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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 are the sx of cardiac myxoma?
Large - destructive vegetations
Troponin I
Decrease in blood flow to an organ
Pedunculated mass in the LA that causes syncope due to obstruction of MV

2. How does transmural MI/ischemia present on EKG?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
ST- segment elevation
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Nitroglycerin

3. What drugs can cause dilated cardiomyopathy?
Doxorubicin - cocaine
Atria and RV
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Months out fibrosis

4. Large vegetations on tricuspid valve?
Reactive histiocyte with caterpillar nucleus
Membrane damage
S aureus
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

5. What is the foundation of a scar?
Infantile coarctation of the aorta PDA
PDA
Coxsackie A or B
Granulation tissue

6. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
Myocardium
PDA
Nitroglycerin

7. What type of vegetations form in nonbacterial thrombotic endocarditis?
Restrictive cardiomyopathy
Cardiogenic shock - CHF - arrhythmia
Sterile vegetations on mitral valve along lines of closure
Tetralogy of fallot

8. What is an Aschoff body?
LA dilation
Tetralogy of fallot
Myocarditis in acute rheumatic heart fever
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

9. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
AD mutation in sarcomere proteins
Mitral valve prolapse
Pump failure

10. Which vasculitis can cause MI?
Kawasaki disease
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Circumflex
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

11. What effect does aortic stenosis have on the chambers of the heart?
Aortic stenosis
Myocarditis
Limits thrombosis
Concentric LV hypertophy

12. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Inability to maintain systemic pressure w/lack of O2 to vital organs
Myxoid degeneration
RHF
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

13. What is a common complication of cardiac metastasis?
Dilation of all four chambers of the heart
Pericardial effusion due to pericardial involvement
PDA
Asymptomatic

14. What is the most common cause of infectious endocarditis?
Systolic dysfx leading to biventricular CHF
Transposition of the great vessels
Streptococcus viridans
Pedunculated mass in the LA that causes syncope due to obstruction of MV

15. What does chronic ischemic heart disease progress to?
Positive blood cultures anemia of chronic disease
CHF
Erythematous nontender lesions on palms and soles.
Yellow pallor neutrophils

16. How do you tx prinzmetal angina?
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
NG or Ca channel blocker
Sudden cardiac death
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

17. What type of shunt results in cyanosis at birth?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Right to left
Small vegetations along the line of closure
Gelatinous - abundant ground substance

18. With what developmental disorder is VSD associated?
PDA
Fetal alcohol syndrome
Intercostal arteries enlarged due to collateral circulation
Congenital rubella

19. What complication occurs 1-3 days post MI?
ST- segment depression
Small - nondestructive vegetations (subacute endocarditis)
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Fibrinous pericarditis

20. What does a biopsy of hypertrophic cardiomyopathy look like?
Degree of pulmonary artery stenosis
Eisenmenger syndrome
Pericardial effusion due to pericardial involvement
Myofiber hypertrophy with disarray

21. With what disease is Libman - Sacks endocarditis associated?
Gelatinous - abundant ground substance
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
SLE
Large vegetations of S aureus

22. What causes microangiopathic hemolytic anemia in aortic stenosis?
AD mutation in sarcomere proteins
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
RBC damaged while crossing the calcified valve causing schistocytes
Valve replacement AFTER the onset of complications

23. What type of ASD is associated w/Down syndrome?
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
Ostium primum
Limits thrombosis
Annular - non pruritic rash w/erythematous borders trunks and limbs

24. What areas of the heart does the RCA supply?
Mitral valve prolapse
Posterior wall of LV - posterior septum - papillary muscles
Breast and lung carcinoma - melanoma - lymphoma
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

25. What is molecular mimicry?
Yellow pallor macrophages
Aortic regurg
When a bacterial protein resembles a protein in human tissue
Myofiber hypertrophy with disarray

26. What causes angina and syncope in aortic stenosis?

27. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Posterior wall of LV - posterior septum - papillary muscles
LHF
Systolic ejection click followed by crescendo - decrescendo murmur
Months out fibrosis

28. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
SLE
Stable and unstable prinzmetal
RCA

29. What causes the nutmeg color in nutmeg liver?
Hypertrophic cardiomyopathy
Rhabdomyoma
Decreases LV dilation by decreasing volume
Congested central veins

30. In which chamber of the heart are cardiac myxomas found?
Day 1-7
Circumflex
Holosystolic blowing murmur
LA

31. What is an important complication of ASD?
Paradoxical emboli
RHF
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myocardium

32. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Squat in response to cyanotic spell
RCA
Systolic dysfx leading to biventricular CHF

33. What are the sx of hypertrophic cardiomyopathy?
Indomethacin - decreases PGE
Infectious endocarditis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Infantile coarctation of the aorta

34. What characterizes acute rheumatic fever endocarditiis?
Systolic dysfx leading to biventricular CHF
>60 years - bicuspid aortic valve
Congested central veins
Small vegetations along the line of closure

35. What are the sx of pericardiits?
Eisenmenger syndrome
Friction rub and chest pain
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Inability to maintain systemic pressure w/lack of O2 to vital organs

36. What is systolic dysfx?
S viridans
First 4 hours
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Ventricles cannot pump

37. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Prinzmetal
Congestive heart failure
Holosystolic blowing murmur
Rhadbomyoma - benign

38. What is the gold standard blood marker for MI?
Infectious endocarditis - arrythmias - severe mitral regurg no
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Right -->left
Troponin I

39. Which coronary artery supplies the anterior wall and anterior septum?
PDA
Adult coarctation of the aorta
LAD
Papillary muscle - free wall - IV septum

40. What are the Jones criteria?
Bounding pulse
Months out fibrosis
CK- MB
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

41. What is eythema marginatum? What parts of the body does it commonly involve?
IV drug users
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Annular - non pruritic rash w/erythematous borders trunks and limbs
Concentric LV hypertophy

42. How does adult coarctation of the aorta present?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Chronic ischemic heart disease
Loeffler syndrome
3-8 wks

43. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Dark discoloration coagulative necrosis
Opening snap followed by diastolic rumble
Regurg vs stenosis
Mitral regurgitation due to vegetations

44. What causes endocarditis of prosthetic valves?
Valve scarring that arises as a consequence of rheumatic fever
S epidermidis
Annular - non pruritic rash w/erythematous borders trunks and limbs
Hypercoagulable state or underlying adenocarcinoma

45. In which chamber of the heart are rhabdomyomas found?
Ventricle
Infectious endocarditis - arrythmias - severe mitral regurg no
LA dilation
Volume overload and LHF

46. When does the heart have a yellow pallor post MI?
Yellow pallor neutrophils
1%
Aschoff bodies
Day 1-7

47. What murmur ccan be heard in PDA?
Yellow pallor neutrophils
Holosystolic machine like murmur
Cardiac tamponade
Nitroglycerin

48. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Colon cancer
PDA
PDA

49. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Cyanosis - RV hypertrophy - polycythemia - clubbing
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
PDA

50. What type of tumor is a rhabdomyoma?
Concentric LV hypertophy
CHF
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Harmartoma