What causes heart failure cells?
Holosystolic machine like murmur
PDA
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
RCA

14. What is typically the mechanims of sudden cardiac death?
Loeffler syndrome
Ventricular arrhythmia
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Breast and lung carcinoma - melanoma - lymphoma

15. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Squatting - expiration
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Months out fibrosis
Blood vessels coming in from normal tissue

16. In which chamber of the heart are cardiac myxomas found?
LA
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Anterior wall of LV and anterior septum
CHF

17. What % of MIs involve the LAD?
Paradoxical emboli
MI
45%
Thickening of chrodae tendinae and cusps - mitral stenosis

18. What are Osler nodes?
LHF
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Tender lesions on fingers or toes.

19. What are the tx for MI?
Contraction band necrosis - reperfusion injury
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
PDA
Anterior wall of LV and anterior septum

20. Which artery is most often occluded in an MI?
Pancarditis
Opening snap followed by diastolic rumble
LAD
Ischemic heart disease

21. Pericarditis 6-8 wks post MI.
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Dressler syndrome
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Mitral mitral+aortic

22. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Spontaneous
Chronic rheumatic heart disease
Decreases LV dilation by decreasing volume

23. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Coexisting mitral stenosis and fusion of commisures exist
ASD - R-->L
Tender lesions on fingers or toes.
Valve scarring that arises as a consequence of rheumatic fever

24. What areas of the heart does the LAD supply?
RBC damaged while crossing the calcified valve causing schistocytes
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Anterior wall of LV and anterior septum
Myocardium

25. What effect does dilated cardiomyopathy have on the heart?
RBC damaged while crossing the calcified valve causing schistocytes
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Adult coarctation of the aorta
Systolic dysfx leading to biventricular CHF

26. What are the causes of restrictive cardiomyopathy in adults?
Dressler syndrome
Increased hydrostatic pressure
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Acute inflammation

27. What is the main cause of MV regurg? What are other causes?
Preductal - post aortic arch
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Autoimmune pericarditis 6-8 wks post MI
Day 1-7

28. Turner syndrome is associated with which congenital heart defect?
S epidermidis
Libman - Sacks endocarditis
Rhabdomyoma
Infantile coarctation of the aorta

29. With what endocarditis is S epidermidis associated?
Heart can't fill
Hypertophy of RV atrophy of LV
Endocarditis of prosthetic valves
Chest pain <20 min brought on by exertion or emotional stress

30. What is cardiogenic shock?
Infectious
Right to left
Nitroglycerin
Inability to maintain systemic pressure w/lack of O2 to vital organs

31. What are the sx of pericardiits?
Stable and unstable prinzmetal
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Myocarditis
Friction rub and chest pain

32. What is the most common cause of dilated cardiomyopathy? What are other causes?
Ventricular arrhythmia
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
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Prinzmetal angina

33. What is the effect of mitral regurg on the heart?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Contraction band necrosis
45%
Volume overload and LHF

34. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Holosystolic blowing murmur
Split S2 on auscultation
PDA
Aortic regurg

35. What is a complication of chronic rheumatic heart disease?
LAD
Infectious endocarditis
Trisomy 21
Holosystolic machine like murmur

36. What type of shunt results in cyanosis at birth?
Breast and lung carcinoma - melanoma - lymphoma
Right to left
Decreases LV dilation by decreasing volume
Red border granulation tissue

37. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
LV dilation and eccentric hypertrophy
Wear and tear
Myxoma - benign
Ventricles cannot pump

38. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Holosystolic blowing murmur
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Granulation tissue

39. What effect does transposition of the great vessels have on the ventricles?
Hypertophy of RV atrophy of LV
Increased hydrostatic pressure
Months out fibrosis
Left -->right

40. What causes prinzmetal angina?
Pump failure
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
R-->L
Coronary artery vasospasm

41. What are Janeway lesions?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Ostium secundum (90%)
Aortic regurg
Erythematous nontender lesions on palms and soles.

42. What are the causes of LHF?
Boot shaped heart
Trisomy 21
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

43. What is the most common cause of aortic stenosis?
Wear and tear
Regurg vs stenosis
Months out fibrosis
Mitral valve prolapse

44. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Shunt
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Congenital rubella
Reperfusion injury

45. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Degree of pulmonary artery stenosis
Congestive heart failure
Shunt - PGE to maintain PDA until surgical repair can be performed

46. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Infantile coarctation of the aorta PDA
CK- MB
Nitroglycerin

47. What conditions can cause nonbacterial thrombotic endocarditis?
Systemic venous congestion
First 4 hours
Hypercoagulable state or underlying adenocarcinoma
Hypertrophic cardiomyopathy

48. What % stenosis causes stable angina?
Aortic regurg
Spontaneous
>70%
LA dilation

49. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Mitral regurg
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Prinzmetal angina
RHF

50. What is the only Jones criteria that doesn't resolve with time?
Right -->left
Colon cancer
Congestive heart failure
Pancarditis